Should the NHS focus on early diagnosis instead of treatment and/or prevention?

[TheSingingTowers]

The NHS is a much loved institution...and rightly so...free at the point of access and accessible to everyone is exactly how it should be. However, the UK is still towards the bottom of league tables for survival rates for a number of cancers and serious diseases, despite numerous media campaigns for preventative measures, such as giving up smoking and losing weight. Could the reason for this possibly be that patients presenting with early symptoms are often dismissed as having something less serious until further symptoms develop? Should the NHS focus more on early diagnosis than cure? If more common symptoms were investigated for a more serious cause sooner, would this not save the NHS money in the long run? This is not political as it’s not about funding etc. However AIBU to think a change of culture is necessary to bring us in line with other countries who seem to take patients concerns more seriously and diagnose things earlier?

Weirdly private insurance does this too. They don't fund preventative medicine. It is ridiculous because it would save more in the long run than spent in the short run. I suppose in terms of the NHS they're mostly fire fighting so don't even have time to get into the preventative stuff and with private insurance they mostly hope you'll pop your clogs quickly.

Youll always get the usual suspects complaining about nannying.

One day they may realise that such advice is not targeted at them

Could the reason for this possibly be that patients presenting with early symptoms are often dismissed as having something less serious until further symptoms develop?
Yes

Should the NHS focus more on early diagnosis than cure?
It is not an either/or situation. You can have both.

If more common symptoms were investigated for a more serious cause sooner, would this not save the NHS money in the long run? This is not political as it’s not about funding etc.
I would expect it to but I don’t know of any figures that say conclusively either way.

AIBU to think a change of culture is necessary to bring us in line with other countries who seem to take patients concerns more seriously and diagnose things earlier?
Not unreasonable at all. I have experienced healthcare in a range of countries. The NHS is not my first choice (or second, or third) for treatment.

I do wonder about this. Do we as a country have poor outcomes because the NHS is free at the point of access? Do people take less personal responsibility because of this?

Perhaps if they spent less on detection methods that are archaic and wouldn’t stand if introduced now instead of people presenting with actual symptoms they might do a better job.
I’m so thankful we have free health care but it needs an overhaul.

@IWantADifferentName, what would be your first, second and third choices for health care and why?

Australia is first choice. France and the Netherlands next.

Australia provides a medical safety net. However, there is the expectation that if you can afford it, you will pay for private health insurance. I like that system as it offers affordable flexibility and choice.

The healthcare system works well. I can see bulk billing GP and pay nothing or pay a small fee and see a private GP. For £15, I can always get a appointment with a GP the same day. Usually, it is with my choice of GP but in an emergency, there is always an appointment available,e with someone.

I don’t have to go to a hospital for blood tests. There are lots of labs all over the place, even one in my GP’s surgery so that I can pick and choose (good when you are doing a fasting blood test).

You might have to share a room in a hospital with another person but there are lots of private rooms available as well for clinical need and those who wish to pay for them.

Australia is a world leader in cancer research. Medical and surgical outcomes vary between hospitals but are generally excellent.

This all sounds wonderful, doesn’t it? But I have also had two negative experiences, both involving nursing care. One was, I think, incompetence and the other was a judgemental bitch who decided withhold painkillers. But that is two nurses out of many, many more. I do think nursing standards are generally high here but, like elsewhere, there are some people who do not belong in a caring profession.

The Australian Medicare system works with private health insurance, not against it. It hasn’t been free but it has been affordable and of a significantly higher standard than the NHS.

France and Holland have been similar but a little more complex for me to understand as a patient,

Yep. My lovely friend was diagnosed with skin cancer last month. Her Gp had said for two years it was thrush! A gynecologist took one look at it and was confident it was cancer. Good job her periods were messing her around as be only discovered it looking at something else! They need to massively improve this as I've heard several people get diagnosed later than they should! Some have died. My neighbour was told her stomach hurt because she depressed due to a loss. She was riddled with cancer and died weeks after they sent her home with anti depressants

I agree that access to GPs in Australia is good IWantaDifferentName but I think the picture you paint of private health insurance here is overly rosy. The premiums are rising above inflation every year and depending on your circumstances you could end up with having to pay an excess bill in the thousands. Not an issue if you’re a high earner but can be a huge burden for those struggling to ‘do the right thing’ and keep their insurance only to find they can’t afford to use it.

Personally I feel it lurches closer to the American system every year.

This is not political as it’s not about funding etc.

But it is about funding to some extent. Sending everyone presenting with early symptoms of something to be tested further would be very expensive and as it currently stands would cause even longer waiting times than we already have.

I think we need a massive cultural shift in personal responsibility for following basic guidelines too - it should be a bit embarrassing to be sedentary. It costs nothing to get out for a 20 minute walk each day or do a few star jumps at home. I get the ‘healthy eating is expensive’argument but actually there are lots of foods which are affordable - potatoes, peas, apples, carrots etc.

Would it solve all the problems - no, and dies the nhs need more money - yes. But I think it would be a good start.

Read the NHS plan for the next 5 years. That is exactly what its focus is on, especially in relation to Cancer. Evidence is strong that survival rate is directly linked to early diagnosis.

The problem is that for this to work, you need good primary care (GP), not so much for them to follow the correct pathways, but to build people's confidence to go instead of thinking 'no point in going, I won't get an appointment for a week and that my GP will tell me I'm being silly, I'll wait to see if I get better'.

The other problem is that for any early depicted condition, you have many people going for more appointments, more tests, which for most will come out fine, so it's a lot of potential added pressure on a system that already can't cope.

The NHS is a chicken and egg institution. It's all good to focus on preventive, but doing so with the current resources will have a serious impact on current emergency care, let alone non-emergency. Give it more money is good of course, but it will be a very slow process until the good comes out of it. It will need to recruit new good trained staff and for this, we need to train more good people. It will need to cope at some point with treating more acute people whilst investing heavily in more preventive work. Preventive work always take quite some time to get off the ground, so in the meantime, it's a lot of pressure on staff who are already under much pressure, and this can lead them to leave the NHS, which takes us back to the start of training and recruiting.

If we get more funding and do things right, it will likely take up to 10 years to really see the benefits, and politicians love to make their print into everything, no initiative lasts longer enough to make that impact. We are stuck in a wheel of initiative driven policies which are then put in the bin for new much more innovative policies, which are not much different to the one before, and off we start again, wasting money, never going far enough to see results, whilst people's morale is whipped.

That's the NHS, and it's all down to us, mistrusting and always pushing for change.

France and Holland have been similar but a little more complex for me to understand as a patient,
Indeed! The French system is totally collapsing. It is much more expensive and yet not much more efficient than the NHS. Waits are long, treatment is questionable.

A colleague of mine had to have some genetic tests done following a suspicious condition. They were referred in the UK to a genetic clinic, and their sibling who is currently studying in France did so there too. My colleague had her appointment 3 months earlier, her tests within a couple of weeks, and results 6 weeks later. Her sibling who started the pathway at the same time is still waiting for hers, 2 1/2 months later.

I've had other examples of people living in France that made me really happy to be in the UK.

Should the NHS focus more on early diagnosis than cure? If more common symptoms were investigated for a more serious cause sooner, would this not save the NHS money in the long run?

YANBU The focus on early prevention is already the agreed approach. I encourage you to read the NHS long term plan:

www.england.nhs.uk/long-term-plan/

a change of culture is necessary to bring us in line with other countries who seem to take patients concerns more seriously

Healthcare professionals do want to see the change, the challenge is directly related to staffing issues - the current workforce is woefully under resourced leaving the staff tired, burnt out and despondent, this is one of the factors that causes the mis-diagnosis of patients symptoms.

We already have hugely under used screening programmes. Cervical screening uptake is at is lowest. Breast screening at 75 % or less Bowel cancer screening about 60 something %.

France's system is in deep trouble, as it just costs more than anyone is willing to spend on it. There are massive shortages of doctors, round here you have to wait 8-12 months to see a gynecologist or an ophthalmologist and there is no private option. Some things are referred immediately for investigation but only if they fall under the list of government approved pathways (if the government hasn't issued a bulletin about something doctors don't even know about it - CPD is non-existent).

Prevention is a double edged sword if you want to be blunt. The people whose problems are caught early to be prevented will go on to suffer from something else later on and cost even more money. Risky lifestyle choices are actually cheaper overall as people are more likely to die middle aged than make it to old age with its crippling health and social care costs.

Not sure it's good to have a private option. You usually see a Dr who also works for NHS so people who can't afford it are waiting longer for their appointment.

It's an interesting point but it won't be answered by speculating here. This is the kind of thing that would need to be answered by simply looking at the statistics. It's impossible to compare countries simply by looking at outcomes as cultural differences make a huge difference (how likely are people to go to the DR early, how much of a culture of drinking and smoking exists etc.)

If private health insurance could save money by doing this they would. What they probably find is that it's cheaper to simply refuse insurance for people at higher risk of cancers.

I think we need to have a serious review on what is needed and what should be payable by individuals.

I agree. How many women have I known die at stage 4 after battling GPs for a referral for years. The thing is, Grenfell killed a lot of people due to corruption, mismanagement and cuts. Outcry. The NHS kills 100 times mire people and those families complain with no result. It's a mass killer and the NHS lovers refuse to admit it. The last funeral, a 42 year old woman who wasn't seen until she had stage 4 cancer, despite begging for a referral for 3 years, her husband talked about the wonderful care from the NHS. It's not wonderful, it's a political toy and a complacent killer. Nowhere else is quite so indifferent to human life.

YANBU. My husband was diagnosed and treated very quickly. We were lucky as our area has the highest rate of detection and fastest detection to treatment rate for his type of cancer.

I have heard countless stories of people being diagnosed with anything and everything first. A friend of a friend is currently having aggressive chemo due to being told her cancer was constipation among other things.