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Duncan Selbie's Friday message – 13 Jan 2017

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Dear everyone

One in 4 people has a common mental health problem at any one time, yet access to mental health support is often varied and inconsistent. On Monday the Department of Health, NHS England and PHE published a joint response to the Mental Health Taskforce’s Five Year Forward View for Mental Health – along with a comprehensive package of measures to improve mental health support in schools, workplaces and communities announced by the Prime Minister.

An update to the cross-government suicide prevention strategy was also published on Monday alongside a number of new resources from PHE to help local decision makers improve support for those bereaved by suicide, as well as a new Atlas of Suicide Prevention. It is of testament to local authority commitment and the support they have from wider partners that 95% either have a suicide prevention plan or are developing one, but there is more to do to ensure the quality and effectiveness of these plans and this is the task that lies ahead.

Also this week, we published an updated Atlas of Variation in NHS Diagnostic Services in England, in collaboration with NHS Right Care and NHS England. This reveals that the average level of access and quality for many diagnostic services at national level has improved, and in some areas the degree of unwarranted variation has reduced – however for others it remains wide.

It is good to see improvement in some services such as the rapid diagnosis of stroke, yet other services such as diagnostic testing rates for bowel cancer vary significantly between CCGs. Addressing variation at local level has significant potential to save lives and prevent emergency hospital admissions, and everyone has a role to play in considering how we can better understand and tackle the underlying causes of variation. Exploring the data will be an important starting point.

On Wednesday, Revolving Doors and PHE, working with NHS England and the Home Office, published a new resource for directors of public health, police and crime commissioners and other local leaders on addressing the sharp inequalities experienced by people who have been in prison or in police custody at some point in their life.

Perhaps unsurprisingly, many face considerable health problems, often complicated by unemployment, debt, homelessness or social isolation, and a near 50% greater chance of early death and of course poorer health in life. More than 80% smoke, 15% are homeless before going to prison, 45% of people involved with the police have a mental health problem and 13% have never had a job.

Rebalancing Act aims to support collaborative work between criminal justice and health agencies and a much broader range of local partners. Importantly, this is not all about creating new services or finding more money, but rather sharing information, pooling funding and working better together to deliver services that are not only more efficient and effective, but also more cost effective.

This week the Local Government Association drew attention to the latest evaluation of the NHS Health Check published by colleagues from Queen Mary University. This study suggests that the programme has prevented up to 8,400 heart attacks and strokes and that statins were 40% more likely to be prescribed to attendees compared with non-attendees.

This and earlier national evaluations have also demonstrated that more people from deprived communities are accessing the NHS Health Check, which demonstrates strong local public health leadership in commissioning this service and on Tuesday we published new guidance to support local teams completing health equity audits related to the programme.

On Monday our Be Clear on Cancer campaign pilot began across the North West of England, funded by Cancer Research UK and aimed at increasing participation of 60–74 year olds in the NHS bowel cancer screening programme. Bowel cancer is the fourth most common cancer and the second most common cause of cancer death in the UK. Trials show that bowel cancer screening can cut deaths by 15% in people aged 60–74, yet overall uptake of bowel cancer screening in England is low at 58%, and as low as 33% in some areas.

Screening is a choice, and gives those who participate, and who are unknowingly living with the earliest signs of bowel cancer, the best chance of successful treatment. The campaign speaks to a number of barriers to participation as indicated by the evidence, including fear of the test outcome, being asymptomatic, having a low perceived risk of bowel cancer and concerns about the practicalities and cleanliness of the test. Subject to the evaluation of the pilot, the campaign will be rolled out across England from next year.

And finally, on Tuesday I spoke at a summit on Sustainability and Transformation Plans held by the Institute of Healthcare Management, which has published Swimming together or sinking alone, a report aimed at senior leaders in health and local government to support the culture change and skills development necessary to work better together and deliver cost-effective services appropriate to local needs.

The report, written by journalist and policy expert Richard Vize, is a good read and presents a number of approaches and opportunities to help local leaders as they move from focusing on their own organisations and hierarchical structures to operating more collaboratively across local health economies.

As local leaders begin to implement their plans, PHE will align its support around these and do all we can to see them succeed.

With best wishes,

Friday messages from 2012-2016 are available on GOV.UK

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  1. Comment by Eamonn O'Moore posted on

    Great to see Duncan highlighting the work on addressing health inequalities among people in contact with the criminal justice system especially the partnership between PHE, third sector, NHS and Home Office and identifying the critical role at local level Police & Crime Commissioners along with DsPH.