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The NHS is a “sickness system not a health system”

14 August 2008

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The UK government has largely ignored lessons to be learnt from 60 years of NHS reorganisation leading to failures in the system, argues professor David Hunter, a professor of health policy and management with Durham University.

In his book, The Health Debate, to be published by at the University of Bristol, he analyses the challenges faced by the NHS.

The NHS has subsequently evolved into a “sickness system” primarily designed to repair those who fall ill and doing little to promote or improve health, says professor Hunter. Yet the government now needs to take major, well-informed action if it is to control health problems like obesity and reduce the massive burden on the health system.

He said: “One of the curious ironies of the NHS, and many other health systems like it, is that it does not pay enough attention to health, focusing instead on ill-health and disease. The NHS diagnoses and treats rather than predicts and prevents.

“The government needs to shift this balance as the increasing cost of lifestyle-related diseases, such as diabetes, obesity and some forms of cancer, will prove financially unsustainable making the NHS unaffordable.

“Changing people’s behaviour is difficult and merely giving people information and advice is known to be ineffective. It needs for the government to take bold action to control rising obesity levels and other health problems. Yet, government does not want to be accused of being the ‘nanny state’ and is reluctant to act on some of the determinants of ill-health.

“Bold action on the part of the government should include taking tough action to control levels of fat, sugar and salt in foods, as well as trying to narrow the income gap between rich and poor.”

In his book, Professor Hunter also argues that the search for solutions to today’s health challenges has led to an unwise and unproven reliance on private sector management styles and international healthcare businesses. Policy makers make unproven assumptions about the ability of new social enterprises to run complex services.

He said: “The NHS faces some key ‘wicked issues’ to which there are no easy or ready solutions. These issues are very much focused on the way the healthcare is funded, prioritised and managed, and how it has evolved over the years.

“There is a fixation on the latest fads and fashion in management, combined with a ‘terror by target’ culture, which has resulted in low staff morale and a breakdown in relations between clinicians and managers.”

Durham University