When you write a weekly blog and
the week just passed contains the UK 2018 Budget statement, it is hard to not comment
on the content. Better bloggers than me tried last week. My fellow blogger
@RoyLilley wrote about the pre-budget ‘leaks’ on the Monday, largely ignored it
on Tuesday (but thank you for providing the link to the Red Book) and returned
to the subject once more on Friday. I have to say I think I am in the same
place as Roy in my thinking – that is Disillusionment
City.
All 107 pages that make up The
Red Book are full of positive-sounding rhetoric about how the NHS is the Government’s number one spending priority; how the settlement (the planned allocation of
cash) will enable the NHS to plan for its future and support it to deliver
world-class care that people want and expect; it’s essential that every pound
in the NHS is spent wisely; and so on. It sounded like more money was being
promised. An extra £20.5bn over the next five years, with a minimum extra £2bn
a year for mental health services. There were some interesting but long overdue
commitments, for example: ensuring there are mental health services in all
A&E departments; providing more mental health ambulances; and establishing
a national 24-hour mental health crisis hotline.
Although some commentators feel
this doesn’t go far enough to meet the current unmet need, see here for
example, I welcome any, and all funding to support the growth and development
of high quality mental health services. I will never ever tire of saying that
there is no health without mental health. To quote the World Health Organisation
more accurately, they state that ‘health is a state of complete physical, mental
and social well-being and not merely the absence of disease or infirmity’. This
is quite a complex concept, and one I sometimes struggle to fully grasp or
understand in its application.
Here’s an example. The Budget
text states very clearly that the settlement will allow the NHS to not only plan
for its future, but also to reduce the growth in demand for care by better integration
of services and more effective prevention strategies. In the 2018 Budget, the
cost of wine rose by some 8p a bottle, whereas beer, cider and spirits had their
duty frozen. Tobacco duty will continue to rise by inflation (currently 2.4%)
plus 2% and a packet of cigarettes went up by 33p. That puts the average cost
of a packet of 20 cigarettes at around or above the £10 mark. Just do the arithmetic
– smoke 20 cigarettes a day, that’s £70 a week, or 3640 a year. That a lot of
money simply going up in smoke. And that’s not even considering what smoking 20
cigarettes a day might do for your health. But it won’t be good.
What’s more worrying about these
figures is that despite the overall the prevalence of people smoking has
declined, smoking is increasingly concentrated within more disadvantaged
communities and groups. In a report published in September this year by Public
Health England the evidence reveals that one in four people working in routine
and manual occupations smoked, compared to one in 10 people in managerial
and/or professional occupations; those who are unemployed are almost twice as
likely to smoke as those folk in work.
Wearing my ‘reformed smoker’s hat’,
I struggle to understand how and why these people continue to smoke. Putting on
my ‘health care professional hat’, I perhaps can understand the complex reasons
that individuals take up smoking and continue to do so. Whilst I don’t accept
any of the reasons people give for continuing to smoke, I do have a
professional responsibility to try and help them quit, and thankfully, many folk
do want to stop smoking.
Approximately 60% of smokers want
to quit. We have seen the largest reduction in smoking among those who are aged
18-24 years old – those aged between 25 – 34 are the age group with the highest
number of smokers. Whilst there was a passing nod towards public health in the
Budget statement, there was nothing explicit said about smoking other than to
raise the tax on a packet of cigarettes. Given the huge financial burden
smoking brings to the UK economy, estimated to be around £12bn a year in health
care lost productivity and cost to the adult social care system, I wanted
something more pointed to be said, particularly about how health and social care
providers should better utilise the evidence-based approaches to helping people
give up.
Around 50% of folk try to quit
smoking unaided simply using willpower alone. Only three in 100 people using this
method succeed. Many years ago, I was one of those people. The evidence is unequivocal
on the most effective way of stopping smoking. It’s with expert behavioural
support from local smoking cessation services combined with ‘stop smoking’
aids. This approach costs money. I am sure there are many people like me who might
struggle with the notion that if people continue to smoke even in the face of
the overwhelming messages on harm is finding the money to pay for such services
a good use of public money. Despite my struggles and exasperation at times with
those who smoke, I absolutely believe that ensuring such services are available
in every primary and community care setting, together with support for
employers would be a very good use of the increases to the NHS resources. We
shouldn’t just be using the increased funding to do more of the same. Taking a
different approach would be something to move me out of Disillusionment City.
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