Don’t we have an obligation to be guardians of health?

People say there are transformational moments that will go on to affect your life in ways you can’t imagine. Mine was a busy shift in the emergency department. 

Despite not even being three years into my clinical training I was the most senior doctor in the resuscitation room that night. We had five beds and they were all full. One stabbing (a boy I recognised from a previous time), a woman with severe chest pain (likely a heart attack), two people seriously injured from road traffic collisions, and a man with a head injury he’d sustained while drunk. I was feeling overwhelmed and out of my depth, not just from the volume and severity of patients’ conditions, and because the system around me wasn’t operating well, but because it felt like there was more we should do.

It was that shift that caused me to stop and reflect on a couple of things. Firstly, that many of the people we treat have things wrong with them that might have been preventable, or amenable to different interventions. And secondly, and this was a more personal realisation, that while we need people who are clinically excellent to deliver care when sick people need it, while I worked with one patient at a time, my impact would be limited. It was this that compelled me to do more around the ‘bigger picture’ of health care, and I’ve now been a public health doctor for almost 11 years. 

Over that time, I’ve become deeply interested in understanding what makes people ill, how and why they use health care, how health care can play a role in improving health (not just treating sickness), and how we can make improvements to health care to enable this. 

You’ve probably heard that widely quoted statistic that health care contributes to (and estimates vary) as little as 10% of a person’s health. The Health Foundation’s programme of work on healthy lives is focusing on the factors outside the health and care system that define the other 90%. And in this month’s newsletter, we’re looking specifically at how the NHS can contribute to supporting people to live healthier lives.

While this is a relatively new area for us, it’s by no means new ground. Over the past decade, the Health Foundation has funded over 100 improvement projects focused on prevention or on tackling the social determinants of health (the circumstances in which we are born, grow, live, work and age). 

In her blog this month, Susannah Pye outlines several ways in which health care professionals and services can improve people’s health and wellbeing by addressing the social determinants of health. We also showcase three projects funded by the Health Foundation that address prevention for both physical and mental health, including one project that’s taking advantage of a ‘teachable moment’ in the emergency department to help vulnerable young people find a route out of violence and crime. 

We are only starting to unlock the possibilities of the role that health services can play in prevention and population health. Many of those relate to how we can better design and integrate services and systems across places and communities so that they maximise their contribution to people’s health. 

However, there is more that the NHS could do to improve people’s health. These include the NHS’s responsibility as an employer and an anchor in the community. The people who make up the NHS and social care workforce account for over 5% of the UK population. There are huge opportunities to improve the physical and mental health of people who work for the NHS, and in turn help them to provide not only better care, but to focus on the wider health of the patients they see, and perhaps their families and wider communities. 

In her blog, Sarah Reed describes how the NHS could play a greater role in its local communities and economies, addressing inequalities through employment practices, procurement, and use of facilities and estates, through its role as an anchor institution. 

As well as being a public health doctor, I’m also an improver. And to quote Paul Batalden: ‘Everyone in health care has two jobs when they come to work; to do their work and to improve it’. Imagine harnessing some of those improvement methods and effort to focus more on preventing ill health and improving the wider factors that influence the health of the public. Our interview with Jason Leitch provides insights into how Scotland is now using improvement approaches within and beyond health care, and how that’s having a positive effect on the health of the people of Scotland.

No doubt all this work requires doing some things differently – greater partnership working, really understanding the needs of people, and working more with people and communities. And it won’t always be easy. Change takes a long time, it’s complex, and doesn’t align with operational and financial pressures on an already stretched system. Not to mention the fact that the NHS isn’t set up to do this kind of work.  

But don’t we have an obligation? 

My mind is drawn to this quote from Elizabeth Blackwell, the first woman doctor: ‘We are not tinkers who merely patch and mend what is broken... we must be watchmen, guardians of the life and the health of our generation, so that stronger and more able generations may come after.’  

We’ll be continuing to explore these and other issues over the coming months as we work out where it’s best for us to concentrate our efforts. If you’d be interested in helping to shape this work, we’d love to hear from you. 

Dominique Allwood (@DrDominiqueAllw) is Assistant Director of Improvement at the Health Foundation and a Consultant in Public Health Medicine and Quality Improvement working in a large teaching hospital in London