Do not rely on national health screening

It’s difficult to imagine that Prime Minister Gordon Brown is really the centralist dictator that Private Eye would have us believe. But then he announces national initiatives, like deep cleaning hospitals and national health screening programmes, and you begin to wonder. Perhaps he really is the sort of man who issues a memo to Number 10 kitchen staff to ensure they put the plates in size order in the dishwasher.

The problem with national initiatives, besides the contradiction with the government’s own insistence that services are best delivered locally, is that they are often politically motivated and seem to ignore what we already know.

Screening programmes can be effective and, as Richard Horton points out in his blog, the Prime Minister and the Department of Health have chosen their screening wisely - heart disease, strokes, diabetes and kidney disease. But screening takes time and money. It will also fail if the results are not followed up in the appropriate way and are not used to improve the lives of those people who are at risk.

Why spend money on screening when sophisticated predictive risk tools already exist. We know how to find those people who are at risk of hospital admission not just tomorrow but in two year’s time. Primary Care Trusts are already using these tools to identify people with long term conditions. So finding these people isn’t the issue.

Encouraging the appropriate lifestyle changes is where the challenge begins. How do you encourage someone in their fifties, who has smoked since their teens and is presenting with the early symptoms of chronic obstructive pulmonary disease, that lighting up first thing in the morning is a ticket to a painful death.

As Hugh Fearnley-Whittingstall found out in his Axminster crusade, it’s hard enough to get people to buy free range chickens, never mind ditch their fags. People in Axminster thought Hugh was a posh bloke who was out to feather his own nest and his words fell flat.

How many of these same people read the news about health screening in their daily red top and thought there’s another posh bloke telling us what to do. Effective communication that leads to lasting behavioural change is perhaps the biggest challenge facing the NHS. To be honest, not many NHS communicators are up to the job. It demands a whole new set of skills beyond fronting up to the local media and until the NHS takes it seriously, prevention will never get out of the starting blocks.