The NHS has published its Long Term Plan (LTP) hailing prevention as a way to save 500,000 lives over the next 10 years. Public Health England’s chief executive Duncan Selbie discusses this new focus for the NHS and reflects on how it delivers on the top asks of the prevention work stream, co-chaired by PHE and NHS leaders.
This new LTP for the NHS marks a turning point in how we provide healthcare across England. It is a change welcomed by PHE, and we look forward to working with NHS England, NHS Improvement and local government to implement it.
For years we have known that we should be moving away from a system that prioritises treatment, to one that can also predict and prevent poor health.
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. We also want to ensure that those people with the worst health outcomes get the support they need to have a better quality of life.
A stronger commitment to tackle smoking
We called for the NHS to be a more powerful driving force in the battle against smoking and the NHS has committed to embedding the Ottawa Model for smoking cessation. This means everyone admitted to hospital who smokes will be offered help and support to quit.
This offer will be adapted for expectant mothers and their partners, so families can kick the habit together, meaning the chances of still birth, miscarriage and sudden infant death will be reduced.
Given that smoking remains England’s biggest killer, ending the life of 200 people every day, this was our biggest ask.
Focused support for alcohol dependent people
We also suggested Alcohol Care Teams (ACT) be established in those hospitals with the highest rate of alcohol dependence-related admissions.
Alcohol-related harm is estimated to cost the NHS in England £3.5 billion every year. ACTs in Bolton, Salford, Nottingham, Liverpool, London and Portsmouth have already seen a reduction in A&E attendances and readmissions.
Now, as part of the LTP, expert ACTs will work in up to 50 hospitals to provide access to medical care within 24 hours and could prevent 50,000 admissions over the next five years.
Helping more people avoid type 2 diabetes
Another obvious priority for the NHS LTP was obesity and type 2 diabetes. We highlighted the opportunity to expand the National Diabetes Prevention Programme (NDPP) to identify and help more people who are on the cusp of developing diabetes, keeping them in better health for longer.
The LTP has committed to doubling the NDPP over the next five years. A new digital option will help to tackle inequalities and widen patient choice, so those who cannot attend classes in person can still access the support they need.
NHS England and NHS Improvement have also outlined the steps they will take to provide targeted weight management support to those who need it most. People who are obese and have type 2 diabetes or high blood pressure will gain better access to appropriate services, which could have a significant impact on improving health.
Working with local government
Prevention is always underfunded when compared to treatment. The actions laid out in the LTP will go towards redressing the balance. However, as the plan says, good health is about more than healthcare alone.
Wider determinants, including income, are even more important because to stay healthy people need homes, good jobs and friends, and an environment that makes healthy choices possible.
Therefore, it is vital for the NHS, with its new focus on prevention, to work alongside an adequately funded and appropriately resourced local government.
The LTP has asked whether there is a stronger role for the NHS to play in commissioning some of the services currently led by local government. The rationale for local government to lead on public health remains unchanged, but this joint review between the NHS and local government will ensure that we have the best possible join-up between them, with no predetermined outcome. Local authority directors of public health will bring invaluable expertise and insight to this.
The opportunity that we have now as a public health family is to recognise the opportunities the NHS LTP offers and work alongside each other to maximise its positive impact.