Prevention Not Always Better than Cure, Mr Hancock

Health and Social Care Secretary Matt Hancock has jumped aboard the prevention bandwagon, telling the International Association of National Public Health Institutes ‘If there’s one thing that everybody knows it’s: ‘prevention is better than cure’’. Sadly it isn’t. Prevention, like any intervention, can have side effects that outweigh the benefits as his predecessor Jeremy Hunt found. After meetings with drug companies researching dementia, Hunt decided that GPs needed to pick up dementia earlier, to prevent it getting worse, so he offered them £55 per new diagnosis via screening. The trouble is, the screening tests are often wrong.  Take 100 people over 65, and 6 will have dementia. Screening will miss 2 of them. Even worse, 23 will have a false positive result. Only when the press found people were panicking, selling up and moving into care homes when they thought they had dementia, only to find they had mild cognitive impairment, did Hunt and NHS England ditch the bribe (Eye ..).

There are three types of prevention. Primary, which aims to stop a  disease occurring at all (e.g. healthy living, vaccination).  Secondary, which aims to control a disease in an

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Dr Chris Day part 94

In a perfect NHS, we wouldn’t need whistle-blowers. Managers would thank staff for raising concerns and act swiftly to prevent avoidable harm to patients, as happens in many hospitals. But not all. If managers refuse to act and staff refuse to shut up, a protracted legal dispute is inevitable, with the odds stacked heavily against the whistle-blower. In Dr Chris Day’s four year legal struggle against Lewisham and Greenwich NHS Trust and Health Education England (HEE), he at least secured the badge of honour of a ‘good faith’ whistle-blower and managed to extract £55,000 in costs from HEE because of its earlier flawed conduct. Day and his legal team also exposed and then closed a loophole in the law that had previously excluded 54,000 junior doctors from any statutory whistleblowing protection (Eyes passim). But Dr Day found, as many others have, that such protection is very flimsy. After suffering six days of cross-examination by two tax-funded QCs, Dr Day decided not to risk financial ruin like Ed Jesudason (Eyes passim) and agreed to drop his claim. In return, Dr Day will not be pursued for eye-watering costs. In a fantastical joint statement, the two

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Goodbye Hunt, Hello Hancock

Ultimately, a health secretary can only be judged by whether the health service and health of the nation was better on leaving office than entering it. On both these counts Jeremy Hunt – in post for nearly six years – does not fare well. Getting access to the NHS, and the times spent waiting for treatment,  deteriorated across the board from emergency departments to cancer care, with over 4 million on a waiting list. The gap in life expectancy, and years lived in good health, between rich and poor is as large as ever, and steady improvements in life expectancy flatlined between 2015-2017, and remain lower than in many other comparable countries.  Most alarming,  the number of babies dying within a year of being born is on the rise, from 2.6 neonatal deaths per 1,000 births in 2015 to 2.7 for every 1,000 births in 2016. The likely causes are smoking among mothers, maternal obesity, poverty, cuts to public health programs and the England-wide shortage of midwives.

Clearly not all of this was Hunt’s fault, but it seems odd such widespread failure was deemed worthy of promotion to foreign secretary. Hunt’s tenure was blighted

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