Prevention in the NHS requires leadership willing to break the old rules

Posted On: 
21st June 2019

The NHS Long-Term Plan delivered a new focus on prevention but came with a warning: government needs to deliver on public health funding, writes Dods Monitoring's Daniel Laing. 

Credit: 
PA Images

The health sector has made major strides towards a focus on prevention. It features heavily in the NHS long-term plan, Matt Hancock has promised a prevention green paper and leaders in every political party want to be the one to correctly turn on the public service tap. The one to do it should be prepared to tackle the challenges of integration, think big in the Spending Review and look closely at environmental and economic factors.

The NHS Long-Term plan brings new prevention impetus: but won’t take sole responsibility

While the NHS Long-Term Plan delivered the far-sighted approach for the sector, a cross-government prevention plan is required to ensure eyes are focused on models fit for the 21st Century. With the NHS Long Term Plan’s Implementation Framework on the horizon it will be important to ensure the NHS can see prevention models it will look to integrate with.

The publication of the NHS Long-Term plan was generally seen as good news for the sector and it did refocus things to 10 years and remove planning from political cycles. As a result, prevention become a key tenet of the plan with an entire chapter dedicated to health inequalities, smoking, obesity, alcohol, air pollution and antimicrobial resistance. These ambitions are significant priorities in meeting growing service demands, an ageing population and delivering on the potential of new technological innovations.

With that said there is a key line which reads as if it were from a public affair briefing and illustrates the dilemma: “Action by the NHS is a complement to, but cannot be a substitute for, the important role for local government (p33).”

Given these points it is clear the NHS is unable to properly deliver prevention on its own. The picture is clear, a prevention agenda requires a wholesale review of the health economy and shift towards integrated health policy.

Prevention is not bound to a sector and spans everything from public health initiatives delivered in local government to immunisation carried out in a GP surgery. Indeed, thinking around the wider determinants of health stretch this definition further, with environmental factors such as air pollution, housing quality and economic factors entering the conversation.  It is therefore inevitable that health will become everyone’s business.

A paradigm shift in health could be approaching

The NHS Long Term plan is clear that the prevention challenge hinges on a paradigm shift in policy making.  However, this logic has rarely extended to health and many of the service models in the NHS are, by the plan’s own admission, the same as they were when it was founded.

The problematic consequence remains the difficulty in measuring the impact of prevention and the short-term gains associated with more traditional NHS measurements. Indeed, it is the services which are hardest to measure that have suffered at austerity’s calculating hand. Local government funding pressure has led to public health dropping down the priority list. As David Buck of the King’s Fund said in front of the Housing, Communities and Local Government Committee: “the preventive end of the public health grant is where the cuts have come more.” Thus, prevention agenda starts from a position of weakness and requires a refocus of policy and funding priorities.

Public health funding won’t be the only area where prevention will feature heavily…

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