To ask why prevention isn't a bigger deal in the UK?

[willisurvive3under2]

Posting here for traffic really.

I moved to the UK as a young adult and I was used to a different health system. Have lived here a long time now and I can see pros and cons of the NHS. My question is, why isn't there more of a prevention culture? Of course I don't expect the NHS to pay for it all. I understand it wouldn't be possible.

In my home country, private healthcare is very affordable and often subsidised. So for example girls have a routine gynae check up once a year... a bit like a dentist check up. You can get an abdominal and breast scan as part of it. It will set you back no more than £100. Wouldn't most people go for it if that was the case in this country? A few years back I had to have a private mammogram in the UK (I'd had a scare but the GP wouldn't refer me for a follow up). I spent £340 at the Nuffield. This is ridiculously expensive, I think everyone will agree. Why can't I pay a reasonable amount of money and have a mammogram every 1-2 years?

Someone I know has gynae issues which are impacting her fertility. If these had been monitored in her 20s, things might be different now. I'm angry on her behalf that she might not be able to have children because of this.

Why can we not pay £30 and have yearly bloods like they do in a lot of countries? Things like high cholesterol and low iron would be picked up easily, saving a lot of money and resources down the line.

I'm just interested to hear others' opinions on this.

Previously I would have been all up for yearly blood checks and the like, I'd looked into the thriva kits and at home genetic health testing but I've now changed my mind slightly and am undecided on how helpful or necessary it all is. I'm currently reading the patient paradox, I haven't finished it yet but would recommend it so far. From the blurb:

"Welcome to the world of sexed-up medicine, where patients have been turned into customers, and clinics and waiting rooms are jammed with healthy people, lured in to have their blood pressure taken and cholesterol, smear test, bowel or breast screening done.

In the world of sexed-up medicine pharmaceutical companies gloss over research they don’t like and charities often use dubious science and dodgy PR to 'raise awareness' of their disease, leaving a legacy of misinformation in their wake. Our obsession with screening swallows up the time of NHS staff and the money of healthy people who pay thousands to private companies for tests they don’t need. Meanwhile, the truly sick are left to wrestle with disjointed services and confusing options.

Explaining the truth behind the screening statistics and investigating the evidence behind the hype, Margaret McCartney, an award-winning writer and doctor, argues that this patient paradox – too much testing of well people and not enough care for the sick – worsens health inequalities and drains professionalism, harming both those who need treatment and those who don't."

It's an interesting read and puts across the other side which I hadn't thought about at all.

A lot of people just don't care.

You answered your own question you underwent a unneeded procedure at huge expense. Mammograms for instance aren't great on women under 40ish might even be older.

It’s a very reasonable question. I was a nurse for 26 years and dh is a hospital consultant, there is a lot more that could be done in terms of prevention and early diagnosis. We are still diagnosing far too many cancers at a late stage. No doubt people will say it’s unaffordable (particularly for the NHS to fund) but it’s a lot cheaper in the long run than treating advanced disease.
I do like your idea of paying a set fee for a series of checks, however what about the people who can’t afford it? And of course all these checks might result in more referrals to the hospitals and they are struggling already. That’s not the public’s fault though and as a supposedly first world Country we should be able to cope.

I should also mention that not all healthcare professionals agree with health screening. For example there is a lot of discussion about how breast screening can cause harm. I however am firmly in the camp of prevention is better than cure.

Because the NHS has a limited pot it takes a cost-benefit approach to prevention. In other words if it's cheaper to prevent (cervical smear tests for example have a clinical benefit), they do it. If there is no cost saving (mammograms on those under 40 have no clinical benefit) they won't do it.

I would love a yearly check like that and would be happy to spend £100.

OP I went for my 40+ NHS check up and I was told that the only people who bother turning up are those who take care of themselves in the first place.

In regards to the tests you have mentioned - the majority of people who would pay for them, or even go to have them with they were free, then heed the results are those who are inclined to take care of their health in the first place.

Oh and if you test people unnecessarily you throw up a load of false positives.

Unless all this routine testing actually saves a huge number of lives there is probably very little point in doing it.

The NHS doesn't have the money to support testing for testings sake and a large percentage of the population don't the money for these sort of tests, even if they will 'only set them back about £100'. And yes, as MelonSlice says, most people aren't interested in testing for something they probably don't have.

Whilst things like high cholesterol, to use your example, generally don't present symptoms, a lack of iron will generally make you feel under the weather and if you go to your GP with the relevant symptoms you'll be tested for these things. After a certain age, when it's more likely to affect you, your GP will test regularly for high cholesterol and other age related problems.

The regular tests that are carried out by the NHS, such as for breast and cervical cancer, could probably be done more frequently but the money just isn't available to the NHS to do it. If people really want them they are available, they just have to be paid for.

Can't see any benefit in needless tests year after year. The only people to gain from that is the companies making a nice profit from carrying out the tests.

Thank you for taking the time to reply.

I used the wrong word - it's a breast scan, not a mammogram. A mammogram is of course a breast x-ray and it's not suitable for younger women. I had a private breast scan which I don't believe was entirely useless. It confirmed I had the all clear after having issues 18 months prior to that.

Those of you who say there's no point in doing routine checks - do you go to the dentist regularly?

Because they have done plenty of studies on when to start screening and frequency, private medicine makes money from your visit so frequency increases profits - very different. I heard a radio documentary on cervical smear testing and the U.K. is in the middle ground for testing - some don't start until 30, some are every 5 years and many countries charge - the US offer annual or rather insurance does but there's no evidence it makes any difference to outcomes and it does increase costs.

Could we have optional screening at a reasonable cost, well that goes against the nhs, and makes it two tier - private healthcare is available to those who desire it.

I'd love an annual health check. I had one at 40 and that was it.

Completely agree OP, but because we have the NHS everyone expects everything for free.

Ivf is a good example. The NHS could serve many many more couples if it just offered ivf at cost, with maybe those with the least money getting one cycle for free. But, no, everyone gets one cycle for free (if its not secondary fertility which is actually more common) and then has to pay a fortune privately.

I would be very happy to pay £100 or whatever it cost for the NHS for the sort of health check you describe, I'd actually be happy if they made a bit of profit on each one to subsidise other areas of healthcare.

But it will never happen as the NHS is not allowed to do anything entrepreneurial or anything that it can't offer to everyone. So people in the UK die/suffer needlessly as a result compared to countries like your home country.

I wish we could have a more sensible attitude to healthcare in this country but any mention of reforming the NHS is met with howling and wailing which is fueled by the press so no political party will touch it.

Regular check ups are only one part of prevention. Healthy lifestyle, stress reduction, awareness of signs are also important.

Because the cost benefit analysis usually doesn’t add up. The cost of doing the 10,000 blood screenings is more expensive than the cost of providing treatment for said condition that was not averted.

All health care systems work on the same principle, even private ones (this is why health insurers ration what they will reimburse for). But in private systems many decisions (like your breast scan) are also made because they generate profit even where there is little benefit to the individual.

Most people don’t want this sort of system in the U.K. because it can be stupidly expensive (the reason why the us health care system is the most costly in the world). But the good thing is that people can buy private health care if they wish, but no one is made to as there is a decent enough system in the NHS that mostly works well in terms of cost/benefits. Like any health care system though, it doesn’t always mean any one commissioning decision benefits every individual. Some people will always fall through the cracks. It’s just different people depending on the system.

But god, no, personally I would not opt for annual bloods or scans or gyn appointments. I say this even as someone being investigated for a chronic illness. I’d rather have access when I need it, not just when I get a whim and want it.

I agree op, I think there is an attitude of entitlement in the UK around anything society believes should be given to them that is not productive.

Prevention could save so many lives and a lot of money but huge chunks of society refuse to take responsibility because they're 'entitled' to do what they want and get free healthcare. I would much rather pay reasonable amounts towards healthcare and have better prevention and routine screenings. I also don't think ivf should be offered for free by the nhs when so many necessary areas are struggling (as in, you won't die from not getting an ivf cycle but delaying cancer diagnosis and treatment does cost lives).

My dad died at 50 from a cancer that would have been treatable if caught sooner, my grandmother died in awful pain because her cancer was found too late, my mum now has a fibroid weighing around 25lbs that could have been treated much earlier with routine checks but now needs a big operation, hospital stay and weeks of sick leave- costing a lot more to her and the nhs than treatment would have if caught early.

I think much easier access to physio and counselling would be my priorities. That could help loads of people and head off a lot of more serious problems. I've paid for both those as I know they're nearly impossible to access on the NHS so I didn't even bother trying. The annoying thing is the NHS could no doubt use its massive buying power to supply them at a much lower cost than private providers.

I would happily pay for annual health checks. Maybe a private firm could offer them at a reasonable price so that everyone who wanted them could afford them?

I went to my GP with very painful varicose veins. She said that the NHS won't treat them until ulcers develop.
I paid £280 for a 20 minute appt with a private vascular consultant (worked for the NHS also.)
Still debating whether to have the surgery privately.

I think that there should be more flexibility in the NHS in service provision, and maybe moving towards being proactive rather than reactive. I agree with OP that prevention would be beneficial.

Oh, regarding your actual question. The NHS was founded in the 1940s when modern medicine was in its infancy and the founders seem to have genuinely believed that once they'd supplied enough trusses, crutches and false teeth the population would become healthy and the need for healthcare would diminish. The diseases of affluence: obesity, depression, anxiety - hadn't yet taken hold and people didn't generally live long enough to suffer from diseases like cancer. So the demands on it have entirely changed over time.

Yes, I go to the dentist for regular checks but that is immediate and hands on prevention. I really can't see that as the same thing as regular screening for a variety of health problems that I probably don't have and possibly never will.

I think a lot of those tests wouldn’t be necessary for the majority of the general population annually so it wouldn’t be cost effective long term - doesn’t make sense to test/scan etc for anything and everything when the patient is generally healthy.

Having said that, I have personally found my GPs to be really helpful when I have had minor concerns so in terms of prevention I’m probably biased as my doctors have been more than happy to listen to my concerns

NoYo I've just had that surgery in both legs (fortunately my work offers private cover) and it's amazing what they can do and it's day case and doesn't even require an anaesthetic. That's terrible that you have to get to the ulcer stage . My DDad has those and it really limits his life. I am pretty sure the NHS would have deemed my treatment 'cosmetic', yet one of the veins had ballooned to the size that it was given me an increased risk of a DVR. I wouldn't have even had it checked out without the private cover.

DVT

I get more checks because of a health condition. Every 12 weeks I go to haematology and they do full bloods, turnaround of an hour. It does reassure me they will pick up something if it's wrong, especially because the drug I'm on can cause an increased risk of leukaemia

Op I agree with the gist of your argument.

It has been reported for years that people in the UK have bad outcomes for cancer compared to other European countries.