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Empowering patients for better health outcomes

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28 December 2017

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Dr Sam Everingtonsays we already have the resources to improve health — if more power is given to patients

In the East End of London, the difference in life expectancy between rich and poor is 11 years and the gap in quality of life is 20 years. This means that at age 55 they can expect to feel like 75 in terms of their mental and physical state. So what is the solution?

Dr Sam Everingtonsays we already have the resources to improve health — if more power is given to patients

In the East End of London, the difference in life expectancy between rich and poor is 11 years and the gap in quality of life is 20 years. This means that at age 55 they can expect to feel like 75 in terms of their mental and physical state. So what is the solution?

Spending more money is not necessarily the answer. Life expectancy in Israel is similar to this country and yet they spend half as much on healthcare. They have four accountable care systems and GPs (generalists) are at the front door. I am told they pay the GPs more than non-generalists. GP consultation rates are typically three times higher in the UK than Ireland and New Zealand and outpatient appointments have nearly doubled in the past 10 years. So do we need a radical change in our approach to healthcare?

When you look at the evidence on cancer and chronic disease prevention, prevention lies in being happy and active, eating a more Mediterranean-style diet, drinking alcohol in moderation and not smoking. We also know from Professor Sir Michael Gideon Marmot’s work that 70% of health and wellbeing relates to social factors. At best 30% of health is delivered by the NHS. Even within this we need greater efficiencies and improved pathways. Half of outpatient visits could be avoided using different pathways and technology.

In secondary care, typically 50% of patients die in hospital even though most of us say we would rather die at home surrounded by our loved ones. The failure to deliver on this is both cruel and uneconomic. So many of the things we do should be delivered in a different way. Outpatients needs a new payment and IT system that incentivises the most clinically effective resolution of an issue rather than a default visit to outpatients.

And what about Professor Marmot’s 70%, the social determinants of health? Perhaps this is where we need our biggest revolution – on issues such as activity (you’ll lose 10 years of life if you are inactive), good employment, education, the environment and creative and spiritual fulfilment. The focus needs to be on what matters to patients, not what is the matter with them.

With this comes the handing back of responsibility to patients. When patients with terminal illness are given Skype or mobile phone access to doctors and nurses, they describe how they now feel in control of their life and death. The norm in general practice should be to connect patients via social prescriptions to local services. All patients should have access to their notes and for the 85% of our community that are tech savvy, the norm should be for the patient write a note to the clinician ahead of their consultation to ensure they get to the right place first time and are prepared for a consultation that might be the most important 10 minutes of their life.

Drugs and operations are not going to ensure everyone reaches the age of 75 in the same healthy state. It is time for professionals to hand back control to patients and support them to manage their health and wellbeing in its widest sense.

Dr Sam Everington is chair of Tower Hamlets clinical commissioning group in east London, NHS England’s adviser on new care models and chair of the Healthcare Leader editorial board

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