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Durham University News

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NHS is a ‘sickness system’ not a health system, according to new book

(13 August 2008)

Professor David Hunter

The UK Government has largely ignored lessons to be learnt from 60 years of NHS reorganisation leading to failures in the system, argues the author of a forthcoming book.

The NHS has subsequently evolved into a “sickness system” primarily designed to repair those who fall ill and doing little to promote or improve health, says the author. Yet Professor David Hunter says the Government now needs to take major, well-informed action if it is to control health problems like obesity and reduce the massive burden on the health system. Professor Hunter, a professor of health policy and management with Durham University, has observed and commented on fourteen reviews of the health service. In his book, ‘The Health Debate’, to be published by the Policy Press at the University of Bristol, he analyses the challenges faced by the NHS. Professor Hunter argues that the majority of challenges the NHS grapples with today are, or resemble, those which preoccupied the health service in every previous reorganisation but lessons are often ignored. Policy makers ignore history at their peril and this failure to learn the lessons of the past can account for failure in the present and future, says the author. Professor Hunter commented, “One of the curious ironies of the NHS, and many other health systems like it, is that it does not pay enough attention to health, focusing instead on ill-health and disease. The NHS diagnoses and treats rather than predicts and prevents. “The Government needs to shift this balance as the increasing cost of lifestyle-related diseases, such as diabetes, obesity and some forms of cancer, will prove financially unsustainable making the NHS unaffordable. “Changing people’s behaviour is difficult and merely giving people information and advice is known to be ineffective. It needs for the Government to take bold action to control rising obesity levels and other health problems. Yet, Government does not want to be accused of being the ‘nanny state’ and is reluctant to act on some of the determinants of ill-health. “Bold action on the part of the Government should include taking tough action to control levels of fat, sugar and salt in foods, as well as trying to narrow the income gap between rich and poor.” In his book, Professor Hunter also argues that the search for solutions to today’s health challenges has led to an unwise and unproven reliance on private sector management styles and international healthcare businesses. Policy-makers make unproven assumptions about the ability of new social enterprises to run complex services, according to the author. He said: “The NHS faces some key ‘wicked issues’ to which there are no easy or ready solutions. These issues are very much focused on the way the health care is funded, prioritised and managed, and how it has evolved over the years. “There is a fixation on the latest fads and fashion in management, combined with a ‘terror by target’ culture, which has resulted in low staff morale and a breakdown in relations between clinicians and managers. ” In addition to exploring the broad range of interrelated, recurring and largely unresolved, policy puzzles, David Hunter also makes comparisons between the UK NHS and other global systems, bringing examples together for the first time from mainland Europe, New Zealand and the United States.

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