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Caroline Jessel

Clinical Strategy Lead, Kent and Medway Area Team. Lead for Sustainability and Health, South Region. NHS England

I’ve read and enjoyed both blogs and happy to put in a few thoughts for you to consider. The focus in your thinking is on the NHS as a reactive organisation which is clearly buckling under the pressure of both increased needs and restrictive budgets. I believe it needs to tackle health issues more proactively if it is not to drown

My perspective is as that if we seriously tackled the reasons for increased need we would use less resource and create a more resilient contented society. We need to focus on


1.       Mental health- this has been worsening in the population for several decades – complex reasons for this but there are good evidence based solutions out there. We need to start young and build in mental health resilience in schools and within the family. Also look to how the media increases anxiety and how we can all look after our mental health more effectively. as one approach focussing on the whole family. Addiction and substance misuse are also very important areas which we tend to neglect with far greater expense in picking up the pieces than if we intervened earlier and more strongly.

2.       End of life care- the irony is we spend a lot of money in the last year of life (average of 5 admissions I believe) –often the quality of the experience is poor and patients and their relatives feel they are being “done to” - but if we were much better at listening to people and ensuring they have an advance care plan, a lasting power of attorney in place before they lose capacity and also make use of advanced decisions to refuse treatment  a great deal of needless unpleasant treatment could be avoided. Evidence shows the majority of people want to die at home and have few interventions in the last few months of lives- but they get the opposite.

3.       Obesity – we are doing very badly on this compared with most of Europe but the solution lies in the environment and in our eating culture- both of which can be addressed .  solutions include enabling more active travel, getting rid of the long hours culture at work and plenty of local veg/fruit being cheaply available – not impossible in a country like ours


So we need to think outside the health care system for some of these solutions –the new Health and wellbeing boards are making a start on this – quite hopeful I feel.  The NHS England 5 year Forward View also recognises the importance of prevention which can only  be done properly in partnership with other players and by starting with NHS staff – lead by example  -we have only played at this before I think

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