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NHS: Preventive Medicine

Volume 768: debated on Wednesday 20 January 2016


Asked by

To ask Her Majesty’s Government how they intend further to incorporate preventive medicine into the National Health Service.

My Lords, the NHS five-year forward view set out a shared vision for the future of the NHS. It includes the long-standing aspiration for the NHS to focus as much on prevention and promoting wellness as managing poor health, working in partnership with local public health services through health and well-being boards.

My Lords, I thank the Minister for his positive reply. I never thought that I would quote in your Lordships’ House the leader of the Opposition in the other place. He asked the Prime Minister at Prime Minister’s Questions recently whether he had,

“forgotten the simple maxim that prevention is cheaper and better than cure”.—[Official Report, Commons, 16/12/15; col. 1545.]

I commend the National Health Service for shifting its policy from sickness and cure to wellness and prevention. Would the Minister, through the National Health Service, encourage private health insurance organisations to do likewise, thus evading certain serious sicknesses and not adding to the National Health Service’s overstretched budget?

My Lords, there is clearly a direct legal contractual relationship between a private insurance company and an individual. The NHS cannot interfere directly with that contract. There is no similar legal relationship between the NHS and the citizen, although there is clearly a social and moral contract between the two. As part of that contract the state agrees to provide free, high-quality healthcare. It is only right that the individual should accept personal responsibility for their health and well-being, and that of their family.

Can I make a suggestion to the Minister? If the Government want to take preventive medicine seriously, they should invite Sir Nicholas Wald, Professor of preventive medicine at the Wolfson Institute, to come and talk about his lifetime’s work on things such as the polypill, and, indeed, his leadership in1990 of the Medical Research Council’s work on preventing spina bifida and neural tube defects in babies by the use of folic acid in flour.

I thank the noble Lord for raising this issue today. We discussed it yesterday and the Government will give him a full response to the issue of fortifying bread with folic acid in the very near future.

Does the Minister recognise in his answer that people should be responsible for their own health and the health of their families that there is a responsibility on the NHS to ensure that there is adequate support before, during and after bereavement of children? The preventive effect on mental health problems later in life is very clearly shown. Those who are unsupported do less well in the whole life course in mental health, and in social and educational outcomes.

My Lords, clearly, the state has a huge role to play in prevention; I was certainly not questioning that for one moment. I was just saying that I believe that individuals and families have responsibilities as well.

My Lords, given that £1 in every £5 of healthcare costs is associated with conditions that could be prevented, what assessment have the Government made of the likely cost savings on NHS spending of using more preventive medicine?

My Lords, if the noble Baroness reads the Five Year Forward View, she will see that prevention is a very critical part of that. But, of course, prevention goes much wider than healthcare in the NHS; it goes to employment, housing, education and a whole range of other things. Having a strong and vibrant economy with high levels of employment is vital.

My Lords, in their preventive strategy what will the Government do to attend to the social determinants of ill health, including inequality, deprivation in early childhood and deteriorating public services?

My Lords, it is a very serious issue that over 40 years, and probably for longer, the difference between the life expectancy of the rich and the poor has always remained at about 10 years: and for healthy living it is more like 25 years. I think it is fully understood from Sir Michael Marmot’s report and thereafter that the social determinants are more important in closing that gap than anything we can do in healthcare directly, so what the noble Lord says is absolutely true.

In the 2015 report Opportunity Knocks: Designing Solutions for an Ageing Society, the University of Cambridge Engineering Design Centre, the ILC-UK and the IET highlighted the vital role of good design and technology in supporting preventive medicine, particularly, but not exclusively, for older people. The OBR warned us last year that without technological innovation over the next decade, health spending in 2063 might be 5% of GDP higher than currently projected. Do Her Majesty’s Government agree that we must invest in technology to save money by facilitating the preferred solution of sustaining independent living, particularly among older people and those subject to the revolving door syndrome? Will the Government support this and invest in it?

My Lords, good design is very much part of any long-term strategy towards improving the lives of our citizens, so it is a hugely important part of our longer-term strategy.

My Lords, we know that smoking is by far the biggest cause of death in the UK and research shows that two-thirds of smokers want to quit, yet the recent ASH survey has shown that the cuts in public health funding and in council budgets have led to 40% of local authorities having to cut stop smoking services. Last year these were used by more than 450,000 people. They are three times more likely to quit if they get the vital support of these services. How can it make sense to cut services when for every £1 spent on cessation services, £10 is saved in future NHS and health gains?

Successive Governments have had a huge impact on reducing smoking levels, which are now down to 18%—the lowest they have ever been.

My Lords, would this not be a suitable subject to be considered by a royal commission on the health service, which my noble friend Lord Fowler has advocated and for which he has considerable support in all parts of the House?

My Lords, the issue to which my noble friend refers was fairly fully discussed in a debate in this House initiated by the noble Lord, Lord Crisp, only some two months ago. If Members of this House wish to discuss it further, they are, of course, very welcome to do so. However, I am not sure that a royal commission is necessarily the right way to proceed.