Doctors, health and happiness: is this the road to Norway?

Last week, I was the Internal Examiner for one of the School’s PhD students. It’s always a privilege to be part of an individual’s doctoral journey, and it’s always interesting to hear the results of their research. This thesis explored the effectiveness of ambulatory emergency care, a very topical subject. She did well and I’m sure her research will broaden our understanding of how this area of health care gets developed in the future. Ambulatory emergency care is one of the ways that the ever-increasing demand for health care can be met, both in primary care and in addressing the needs of an ever-growing elderly population, who live longer with often very complex health care needs. More of which later, first a slight detour.

My drive back home from the viva was interrupted by a long traffic jam. As I sat there, my mind wandered, and I thought about one of my PhD students who lived and worked in Hungary. I had met him at a conference in Slovakia a few years earlier and he had approached me to see if I would supervise him. Courageously, he wanted to undertake his PhD in English. Over the next three years we had a great time, me popping across to Hungary and he coming across to the UK for supervision sessions. He was awarded his PhD in 2006. A year later he invited me and my long-standing collaborator and writer, Professor Sue McAndrew to visit him as part of an education exchange (and I also think to say ‘thank you’; Sue spent many an hour coaching him with his written English). 

Of the many things we did, two things stand out in my memory. The first was a visit to the Semmelweis Museum of Medicine. It is an absolutely fascinating place and it has one of the best Clemente Susini anatomical wax sculptures to be seen anywhere (although not to everyone’s taste, see here). The museum is housed in the childhood home of Dr Ignaz Semmelweis. He is best known as the Father of infection control, and antiseptic techniques. Working as an obstetrician and surgeon, he made the connection between hand washing and infection. His work at the time saved many lives, but it was not recognised due to a lack of scientific evidence. He endured many years of ridicule and was ostracised by much of the medical profession of the time. Ironically, and very sadly, he died in a psychiatric institution from what we would now know as sepsis, some 14 days after having been severely beaten on his admission. His work was later recognised as ground-breaking when Louis Pasteur and Joseph Lister provided the underpinning science to the ‘germ’ theory of disease. 

The second thing that stood out in my memory was meeting a whole bunch of medical students from Norway. They were studying medicine (in English) at the Semmelweis University. The University has over 230 years’ tradition of providing medical education and its Degrees are recognised worldwide. The Norwegian students were very pleased with their experience, particularly as the Norwegian government paid for all their fees, accommodation and travel. It is their investment in the future as whilst the economic climate is good in Norway, the number of doctors (and other health care professionals) is very low. 

It’s an investment in national health and social care that seems to be paying off. The latest Hartford Ageing Index report, developed by Columbia University, shows Norway as being the best place in the world to be if you were growing older. The index measures a number of different social and economic indicators that reflect the status and wellbeing of older people in a country. These elements include productivity (connectedness within and outside the workforce); wellbeing; equity (the gap between wellbeing and economic security); cohesion (social connectedness); and security (measures that support retirement and physical safety). Norway was ranked top, followed by Sweden, the USA, the Netherlands and Japan. The UK was ranked 11th. Norway also came third in the latest World Happiness Report rankings, whereas the UK was ranked 15th. Finland was ranked No 1 and the least happy place in the world was South Sudan.  

And so back to the UK’s growing ageing population. Last week the think tank Policy Exchange published a report entitled  ‘21st Century Social Care: What’s wrong with social care and how can we fix it?’ It is worth a read. It notes that like many other countries, the UK faces a serious demographic challenge. In 1991 some 15.8% of the UK population were aged 65 or over. This rose to 18% of the population by 2016 and is expected to rise to more than a fifth by 2030. This group in society is the one where increasing numbers of individuals are living with complex health needs, requiring integrated health and social care responses. 

The report notes that in the UK, some 410,000 people live in 11,300 care homes operated by 5,500 providers. 95% of these beds are provided by organisations in the independent sector. Many of those using these services are paying for their care themselves. And that is just those that are easily counted. As the Mirror and Mail newspapers pointed out last week, there are around 690,000 people living with dementia in England and over half of them pay for their own care. Their tabloid headlines of the £25 billion cost was actually quite accurate. The Alzheimer’s Society report that the cost of dementia is around £26 billion a year with only about £10 billion being paid for by the NHS. It suggests that on average, it costs £100,000 for an individual’s dementia care. And don’t get me started on the cost of unnecessary days that many individuals spend in hospital when they are physically well enough to go home, but where the necessary social care is not available.

In the last few weeks I have heard the Chair of the CQC, the NHSIE Regional Director, the NHS Providers organisation, 2 CEOs (and 3 want-to-be CEOs) all talk about the need to move away from hospital centric care, and to think how we can best develop neighbourhood approaches where the whole health and care system can become more integrated in providing the care that people need. I’m getting dangerously close to that 18% of the population and it would be good to see some real action in moving things forward!