There has been a recent focus on the value of preventive measures in healthcare. There is no doubt that with the economic recession and the growing demand for healthcare, the preventive approach needs to take centre stage.
Supported self-care is the focus for those with long-term conditions with the aim of maintaining patients in their own homes and preventing avoidable admissions and readmissions.
There is another form of prevention which is labelled by some as extreme, such as the step taken by Hollywood actress Angelina Jolie to prevent breast cancer. In 2007, I underwent the same operation, choosing a bilateral mastectomy following the results of a lumpectomy which showed atypical ductal hyperplasia.
This is a pre-cancerous condition, but my mother had been diagnosed with breast cancer at 45 and had later died of the disease at 54 - so I was in no doubt that the preventive measure was the right step for me. I was fortunate to have had a compassionate, caring and skilled surgeon who produced the most realistic reconstructions I could have wished for. I also experienced excellent nursing care in the days that followed - and one hilarious incident with a student nurse which I think neither of us will ever forget.
Prior to surgery I reasoned that not only would the operation save distress and discomfort later should I be diagnosed with breast cancer (I was convinced that was my future), but I would be saving the NHS thousands of pounds in chemotherapy and radiotherapy which would be needed on top of any future surgery.
Since Angelina Jolie's announcement,the media has been full of debate over the advantages and disadvantages of preventive mastectomies. It is a highly personal and individual decision and while I have never had a moment of regret, I understand such extreme measures are not for everyone. However, it is important the issue has been opened up and many 'previvors' are emerging to tell their stories, share experiences and contribute to an informed debate.
Crystal Oldman, chief executive, Queen's Nursing Institute