Dr Steve Ohlsen: Moving from treatment to prevention
Dr Steve Ohlsen, a Yorkshireman, started on a humorous note. ‘What’s a Yorkshireman? A Scot stripped of his generosity!” A joke one suspects is reversed in other company but raising a smile for its amusing twist.
He observed that in the recent NHS 5 Year Forward View Report that prevention did get a mention. Fine words not reflected in the 3% earmarked for prevention in the NHS budget. Dr Ohlsen noted that Former banker and advisor to the Labour Party, Derek Wanless had argued for a ‘prevention upgrade’ in healthcare over a decade ago but in a Treasury, rather than DoH, document. And, although everyone agrees about the need for prevention, some argue that ‘death is cheap!’ A chilling and cynical thought. Dr Ohlsen went on to highlight the problems facing the country. Accident and Emergency Units are failing to cope with growth in demand. Bed blocking is common place because support is lacking at home. There is increasing pressure on residential care. He indicated that the sector had ceased to grow in 2015. Government funding support was in decline and, as the sector was in equity ownership, they had started to withdraw from unprofitable residential care homes and pass the responsibility back to local authorities. Who, of course, were also faced with the challenges of considerably reduced resources and of an aging population. Research suggests that for every day one is in hospital one loses a month of life. A stark statistic which underpins the argument for prevention. This raises the issue about the balance between health and social care. Dr Ohlsen believes that we are approaching the problem more effectively in Scotland as it is policy to have integrated health and social care. Notwithstanding health and social care provision, there is also the matter of lifestyle considerations. Currently in society there are major issues of obesity, excess alcohol, smoking, lack of exercise, etc. Dr Ohlsen highlighted that treating diabetes accounted for 10% of the NHS budget. Interestingly loneliness is estimated to have an equivalent impact of 15 cigarettes a day underlining the importance of mental health and a sense of wellbeing. The relationship between diseases and ill health are well understood within the NHS and government. Part of the problem is communicating the message to the public. In terms of the way ahead, Dr Ohlsen believes that the ‘virtual hospital’ offers promise. There are already examples of making improved use of intelligent technology (IT) which support a prevention approach. New technology such as internet access, mobile phones, etc provide a means to improve communications between GPs, hospitals, specialists and their patients. In Japan, facing a crisis of older people, they are even making use of robots with some success! There are now websites which patients can interrogate for useful information on their condition(s). These applications are increasing available. Dr Ohlsen’s message is ‘watch this space for pro-active approaches to prevention’! Food for thought indeed as demonstrated by the lively Q & A session.