Should the NHS stop spending so much money trying to 'help' people who WON'T be helped?

[whippet]

I don't want to be too specific, but I work in the public sector, and in health (and have done for the last 10 years or so).

I'm getting increasingly frustrated and demotivated by the huge amount of taxpayers money which is poured into activities which are designed to 'reduce health inequalities' i.e. improve the health of people in deprived & disadvantaged areas or 'Tackle Obesity'
The latest attempt is a national programme called 'Change for Life' which is trying to get parents to make small chnages for the overall benefit of their family's health.

Now, I know the NHS & Govt can be responsible for some crap ideas, but there are some half decent ones out there too. In the last few years there have been lots of attempts to make things easier for people to do - to stop smoking ot lose weight for example.

However so many of the people we are trying to help are just so downright bolshy, unmotivated and disinterested in taking any action to improve any aspect of their personal health, that I'm now beginning to just think "WTF? Why not just bypass this generation (or 2) and focus on children and future generations"

Do you think we have a moral obligation to at least attempt to make people healthier??

Why do people simply not care about their health? Can they really not see the consequences of their current lifestyles?

whippet - I share your pain. One of our new things is equality of access to care for prisoners. Now, one can reasonably argue that being a convicted criminal does not mean your healthcare choices should be compromised. Hell, I'm a member of Amnesty, at the very least the possibility of a miscarriage of justice means you should not by default treat all criminals as if they deserve what they get and so on.

On the other side of the coin, my dh is chronically ill and, as a highly eloquent, middle-class user of the service, I get jack shit out of it and I genuinely wonder how much worse it must be for people who can't interact with clinicians as equals, who can't ask the questions (and still fail to get the answers because The System Doesn't Care).

I think the targets are generally well-meaning but out of touch with reality. I don't know what else any government could do - the people who won't deal are the people who need targeting. But then I think, why should we be ignored/sidelined/treated like shit, because we don't fit that demographic? But to be quite honest - and I should stress, I work for the NHS - being treated like no-one gives a toss is the norm when you have a non-life-threatening chronic condition with no easy answers. I don't know what to say. My step-father has cancer and has received excellent care this past year so I can't say resources aren't being properly deployed. But for those of us dealing with the reality of a chronic condition that has effectively ended my husband's meaninful life aged 35 and no-one cares, that's the bit that does my head in. He isn't going to die. But he also isn't going to live. And no-one, no-one cares.

tribpot - so sorry to hear about your DH's situation.

My Mum had cancer and received good care, but as you say, if it's something non-life-threatening then it's hard to get anything...

I think I agree that everyone deserves a chance for good health, but tha there needs to be a cap on it, and if you can't be bothered to 'do your bit' towards it, then you don't deserve to keep having money thrown at you (unless we're talking mental health issues/ reduced capacity etc)

I despair when I see the abdication of responsibility from some (too many!) parents these days - to their children's weight/ diet/ exercise/ education/ self- discipline etc.

I just can't see what the fundamental change would be that would make a difference?

DH is a cardiologist so he sees people every day who make poor lifestyle choices.

There is a clear association between smoking, obesity and poverty. Most of DHs patients have no idea what constitutes healthy eating (even appropriate portion size). Because their friends, family and neighbours all smoke and eat shit - they have no positive reference point.

What DH finds is that the govt is very good at telling people to eat well and exercise, but his patients have no idea where to begin - and they feel lectured and victimised. A lot of his patients do not have the cognitive ability to figure all this out for thmesleves. Contrary to what the OP thinks, his patients do care about their health, but many are unable to see the link between smoking and overeating and poor health. Indeed, what he's seeing more and more is that there are now 2 to 3 generations of families that have never worked, all smoked and eaten poorly. A lot his patients firmly believe that that their poor health is down to a hereditary factor.

On the one hand the govt is handing out ASBOs, allowing cheap booze deals (and thuis binge drinking) in pubs, allowing the cheapest food in shops to be unhealthy ready meals. There is no sense of social, perosnal and moral responsibility in our communities.

As a nation, the message we get is to aim low - the govt desperately needs to institute more of a nanny state and turn around our society.

I should add that we have changed our tune considerably on this subject in the past year or so.

what about high risk activities like motorcycling, horse riding, crossing the road?

when we lived in Canada, we had to contribute to the govt health insurance scheme - think it was approx £30 each. kids go free.

I was very surprised that we didn't have to pay a premeium, given that DH and I were into risky sports (skiing etc).

actually mystery that's interesting.

Pushing childbirth aside, I've accessed the NHS twice so far in my adult life.

Broke my arm in a moutaineering accident.

Recently had both bunions operated on because it hurts when I run, ski and surf............

I've seen a physio a lot over the years but I've always gone privately as I've seen it as a bit self-inflicted.

Put very simply it's cost-effective to spend money on these measures rather than fix them when they've had heart attacks, blood pressure drugs, emphysema etc.

They're not doing it out of the goodness of their hearts.

Agree with Laurie, but also there is no sense whatsoever in saying "Why not just bypass this generation (or 2) and focus on children and future generations"

Today's adults who you think are a lost cause are the parents of tomorrow's children, who will be a lost cause if their parents don't pass them on a healthy upbringing/ understanding about a healthy lifestyle.

Weeslee - but that's my point exactly... that's the sensible rationale for doing the health promotion type stuff, but the reality is (and I've seen countless studies that prove this) that it doesn't work quite simply because people aren't motivated (or educated?) enough to take advantage of them.

Highlander, I DO see what you're saying about some people just not having the capability to know where to start, but there are many, many people who are given the 'first step' - an appointment with a stop smoking counsellor; or a toothbrush for their child etc but then angrily 'defend' their right to 'live their life as they want' . In this case, I just wonder if the state should stop trying to help them (and stop throwing good money after bad).

I agree with your 'nanny state' comment to some extent, but how can this be achieved with people who already feel 'victimised and lectured' ?

What did you mean when you said "we have changed our tune considerably on this subject in the past year or so"?

I think injuries due to dangerous sports are a completely different issue - not comparable really.

I agree with you to some extent, whippet, but someone has to do something. Short of having compulsory classes for ALL to learn what constitutes healthy eating/ living, it is difficult to see how it is going to change. TOo many people ALREADY whinge about the nanny state and actively do what they are told NOT to because "no one is going to tell me how to feed my kids" etc.

What would help more, imo, is easy, affordable access to leisure facilities. Instead, they are all becoming private and cost too much for the lower-paid to join.

We had a council leisure facility at a local school that cost £12 for annual membership and then £2.50 each time you went - this was then re-furbed by the council and they made it more like a private leisure centre, so now it costs a minimum of £300 annual membership. How MENTAL is that? Like all these other councils reducing leisure and training facilities, when we are supposed to be working up to 2012?

More walking, more cycling facilities, more activities and encouragement to participate in activities, legislation against shit-food manufacturers so that their shit-food has a minimum nutrient content, or something (top of the head, not sure that would be feasible!)... all these would be beneficial.

Out of interest Whippet why are injuries due to dangerous activites different?

Just interested really because the only difference I see is that one set of expensive ailments are due to activites deemed to be bad while other expensive ailments are due to activites deemed to be good.

I'm with tumtetum and I enjoy both sets of activities regularly

I think injuries due to dangerous activities are mostly accidental, therefore not preventable unless the activity is avoided completely.

Many of the conditions people suffer today are entirely preventable, but just people choose not to follow advice, or are too lazy or poorly educated about how to prevent them?

Is it because one set of risky activites are associated with uneducated people and the other set of risky activites are associated with more educated people/a more aspirational lifestyle?

But people who take part in dangerous activites could also avoid the activity completely...

there is also the point that dangerous activities will mostly (not always, granted) result in short-term damage, usually heals realtively quickly.

Wilful poor-lifestyle is more likely to result in long-term and more costly life-long treatment

No5t really. My mum worked in A&E for a while and many young motocyclists would come in - needing extensive surgery and often ending up in wheelchairs/brain damage and long term care needs.
5
Ditto rugby players breaking their necks - not a hugely uncommon injury in that sport.

Skiing accidents can have long term consequences...

And so on and so forth before we even think about young men driving cars too fast and crashing etc causing long term damage to themselves and those around them.

A lot of people who get short term, quick healing damage will go back to doing the activity that injured them in the first place and do it all over again.

I agree that people make bad lifestyle choices - but it irritates me slightly that the choices seen as a bit chavvy are deemed so much worse than the ones not chavvy IYSWIM

OK - I see your point, but in volume terms (and therefore total cost to the NHS and the taxpayer) it's long term conditions that are the biggest problem, not the reckless accidents.

There are accidents in all sports. Personally I'm not particularly pro motor-racing or highly dangerous sports, but sports like rugby are a good way of keeping fit. Someone is still more likely to die in a road traffic accident than in a rugby one.

Anyway, this is getting away from my original question really, which was

"Do you think we have a moral obligation to at least attempt to make people healthier"

and how much is reasonable before you say 'sod it, why bother?'

If the parents are a lost cause, then focusing on educating and changing the habits of the children can sometimes be helpful because occasionally they (the children) can help their parents learn and change their behaviour, or simply guilt them into making mroe of an effort.

I don't know what the answer is. I just know that all the things that are being tried at the moment ain't working!

Sometimes I think people should be required to have a 'Child Licence' before they are allowed to have children, and they should have to prove sufficient understanding of parenting, nutrition and social responsibility...

whippet - just warning you that the nippers may demand my attention so I may not be able to reply as quickly as you want.

Nanny State - it has to apply acoss all sections of society. Socially deprived areas tend to feel isolated, with no-one really understanding how they live. They feel lectured because they are lectured to by middle class intellectuals who have never had to live in poor housing, on a pitiful budget in an area where broken glass and dog shit litter the pavements. As far as they see it, there is no way out so why should they eat healthily when there is no way out? Why not indulge in satisfying food (ie chips and curries), beer and fags - after all, all the celebs on TV do it?

My sister is not well off and lives on a horrible housing estate. She is overweight. She finds she is targeted by the HV with all sorts of patronising comments and and feels that there is the insinuation that because she is fat and poor she is a bad mother. I spoke to my friend (a paediatrician) and she confirmed that poor mums are red flagged by the HV. I relayed this to my sister, who said 'is it any wonder people get defensive about how they live. I bet your HV never interfered in your life like this' You know what - she was spot on.

Sorry waffling. Close shitholes like Iceland. Subsidise fruit and veg in supermarkets (vouchers are soooooooooo humiliating). Look at housing estates - put on buses to supermarkets . Peer education - heavily subsidise community centres for healthy eating and excise. Build bigger, nices palygrounds on estates. yeah they'll get trashed - repair ASAP. Street cleaning teams - focus on horrible areas, even if it means cleaning up the dog shit for people. Chasing after them and nagging doesn't work. If govts work hard to keep an area nice, more people (families) go out and use it. if an area looks tidy, people are far less likely to litter etc.

Think the the govt needs to spend the moeny to aim high and build from the bottom, rather than nagging. By giving out the message that they're willing to spend money to support and encourage people to live well then I think a sense of personal responsibility for your own health and community will gradually follow.

DH and I used to have exactly your viewpoint whippet. Now that DH is a consultant he is forming longer lasting relationships with his patients and their families and is learning more about their lives in general.

It's entire communities that need practical help and investment.

We lived in Canada for 2 years. Prior to that we were real ready meal, bottles of wine, TV watching people (admittedly less so in the summer). canada has a much healthier lifestyle. There's a community ethos of healthy living. Lots of parks, every community centre is heavily used etc . it was very, very easy to slip into a far healthier way of living that we've thankfully been able to maintain ever since.

have to go DS2 has woken up and popped a right stinker in his nappy

Highlander - thanks - interesting views and ideas.
It's true that you need to raise the standard to get everyone appreciating looking after a communal area. My brother lives in a council flat in a run down part of Manchester. He and some of the residents were involved in an 'urban garden/ orchard project' - it sounded great. The council sold a lot of the land to a private developer and they had it paved over for car parking .

(Different question - did you have bunion surgery, and would you recommend it? I have 2 really bad ones too, and am considering it.)

P.S. I also loved in Canada for 3 years - and I found it so easy to live healthily - lots of outdoor space/ recreation facilities etc.

tsk - lived (and loved!)