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Nanny State: NHS Told to Round Up Ill-Looking Scots

Posted on: Monday, 26 September 2005, 12:00 CDT

FIRST there were the healthy eating campaigns. Then, there was the plan to ban public smoking. Now ministers are stepping up their assault on flabby and nicotine-addicted Scotland by establishing the health equivalent of a press gang.

Ministers intend to create squads of "health enforcers" who will seek out those citizens in greatest danger of an early exit and badger them into visiting a GP for a check-up.

Only poorer parts of the country will face the crackdown, on the grounds that deprived areas have much worse health problems. People in inner-city schemes are also known to be far less likely to visit their GP than health-conscious suburbanites, hence the need to seek them out.

But the plan is already facing strong criticism as yet another encroachment by the nanny state. Doctors warned that the last thing the already over-stretched NHS needed was a plan to recruit patients, rather than simply treat them.

But ministers insist that, in the long-term, the practice of "case finding" is a good example of prevention being better than cure. They argue that it will save lives and money by nipping the health problems of thousands of poorer Scots in the bud.

Under the scheme, the new health workers will visit deprived areas of the country, targeting the people deemed to be at greatest risk of future health problems, particularly heart disease and cancer.

Information on local rates of smoking and deprivation could be used to isolate particular health blackspots, such as Shettleston in Glasgow, where average male life expectancy is only 63, compared with the national average of 73.4.

Backers of the plan say the health workers would then visit people at home, set themselves up in community centres, or send out letters urging them to get a check-up, in much the same way as elderly people are warned about winter flu.

If someone was found to show classic indicators of major health problems later in life - such as a poor diet, smoking, or bad family health history - they would be urged to go to the GP.

The details of the plan were revealed last week by Professor David Kerr, the cancer specialist who recently led a major review of the Scottish NHS. Health Minister Andy Kerr is studying those findings and has now backed his proposal to seek out the patients.

In previously unreported comments to MSPs last week, Kerr said: "We want to employ a new type of healthcare professional working in primary care who will be case finding and would be going out to encourage people to come in for health screening.

"If we are waiting for those who are disadvantaged or less well off to access the health care system - we know that they don't," he added.

The idea is at an early stage and it is not yet clear how many health workers would be assigned to case finding or whether they would be recruited to do the job or assigned from other tasks.

The move was greeted with scepticism by many patient groups and doctors.

Katherine Murphy, from the Patients' Association, said: "I cannot understand the logic behind this idea. Everybody is registered with a GP, who can already provide health advice should patients need it and they can send patients for tests if they have concerns."

She added: "I can't see how this exercise is going to be effective. How do they identify the people they are going to see? If the Scottish Executive has some extra funding it is needing to spend, it would be better spent on actually improving patient care. The list of areas that need more resources is endless: waiting times, more nurses, doctors, GPs, dentists. This exercise will only increase waiting lists further."

David Love, chairman of the British Medical Association's Scottish GPs' committee, added: "There are general practitioners already operating in the communities they are intending to target, so how is this going to operate?"

Frank Sullivan, professor of community health at Dundee University, said: "My concern is the approach is going to be a bit vague and not targeted enough to provide actual long-term benefits from any screening.

"If you only get five out of every 100 people you look at who needs any help, how cost-effective is that going to be?

"The health service is currently having to run just to keep up with the patients who perceive they need treatment without adding those who are unaware. If we had a magic wand we could wave over everyone to find out what is wrong, that would be great, but in reality there is no simple test."

Nanette Milne, Scottish Tory health spokeswoman, said: "While I understand the need for preventive medicine, this sounds like a bizarre idea. People have a right to be in charge of their own health care and I do not think this approach will have the impact the Executive is hoping for."

The decision to isolate poorer parts of Scotland has been prompted both by the claims many deprived people do not visit the doctor and by findings which show the gap between rich and poor is widening. Labour chiefs believe the plethora of healthy-living initiatives introduced by ministers have only struck home in health- conscious middle-class homes.

As a result, the health gap between rich and poor is widening. For example, while mortality rates from heart disease in Glasgow Maryhill is 183 per 100,000, it is only 85 per 100,000 in affluent Edinburgh West.

Duncan McNeil, Labour MSP for Greenock and Inverclyde, said: "The healthy segment of the population make all the demands on GPs, meanwhile we are leaving behind the less assertive, less secure, less articulate group of people who are dying 15 years earlier."

He added: "The healthy living debate is only going on among people who are concerned about it. Meanwhile, people are dying silently week after week. In my area, there is a 15-year gap between Kilmacolm and Port Glasgow.

"It is a case of do we wait on them coming through the door or do we target them and if we do, then we will add years to their lives because the drugs are there to help them," he added.

Andy Kerr added: "Currently care can be reactive, hospital- centred and geared towards acute conditions. Tackling conditions and potential conditions in advance can pay massive dividends for everyone down the line."

Kerr has told health boards to identify patients who are known to have long-term health problems and to try to pre-empt any worsening of their condition. He added: "I also want them to seek out people in deprived areas who are most likely to need care in the future and help them to access it earlier and to provide support and encouragement for patients and their carers to manage their own health-care needs and to help others."

Source: Scotland on Sunday

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