More than an ounce of prevention is vital now

Written by Jenny Randerson AM and published in Western Mail on Mon 26th Nov 2007

While re-organisation and re-configuration seem to be the watchwords in Welsh health debate, it seems that prevention has become largely forgotten.

We are being distracted from a major push on preventative health, by an obsession in some quarters with being seen to make radical changes. New structures on their own don't treat any extra patients.

That's why a major reorganisation of local health boards (LHB)s would be a mistake. The upheaval would strain an already overstretched service. Evidence from England shows that each NHS reorganisation leads to three years of upheaval before the service gets back to its starting point in terms of efficiency.

While I agree LHBs need to work together at a regional level in commissioning secondary care, for primary care and community services LHBs need to be strengthened. Greater emphasis should be placed on closer working with Social Services. Joint targets and joint budgets would tackle bed blocking far better than the current ping-pong blame game. It would ensure that more people are cared for in their community - without ever having to go to hospital.

The angry public reactions to reconfiguration proposals (aka hospital closures) which coloured this year's election came about because people believed they were losing much loved facilities. The Auditor General's recent report on delayed transfers of care says we need upfront investment in new community services, to stand alongside the present hospital-centred services, until a smooth handover to the new model of care has taken place. I have long argued for this up front investment in community care. It will be hard to find the money - particularly in such a tough budget year - but if we don't, we will be trapped forever into the more expensive, less effective hospital-based model.

A key factor in the new model of care is community nursing, in all its forms. I find it mystifying when the RCN says the number of district nurses in Wales has fallen in recent years. While I strongly support more school and practice nurses, it is the district nurses who go into patient homes to ensure they only go to hospital when absolutely necessary. They are key to taking early, preventative action.

As the Auditor General pointed out, physiotherapists and occupational therapists are also vital to community treatment. Their role in preventing hospital admissions and aiding recovery is frequently overlooked. It is simply not prioritised by either the NHS or social services.

Just because people generally do not die from a lack of physiotherapy, the service falls off the radar. Put simply, more physios mean more people able to live independently at home. Cheaper in the long run and a better deal for patients.

The Welsh Liberal Democrat emphasis on prevention and local solutions includes dentistry too. When the new dental contract was introduced I wanted to include a Unit of Dental Activity which would reward dentists for preventative work. The Labour government rejected it. At the recent elections we proposed giving every 5 year old a free toothbrush and toothpaste as a way to teach all children how to brush properly. Evidence shows that too many of our children have never learnt.

Wales has the worst child dental decay rates in the UK, just as we have some of the worst rates of cancer and a host of other illnesses. To me, it is clear that the current crisis-to-crisis approach to health services is not working and the answer lies in a fundamental change in approach.

We need a new emphasis on prevention - not a major reorganisation of the way the system is managed.