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NHS urged to change so prevention vision can become reality

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Health and social care secretary Matt Hancock promised to “radically change the focus” when he announced his new prevention vision last month.

His insistence that the NHS, as well as local government, must put prevention at the heart of everything it does and tackle the root causes of poor health, rather than simply treating the symptoms, was welcomed as sound logic.

But details of how this ambitious vision will be put into practice must wait until the promised publication of a public health green paper next year. With the ongoing political turmoil in Westminster, one could be forgiven for wondering when, or indeed if, it will ever materialise.

And, of course, we have been here many times before.

The latest example of words around evidence-based, strategic interventions to maintain health, tackle poverty and inequality, and stimulate economic growth can be found in the NHS Five Year Forward View which promised in 2014 to “get serious about prevention”. However, that strategy is generally perceived to have failed to deliver at any notable scale.

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There is a large question mark over Mr Hancock’s pledge to realise councils’ “potential as leaders in local health improvement” when the planned reduction in public health grant is set to hit £700m between 2014-15 and 2019-20.

The King’s Fund’s vision for population health, launched last month, called for a cross-government strategy for reducing health inequalities and increased investment, including an uplift in the public health grant of at least £690m.

But speaking at the health thinktank’s annual conference last week Adrian Masters, NHS England’s director of strategy, said there are just “prevention elements” in the forthcoming NHS long-term plan. He urged delegates to be “pragmatic” and focus on specific interventions which build on the government’s existing priorities, rather than set “high level” goals.

Speaking at same event, Dr Ruth Hussey, former chief medical officer for Wales, called for England to adopt legislation akin to the Well-being of Future Generations Act 2015, which requires the Welsh Government and public bodies to make long-term, preventative decisions.

Shirley Cramer, chief executive of the Royal Society of Public Health, said the “health community” in England should also say more about the role of the state and the impact of policies, such as universal credit and cuts to local government funding, in making people poorer and less healthy. Public health efforts to address these issues had been limited by “political short-termism”, she said.

The correlation between poverty and poor health is clear, so creating jobs and boosting economies is key.

Michael Wood, local growth adviser at the NHS Confederation, said prevention policies must address regional economic imbalances but added the NHS is not getting involved in addressing low productivity.

He also questioned why local enterprise partnerships, councils’ heads of economic development and representatives from chambers of commerce were not at meetings of sustainability and transformation partnerships or integrated care systems. Their attendance could open up “new approaches and new sources of funding which will help us all to achieve what we want to achieve,” Mr Wood said.

Dominic Harrison, director of public health at Blackburn with Darwen BC, told LGC the government must use the green paper to end the NHS tariff system which pays trusts and other organisations for detecting and manging conditions rather than providing an incentive to prevent them.

Mr Harrison said there should be local agreement between councils, NHS organisations and other partners on how best to spend the funding available in the places they serve, which he said would result in the NHS investing in non-clinical interventions outside the health and care system.

The current system feels like an NHS England control freakert of national rollout of services unter their control that ignores existing infrastructures

These interventions, Mr Harrison added, could include investment in “social infrastructure” to prevent vulnerable people becoming isolated, such as community centres and meals on wheels.

Mr Harrison also said prevention could play an important role after Brexit.

“Whatever happens post-Brexit there is going to be a high demand for changes that would bring greater equality,” he said.

“The population health agenda is a real opportunity to put some practical steps in place and say we know certain members of society feel excluded, feel undervalued, feel their children are not getting the same chances as everybody else; here are some ways we can fix that which also has the added advantage of improving health and wellbeing outcomes in poorer communities.”

Jim McManus, director of public health at Hertfordshire CC, warned against the NHS leading efforts to improve population health as it has a poor record in running national prevention programmes. He said the £100m diabetes prevention programme, introduced in 2016 alongside existing local systems, achieved an average weight loss of 7.7lbs over four to five months. The benchmark programme for local government in Wigan MBC achieved an average 6lb loss in four weeks.

Mr McManus said the current system “feels like an NHS England control freakery of national rollout of services under their control that ignores existing infrastructures”.

He added: “Here we are with NHS England trying to hoover up every bit of available cash to deliver a preventive programme they think is going to work with the long-term plan. If they just go on with that it will completely preclude a valuable discussion that we could have under the green paper.

“The prevention green paper is a great opportunity but if it is all done and dusted under the long-term plan there will not be an awful lot of point having the conversation.”


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