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.

As a bit of an aside, as a school nurse the basis of my work should be health promotion, public health and early identification of health need. The sad fact is with current scarcity of resources, lack of funding and staffing problems our time is spent dealing with safeguarding and kids, teens and families already in crisis, and specially around mental health and emotional well-being. Even ten years ago we spent more time with primary age children and families around dental health care, handwashing, dietary advice and healthy lifestyle and smoking cessation, sexual health promotion with the teens etc. Nearly all of that work has been cut from our core offer and we're not commissioned for it any more. So so shortsighted.

Yes it is short-sighted. The money invested by the NHS about 10-15 years ago on smoking cessation workshops, is probably saving money today, and many people's premature deaths.

Haven't read the full thread so apologies if this has been mentioned but look up lead-time bias in the context of medical screening. There is a massive psychological impact.
Money would be better spent on educating and empowering people into leading a healthy lifestyle.

Why can't I pay a reasonable amount of money and have a mammogram every 1-2 years?

Because it would expose you to unnecessary radiation which is detrimental and mammograms are very unreliable under the age of about 40, so testing at will would lead to a lot of unnecessary referrals.

The NHS uses an evidence-based approach guided by medical expertise rather than a consumer-demand approach. It’s more effective and less risky to allow medical professionals to make medical decisions

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.

Does it do any good? I had an ovary that was producing cysts that were bursting and causing huge amounts of pain, I had several US scans but only the one done when I was in hospital as an emergency admission showed the cyst, it was the size of a grapefruit.

A lot of tests only show what is happening at the time and cannot predict the future.

Some screening works, some doesn't and it can make people think there is nothing wrong eg an ECG recorded on Monday can be completely normal so when you have chest pain on the Tuesday you may not seek medical help.

There is a very low rate of take up on the tests which are regularly offered - mammograms and smears.

Mammograms are offered, at least by the service which deals with my local health authority, by sending an appointment for a local centre - which can then be easily changed. This is done on the basis that people will be less likely to ignore that then than just an invite letter.

Smears are an invitation to contact your surgery for an appointment ( with accompanying literature) and a follow up if you don’t get it done.

There is also a bowel cancer screening programme for those over 60 - done directly to your home.

The take up for these personalised, free invitations is still low - especially smears: there was a lot in the news recently about the declining rate of women attending appointments.

I would say that people can keep themselves as healthy as possible.
Reasonable diet to keep to healthy weight
No smoking
Moderate drinking
Checking moles/breasts/balls (delete non applicable)
Etc.
This would also cut down health issues or catch issues early.
Also, many people don’t go to dentist regularly, even though that is preventative so many wouldn’t go for a £100 medical.

And you can go for an annual check up with your GP. Everyone is entitled to this. Most don't do it because unless you have issues, it is a waste of time.

The NHS is dangerously understaffed at the moment so not enough professionals to cope with extra preventative work. I have type I diabetes and am very concerned about the shortage of insulin prediction, even with my diagnosed condition it's still very difficult to get to see anyone about it
This article is very interesting
www.health.org.uk/news-and-comment/news/nhs-staff-shortages-put-long-term-vision-for-primary-and-community-care-at-risk

Many surgeries have blood pressure test machines (automatic) in the waiting room. I was in a pharmacy linked to surgery yesterday that has such a machine. You don't have to be a patient of that surgery, anyone can walk in & use them. Quick google to see if the numbers matter.

I agree OP. I'm not in the UK and we have a similar system here. You can go privately for not a huge cost like at home. I had some issues getting pregnant that were flagged up because I chose to get checked out privately. It took 6 months to get my BFP and it wouldn't have happened probably for years in the UK. I know it's not the same as illness but I now get yearly breast scans and yearly gynae checks. On the flip side there is a lot of paranoia here about health from health professionals which can be extremely stressful for the patients. There's pros and cons to both systems but at the end of the day the NHS is a publicly funded system and works at the moment quite well.

I do think a yearly check up would be beneficial for all. I actually think it would save the NHS in the long run because problems would be picked up much sooner so treatments would in turn be easier.

I have a range of health issues so have to have check ups

it has become such a nightmare - see patient paradox - I ended up being told I probably had cancer last year.

I am now trying to avoid the doctor as much as I can. I think if you feel fine and you want private screening for all possibilities, let the NHS crack on with their work and go pay privately for the things you are pondering.

PS I've often wondered why some countries ask for a routine gynae check. What is it for? Sounds like a way to make money from the worried well.

also I gather in the US, a colonoscopy is now standard for men over a certain age each year. WTF? Who wants to go through that when they are feeling perfectly fine!

It's been mentioned many times before but I can't recommend the patient paradox enough. Or anything else by the same author - there's lots online.
She's a very clever lady who explains statistics and the pros and cons of things really clearly.

I suppose a lot of this perspective depends how long you want to live

I am horrified by life expectancy generally and in my family there is a big problem with longevity.

my mum is in her 80s and her fragility terrifies me. What on earth will life be like if she carries on into her 90s? She does take a couple of heart meds but has refused a pacemaker etc. Dad got one of those and survived long enough to enjoy cancer, which luckily killed him much faster than some other types would have done.

if she carries on, what is ahead? The joy of dementia or Alzheimers'?

I have to be treated for a couple of things in order to live a normal life. But preventative medicine will not be happening for me, I will not be going for scans etc

oh and it's sod's law, you will go to the dentist, everything will be fine, two weeks later you'll get a hell of a toothache.

NoYo I had ligation of the big vein plus lasering in one leg (done at the same time) then lasering of the other leg a week later. Both with sedation and local anaesthetic and day case. I can opt for foam sclerotherapy 6-8 weeks later if I want. That requires another week of bandage and two weeks of support stocking so if it's only cosmetic by that stage I may not do it. It doesn't come cheap though. £5k so far! But I only had to pay a small excess (plus my monthly contributions to the insurance have covered about half the rest).

Re the article on untreated high blood pressure. DH and I are both in our 50s with blood pressure on the low side. It has been like this since we were both in our 20s. Barring significant lifestyle changes and huge weight gain that is unlikely to change and we don't need annual checks.

Otoh other friends and relations have had high blood pressure which needs monitoring since their 30s.

I think it would make much more sense for screening and propensity to treat to be targeted around risk factors rather than at population level.

Another vote for Margaret McCartney and The Patient Paradox. The vast majority of people going for screening tests are not properly informed about the pros and cons of such tests and therefore they can't give proper informed consent. Whether you'd choose screening or not, for me, that is a big problem! Public Health England are terrible in this respect. I have yet to see any information they publish that provides proper information on this. The latest leaflet was their antenatal screening one which does not mention false positives or false negatives at all or that there is a heavy age-related component in the combined screening test calculation. Thank heavens for Emily Oster's book, however, it makes me angry that less well researched prospective parents wouldn't know this information. I've lost count of the number of posts on the relevant boards on here where women are stressed out by results when it's clear from what they say that they haven't fully understood what they were putting themselves in for.

I agree @howabout regarding risk factors - that Heart Risk questionnaire that was put about last Autumn was typical of this sort of thing too. I am fit, sporty late 30s, and I did the questionnaire (out of curiosity) and without asking me about current activity levels it told me I had to do more exercise (and my risk was calculated using postcode data!) 🤦

Weathergirl have you ever seen the leaflet that accompanies the bowel cancer screening test kit? I’m pretty sure that covers false positives and risks. To be honest it’s probably the best cancer screening program we have in the UK, and definitely worth doing as the evidence is indisputable.
I know the breast screening leaflet had to be redone though to give more information about risks.

curious about this pointless heart risk test?!

sorry to hear about posters with varicose veins. I think it's horrible that people with problems are lower on the list than getting a bunch of screening things done.

@MissyB1 I haven't, no but I haven't reached their target demographic yet. You say it's worth doing, and it may be for you, but different people have different attitudes towards risk and I think that needs acknowledging (as per a PP who talks further upthread about quality of life).

The best breast screening information I've seen was an Australian version which very clearly explained in layman's terms about false positives and false negatives, even the revamped UK version wasn't as clear as I recall.

@RosaWaiting I think this was it:
www.bhf.org.uk/informationsupport/risk-factors/check-your-heart-age
It was widely reported in the news last September (I think) - BBC News ran with it!

When I say bowel cancer screening is worth doing what I mean is the evidence definitely shows that it not only saves lives through detecting cancers, but it can also prevent cancers from actually occurring - pretty clever!
But yes I absolutely understand different people have different attitudes to risk.

You are medicaliaing prevention. Prevention needs to start much earlier, healthy children, healthy adults, healthy habits formed. No obesogebic environment. No tobacco.
We do have the NHS health checks - which local governments pay for.

I cringe when posters spout - the NHS isn’t a liner less pot’

There would be a hell of a lot more money if the hospital chiefs were not raking in millions for them self’s each year, or the the government stopped building useless medical buildings (that cost millions) that can’t even be used because they are too expensive to run.

People should get angry at the government not just accept it.

Op you are right. Prevention is better than a cure but I think the government relies on deaths to keep the money in the ‘pot’ tbh.