5/5. The NHS is under huge strain as it struggles to cope with an ageing population and illnesses caused by unhealthy lifestyles on top of increasingly expensive drugs, procedures and treatments. It's an unsustainable situation, says former NHS chief executive Nigel Crisp, and requires a complete rethink of the way we think about and manage health.
In the final programme of the "Healthy Visions" series Lord Crisp develops the ideas covered in the previous four programmes to argue that all of society must take responsibility for health. Citizens must become partners in health promotion and health care. Planners and designers must put health at the centre of new projects. And the NHS must change from a hospital-centred and illness-based system to one where patients and communities are in the driving seat.
Lord Crisp visits the St Paul's Way Transformation Project in Tower Hamlets to see how housing, health care facilities, education and leisure can be planned to promote good health and prevent disease, with a particular focus on preventing diabetes. And he suggests practical ways to manage the financial and political implications of this radical shift in focus.
Presenter: Lord Crisp
Producer: Lucy Proctor
Editor: Andrew Smith.
4/5. In 1900 about 4% of the population was aged over 65 - now it is over 20%. And within the foreseeable future we can expect most people to live to the age of 90 . This, says Professor John Ashton of the Faculty of Public Health, means we need big changes to how older people live - especially how they are housed.
In his "Healthy Visions" programme, John Ashton inverts the usual terms of the housing debate. He believes that by concentrating on the needs of older people, the housing problems of younger people can be tackled too.
Living to your dying day in the house you've lived in for fifty years will often not be the wisest option. Instead, planned new types of housing should be encouraged that support living in the neighbourhoods where people have recently lived. These new units would be built on a human scale, with the flexibility to adapt rooms to changing needs as people get older and their health deteriorates. They would be close to health centres and would be underpinned by local people actively supporting independent living.
Escalating property prices, economic growth and rising living standards have all helped many baby boomers get richer. Now, argues John Ashton, it's time for them to help themselves and other generations in a new compact. The properties they move out of can help younger people get on the housing ladder.
John Ashton visits examples of future living and community support in north-west England to illustrate how his vision can be realised.
Presenter: Professor John Ashton
Producer: Simon Coates
Editor: Andrew Smith.
Wellness at Work
Dame Carol Black argues that it is important to promote health and well-being at work. Both employers and employees need to do their part. If they do, it will benefit everybody - companies, staff and the NHS.
Achieving improved health in the workplace, she says, can help to significantly reduce demand on stretched NHS services. But the benefits are not just for the NHS. Healthier staff will feel better, be more productive, and happier at work. And employers can save money on sick pay or the costs associated with high staff turnover.
Some companies are at the forefront of this, such as the Ipswich Building Society. They have a points scheme, for example, whereby staff can earn points for walking or exercising at lunchtime. These can then be cashed in for time off work. They also offer lunchtime team walks, pedometers and "couch to 5k" podcasts that help non-runners to gradually build up to running five kilometres. One member of staff says that as a result, she not only feels more valued at work but has also not had a day off sick in seven years.
Presenter: Dame Carol Black
Producer: Arlene Gregorius
The Patient in Charge?
Most health care is delivered face to face with a highly and expensively qualified practitioner who acts as gatekeeper to any treatment we receive. If we seek advice from our GP, they will generally either prescribe medication, refer us for investigative tests or send us to a specialist consultant who will in turn assess our need for treatment.
In the second programme of this Healthy Visions series, Dr Charles Alessi argues that this model of how we access and interact with our health care system will be required to undergo considerable change in the future. Not only do NHS resources need to be saved, but people are becoming increasingly knowledgeable and interested in their health and want to be more involved and in charge of their own care.
In the digital age it is now becoming much easier to access and share information about health. Patients Know Best is the world's first patient controlled online medical records system and is based on the premise that patients have the right to, and are best placed to be in control of their own records. By having their own unique profile on a website, patients are able to gain access to their data via a computer or smartphone. Linking together the care teams that treat them, management of any condition is made much easier for all involved.
Patients are also becoming more active in their own care as treatment moves away from solely being provided by health care professionals. An illustration of this is the self-care kidney dialysis unit in Harrogate, Yorkshire, the first of its kind in the country, where patients undertake their own dialysis at times that are most convenient for them. This affords them much greater flexibility and can substantially improve their quality of life.
Presenter:Dr Charles Alessi
Do I Need the Doctor?
Healthy Visions offers five expert views of how healthcare can and must change if current levels of provision are to be maintained and grown - meeting the high level of expectation from patients as medical advances continue and as the population becomes larger and older. In this edition Dr Michael Dixon argues that the idea of doctor as ultimate dispenser of all medicine, may have to be sacrificed, with the expertise of a wide range of health practitioners called upon to get best care. Dixon has been implementing his views successfully in his Devon GP practice for a number of years and his ideas are now being extended elsewhere. The programme visits a Brighton surgery which practices "narrative" surgery - instead of patients turning up for specific treatment for specific ailments, they tell their "health story", throwing up a list of possible medical issues which can be treated as a whole. Recommendations include singing and writing sessions which can help deal with some of the underlying causes of ill health. The emphasis is, not just making people "better" in the conventional sense, but helping them to be well - in a wider and deeper sense.
Presenter:Dr Michael Dixon
Recording of singing provided by Grey Matters Productions.