Here’s a new take on the better sense of trying to prevent ill health rather than merely treating it. It’s from a speech last week by a Conservative member of the House of Lords, Lord Prior of Brampton, a former UK Minister for NHS Productivity:
“Simply putting more money into the NHS and hoping for the best will not work. With funding must come radical reform. We need a shift from ‘diagnose and treat’ to ‘predict and prevent’. Care must be joined up around - and tailored to - the patient.”
And here’s the take on the issue from 1895 – 123 years ago – with which everyone is familiar.
The Fence or The Ambulance
by Joseph Malines, "an American physician"
‘Twas a dangerous cliff, as they freely confessed,
Though to walk near its crest was so pleasant:
But over its terrible edge there had slipped
A duke and many a peasant;
So the people said something would have to be done.
But their projects did not at all tally:
Some said, “Put a fence around the edge of the cliff”
Some, “An ambulance down in the valley.”
But the cry for the ambulance carried the day.
For it spread to the neighbouring city:
A fence may be useful or not, it is true,
But each heart became brimful of pity
For those who had slipped o’er that dangerous cliff,
And the dwellers in highway and alley
Gave pounds or gave pence, not to put up a fence,
But an ambulance down in the valley.
“For the cliff is alright if your careful,” they said,
“And if folks even slip or are dropping,
It isn’t the slipping that hurts them so much
As the shock down below - when they’re stopping,”
So day after day when these mishaps occurred,
Quick forth would the rescuers sally
To pick up the victims who fell off the cliff,
With their ambulance down in the valley.
Then an old man remarked, “It’s a marvel to me
That people give far more attention
To repairing results than to stopping the cause,
When they’d much better aim at prevention.
Let us stop at its source all this mischief, cried he.
“Come neighbours and friends, let us rally :
If the cliff we will fence, we might almost dispense
With the ambulance down in the valley.
“Oh, he’s a fanatic.” the others rejoined:
“Dispense with the ambulance Never!
He’d dispense with all charities, too, if he could:
No, no! We’ll support them forever.
Aren’t we picking up folks just as fast as they fall?
And shall this man dictate to us? Shall he?
Why would people of sense stop to put up a fence?
While their ambulance works in the valley?”
But a sensible few who are practical too,
Will not bear with such nonsense much longer
They believe that prevention is better than cure
And their party will soon be the stronger
Encourage them, then with your purse, voice and pen
And (while other philanthropists dally)
They will scorn all pretence, and put up a stout fence
On the cliff that hangs over the valley.
PPS (Post Poem Script): When Bruce Harris sent me a copy of this poem in 1997 as part of my training for work in the health sector he commented – with his usual wit and wisdom – as follows:
“From the parable:
– choose to live in a place with no cliffs – ideal but unlikely;
– don’t go near the cliff – education, expects too much;
– build a fence – authoritarian, expensive.
Until these happen, some of us have to man the ambulances!”
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