Why the NHS could soon prescribe home improvements and knitting
With mounting deficits, an ageing population and £22bn of "efficiency savings" to find in the next five years, the NHS is facing a monumental task.
This is reflected by the fact that the opening weeks of this government have been dominated by initiatives to get the health service back on an even keel by driving down costs by targeting areas such as spending on agency staff.
But dig a little deeper and there is a fascinating parallel debate going on about just how ambitious and radical the health service should be.
It centres on this: to what extent should the NHS think outside the box as a way of preventing ill-health?
There was a sense of this during last week's annual conference of the NHS Confederation, the body which represents health service managers.
NHS England chief executive Simon Stevens spoke about the need to focus on health as well as ill-health. He cited the example of child obesity to make his point, saying if this was not tackled it would lead to a tide of new cases of cancer, heart disease and diabetes. He urged the NHS to "rattle the cage and try something different".
But he could have chosen a range of other issues from smoking to drinking. The theme cropped up again in a separate debate on the devolution of public spending in Greater Manchester. Philip Blond, director of ResPublica, a think tank which has been looking into the case for change in the region, spoke about his desire to see the health service intervening early to prevent people developing health problems in the first place.
He floated the idea of GPs being able to refer patients for home insulation as a way of keeping their homes warm.
It may sound fanciful, but consider this: research shows cold, damp and dangerous homes cost the NHS £2.5bn a year. Not only do they increase the risk of respiratory problems, but hazards in the home are the most common reasons for falls among the elderly.
Some areas have already looked at these things. In Liverpool the council and the NHS have been working together on a Healthy Homes Programme since 2009.
Last year in Sunderland, doctors began offering help with insulation, double-glazing and boilers and started seeing some falls in demand.
There is also growing interest in social prescribing, whereby GPs refer patients on to knitting clubs and fishing groups, as a way of tackling problems such as depression.
Offering befriending services is another novel idea that is growing in popularity as a way of tackling social isolation among the elderly, which is increasingly been recognised as a risk factor for ill-health and death.
In health circles, it all comes under the umbrella of what is called "upstream" intervention. That is to say supporting people before their conditions worsen and they end up in hospital or a care home, which are the two most expensive ends of the health and care sectors.
This agenda requires the NHS to work with local partners, particularly councils. The big unknown though - as the pressure on the service intensifies in the coming years - is whether there will be the breathing space for it to do so.