GP Sir Sam Everington OBE, Chairman of Tower Hamlets CCG, examines whether the UK’s life expectancy rates could be dramatically improved by focusing on social determinants and a better use of technology:
In the East End of London the difference in life expectancy between rich and poor is 11 years and quality of life is 20 years.
Put simply, you can expect to reach the age of 75 at the age of 55 in terms of your mental and physical state.
So what is the solution? Life expectancy in Israel is very similar to this country and yet they spend half the amount on health care. Just more money is not the answer.
Interestingly, in Israel they have four accountable care systems and GPs are at the front door of care, with many paid more than specialists.
GP consultation rates are typically three times higher in the UK than Ireland and New Zealand and outpatient appointments have nearly doubled in the last 10 years.
Is more of the same therefore the solution, or do we need a radical change in approach to healthcare and health improvement?
When you look at some of the evidence on cancer and chronic disease prevention, it’s clear that being happy, active, and enjoying a good diet with moderate alcohol consumption and not smoking are all powerful allies when it comes to staying healthier for longer.
Medical practitioners know from Professor Marmot’s Fair Lives, Healthy Society work that 70 per cent of health and well-being relates to social determinants. At best 30 per cent of health is delivered by the NHS.
And even within this 30 per cent there needs to be greater efficiency and improved clinical care and pathways. Around 50 per cent of out-patient visits could be avoided using different pathways and technology.
In relation to in-patients, typically 50 per cent of patients are dying in hospital despite virtually all of us saying 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, need to be delivered in a different way. Out-patients need a
new payment and IT system that enables the most clinically-effective solutions.
Perhaps the biggest revolution needs to be a greater focus on the 70 per cent, the social determinants of health – issues such as activity (a potential ten years’ loss of life if you are inactive), good employment, education and the environment alongside a positive creative and spiritual side.
The focus needs to be on what matters to patients, not what the matter is with them. We must let patients maintain responsibility for their lives.
For example, people with terminal illnesses who are given Skype or mobile phone access to doctors and nurses have described how they now feel more in control of their life, and their death.
The norm in general practice should be to connect patients via social prescriptions to the myriad of local voluntary and local authority services.
All patients should have access to their notes and, for the 85 per cent of our community who are tech-savvy, the norm should be writing a note to a clinician ahead of your consultation to ensure you get to the right place first time and that you are prepared for a consultation which might be the most important ten minutes of your life.
It is time for professionals to hand back control to patients and support them to manage their health and well-being in its wider sense.
More drugs and operations are not going to ensure everyone reaches the age of 75 in the same healthy state.