We need to play our part in saving the NHS by taking responsibility for our own health…

Criticising our over stretched health and social care service is less of a public pass-time than it was five years ago.    This is good and perhaps reflects a growing maturity as we begin to realise that these vital services, on which we all rely, can only do so much.   In the social contract – the basis of the 1948 Health Service Act – there were two sides; (1) government agrees to provide a health service free at the point of access and (2) the public agree to take better care of themselves; prevent illness and self-treat when possible (Self Care).

Over the past 70 years since 1948 our understanding of what increases the risk of long-term conditions (and worsens them when we get one) turned out to be relatively few and relatively simple;  smoking, poor nutrition, lack of exercise and too much stress (alcohol misuse).  The paradox is that raising awareness of the danger of these behaviours risks nanny-state accusations.  Some successes have been achieved; smoking has declined from 33% to 22%  over 20 years (still could do better) but behaviour change is difficult and perhaps we don’t know how to do it.

An acquaintance who always had “a weight problem”, has just had the shock of a type 2 diabetes diagnosis.  In his late 50s he is just coming to terms with the badge of a long-term condition with the same quiet stoicism he dealt with his long-term gross obesity; in denial.   Over the years his obesity was in plain sight but seldom, if ever, discussed.    Ten years ago something happened and he decided to lose weight and ask for help. A month or two later, not noticing any obvious weight loss, I casually asked about his diet.  He aggressively censured me to mind my own business.   Suitably admonished I never again broached the issue.   In recent months a skin infection hospitalised him twice, and kept overnight on both occasions, he was released into the care of his GP without any comment on the obvious need to address his corpulence.  The only advice he got, following his second hospital visit, was to see his GP as his blood glucose was “raised”.  It was indeed raised at 23 mmol/L and when starving himself he could get it down to a respectful 12 mmol/L but too far from the normal of 4-8 mmol/L.   He hadn’t visited his GP for years knowing the consequence would be a tough conversation he didn’t want.

He is now a fully signed up type 2 diabetic with; a concerned GP, a dedicated practice nurse and a highly trained consultant diabetologist.  His management over the coming 20 years or so will prove expensive for our health service, a cost I certainly don’t begrudge him but prevention might have saved him, his family and the state a lot of future cost and grief.  The evidence is clear a 50% to 60% reduction in diabetes prevalence with small changes to diet and exercise or put another way about 50 out of every 100 patients with type 2 diabetes, with a little restraint, would not have developed the disease.

My acquaintance manifests the challenge of our health service as it struggles to transform.   He, like those of us who; smoke, drink too much, eat too many calories and take little exercise, was an obvious target for primary prevention that didn’t happen.  Of the £4.5 billion we consume annually in providing our health and social care services only 2% is targeted at prevention much less in supporting self-care.

Terry Maguire is a pharmacist in Belfast

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  • file

    There is a body of research promoting exercise as the best (preventative) medicine. The trick is in getting an active lifestyle embedded in the mind of everyone.

  • Oriel27

    Best health insurance policy is – stay healthy & exercise, go for a check-up once a year, dont smoke, drink some, and enjoy nature as much as possible (mindfulness).

    Me – Office worker – mid 30’s. ex – 20 a day smoker & quit in late 2009. Drink mildly (I dont drink in November, I dont drink in January & February), when i do drink its every weekend a few pints of Guinness (never spirits or wine).
    I run on average – 25 miles per week. I aim for 4 marathons a year (and have done it repeatedly since 2010). I always have a race or marathon in mind to keep me in training and keep me focused and healthy. Fast food, i regularly eat it – once a week at least. But everyday i have a salad for lunch. Never have white bread. Spuds – once a week.
    Plus i tend to drive everywhere when i go out – saves money and keeps me off drink.

  • Cosmo

    Why are NI GP’s so averse to telling patients they are overweight, and that their nutritional choices are poisoning them? Will they be physically threatened in reply ? Does it take too long and they don’t have the time in their 10 minute slots? Have we imported some kind of American obesity lenses, along with the addiction to cars, for the shortest of journeys? why aren’t the schools being enlisted to teach about nutrition, and cooking from first principles ?

  • AntrimGael

    If the NHS is to survive there will HAVE to be some serious changes of habit and tough decisions. The consultants have to stop acting as if it is 1957 and not 2017 where they MUST have every second Tuesday off for golf and half days on Fridays. There will HAVE to be charges for a GP visit, an A & E visit which is non emergency or increased taxation. Furthermore, like the NI Civil Service, at least half of the middle and senior management are just not needed and only succeed in cluttering up the system and preventing things getting done.

  • Oriel27

    I agree, time to bring in charges for Doctor visits. Its completely crazy in the North when one goes to the doctor, the waiting room is packet out. Any wee cold at all people go to the doctors. I find as well the doctor kind of hurries one along. etc.

  • notimetoshine

    Increased taxation is the simple solution. The UK has a very efficient health service considering per capita health spend is lower than most western nations (http://www.cityam.com/1403103225/there-may-be-funding-gap-nhs-spends-less-head-us-or-european-counterparts).

    We are running a health service with increasing demand, it makes sense that we increase funding. There is widespread public support for increased taxation to fund health care, especially so if it is ring fenced. (https://yougov.co.uk/news/2017/01/12/majority-people-would-support-raising-national-ins/)

    A two pence on the pound increase in income tax would see to much of the immediate and ongoing funding problems healthcare faces.

  • Zig70

    Actually, the biggest concern I would have is the blurred private use of the NHS. We seem to be allowing NHS consultants to use the facilities for private work without charge, checks or wage recoup

  • notimetoshine

    Problem is, you just penalise poorer people with a charge for appointments. Those with sufficient means will pay, and unless the charge is high enough, the cost won’t put them off. Those on low or fixed incomes will have decreased access to medical services, furthering health inequality and ultimately making the whole scheme self defeating.

  • AntrimGael

    I went to the doctor last week. He told me I was overweight and I said I wanted a second opinion. He told me I was ugly as well…..boom boom. A lot of GP’s are leaving or retiring early because the stress and pressure is too much. We have become a mentally and physically weak race who don’t take responsibility for ourselves and there us a younger crowd out of their heads on drugs torturing doctors for ‘uppers, downers, inners, outers etc’. Who would want to be a GP in the rougher parts of Belfast, Derry, Ballymena, Portadown etc?
    5/10 years ago when you went to the doctor you got to see YOUR doctor who knew you, your health concerns and circumstances etc. Now for many genuine patients you only get to see a locum who doesn’t know you. The system is falling apart.

  • notimetoshine

    Aging population, higher life expectancies, an increasing trend towards the chronic rather than fatal and poorly funded old fashioned social care means one thing. More money needed.

    We are just going to have to pay more for the healthcare we want. In our single payer, free at the point of delivery model that means higher taxes. Something the UK population is surprisingly open to if the money is ring fenced. We get a lot of bang for our buck already, with quite a low spend compared to other western nations. Time to increase taxes.

    All the prevention in the world isn’t going to allow us to avoid the demographic inevitability that is facing health and social care in the UK. The sooner we realise this the sooner we can start funding the thing properly.

  • hgreen

    Yes as individuals we need to take responsibility however corporations also need to take responsibility as well. We need a sugar tax in the same way as we have a cigarette tax with the funds raised going to support the NHS. This way people who consume more pay more towards their treatments and as consumers we’ll have an incentive to eat better.

  • Zorin001

    “along with the addiction to cars, for the shortest of journeys”

    I think this is a major one, anywhere that is upwards of 15 minutes walk is “out of the way” and requires a car journey. Never mind the chaos it causes on the roads either, just look at peak time Monday to Friday.

    The Americans have the excuse for the car, especially outside major urban areas where your nearest mall may be two towns over. I have friends in California and they thought nothing of driving for an hour to get breakfast, in fact they had to because they lived in the middle of nowhere.

  • hgreen

    Please tell us more. You seem to know a lot about this subject or did you get your information from a man down the pub?

  • file

    As my Ma says, “There is nothing worse than a reformed prostitute.”

  • Cináed mac Artri

    Your regime suggests you are a regular binge drinker, “”every weekend a few pints of Guinness”. Where do you source the ingredients for your daily salad? From supermarkets? Therefore processed, grown intensively and dowsed in chemicals.

    Road running? Punishing on the joints, in urban areas exposed to high doses of particulates from traffic fumes (ingested more rapidly when breathing increases due to heightened heart rate).

    Healthy lifestyle? 😉

  • John Collins

    Cosmo
    Tomas O’Se a primary schoolteacher, from a family where three of the four boys are schoolteachers, finess fanatic and outstanding Kerry Gaelic Footballer wrote an interesting article in a southern newspaper some while back.
    He attended teacher training college about twelve to fifteen years ago. During that training he said that while there huge emphasis put on getting the best acaedemic outcomes for the pupils, it was stressed that physical exercise should be also an important of the school curriculum.
    However after a few years teachers were being told to stop children from running about in the school yard, as the school authorities were afraid they would be sued if a child got injured while playing. Needless to say Mr O’Se was not best pleased with this turn of events and voiced his opinion that this development was little short of utter madness

  • Zorin001

    Would be nice but the government have caved time and again to the major food corporations to stall a sugar tax; and I wouldn’t hold out much hope for an improvement post-Brexit when they start slashing regulation.

  • Zig70

    You have to look at the food industry regards people’s calories. I’ve been on a bit of a post Christmas health bing and some of the calories in cheap ready meals are horrendous. If I was on a budget and the choice was between a 600+ calorie ready meal for a £1 and several £ on a meal from scratch, I’d go ready meal and let’s face it, would taste nicer. On top of that fruit is expensive compared to chocolate etc. £2 or more for a carton of grapes? Need to tax calories and relief on fruit and veg to redress the balance.

  • Brian O’Neill

    You are missing the point of the post. Where is the citizens responsibilities in all this?

  • AntrimGael

    A man down a pub. He was a consultant just finished 18 holes and he was in the company of a recently retired GP who is now working privately. Ha ha, you are either one of these consultants or useless public sector managers.

  • AntrimGael

    Oh the public HAS to change their behaviour massively but maybe they are taking their cue from an obviously bloated NHS and doctors, consultants, managers who look after themselves. Many of these certainly don’t set great examples.

  • Oriel27

    Notimetoshine, i used to be in the Southern’s health system until i began working and paying national insurance to the Northern System (for the last 8 years now).
    I found when i was going to the doctor in the South, one got an appointment straight way. The cost was 40 euro for the visit and 30 mins consultation. I have to say the consultant was thorough and long. Yes one had to pay for prescriptions, but i coudl afford it.
    In the south i paid private health with VHI, i had to use it on 2 occasions. i found it value for money. Health insurance i paid 80 euro a month.
    If you were not working in the South or on a low wage, you get the medical card (my brother does).

    Now due to job changes im working in the north and paying a high National Insurance sum a month. Visiting the doctor (once a year) – there is a 4 week waiting list to where i go, and i feel one is rushed out the door. Bottom of the barrel prescriptions offered at the chemist as well.
    One time i needed to go to the physio for a runner’s knee issue i was having. There was an 11 month waiting list on NHS. I ended up paying private treatment. I havent been to the hospital yet for myself. But having visited Newry Daisyhill hospital – all i can say is – what a kip.
    My employer offers me private health insurance since last year because waiting lists on the NHS is that bad.

    So to be honest, the bottomline is, there is no such thing as a free dinner. You pay for what you get. In fact, i think the NHS is a raw deal for tax payers in the North.

  • Oriel27

    Ha !

  • Oriel27

    Ah feck sake, i do try ye know !. – ye got to do something. Millions think of excuses not to do anything.

  • Cináed mac Artri

    Thinking up to excuses can be very taxing. It must be good for you – at least that’s what I’m hoping. 😀

  • hgreen

    Just because you made poor life choices there’s no need to be jealous or lash out at others who didn’t.

  • AntrimGael

    Kids can sit in front of the TV and play football, Gaelic, tennis, rugby, wrestling and if they get bored they can stick on one where they get tooled up and shoot everybody they don’t like. Then they go on Facebook where they tell their 400 friends what an active life they lead and how exhausted they are. Meanwhile no one calls at the door for them, they wouldn’t know how to start climbing s tree and mammy doesn’t let them kick a ball outside. Then we wonder why they adapt all these allergies and end up on the autism scale?? FFS!

  • hgreen

    The cost of implementing the scheme would outweigh the benefits. We pay for health through general taxation and the vast majority want to keep the service free at the point of use. I agree however with the principle of charging a fee for people who do not turn up for appointments.

    The reason the service is struggling is due to under funding. We want a world class service but don’t want to pay for it.

  • AntrimGael

    Ha ha I was correct.

  • lizmcneill

    Look at what Trump wants to do to the FDA and EPA (food & drug safety and environmental protection agencies), and hope it doesn’t give May and co any bright ideas.

  • lizmcneill

    Wasn’t this part of the reason behind scrapping prescription charges?

  • hgreen

    Nope you are wrong, just like the rest of your half baked theories on this thread.

  • lizmcneill

    Depends what he means by “a few”. 😉

  • AntrimGael

    Well surely half baked would be a healthier option given that the quacks told us yesterday that grub spending too much time in the oven gives us cancer. Booooom this is too easy!

  • notimetoshine

    GP costs vary wildly though in the South don’t they? Upwards of 65 in parts of Dublin with an average of around 50. That’s not even going into out of hours where costs are huge and are they are generally unexpected needs would be the hardest for low incomes to hit. That’s before one factors in prescriptions which (although you can) not everyone could afford if they were an unexpected expense.

    As for the medical cards, not everyone can get one and having looked at the criteria, I would be concerned for those considered not quite poor enough to receive one. I suppose I’m just silly that way in that I think the determining factor for treatment should be medical need not financial status.

    What constitutes a bottom of the barrel prescription by the way? Or do you prefer brands instead of generics?

    As for your GP surgery here I’m sure you are waiting too long, but that is because we need to increase funding for primary care. Also (though I am loathe to use personal anecdotes as evidence) I never wait more than about 2 to three days for an appointment and can always get one same day if I need to. But again that is just my story it is not relevant nationally.

    As for Daisy Hill what do you mean by kip exactly? Not exactly the most aesthetically pleasing building certainly but surely that’s less than important than oh you know, the medicine?

    Look bottom line, the NHS has real problems, but it just needs more money. If you do some research you will find that the NHS is actually rather financially efficient in what it provides for its cost. The UK spends much less than many other western countries on healthcare, yet provides a comprehensive service, but that is a service that is coming under increasing strain from demographic pressures. It just needs more money and the social care system needs fundamental reform.

    As for the North specifically, there are systemic issues caused by political dithering and incompetence, especially when it comes to implementing recommendations from the health reviews that have been periodically commissioned and then ignored.

    Finally, if the Irish system is so superior, why is the Irish healthcare spend proportionally the second highest amongst developed countries yet with some of its worst health outcomes? Convenience does not equal good care, regardless of your anecdotes.
    (http://www.finfacts.ie/Irish_finance_news/articleDetail.php?Ireland-second-highest-OECD-health-spending-poorest-outcomes-506)

  • Cosmo

    Litigiousness, sorry I see this as another import from the ‘evil empire’. The lawyers’ ( advice to education authorities and schools) and threat from, should be told to buzz off, or stood up to.
    However, don’t think sports is the only way to encourage physical fitness, indeed as I recall in my youth P E teachers ( looking for sports winners only) deterred some kids from trying.

  • Brian O’Neill

    Pot kettle I think. Many of our GPs are overweight and they drink like a fish.

    But the whole political correct culture does not help things.

  • Brian O’Neill

    Fruit is very expensive and a variable quality. Buying kiwi fruits is really hit and miss.

  • ted hagan

    You’re a very special person.

  • Cináed mac Artri

    A few? At least three.

    With three units of alcohol in a pint, and a binge is eight or more units.

    Ergo a “few pints” is a binge.

  • Cosmo

    Why am I reminded of Steve Martin’s LA Story, where he uses the car like a kid’s scooter, just to visit the next door neighbour ?
    back in NI, it’s sad we are letting our environments become increasingly unpleasant/ even dangerous for pedestrians or cyclists. Take most country roads. It is reckless to try.
    But not to really consider the issue for how kids best travel to schools, seems short-sighted.

  • Cosmo

    …. an apple a day is probably just fine for our puritain constitutions. I know someone who reckoned ( exotic) grapefruit actually put his blood pressure or was it cholestoral, up.

  • Cosmo

    we must stand against a trade deal with US. I don’t want any more of their junk food coming our way.

  • Cosmo

    i hope there is still a ban on biscuits, in Stormont !

  • Zig70

    Ha, my Dad blamed grapefruit for his cancer.

  • Zig70

    Don’t even start me on those oranges from that shop beginning with T that are lovely on the outside and dried up inside.

  • Zorin001

    A Trump led USA is probably one of the few friends* the UK will have left post Brexit so expect any deal to be on the Americans terms, and since Trump is determined to cut as much regulations as possible you can expect nothing but junk. Potentially dangerous junk as well.

    *when I say friend I fully expect it to morph into a ersatz Lord/Vassal relationship. It’s nearly there already.

  • Doctor M

    I am a consultant. I don’t play golf but I do have an early finish one day a week, but only because I work 10 hours per day on the other four days and the hospital only agrees to pay me for 46 hours per week (a regular consultant’s contract is for 40 hours). Like most consultants, I have been doing paperwork from home (unpaid) well into the evening this evening like most evenings. The vast majority of consultants are working extremely hard to deliver a safe service in difficult circumstances.

    I try not to have overbooked clinics, but demand for appointments is soaring and yet approximately 10% of patients don’t attend their appointments. I try to ensure that only people who need appointments get them but there are a lot of patients who don’t want to be discharged “just in case”.

    It is often said of healthcare systems that you can have any two of the following three characteristics: cheap, high quality and rapid access. We spend less than the European average on healthcare as a percentage of GDP and we like to think that we deliver high quality healthcare….

    I think that self-care should be encouraged as much as possible to free up resources for those that need them. We are told that a prescription for paracetamol will cost the NI HSC about £15 but you could by it in a shop for less than £1.

  • Am Ghobsmacht

    More sectarian diatribes from Zig!!!!

    (Sorry, couldn’t resist it…)

  • AntrimGael

    Fair enough I accept that you work hard in difficult circumstances and it is easy to point the finger and stereotype. However didn’t the businessman Gerry Robinson do a TV series on the NHS a few years back and concluded that existing age old practices and opposition to ANY changes amongst consultants and other senior medical staff was as big an obstacle within the Health Service than simply a lack.of resources?
    Correct me if I’m wrong but when Gerry Robinson brought in a few simple changes to working practices like bypassing middle and senior managers who he really had no time for, directly asking consultants to change their traditional days/half days they had off, opened operating theatres and clinics on days they weren’t meant to, involved nursing staff in discussions etc…..the waiting lists came down over the short period he was there? The NHS is like the NI Civil Service, they are two monoliths that can’t and won’t change. Yes Minister and Yes Prime Minister didn’t get to the half of it.

  • Am Ghobsmacht

    This is a difficult one for many reasons but a main one is that any one who tells the public not to do something is a/ ‘condescending’ (if they heed their own advice)
    B/ a hypocrite (if they don’t heed their own advice).

    A doctor said to me that one has 21 meals a week, try to have only 3-5 that are unhealthy.

    Plus i think in the UK and Ireland we actually don’t know what is ‘food’ any more e.g. coke & crisps aren’t food and you certainly shouldn’t eat them when you’re hungry, same with biscuits.

    (Coke is sheer evil, if you’re overweight and drink coke, well, start there before going on a diet and see what happens)

    Also, how many aisles are dedicated to rubbish?

    And how does that compare to countries where people aren’t so overweight on average?

    We’re lucky to have the NHS so we should all support it both financially and pragmatically.

  • Oriel27

    Thorough answer thanks. I would be referring to my doctor in Lurgan where i had to wait several weeks for an appointment (not an urgent appointment – where i was told i could be put on cancellation list if i wanted etc).
    Ok, referring to Daisy hill, i was being a bit extreme. Visiting my partners grandmother when she was dying over the Christmas period, i thought it sad there simply was no waiting room to use. It was being converted into an addition ward. I just thought it sad for the family – having to stand around corridors and around the lift etc. Only 6 people allowed around a bed in a ward of 6. Ok it was the NHS, they were providing services to the patient and not to the public i suppose. Contrasting that to my own mother in the Private Matter in Dublin, ok she paid for the treatment – the hospital was excellent – and allowed her dignity in her final days. One had their own room & yes there was a comfortable waiting room for visitors.

    My point is, when you pay for a service you should get good treatment. I pay a huge amount of National Insurance a month, i just feel im not getting value for money. I feel one still has to pay that extra on private medical care to ensure one gets treatment when needed. So whats the point of the NHS, i ask? Is it a fair deal for the people who actually pay for it?

  • Oriel27

    thanks ted, whats your regime smart arse?

  • Brian O’Neill

    We have enough of our own junk food to last us. Always amazed at those American candy stores. American chocolate etc is atrocious.

  • ted hagan

    I prefer to remain modest about my cycling, walking and dietary habits.

  • Old Mortality

    Unfortunately obesity is so rife in NI, prevalent even among the relatively affluent, that no politician wants to discuss it. If the politician is not obese, he or she is reluctant to risk giving offence to voters. Of course, if they did, you can be sure that the obese would be considered utterly blameless for their condition which is of, course, entirely due to either poverty or busy stressful lives or sometimes both.

  • Old Mortality

    ‘Many of our GPs are overweight and they drink like a fish’.
    I think (and hope) ‘many’ is an exaggeration. However, chronically obese employees need to be weeded out of the NHS, starting with doctors.

  • Old Mortality

    ‘upwards of 15m’. That’s nothing, I’ve seen them driving from the pump to the kiosk to pay at filling stations.

  • lizmcneill

    Yep . I’m sure May will be eager to bend over backwards to get any sort of trade deal, though.

  • Cosmo

    Afraid we are heading into the ‘poodle’ scenario. But, Trump is demanding an August visit with Queen, play on her golf course with Queen watching(!), and photo-ops, to rival those of Reagan’s. Surely, even May will find this hard to stomach, especially as Farage has already promised it.

  • Cosmo

    Unless, they have travelled, I don’t think people in the US actually realise what a poor quality of nutritional life they really have.

  • Cosmo

    Wasn’t being flippant. A serious guy, who they wanted to put on statins, so he started really monitoring what was going on, and found that for him, grapefruit was triggering stuff.

  • lizmcneill

    I thought Farage had gone to Fox news. It would be the one silver lining of Trump (from the pov of this side of the Atlantic).

  • Cosmo

    He pops up with pieces on Breitbart (Remember his Turkish Steam bath companion and former advisor, Raheem Kassam is now the editor of Breitbart London).,

  • lizmcneill

    Vom.

  • babyface finlayson

    Spuds once a week! No wonder the country is going to the dogs.

  • Cosmo

    I’m so old. Had to look this up, to realise you mean puke!
    how apposite. A repulsive pack of putrids.

  • lizmcneill

    Brexit is just great, they tell us.

    The sad thing is, we’ll probably still be a lot better off than ordinary people and minorities in Trumpistan.

  • lizmcneill

    Brace yourself for incoming high fructose corn syrup!

  • Oriel27

    I just rang my doctors in Portadown 2 minutes ago. They told me – ” there is no appointments available until early March, February is fully booked up “. They wouldnt even allow me to give my name to get on a list for appointments, have to ring back next Thursday for that. the NHS is a complete joke. There is nothing wrong with me, thank god. I only want a check up. — And i pay almost £400 national insurance every month.