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Although progress has been made through efforts to improve public ...
Although progress has been made through efforts to improve public

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

health aspects.

* A summary of the report is available here, and the full report is

available here.

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