IOM DHSC & MANX CARE

[Newbie]

3 hours ago, wrighty said:

I think we, as in society, need a massive shift in focus with regard to health. Our health service is anything but - it’s a sickness service (apart from a few screening programmes and vaccinations). Society needs to get healthier. Perhaps if we could do that, we could afford a sickness service that works. I’m sure it’s been worked out somewhere (cue @Roger Mexico to google it for me) but the following conditions probably cost or contribute to a large portion of health spending  

• Smoking
• Excessive alcohol
• Drugs
• Obesity/type II diabetes
• Frailty/osteoporosis/sarcopaenia
• Dementia

I don’t know how to do it, but if everyone could be persuaded not to smoke, not drink excessively, don’t take drugs, eat a good diet and get outside and exercise, we’d be a whole lot better off.

No-one could argue that from an individual perspective it makes absolute sense to live healthier lives, stop smoking, drink less alcohol etc, but the financial calculations are extraordinarily difficult.

The area that has been most looked at in financial terms is smoking, and the answers are far from clear. The most recent UK Gov estimate for excess costs to the NHS from smoking was £2.5 Billion annually, and a further £1.4 Billion excess annual costs in Social Care. Compare that to approximately £10 Billion raised in tobacco duty annually and a further £2.5 Billion paid in VAT by tobacco companies and you can see that it isn't straightforward. Other studies have reached the conclusion that average annual healthcare costs are slightly higher for smokers compared with non-smokers, but that total lifetime healthcare costs are slightly higher for non-smokers due to their longer life expectancies.

 None of that is to suggest that smoking is a good idea, but to blame the problems of the NHS on individuals' lifestyle choices does feel a bit like another attempt to blame the public (without any compelling evidence) rather than looking at how the service is set up and run.

[wrighty]

3 hours ago, Newbie said:

No-one could argue that from an individual perspective it makes absolute sense to live healthier lives, stop smoking, drink less alcohol etc, but the financial calculations are extraordinarily difficult.

The area that has been most looked at in financial terms is smoking, and the answers are far from clear. The most recent UK Gov estimate for excess costs to the NHS from smoking was £2.5 Billion annually, and a further £1.4 Billion excess annual costs in Social Care. Compare that to approximately £10 Billion raised in tobacco duty annually and a further £2.5 Billion paid in VAT by tobacco companies and you can see that it isn't straightforward. Other studies have reached the conclusion that average annual healthcare costs are slightly higher for smokers compared with non-smokers, but that total lifetime healthcare costs are slightly higher for non-smokers due to their longer life expectancies.

 None of that is to suggest that smoking is a good idea, but to blame the problems of the NHS on individuals' lifestyle choices does feel a bit like another attempt to blame the public (without any compelling evidence) rather than looking at how the service is set up and run.

The “smokers contribute more in tax” argument is well established and does add to the overall complexity of my suggestion. The same can’t be said for type II diabetes, which costs about 9 billion now, and is predicted to double in 10 years. Ditto frailty.

The other problem with what I suggested is that none of us are going to live forever. So if we don’t smoke or drink, eat healthily and stay slim, and spend our free time lifting weights and running marathons, what are we going to die of? Cancer probably. And that’s not cheap to treat. And dementia - all the positive actions in my list might delay it, but perhaps we’ll just shift the clock back 20 years and end up with nursing homes full of 100 year olds rather than octogenarians. 
 

It is complex. 
 

I wasn’t blaming the public for the NHS’s current difficulties, although there are certainly several individuals whose lifestyle choices are not helping it. But we can’t go on as we are, with ever worsening problems of access to a perpetually overstretched service. Something needs to change, and effective health promotion is surely one thing to be done. 

[Apple]

12 minutes ago, wrighty said:

Something needs to change, and effective health promotion is surely one thing to be done. 

https://www.gov.im/media/1367077/director-of-public-health-annual-report-2019.pdf

Henrietta report (too soon ?)

See page 11. Says it all really.

 

[Newbie]

52 minutes ago, wrighty said:

I wasn’t blaming the public for the NHS’s current difficulties, although there are certainly several individuals whose lifestyle choices are not helping it. But we can’t go on as we are, with ever worsening problems of access to a perpetually overstretched service. Something needs to change, and effective health promotion is surely one thing to be done. 

Effective health promotion is doubtless a good idea, but whether it would relieve the pressure on a perpetually overstretched service is doubtful, I would suggest. Quite apart from the problem of how you deliver effective health promotion, it would take many years to have a significant impact on the levels of illness. Unhealthy people who have already lived a significant portion of their lives will continue to become unwell and need treatment, and at the same time a lot of resources would presumably have to be put into health promotion. Eventually, once (if!) it starts working, you will have a gradually ageing population needing to be looked after. As you said, people are going to die of something.

One thing that maybe can be learnt from the studies around smoking is that, quite independent of the taxes raised from smokers, in absolute terms it costs more to look after non-smokers than smokers because they live longer and then die of something. If you look at it in broader terms than just health, the differences become more stark due to differences in pension payments. So leading healthier lives is a good thing, but the idea that it will relieve pressure on health services, or reduce costs doesn't really stack up.

[Jarndyce]

1 hour ago, Roxanne said:

8 hours ago, Jarndyce said:

Wrighty for Health Minister?

I wouldn't want to put him through it tbh.

Don’t worry, it would never happen - even if the great man were to stand as MHK.   First rule of comedy: NEVER put anyone in charge of a department, if they already know something about the subject matter…

[wrighty]

18 minutes ago, Newbie said:

Effective health promotion is doubtless a good idea, but whether it would relieve the pressure on a perpetually overstretched service is doubtful, I would suggest. Quite apart from the problem of how you deliver effective health promotion, it would take many years to have a significant impact on the levels of illness. Unhealthy people who have already lived a significant portion of their lives will continue to become unwell and need treatment, and at the same time a lot of resources would presumably have to be put into health promotion. Eventually, once (if!) it starts working, you will have a gradually ageing population needing to be looked after. As you said, people are going to die of something.

One thing that maybe can be learnt from the studies around smoking is that, quite independent of the taxes raised from smokers, in absolute terms it costs more to look after non-smokers than smokers because they live longer and then die of something. If you look at it in broader terms than just health, the differences become more stark due to differences in pension payments. So leading healthier lives is a good thing, but the idea that it will relieve pressure on health services, or reduce costs doesn't really stack up.

Can’t disagree with any of that. One logical conclusion could be healthy lives for all, followed by compulsory euthanasia. There’s a great episode of Star Trek Next Gen that explores the ethics around that. 

[Apple]

17 minutes ago, Newbie said:

Quite apart from the problem of how you deliver effective health promotion, it would take many years to have a significant impact on the levels of illness.

The Health of the Nation document makes it clear that health promotion has to go hand in hand with other lifestyle choices and political / social initiatives and changes. One thing is clear is that an element of choice and self responsibility plays a large part.

It is already being effective to some degree. Look at the number of people out walking, riding bikes, taking up sports, marathons etc all in search of prepping to staying healthier for longer.

In my view this document (after revamping and updating) should be available to everyone in GP surgeries, hospital clinics etc. I don't understand why it isn't. 

[Newbie]

19 minutes ago, Apple said:

It is already being effective to some degree. Look at the number of people out walking, riding bikes, taking up sports, marathons etc all in search of prepping to staying healthier for longer.

I would agree with that, and yet, at the same time as people are becoming increasingly health conscious, we see the NHS coming apart at the seams which was my point really. It doesn't relieve the pressure on the NHS/Social Care.

[WTF]

1 hour ago, wrighty said:

Can’t disagree with any of that. One logical conclusion could be healthy lives for all, followed by compulsory euthanasia. There’s a great episode of Star Trek Next Gen that explores the ethics around that. 

logans run springs to mind too.

[Gladys]

As an entirely theoretical, philosophical  argument, does humankind need to very carefully consider whether to stop medical research and many treatments of otherwise terminal conditions?

Many would argue that the planet is unsustainably populated, polluted and we are rapidly securing our own extinction.  By constantly improving health treatment the population continues to grow without the ability to care for it adequately.

Not that I am volunteering either myself or any other individual(s) to be sacrificed, but is the current health and climate crisis, worldwide, due to over-population and increasing longevity?  Perhaps, this is the time for a look at this kind of debate?

 

[Two-lane]

50 minutes ago, Gladys said:

Many would argue that the planet is unsustainably populated, polluted and we are rapidly securing our own extinction.  By constantly improving health treatment the population continues to grow without the ability to care for it adequately.

The global warming/pollution problem is proportional to the never-ending increase in the (industrialised) world's population. But stabilising or reducing the population is not something that is discussed.

[In terms of pollution, whatever the IoM does is less significant than a butterfly flapping its wings on the far side of the universe. Plus or minus one gas-powered power station in the world is irrelevant. I think that the people here who are promoting green schemes are more interested in their own egos than the health of the less-well-off part of society. Keeping people warm/healthy over winter is far more important than reducing gas consumption by an amount that immeasurably small in global terms. Electricity is essential to life, and what should be of concern is that the IoM is not susceptible to a single-point failure of the electricity supply. ]

The increase in population due to better health care is insignificant compared to the gov.'s intention to increase the population by 20,000 people.

If the environmentalist here want to set an example to the rest of the world, they should be promoting the stabilisation or reduction of the population.

If the 20,00 people don't come here, what will happen to them? Not my problem. Setting an example is more important.

Wrong thread, but who cares - it's only ManxForums.

[Non-Believer]

1 hour ago, Gladys said:

Not that I am volunteering either myself or any other individual(s) to be sacrificed, but is the current health and climate crisis, worldwide, due to over-population and increasing longevity?  Perhaps, this is the time for a look at this kind of debate?

There's far too many in the DOI offices.

[Gladys]

13 minutes ago, Two-lane said:

The global warming/pollution problem is proportional to the never-ending increase in the (industrialised) world's population. But stabilising or reducing the population is not something that is discussed.

[In terms of pollution, whatever the IoM does is less significant than a butterfly flapping its wings on the far side of the universe. Plus or minus one gas-powered power station in the world is irrelevant. I think that the people here who are promoting green schemes are more interested in their own egos than the health of the less-well-off part of society. Keeping people warm/healthy over winter is far more important than reducing gas consumption by an amount that immeasurably small in global terms. Electricity is essential to life, and what should be of concern is that the IoM is not susceptible to a single-point failure of the electricity supply. ]

The increase in population due to better health care is insignificant compared to the gov.'s intention to increase the population by 20,000 people.

If the environmentalist here want to set an example to the rest of the world, they should be promoting the stabilisation or reduction of the population.

If the 20,00 people don't come here, what will happen to them? Not my problem. Setting an example is more important.

Wrong thread, but who cares - it's only ManxForums.

I was thinking more globally, really.  It is an abhorrent discussion, I accept that,  and definitely ethically challenging. But is one that needs to be had and not just by environmentalists. 

It is also about channelling funding to keep one sector alive to the detriment of others and even those in that sector. It is about accepting that death is a natural consequence of living, at what point do you say the quality of life we can give you is minimal?

Millions are diverted to that kind of research which may be better spent  enhancing the lives of younger people who have their life ahead.

We just seem to be on the hook of longevity being good, when really we should be accepting that death is inevitable and a natural outcome.

Personally, and this is counter to the macro view I was trying to explore, the moment I become unable to communicate with my family or deal with my own body, I would like to go, not be kept alive for years because it was possible.  

Years ago the criticism of doctors was that they were playing god by deciding who and how they would treat people.  Now my question is whether they are still playing God  by trying to treat everyone.  

Sorry Wrighty, I know this is a hard one, ethically, and I do not expect you to respond. 

 

[Apple]

9 minutes ago, Gladys said:

We just seem to be on the hook of longevity being good, when really we should be accepting that death is inevitable and a natural outcome.

All things die.

You are right that this debate, and the relevant related issues, do need to be explored more generally as more and more people become aware of the options for making decisions about how they die whilst still able to choose. Isn't Dr Allison working on this and as part of the intended Capacity legislation ?

[Wavey Davey]

5 minutes ago, Apple said:

All things die.

You are right that this debate, and the relevant related issues, do need to be explored more generally as more and more people become aware of the options for making decisions about how they die whilst still able to choose. Isn't Dr Allison working on this and as part of the intended Capacity legislation ?

Quality of life is the main issue. Once that’s gone there is little point in hanging around.