If we really want to ‘protect the NHS’ we must invest in prevention

Meet Rafaela. Rafaela is from Chile. She is an experienced care professional recruited to a new management role in the UK. That’s how she comes to be sitting in enforced hotel quarantine in Hounslow. Determined to improve her understanding of her new country, she turns on the TV in time to hear the Chancellor of the Exchequer,  Rishi Sunak, present his Budget.


He says he is laying the foundations for the post-corona virus economy. That gets her attention. She knows that this country has suffered more deaths per head of population than anywhere in the world except Slovenia, Belgium and the Czech Republic much worse than her own country. She is wondering how the UK is investing to make things different in the future. Where the money flow and what will will be the priorities?


The Chancellor describes the success of the furlough scheme in protecting jobs. Then he turns to ‘the work of building our future economy’.


She learns about tax incentives to encourage fresh investment by companies and funding for apprenticeships. There are plans to revive town centres; tax relief for hospitality business; incentives for people buying their own homes. She picks up her ears when the Chancellor mentions mental health – he’s giving £10m to support military veterans.


He warns about levels of government debt. He mentions ‘green growth, then says a lot about ‘Freeports’. He praises the Mayor of a place called Teesside.


In his summing up there is a brief reference to ‘keeping our NHS strong’.  So, she wonders, where is the plan for keeping the NHS strong?  Rafaela knows from experience that it is not enough to have a good illness service.  The effectiveness of acute services is determined by the strength and breadth and depth of the preventive arrangements that surround it and limit the demands upon it.


She has heard that the UK has an excellent system of acute care. It deals well with cancer, heart disease, diabetes once these are diagnosed. But what about prevention – clean air, nutrition, exercise, the combating of loneliness and depression?


Rafaela is headed to Peterborough in the east of England. Her new employer has alerted her to a new report with recommendations for the region. She reads:


Across this region a quarter of adults are inactive and more than a third are not active enough to benefit their health Nearly two thirds of people in the region carry excess weight. 78% of those infected and 62% of hospital deaths from Covid-19 occurred in overweight or obese individuals.


And what about care? The Cambridgeshire and Peterborough report has pointed to new solutions in nursing, and community care which, in Holland, provided a robust return on investment. There is evidence that public health spending is three to four times more productive for health than healthcare expenditure, and will over time reduce costs to the Exchequer. New models of community nursing have emerged from the Netherlands which offer more individual-centred care at lower cost to taxpayers. Rafaela hopes to hear that the Government is going to invest in these but he announces no such plans.


She scratches her head. How do you keep the UK’s beloved NHS strong if the things that drive up demand for its services are not tackled?  Diet, stress; poor housing; vulnerable people living along served by an under-trained  care workforce on a minimum wage; unequal access to vital services made worse by poor public transport; too little health education; work-related stress? A promise to ‘keep our NHS strong’ without an agenda for effective prevention and community care is like boasting about the roof on a house whose walls are crumbling.


There is a knock on the door. Rafaela’s meal is being delivered. She reflects on the irony. Here she is, coming to work in the UK’s care industry.  Before she can start caring for others, she must first be institutionalised.


She picks up the tray at the door and looks at the menu.  It is not appetising. This ten-day quarantine is going to be a long haul. And so, she concludes, will be the UK’s journey from an illness service to a health service.