Vital steps to move the NHS from cure to prevention | NHS
Your articles on health inequality this week included excellent coverage of the government’s project to move the health care health care at the clinic and the prevention hospital through public health initiatives (the Downing Street Downing Street for NHS: the treatment of prevention, June 29). However, a key element is absent from the analysis which has frustrated the implementation of these necessary innovations: the way in which undergraduate students are educated and socialized in medicine in longtime conservative programs.
Historically, doctors obtain an identity rooted in the sacred character of the “clinic” (mainly the hospital) as a territory well patroll with rituals and an idiosyncratic language. Patients are maintained on the other side of the fence. Medical education traditionally offers little experience at work in the first two years, but after that, students are acquiring growing exposure to clinical work. However, this is largely focused on secondary care (hospital and clinical), and healing rather than prevention.
Medicine students quickly learn that their professional identity construction depends on a strict separation of community practices such as social work such as they identify with the healing rituals of the clinic. Health care as a whole will not be able to focus on prevention, as Wes Street wanted, until medical students in the sacred character of clinical healing are discussed. This is an educational challenge that should no longer go under the radar.
Dr Alan Bleakley
Professor Emeritus, School of Medicine of the Peninsula, University of Plymouth
Of course, Denis Campbell is right to say that spending the NHS from prevention treatment is a great idea. The problem is, and has been for years that finding money to prevent poor health is apparently impossible when the NHS has to treat poor health that has not been prevented. Treasury rules seem to prohibit investing in future savings.
Christina Baron
Former president of the NHS Trust
Your report (June 29) on the “medieval” levels of health care inequality affecting the poorest sections of the company is confirmed by the National Diabetes Foot Care Report 2022 for England. This revealed that people with diabetes living in the most disadvantaged regions of England are 82% more likely to undergo a major amputation than those of the least disadvantaged. Such a predisposition to major amputation in the circumstances of poverty contributes to a postal code lottery with a variation of 4.8 times of major amputation rates, ranging from 3.5 to 16.8 amputations per 10,000 inhabitants per diabetes per year.
People in private areas face economic and social obstacles to restricted care and reference routes, resulting in delayed access to specialized care. They are then too late for conventional treatment and require amputation, with all the suffering, costs and effects that change life. Thus, the income and address of the domicile of people living with diabetes can contribute significantly to their loss or leg maintenance.
However, it should be possible to prevent most major amputations. Such aspiration is in accordance with the preventive ethics of the NHS plan at 10, which, hoped, will facilitate faster and equitable access to initial care in the community and prevent the amputations of all people living with diabetes.
Prof Michael Edmonds, Jonathan Hunt (patient)Dr Erika Vainserieri and Dr Chris Manu
King’s College Hospital, London
The excellent black relationship on health inequalities was commissioned by work in 1977 and published in 1980, when the conservatives were in government and the report was marginalized and finally rejected by them. The report recommended improvements in benefits, childcare, preschool education, school milk and meals, deactivation allowances, housing and working conditions. Nothing new there, then. We know what to be done to make the quality of life more equal to all of us. Anyone who lives or knows the parts of the North (and elsewhere) suffering from extreme deprivation knows that things have to change. The situation is intolerable. It is a burn on our so-called civilized society.
Val Cooper
London
The ministerial turnover on the planned reforms of health-related services included a welcome commitment to “listen”. They would do well to study the link between deprivation and “life diseases” resulting from obesity, smoking and excessive alcohol consumption. In addition to explaining the 11 -year life gap of life expectancy between the most and less disadvantaged parties in the country, it is a vital factor but often neglected in the debate on health and disability benefits.
My research reveals that people from the poorest communities generally have poor health up to 21 years earlier than those in richer areas. In Blackpool, for example, “healthy life expectancy” is only 53.5 years old, compared to 74.7 years in Rutland. The inhabitants of Blackpool are therefore much more likely to leave the workforce before the retirement age of the State – and therefore to claim health and disability services – than those of Rutland.
The government must continue a longer -term approach to slow down the social protection costs of poor health and disability. We need a complete public health strategy to combat deep causes of poor premature health. For too long, successive governments have avoided daring actions around smoking, obesity and alcohol to considerably improve public health.
Teacher the Mayhew
City St George’s, University of London
