Since its inception, the NHS has unwittingly contributed to the demise of self-care, writes Dr Selwyn Hodge. Can the NHS ever remain viable if this trend isn’t reversed and health literacy levels increased?
The NHS is undoubtedly in crisis. This situation could become unstoppable if we don’t quickly develop effective strategies to help people look after themselves better.
I’m just old enough to recall the early days of the NHS. Significantly, this child of Aneurin Bevan didn’t immediately make a great difference to most people’s lifestyles except that, since the new service was ‘free at the point of delivery’, people obviously worried less about becoming seriously ill.
This was probably because they were accustomed to dealing with their minor ailments themselves and previously had only sought help when absolutely necessary.
I certainly remember bathroom cupboards full of over-the-counter medicines and remedies for nearly every common complaint, and well-stocked first aid boxes with dressings for every eventuality.
Indeed, before the NHS, people relied heavily on self-care. Visits to the doctor were rare and if someone did become concerned about something unusual, their first point of call was often their local pharmacist. They were the fount of healthcare advice and produced simple concoctions for most common ailments.
Because of the costs involved, people tended to visit the doctor only for conditions such as infections and fevers. For those who could afford the fees, access was straightforward and queues non-existent.
Over time, people became used to the availability of free healthcare, and doctors became the first point of call, setting the scene for the unprecedented waiting times experienced today. Pharmacists have now largely become prescription dispensers, and self-care is not on most people’s agenda.
Prior to the NHS, understanding and experience of self-care was passed down through the family – particularly from mothers and grandmothers to children, who in turn became adept at looking after themselves.
Health literacy levels then were quite high (certainly compared with today), and health education was practical and targeted at people’s everyday needs.
Concerns about public health issues were often communicated to parents and children through schools, most of which also provided rudimentary health education lessons – mostly linked to personal hygiene and the symptoms of communicable diseases.
However, increased access to doctors meant that people began to rely less on self-care and health literacy levels declined rapidly. There were also fewer calls on schools to provide health education, so it gradually disappeared from the curriculum.
If it became necessary for children to know about specific health issues, these were taught in science lessons, or later on through personal, social, health and economic (PSHE) education.
Sporadic public health campaigns also became popular, with children hearing about the dangers of smoking, sun and sugar in one-off lessons, rather than through coordinated health education programmes.
So, while the NHS has undoubtedly improved the health of most people in Britain, and become a pillar of society, it has also led to vastly increased workloads for doctors and health professionals as people have become less knowledgeable and increasingly passive about securing their own health and wellbeing.
Continuing advancements in medical knowledge and treatments will no doubt further increase demands on the NHS. This will become unsustainable if levels of self-care and health literacy among the population are not increased substantially, since these skills would undoubtedly help eliminate a fair percentage of unnecessary visits to doctors and A&E departments.
While we are becoming an information-rich society, this is not being matched by people’s levels of understanding about health issues. For many, looking on the internet for solutions to health problems ends in confusion. Although some people are adept at self-education, most are not and require assistance to assimilate and use anything beyond simple instructions.
In addition, because we can no longer rely on people learning to look after themselves through their families, serious consideration must be given to revisiting the teaching of health education in schools.
This should become a statutory part of the curriculum from nursery through to sixth form, and be subject to regular inspection by OFSTED. This would make real inroads into improving people’s health literacy and hence help reduce unnecessary demands on the NHS by encouraging appropriate self-care.
Poor standards of health education also add to the burden on health professionals. Many patients fail to understand, appreciate and adhere to doctors’ advice, which is often further subverted by uninformed opinions – either on the internet – or from other equally uninformed people.
Since its inception in 1948, the NHS has unwittingly contributed to the demise of self-care, which in turn has exacerbated the increasing problems of access people now experience with health services.
So, during this year’s Self Care Week (16–22 November), which has the theme ‘Self-care for life’, please give serious consideration to how we can best tackle this problem and decide whether the NHS can ever remain viable if the population continues to lose its ability to become fully health literate and self-care proficient.
We are also expecting health literacy to be a strong topic for the Annual Self-Care Conference on 11 November.
Dr Selwyn Hodge is co-chair of the Self Care Forum. Follow the organisation on Twitter @SelfCareForum
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