How NHS Wales could cut its deficit

January 31st 2013

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Latest reports suggest Wales’s Local Health Boards are heading for a deficit of £131 million in less than 10 weeks time.  As ever, politicians play the blame game and the head of NHS Wales digs round for some rescue money.

But there is a simple, highly cost-effective way that the NHS could get rid of its deficit – cut the number of people who smoke in Wales. Nearly a quarter (23%) of the adult population currently smokes – a proportion little changed in recent years despite the ban on smoking in public places.  The proportion of people from low income groups who smoke is much higher – according to the Welsh Health Survey about 44% of people who are unemployed smoke, with the prevalence actually rising in the last few years.

Smoking hits individuals’ health hard – and it also hits the NHS budget. A study by ASH Wales in 2009 put the cost of smoking-related illnesses at £386 million in 2007/08 – a figure that must be even higher now.   More than 27,000 hospital admissions are for smoking-related illnesses, and in addition there are millions of visits to GPs for treatment of long-term smoking-related conditions.  

Clearly, the savings to the NHS from reducing the number of people smoking are not immediate – some of the health risks take some considerable time to fall and some may not disappear at all.  Even so, you might think that faced with a financial black hole that local health boards would be doing all they could to reduce the number of smokers in their area so at least their pressures might ease in future.

But no.  

At least one health boards will not allow prescribing of medication that is proven to be one of the most effective means of quitting.   Why? On cost grounds. Most others only offer help at Stop Smoking groups. Studies show that these are very effective – but only if you are able and willing to go.  So those without a car, with no money for bus fareas, with small children, or who – like all of us – can always think of a reason not to exercise / lose weight / eat our greens, get no help at all. They have to make do with the methods that are the most ineffective – namely nicotine patches and so on or willpower alone.

In the topsy-turvy world of the NHS, those who need the most support to quit are the least likely to get it.  

If the Welsh Health Minister and Wales’s Health Boards really wanted to get ahead of the spendng curve, they would be upping their spend on support to quit. They would make access to help – be it at the GP, or pharmacist or Stop Smoking group – easier than buying cigarettes. They would offer every proven aid to quit available – the patches, the tablets, the advice – all of it.  And they would treat smoking not as a lifestyle choice but as an addiction, that has terrible consequences.

It is hard to understand why Wales’s NHS doesn’t act on the overwhelming evidence that smoking costs not only lives but money.  As the Welsh NHS’s financial year draws to another, nail-biting close, there is a simple way to avoid it in future – invest in quitting.

Victoria Winckler is Director of the Bevan Foundation


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