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Prevention and the NHS long term plan: 3 ways we can save more lives

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Leaders in the health and care system are busy developing a new long term plan for the NHS.  Public Health England CEO Duncan Selbie is leading the work, along with colleagues in the NHS, to ensure prevention is at the heart of that plan.  Here he sets out 3 essential priorities for investment.

Earlier this year the Prime Minister challenged the health family to create a new long term plan for the NHS which delivers better patient outcomes over the next ten years.  This is now very much underway, building on the NHS Five Year Forward View and our new Secretary of State’s highest priorities, one of which is prevention - an area where the stakes have never been higher.

Our baby boomer generation is maturing into older age and in 15 years we will have more than 2 million people aged over 85 – a big rise from the current 1.3 million. This is the single biggest factor affecting current and future demand on the NHS and social care.

We all want people to use the NHS less and later in life, to stay well for longer, be in work for longer and when unwell, to stay in their own homes for longer.  This speaks to almost every strand of the plan and very much that on prevention, inequalities and personal responsibility.

The evidence has existed for many years.  The best way of ensuring a long life in good health is to have the best start in life, a decent education, a warm and loving home and an income sufficient to meet our needs. Or put simply, a job, a home and a friend matter to our health.

But let’s talk about the NHS and what we can do.

The NHS 5 Year Forward View spoke of the importance of prevention and we have seen progress in action, particularly with obesity, diabetes and new immunisation and screening programmes. However, the promised radical upgrade in prevention has yet to be delivered.

I believe there will be three over-arching priorities where we can make the biggest difference. It is not that other priorities won’t matter but these will matter the most.

We need to remove smoking from England – for good, address our appalling obesity levels in both adults and children and tackle the high rates of avoidable deaths from cardiovascular disease.  Each will require action from every part of civil society and the public to make healthier choices about their lifestyles, but the NHS can and must play a bigger role.

Take the NHS Health Check, one of the largest prevention programmes in the world which has benefitted almost seven million people since 2013. This is a good start, but there are many people not taking up the offer that can help prevent heart disease, stroke, kidney disease, diabetes and dementia and the NHS follow-through when a patient has had a check could be more thorough and consistent.  We need to address this. As a way of flagging a heightened risk of various conditions, we also need people to know their blood pressure numbers as well as they know their pin number and for the NHS to normalise conversations on this.

We are in the midst of an obesity crisis with one in three of our children leaving primary school overweight or obese. The Government’s Childhood Obesity Plan has a commitment to halve childhood obesity by 2030 and it is vital that we build on this work to tackle obesity in adults too through actions such as increasing the use weight management services.

Type 2 diabetes, for which obesity is a key driver, is a major contributor to kidney failure, heart attack, and stroke and costs the NHS around £8.8 billion every year.  The new NHS Diabetes Prevention Programme, another world first, identifies those at the highest risk and refers them onto a behaviour change programme.  Its great news that around 100,000 people have benefitted but we should strive, through the delivery of the long term plan, to accelerate this success.

Smoking remains England’s biggest killer and ends the life of 200 people every day. Our prevalence rates are at an all-time low at just under 15% but this belies huge variation, such as in affluent Epsom and Ewell, where rates are at 4.9%, but just 60 miles away on the south coast in Hastings the rate is more than five times greater at 25.7%.  We also see big variation particularly in people in manual work and those who suffer with mental health problems.  Our prisons are now largely smokefree but it can be harder to smoke outside a railway station or pub than it can outside a hospital, and this is not okay.

Smoking is the single biggest modifiable risk factor that impacts on infant mortality and morbidity, causing up to 2,200 premature births, 5,000 miscarriages & 300 perinatal deaths per year.  Almost 11% of women in England are still recorded as smoking at the time of delivery, which translates into over 65,000 infants born to smoking mothers each year. We need to take action and support women to increase the number having a smoke free pregnancy, including implementing the actions set out in the Government Tobacco Control Plan in respect of pregnant women and of the Maternity Transformation Programme.

Our ambition to remove smoking from England will only be achieved by the concerted efforts of everyone, but it can be done, and the NHS could be a more powerful driving force by actively nudging patients and its own staff onto cessation programmes, treating smoking addiction as a medical condition and taking an absolutely zero tolerant approach to smoking on the NHS estate.

All of this and more will play out through the long term plan and this time we must be more literal about the priority that we are giving to prevention. We need less rhetoric and more action. We need to be ruthless in our priority setting and ruthless in our implementation.

It has never been more critical that the health family come together to ensure we are preventing the conditions that pose the greatest threat to our NHS, social care services and ultimately the success of our economy and wealth and health of our people.


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  1. Comment by James posted on

    Meanwhile, austerity focused policies undermine any significant impact that behavior change programmes can deliver. The Prevention agenda needs to be a top policy objective of every central government department. The Secretary of State needs to get out and lobby his colleagues if he want's to see a real change.

  2. Comment by Mr B posted on

    Only local drivers in the system will get local NHS systems moving in the right direction on public health. Statements from unknown (in the NHS) leaders from London with no official authority within the NHS offering guidance from platforms at obscure conferences will change nothing. Local PH teams in LA's are drying up leaving no local drivers to engage on a daily basis (which is what achieves results) with local NHS systems. A couple of statements from on high every couple of months will go by largely unnoticed, proven by the lack of engagement to date with any of the asks from distant drum bangers such as the demand to create a smokefree NHS. If anything it's got worse!
    Get PH in LA's strengthened and then fully support them to get all this achieved.

  3. Comment by Sally Burton posted on

    Clear priorities. Re the Health Check. The issue isn’t just take up, its getting it though be of value. When I told the HCA who did mine that I knew I was very overweight she laughed and said ‘ were all a bit chubby round here’. When I pressed her about what help was available she got out some food packages and showed me the labelled. They were all highly processed and even if low fat were not healthy. Utter waste of time. Spend more money, l health experts and make the checks matter!

    You have missed 2 major issues. First of which is alcohol. This causes untold misery, aggression and illness and the second is mental health of all ages. This requires changes at all levels from stopping the stupid SATs and other oppressive regimes in schools, to addressing the structural determinants of poverty. Public Health England should be much more vocal about the political choices and not blame individuals for poor choices.

  4. Comment by Richard Potter posted on

    Hope working together between social care & the NHS continues to improve. The importance of social contact for the elderly (& all).

  5. Comment by Elcena Jeffers posted on

    I would like to help you to help me.

  6. Comment by JC posted on

    no. NHS role is healing. PHE role is prevention; implicitly passing that buck to NHS is wrong. take responsibility.

  7. Comment by Dr John Ashcroft posted on

    Much of this was better done when it was in Health. Councils are more interested in emptying bins. Smoking, and sexual health services have been decimated since the "reforms"
    Smoking is the biggest single killer, and smokers dont have to smoke .. they can vape, use chewing tobacco, snuff, NRT.
    Diabetes is actually cardiovascular disease, as that is where the deaths occur, and where the biggest prevention gains are with statins and antihypertensives.
    Poorly controlled DM2, at the moment bariatric surgery is the clear winner, it works and saves lives and money. Massively underutilised in this country, and when we use it we target the obese. Risk doesnt come with obesity it comes with DM2.
    Alcohol and drugs are still a growing problem. Pricing for alcohol is weak.
    And the main deliverers of prevention remain primary care, and not secondary and yet we havent seen an real money coming through.
    ?? Build on the 5year forward view?? It stated prevention has to be done radically better if NHS was to balance its books, but 4 years on nothing, and financial turmoil.
    The drivers are set up to put money in to the hospitals.
    One of Matt Hancocks first announcements ... more money to be plowed into A+Es for this winter. So no change there then.

    • Replies to Dr John Ashcroft>

      Comment by Mark Wilson posted on

      Statins and BP meds better than lifestyle change? Are you insane? Stop medicating and start treating your patients. Ask Dr David Unwin for advice.