The health and social care secretary’s prevention vision could, if given the backing it needs, really change the odds for people affected by heart and circulatory disease. By Simon Gillespie
The health and social care secretary’s announcement that prevention will have as great an emphasis as cure in the NHS’s long-term plan will be met with relief by those committed to tackling many of the UK’s most devastating diseases. For too long, the prevention agenda has taken a backseat, to the detriment of patients, as well as the health service.
The case for radical action to prevent needless heart attacks and strokes is inarguable, yet has for many years remained unaddressed. Integral to this is a recognition that the health service’s future hinges as much on what happens outside of hospital as it does inside.
Nearly 30 per cent of the UK population has high blood pressure, but half of those people are currently untreated with many more not managing their condition effectively
Some of the action needed, such as reducing air pollution levels, will be outside the NHS’s control, but will certainly be within the government’s remit. And if the health and social care secretary’s new emphasis is going to have a real impact anywhere, then it will be in turning the tide against heart and circulatory disease.
Common risk factors that lead to heart attacks and strokes such as atrial fibrillation, high cholesterol, high blood pressure and diabetes are all easily identified and treated. Yet our detection rates are poor, and lag behind comparable countries.
Nearly 30 per cent of the UK population has high blood pressure, but half of those people are currently untreated with many more not managing their condition effectively. Similarly, we estimate over 500,000 people are living with undiagnosed atrial fibrillation in the UK, significantly increasing their risk of a stroke.
Add to this stubbornly high childhood obesity rates, and the expected surge in diabetes cases over the next 20 years, and we have a formidable health crisis on our horizon. In the context of a creaking health service that is struggling to cope with more patients living with multiple conditions and vast health inequalities, this is simply an issue we can no longer ignore.
Taking prevention into the community
What then, does effective prevention of heart and circulatory disease look like? It is a combination of the common sense and the high tech. The common sense involves detection coming to people, rather than the other way round.
. This means that people should be able to access, for example, high blood pressure tests in the community, whether in a train station, a pharmacy or a workplace.
The British Heart Foundation is investing £1.5m funding in projects which aim to achieve just that. Our ambition is clear – for those over 40, knowing your blood pressure should be as common as knowing your weight or height. Now we need the government to throw its weight behind similar innovations.
We know from countries like Canada that this can have a significant impact on outcomes. Smoking cessation must also not lose the momentum achieved in recent years – this again means reaching people in the community.
The second aspect of prevention involves embracing the power of data science and our ever increasing knowledge of genetics to offer more personalised care. Recent research we’ve co-funded has paved the way for a genetic test which can better predict during childhood a person’s risk of having a heart attack later on in life.
This kind of groundbreaking work means that we could soon get a much clearer picture of a person’s future risk of disease and tailor preventive treatments to their individual needs.
With further investment, we can accelerate the translation of this type of science from the field of medical innovation into routine NHS use. We believe this is possible within a decade and could completely transform how we prevent disease.
Finding the budget to back the vision
Many lives will be saved if we adopt a more proactive approach to prevention of heart and circulatory diseases, but this will not come for free. Bolstered public health budgets are not optional, but integral.
Bodies beyond the NHS such as local authorities must have the means, financial and otherwise, to make sure that detection really can happen in the community.
Without devoting full resources to prevention and early detection, we will struggle to tackle the marked health inequalities that heart and circulatory disease play such a significant part in.
What is now needed is the detail to make this shift towards prevention a reality. As many have noted, it seems hard to square the laudable aspirations presented this week with figures showing that public health spending is due to fall next year.
The prevention strategy cannot exist in isolation, and must be a cause taken up, where necessary, by departments across the government. It needs to be accompanied by a thorough review of our public health strategy and level of investment.
This week we’ve taken a step in the right direction. The health and social care secretary has correctly identified the problem, but he must now ensure the right tools are available to fix it.
If this significant shift in approach can be achieved, then it will save many lives from heart attacks and strokes in England. If it is a half hearted effort, then the consequences could be felt for a generation.