health in recent years, a step change will be needed if we are to
achieve the 'fully engaged' scenario outlined in my earlier report on
long-term NHS resource and funding issues, Derek Wanless said today.
Announcing publication of his further report 'Securing Good Health
for the Whole Population'*, Mr Wanless said: 'Achieving the goal of a
population 'fully engaged' in improving health, to avoid becoming
sick rather than treating sickness, is a major prize for the whole
'The step change needed will require strong leadership and
organisation in public health delivery, and access to high quality,
personalised information, advice and increased support to help
individuals take vital health and lifestyle decisions.'
'Individuals are primarily responsible for their own and their
families' health, but the government has a major role in the process
by providing the necessary framework for success. Activity is needed
on a wide front to help individuals take greater responsibility.'
'This report's recommendations are designed to ensure that, in
future, the necessary and justifiable support will be delivered. They
set out the work needed to learn how support can be better provided
and to help find answers to the many practical questions still
unanswered. The key challenge is more effective implementation.'
Alongside government-led improvements in achieving a more effective
delivery framework for health service providers nationally and
locally, the report sees an enhanced role for schools, local
authorities and other public sector agencies, employers, and private
and voluntary sector providers in developing opportunities for
individuals to play their part in securing better health.
The report makes more than twenty recommendations to government on
implementing cost-effective approaches to improving population
health, preventio n, and reducing health inequalities consistent with
the public health aspects of the 'fully engaged' scenario.
It suggests that the government needs to set out principles for
action and a framework for assessing the role of economic
instruments, such as taxes and public spending, to choose the right
set of policy levers to deliver public health goals, similar to that
already provided in relation to environmental issues. Another
priority is the organisation and funding of research to ensure we
know what works on the front line and what spending can be justified.
Looking at specific areas of concern, the report recommends that the
government should set a consistent set of national objectives for the
key risk factors such as smoking, physical activity and obesity.
Primary care trusts and local authorities should then agree joint
local targets based on the national objectives and their local needs,
which should then be reinforced through the NHS and local government
performance management and inspection systems and would mobilise
other local groups to provide support.
Primary care will play a greater role in a 'fully engaged' scenario
and give much more attention to helping individuals stay healthy. The
Electronic Patient Record will provide an infrastructure for mapping
out the local prevalence of disease and lifestyle risks for the first
time and will allow enhanced disease management programmes to target
help at those whose need is greatest. An experiment is recommended to
assess the benefits of additional resource in information systems, in
monitoring risk and in providing services to manage risk.
1. Derek Wanless' first report 'Securing our Future Health: Taking a
Long-Term View' was published in April 2002. This identified three
scenarios for meeting the long-term financial and resource needs of
the NHS for the next two decades, to 2022.
2. In its response to the report, the government ann ounced that it
would address the 'fully engaged' scenario identified by Mr Wanless.
Under this scenario the level of public engagement in relation to
health is high, life expectancy goes beyond current forecasts, health
status improves dramatically, use of resources is more efficient and
the health service is responsive with high rates of technology
uptake. The scenario envisaged delivery of better health outcomes at
less cost than the others considered.
3. In April 2003, Mr Wanless was invited to prepare the current
report to government to provide an update on the challenges involved
in achieving the 'fully engaged' scenario, in particular the public
* A summary of the report is available here, and the full report is