The NHS is often hailed as one of the world’s leading health systems; admired the world over by states who can only dream of offering a comprehensive, free of charge health system. However, despite the many successes of the NHS, recent reports focus on junior doctors’ strike, staff shortages, funding cuts and delays and errors in treatment; all of which are contributing to the crumbling foundations of our national treasure. Much of the increased pressure is thought to be caused by the increase in population and the poor provision of primary care services.
Many believe that with a growing, ageing population, a truly comprehensive NHS is no longer sustainable, and the only way to turn the organisation around is to limit the services that are free of charge to the public. But the success of the health service on an island thousands of miles away could hold the key to the NHS’s future.
Cuba, a well known communist state littered with poverty is considered to be one of the world’s leading healthcare providers. Its approach to healthcare has been so successful that diseases normally plaguing impoverished nations leading to relatively young population have been eradicated, and its citizens find themselves succumbing to cancer and other illnesses considered to be more akin to those who have enjoyed a life of comfort and excess in the developed world. It is now said that Cuban’s live like the poor, and die like the rich. So, how does this third world country offer free first world healthcare?
Like many aspects of life in Cuba, healthcare is tightly controlled by the government. The right to free medical care is enshrined within the country’s constitution, and the state ensures that each and every citizen get’s their fair share. Cuba’s approach to medicine is preventative. It believes that a doctor’s job should be to prevent illness and injury before it even happens, and in doing so it can safeguard its nations health at a fraction of the cost of similar systems in the developed world. The UK is very different, in that patients only see their doctor when something has already become a problem.
Cuba spends just $431 per year per person on its full complimentary health service, as opposed to $8,553 in the US. Many could be forgiven for thinking that this cheaper spend per head is due to a lower standard of care, treatment and equipment available in Cuba, but the country has long been praised for the quality of its health facilities. It may well be the case that the most up to date technology is not as readily available, but reliance upon it is reduced due to earlier treatment and diagnosis.
It is mandatory for every citizen to have an annual health check by their local doctor. Most of these take place at the patient’s home, and if they fail to present for the check up, they will be tracked down until it is carried out. Patients with the all clear will then be left for the next 12 months, but with the options to return to their doctor if anything arises. Those whose evaluations reveal something of concern or that might develop into a problem in the future will be followed up on a more regular basis, so that appropriate treatment and preventative measures can be put in place before a disease or disability take hold.
A Doctor’s job is not just to assess the patient, but their home environment and lifestyle. They will assess if there are any obvious risks of injury in their home, their drinking and smoking habits and anything else that may cause illness. These risks are then monitored, with this information being reported to the central government so that any obvious localised risks can be addressed. For example if these reviews record an influx of a certain virus in a particular area, resources can be focused there to bring the issue to a close before it spreads to the wider populations.
Naturally, in a society where we value and insist upon confidentiality and a freedom to make our own decision about our health and life choices, this invasive approach to healthcare and data sharing may be a concern, but with a little thought there is no reason why this type of system cannot be successful in the UK. Firstly, we all owe a duty to the NHS to reduce our need for its services, and it is not unreasonable to require citizens to have an annual health check in order to access NHS services. Pre-contract medicals are often a requirement of private health policies today and can very often highlight issues relating to cancer, blood pressure, heart disease and diabetes, that would otherwise have gone unnoticed until the patient fell ill. This can lead to early diagnosis which we are regularly told, and is proved by the system in Cuba, as being the key to survival to many illnesses.
There have long been advocates within the medical profession of doctors being able to prescribe support and resources other than medication, in order to achieve effective preventative medicine. The provision of double glazing or loft insulation has long been advocated as effective way of preventing flu and other winter illness in the elderly or vulnerable living in cold or dilapidated environments (See our 2015 blog). This is akin to the Cuban’s approach to doctors looking beyond the stethoscope and truly at a patient’s individual and social needs to maintain good health.
Many would be concerned about the increased pressures on GPs who would no doubt be called upon to provide these annual medicals. However, on the assumption that the majority of patients will consult their GP at least once every year, this should be manageable, as these consultations may in fact cut down on regular re-attendance if diseases can be identified and treated early. It is logical that over time, a balance in GP appointments would be restored.
Data sharing is a vital element to the success of disease control and prevention. Local reporting was used in the Bird Flu and Ebola outbreaks, to name a couple, to control the spread and ultimate cure the disease. The same could be achieved for lessor viral infections if the sharing of anonymised data allowed 24 hour monitoring of the populations health. Patient’s would not need to be named in order to share local health data and if contact was needed with that patient for whatever reason, that could be made confidentially through the GP.
Of course, with every great success comes a new problem. Like the UK, Cuba is now facing an ageing population crisis due to the success of its health system. Cubans are living healthier and for longer, meaning the state is having to find money to support the increase in services required by its changing demographic.
There are many ways that the NHS could be overhauled to turn around its fortune, and Cuba should certainly be giving ministers and NHS leaders food for thought. A few return tickets to Havana might turn out to be the best investment made by the NHS in a long time.