Has the government now got the message?
Our guiding principle is that prevention is better than cure. So when the government launched its ‘Prevention is better than cure’ vision paper recently we were keen to see what it had to say.
A worthy aim
The government aims to improve healthy life expectancy by at least 5 extra years, by 2035, and to close the gap between the richest and poorest – something we can all support.
Much of the analysis is spot-on. Here are some examples:
Prevention means stopping problems from arising in the first place; focusing on keeping people healthy, not just treating them when they become ill.
We need to see a greater investment in prevention - to support people to live longer, healthier and more independent lives, and help to guarantee our health and social care services for the long-term.
There is a role for government to create the environment that makes healthy choices as easy as possible, and to address the conditions that lead to poor health. This could be through laws, regulations and incentives
Prevention is crucial to the work of the NHS. But, for too long the health and social care system has talked about the need to refocus its energy away from treating illness and towards preventing illness, without this translating into practical action.
When it comes to prevention, we all have a role to play: individuals, families, communities, employers, charities, the NHS, social care, and local and national government.
The paper recognises the importance for health of things like not smoking, eating a healthy diet and being physically active. It also usefully takes a more holistic approach to health. For instance, it recognises the importance of the early years of life for long term health, the need to combat loneliness and to encourage mental health, that the way jobs are designed has implications for both physical and mental health, and the importance of living in safe, well-designed, connected and healthy neighbourhoods.
So, we’d give the government’s vision 10/10 for analysis. What about implementation?
Weaker on implementation
The paper does sketch out government initiatives to tackle some of the issues identified. These include the 2017 NHS Health and Wellbeing incentive scheme for NHS staff, the 2018 Childhood obesity plan for action chapter 2, and the Cycling and Walking Investment Strategy (with £1.2 billion of funding from 2016 – 2021).
However, in general, implementation is the paper’s weak point. We’d score it 3/10. Here’s why:
Too little too late
The government says that by 2028, 75% of cancers should be diagnosed at stages one and two. It doesn’t indicate how this will be achieved or why we have to wait so long. We have known for years that the UK has lower cancer survival rates than many other European countries – indeed the NHS has had a Cancer Plan in place since 2000. Why is it taking so long to address the problem?
Again, the government’s response to air pollution caused by traffic (and the health risks this generates) is to end the sale of new diesel and petrol cars and vans by 2040. That’s 22 years away. Assuming that new vehicles purchased in 2040 will have at least ten years further life, that’s another 32 years of traffic pollution!
Pass the parcel
This is a recurring theme. For instance:
- The government says it has given local authorities the lead responsibility for improving health locally. What it doesn’t mention is that it has halved its funding for local authorities since 2010. As a result, 80% of local authorities have reduced their public health budgets in 2018. And there was no mention of public health in the Chancellor’s November 2018 budget.
- The government says more employers should help improve the health of their staff and the nation – but gives no idea as to how they will be incentivized to achieve this.
Not addressing the adverse impact of previous government policies
Many of the government’s health ambitions require the UK to have enough trained and committed health professionals. Yet constant reorganisations of the NHS, public sector pay caps and the unpopular junior doctors’ contract have eroded morale and resulted in recruitment and retention problems. According to the British Medical Association:
- The number of applications to UK medical schools has decreased for three years in a row.
- Applications for the first year of doctors’ training following medical school are also down.
- Only half of doctors completing their first two years of on the job training are now going on to NHS training to become a specialist or GP (down from 71% in 2011).
As already identified, the government is also not facing up to the public health implications of halving its funding to the organisations it has tasked with promoting health locally (i.e. local authorities, to whom the government passed public health responsibility from the NHS in 2013).
Not addressing built in inertia
The government recognises that the NHS has been paying lip service to prevention but not taking it seriously in practice. However, it suggests no practical strategies to change this. For example, there is:
- No mention of any changes to the education and professional development of health professionals to give higher priority to prevention.
- No mention of any changes to health career paths to raise the status of preventative health and encourage more able and committed health professionals to make this their first choice.
- No mention of any changes to the way health funding is allocated by Clinical Commissioning Groups to give higher priority to prevention (a local CCG spends nearly £250 million a year but there is no mention in its Annual Report of how much of this, if any, was spent on preventative health).
In 2019 the government plans to put forward a Green Paper to follow up this initial vision paper. This will be a good opportunity to move from theory to practice, in particular to address the weaknesses we have identified. We very much hope the government will take advantage of this opportunity, so that prevention truly begins to be taken more seriously.
Kayhan Nouri-Aria November 2018
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