Stephen Kinnock MP, Minister for health, captured the much needed direction of travel for Labour’s long term health plan on the Today programme (Oct 21st). Yes, in a nutshell, it’s from analogue to digital, hospital to community and treatment to prevention. 

 But so much will depend on a clear understanding of what has gone well and badly in recent history. I wonder how the massive “Listen in” will help. Will it explain why so much taxpayers’ money was wasted on earlier, failed digitisation projects? Or why everything is still framed looking out of a hospital window rather than in the high street? Witness the usual media response where hospital consultants are interviewed, without challenge, when they only see a small, visible part of the picture. Yet the evidence shows that a better educated child will become a healthier adult . Perhaps the listening exercise will finally make it obvious, as perhaps Lord Darzi has in his recent report, that seeing a GP or nurse out of hours or at the weekend is a glaring system hole, if plugged, could prevent hospital visits in the first place. 

This blindness to the wider health system calls into question what we really mean by prevention. Yes, it’s about individual behaviour change, health checks and early intervention to treat disease as Stephen Kinnock pointed out.  This is  what  I’ve called “Light prevention” in my recent book Against the Flow (https://troubador.co.uk/bookshop/autobiography/against-the-flow). Real prevention is so much more than that.  It needs to be supported by “Deep prevention” for whole communities . This straddles practically every government department from housing and planning through to education, transport and more. The Blair government saw this and achieved significant improvement in longevity and health equity. Today’s government has made a start, but are they ready to invest in prevention now or will they be deflected by the inevitable winter pressures and short term solutions? 

And there is another more subtle problem. Hippocrates rightly believed that prevention was better than cure.  But he couldn’t make claim to the  plethora of cost- effective treatments now on offer in today’s ageing democracies.  I can vividly recall the impotent vibes radiating from the vascular surgeon who  I sat  alongside as a medical student.  Patient after patient who’d had surgery to unblock their arteries had to return for more if they couldn’t quit smoking.

 By the time I was a director of public health in London’s deprived East End in the 90s, rationing debates about individuals whose lifestyles resulted in preventable disease were fashionable. Calls for restricting services to those who were overweight, who smoked or drank excessively were rife. But they were short-lived. Such restrictions would clearly affect a large majority of people seeking health care. In a democracy where health care is supposed to be available to anyone who can benefit, such rationing would be seen as immoral. Especially when the greatest burden of ill health falls on the poor. 

This is why it’s time to recognise that prevention and treatment are soul sisters not competitors.  They need to be inextricably linked in any future health plan. In my book  I have described the huge value of doing this early on in the HIV/AIDS pandemic and how a devolved health system served  diverse communities better than a centralised one. All this was achieved in the Thatcher years when politicians still listened to their health advisors. As hospital care costs so much more than prevention, a similar renaissance in prevention funding and practice now  will repay us with better health and a fairer, more effective, health system in the longer term.