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.

phineyj
That's good to hear. Can I be nosey and ask what type of op you had? The consultant mentioned 3 or 4 types. I'm terrified of DVT developing too, apparently VV increase the risk.
Glad you're fine👍

Because £100 for a scan and £30 for a blood test is nowhere near the true cost of those procedures?

Different cross subsidies are interesting when you compare state healthcare systems. I was stunned to pay 6 euros for a packet of ibuprofen from a doctor's surgery / pharmacy in an Austrian village. I felt I did my bit for the Austrian health service at least, lol!

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.

It is £122 at Nuffield here.

Mammograms come with their own risks. Lots of people in the US die because of over treatment. Treating healthcare as something to consume, is not a positive development.

My teeth are shit so I go to dentist at least once a yr, & see expensive hygienist. DH goes to dentist once every 5 yrs & never needs more than a hygienist appt afterwards. We have different needs.

Private paying health care systems can have skewed incentives, means many people are over-treated, over-diagnosed, over-investigated (& others still don't get any tests). NHS is actually very keen on prevention but it has to be cost-effective prevention. In USA there is now circulating advice to suggest some woman start getting annual mammograms from age 35 (or even younger). It's nuts. Zillions of false positives would result.

NHS can't find the numbers to show that annual gynae exams are cost-effective, for instance. Even tiny benefits per patient can save NHS millions in end, but they have to evidence the decision to act.

Yearly bloods, iron & cholesterol tests for £30...

My real thought was... Would people with problem numbers actually take steps to reduce their problem, would they make the info useful? What about 'borderline' problem numbers. Plus, wouldn't the most at risk folk either A) know already for other reasons or B) not bother to go get tested.

Anyway, Chemists sell home cholesterol tests for about £14; you can get a home-iron-anemia test from Amazon for £21 delivered. Nothing to stop people getting those tests if they're so keen.

False reassurance is very expensive. So are false positives.

I think it's a legacy issue. The NHS was founded to provide healthcare to those who couldn't access it. That was it.

To try to turn that on it's head, with everything that would mean in terms of allocation of resources, structuring, staffing, skills, etc, must be as close to impossible a task as there is in government.

And there's the other big issue: prime ministers can only be at the head of government for a finite amount of years. Unless it's their fervent belief to change to a preventative model, they're going to take more short-term measures that will get them personally, or their party, re-elected.

false reassurance is expensive and so are false positives
True but so is late diagnosis.

A lot of people are very proactive with their own preventative healthcare OP. You just might not know them. I've been to my gp annually since I was 17 and I have bloods taken and any concerns investigated properly. I'm 33 now and have caught several things as small issues whereas they could've progressed to major concerns.

It's down to indiviuals to look after their own health too and raise concerns when needed instead of "oh, I'll go next week instead of this week" or moaning about a lack of GP appointments when they havent even tried to call for one, and I guess that depends on their own environment and upbringing too.

In my family you watch your health. And you get check ups. And you keep an eye out for things that could be a big deal.

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

While this may be the case it is also true that the incidence rate is higher in other European countries. Not clear that it is possible to demonstrate that better treatment outcomes are not in fact attributable to picking up more cases which didn't actually need treatment.

If we all took prevention much more seriously we could massively improve our own health. If we all ate healthily and exercised we could all help ourselves but, although we know this will significantly contribute to good health, most of us still don't do it.

We could cut down on diabetes and heart disease and some cancers.

Annual checks by x-rays, scans etc will increase cancers due to excessive radiation exposure.

Fivered , has your gp been judgemental about your attendance? I have been "told off" when seeking help.

eg went with extreme tiredness, falling asleep at 2 pm. My thyroid was only ever so slightly low and the gp compared me to some hero patient whose numbers were through the floor and was still coping etc., etc.

No way would they put up with 17 year olds starting routine annual checks.

OP, I think you're talking about detection rather than prevention. There are risks to examinations that expose you to radiation (like xray), which is why the NHS tries to follow guidance that limits unnecessary exposure to ionising radiation.

Are you sure you are not "worried well" or could you not have asked for more assurance from your GP (who surely knows your medical history)? If you had needed a follow up, your GP should have referred you. Instead a private healthcare company has cashed in on your anxiety. I am sorry your GP couldn't reassure you why they felt a referral was not needed.

Prevention is about adopting a healthy lifestyle. There are many complicated socio-economic factors that affect the uptake of a healthy lifestyle. So many cancers and chronic diseases could be avoided if we were better enabled around healthy living. The government has slashed public health budgets in recent years. This has led to the limiting of lifestyle related support like weight management and stop smoking services across the country. I am more concerned about that than giving those with a spare £100 an xray that is potentially not clinically required and is exposing them to radiation.

If you re-read your post carefully, it boils down to why does something cost £320 in the UK compared to £100 elsewhere.

Because the UK is a country with much higher costs and wages, is one possible answer.

Another possibility is that the £100 is not the true cost and there is behind the scenes subsidy. I think the argument against government subsidising something like this is that it is a subsidy to the relatively well off. It doesn't make sense for goverment to help the middle class afford something that those with more stretched finances are never going to access. Any money the government is going to give away via the NHS is supposed to be spent according to a rational idea of where it will do the most good.

Though I suppose there is a middle ground, where the paying patient pays the marginal cost of a test or treatment the NHS isn't providing, and this is cheaper than private cost because buildings and equipment and most staff costs have already been covered by NHS budget. The extra test/treatment could be viewed as not subsidised, as the NHS is no worse off financially than if it hadn't offered the test/treatment. The reason this won't happen is purely political: politicians won't admit to voters that NHS isn't perfect.

I was recently invited for a general check up at the GP surgery as I had reached the age when they start them.

I was disappointed slightly surprised that the person doing the consultation had minimal medical training.

She measured my height incorrectly (my hair was in an 'up' do), told me I was underweight (I'm not) and refused to be corrected.

She then repeatedly stabbed a needle into my veins (whilst saying 'Sorry, I'm not very good at this bit') to extract blood and then told me to return in two weeks for the results.

When I returned, I had hoped I would see a Dr or nurse, but it was the same person again.

She told me my preferred exercise (yoga) didn't count as exercise, even though I do four classes a week and it leaves me breathless.

If this was prevention screening, it felt cheap and shoddy.

It's not just a financial decision, though that is a big factor in how the NHS makes these decisions. It's also actual resources. Even if you offered these as paid services, there are not suddenly extra doctors, extra nurses and extra facilities. So they would be used for paid screening from people who could afford it, and the people on the NHS waiting lists who actually need these services would wait longer.

Yes, it's true that in an world of infinite resources we could all be screened for everything as often as we wanted and that would mean some things would get picked up sooner. But in the real world, there would be consequences of increasing the availability of these services to people who do not need them, and it's naive to assume otherwise.

Not sure why everyone is focusing on x-rays. Yes, those are harmful and only to be performed when needed. Ultrasound scans are harmless though, and so are blood tests.

@bridgetreilly but why are Southern European countries, which are far less wealthy than the UK, able to do this?

I wouldn’t mind opting out of paying for my NHS contribution (in taxes) if it meant paying for appointments. But I suppose if enough people did what I did there would be no NHS for anyone.

I have a progressive condition.
I would really benefit from physio and hydrotherapy. I can't have it until I get much more disabled. So I struggle on doing the best I can. I can't afford to pay privately because I had to stop work due to my condition.
There is a treatment that works that is standard in other countries, but it is expensive, so NICE won't approve it. So I get the NHS cheaper package which is ever increasing doses of medication that has horrible side effects.
I can only have the treatment that works once I can't breathe or swallow.
I paid for critical illness cover for 30 years, but the condition I have isn't on their list.
It is crap.
There is no interest in preventing something getting worse or improving quality of life.

A previous employer offered us a yearly comprehensive health check of the type you recommend.
We'd joke with whomever's turn it was that we would see them after they came from their near death experience.. There were lots of needless follow-ups with expensive specialists* that ultimately led to NOTHING ACTIONABLE ("slightly raised fatty liver"). I only once saw something serious get caught that may not have otherwise. Do we want such a highly insurance driven health system like the US? Is there a sweet spot?

*Not all but some of these same specialists - especially those who moved into private exclusively in their early years - have less experience than their NHS counterparts due to volume of patients and range of experiences.

@endofthelinefinally That's clearly terrible and you have my sympathies. To me, that's less about having an annual checkup; that's about providing what needs to be provided to people in need. We should be ashamed as a country in cases like this.

@TeddyBear45 would opting out of paying NHS contribution not also mean opting out of emergency care and treatment beyond appointments? That's where the real costs kick in.

So this was in the news this morning:

news.sky.com/story/four-million-britons-under-65-have-untreated-high-blood-pressure-11709719

I just don't see how anyone can think it would be a negative thing to have a yearly checkup.