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‘Prevention better than cure’ vision to add five healthy years to lifespan by 2035

Government sets out its stall on ‘health in all policies’ approach

Caroline White

Monday, 05 November 2018

The prevention of ill health is set to become an integral part of policy across all government departments, in a bid to meet the Ageing Society Grand Challenge Mission, set out by the prime minister earlier this year, and to make ‘prevention is better than cure’ a reality in all parts of the country.

How the government plans to achieve the Mission, which aims to ensure that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest sectors of society, is set out in a vision document* published today.

It will be followed up with a green paper, fleshing out the government’s plans in more detail, and considering the best available evidence of what a 'health in all policies' approach could look like, in the first half of next year.

“When I became secretary of state for health and social care, I made prevention one of my early priorities for the NHS and social care. We cannot continue to invest in the same service models of the past. We will not meet our mission with 'business as usual',” explains health and social care secretary Matt Hancock in the foreword to the document.

“This vision sets out that greater focus, and spending, is needed on prevention, not just cure. With an ageing society and people living with multiple complex conditions it is imperative that this rebalancing happens - to keeping people well, living in the community, and out of hospital for longer,” he writes.

“This means services which target the root causes of poor health and promote the health of the whole individual, not just treating single acute illnesses. In practice this requires greater funding for pre-primary, primary and community care - and support for the staff who work in these services.”

But everyone has a part to play, he insists.

“This includes recognising the responsibilities of individuals and families in reducing the chances of becoming unwell in the first place, but also how the wider environment we live in determines our health.

“Right across government, I want us to be working with all those who have a role in influencing health: communities, employers, industry, local government, housing, schools and charities.”

Among some of the initiatives mooted in the document are better information sharing, collaboration and shared decision-making across health, social care and wider public services, and using the NHS’s influence and financial clout to tackle air pollution.

Public Health England will also bring together a range of experts to model predictive prevention at scale for initiatives that can be rapidly implemented, and a cross-government School Sport and Activity Action Plan, to cut childhood obesity levels and improve children’s mental health and wellbeing, will be published next March.

The home office will pilot a scheme working with Royal Mail, private enterprise, local authorities and the local voluntary sector, to help identify and support older people who are lonely.

And to boost the retention of experienced GPs, the NHS Pension Scheme has agreed to cover all pension tax charges, including those arising from the tapered annual allowance. This means that, rather than paying upfront, GPs can deduct it (plus interest) from the value of their pension when they retire. These new arrangements will be available from the 2017-18 tax year.

Niall Dickson, chief executive of the NHS Confederation, commented: "This is great leadership from the secretary of state. If backed by action and resources this could be a seminal moment.”

But he cautioned: "We need a new mind set which does not necessarily expect payback immediately,” adding: "Of course, we have been here before and the recent record of cutting public health spending must now be reversed. It’s time for real intent around prevention and an acceptance that if we are going to make this a priority, it will mean tough choices about how health money is spent."

British Medical Aassociation public health committee chair, Dr Peter English, agreed: “While the plans outlined in this paper are a welcome step, the government must be realistic about what must be required in order to deliver this.

“There is a need to reserve the cuts to public health budgets, as in many areas, public health services do not adequately meet the health needs of the local population. Reductions to services such as smoking cessation and sexual health in some areas are directly contributing to unacceptable variations in the quality and quantity of care available to the population.”

He continued: “Making the necessary improvements in areas such as mental health will require significant investment in the workforce.

“Prevention is a win-win both in the obvious impact it has on the health of the population and its cost effectiveness in reducing future demand on NHS services. The government has a duty to deliver on this.”

*Prevention is better than cure Our vision to help you live well for longer. Prepared by the Department of Health and Social Care, 5 November 2018.

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