'The earlier the better campaign' - mixed messages from the NHS?

Posted on Wednesday 12th February 2014

Hilary Brown, Health Services Management Centre

Hilary BrownWe are now into the fourth week of the NHS England campaign – ‘the earlier the better’ designed to encourage the over 60s to seek help early over the winter period in order to tackle the rising number of older and frail people who are admitted to hospital because of respiratory or other chronic conditions.

Delaying seeking help for a couple of weeks is easily done – an older person feels a little unwell but thinks it will pass in a day or two. A couple of days later the cough still hasn’t gone and their chest still feels as tight but their daughter is coming at the weekend and they’ll see how they feel then. The weekend comes and they rally – ‘don’t want to make a fuss’. And then the weather turns nasty and they don’t get out to the chemist or the shops for a few days, then it’s too much effort and they just don’t have the strength. Under-nourished and largely immobile, a chest infection has taken hold.

I don’t have an issue with the underlying logic of the campaign but just telling people to seek medical help earlier isn’t necessarily going to have any impact. ‘Help seeking behaviour’ is a complex subject and people choose to access healthcare or not for all sorts of reasons. Cultural values such as independence, strength and self-sufficiency can all play a part, as can simple logistical barriers – the over 60s are probably busier than ever, and simple inertia - how many of us have kept the New Year commitment to change our energy supplier? Therefore, we settle for the default choice of doing nothing, particularly if our previous experience of healthcare was frustrating, unsatisfactory or downright unpleasant.

But information can also act as a powerful barrier. There may be a complete absence of information but more likely these days there is an overwhelming amount of information, a lot of which will be at best ambiguous and at worst contradictory. Over the last couple of years, NHS campaigns have also told people repeatedly not to clog up A&E or their GP’s surgeries unnecessarily. The public could be forgiven for thinking that the NHS is a little fickle – now it wants us… now it doesn’t.

NHS England is in danger of tripping over its own advice on NHS Choices website when it comes to this campaign. For example, the website states that there are two types of chest infection - acute bronchitis and pneumonia and notes that, ‘the symptoms of acute bronchitis and pneumonia are similar, but pneumonia symptoms can often be more severe and need medical attention.’

The website continues, ‘Bronchitis usually gets better by itself, so there is no need to see a GP. You should see a GP if you suspect you have pneumonia,’ but this sentence is followed by the not very helpful qualifier, ‘It can be difficult to know if you have bronchitis or pneumonia as the symptoms are so similar. But it is more likely that you have pneumonia if your symptoms are severe.’ But, how severe, is severe? As we well know, one man’s severe is likely to be another woman’s mild (sorry, I couldn’t resist that one!).

The website suggests severe means that your symptoms last longer than three weeks. So, ‘good patients’ will perhaps wait three weeks to see if their symptoms will last that long before going to the GP, only to be told that their symptoms are severe and that they should have come earlier.

It is reminiscent of the Office of Circumlocution in Dickens’ Little Dorrit.