Better Health For All

As part of FPH’s Public Health Funding campaign, I’ve been leading a Health Foundation funded programme of work examining the role that the NHS plays in prevention now and exploring where the NHS could add the most value in system wide prevention activity in the future. Our project began in July and I’m really pleased to now share with you some of our findings so far.

In order to better understand the current state of play, FPH commissioned an evidence review to examine three key questions:

• What are the main types of prevention work researched in various NHS settings?
• What are the benefits of prevention programmes in the NHS?
• What helps and hinders prevention in the NHS?

For any public health professional or policy-maker, this review is a must-read, neatly summarising on-going activity from over 400 studies, sharing learning about the incredible variety of NHS-led prevention work occurring in communities, primary care, and hospitals and distilling organisational and system wide enablers to the delivery of effective prevention work.

It’s great to see such a wide range of effective, NHS-led and delivered prevention work. I won’t go into all of the findings in the review in this blog because there are simply too many, but I thought I would share with you some of the key themes that resonated with me:

1. Prevention is better than cure. The National Institute for Health and Care Excellence (NICE) use cost-effectiveness to determine which medical treatments to fund. A large amount of preventative interventions meet these thresholds but we do not necessarily invest in them. If we want the NHS to promote wellbeing rather than fire-fighting against ill-health we need to invest in prevention.

2. Prevention only works when you have staff and public buy-in. Training staff in prevention is effective so why not make it part of every healthcare professional’s education? I wish I had given prevention advice to every patient I saw with the same emphasis I placed on ensuring I knew about their drug allergies. Programmes such as Making Every Contact Count are a step toward this and neatly avoid becoming tick-box exercises by getting staff buy-in. Without us educating frontline staff and the general public about the need for preventative action and personalising the advice given to make it relevant to them, our well-meaning advice has been found to fall on deaf ears. It must also be noted that many current preventative approaches are not involving hard to reach groups, which contributes to a widening of health inequalities. This shows we still have some way to go to make prevention in NHS settings work for everyone and also raises some questions about our understanding of ‘what works.’ Does an intervention ‘work’ if it contributes to health inequalities?

3. There is a lack of mental health prevention activity. There is a huge opportunity to really make a difference if we can invest in mental health prevention. 1 in 5 people have suffered from anxiety or depression in the past year so giving people the tools they need to deal with these conditions may increase their resilience and wellbeing. As we saw from the response to my last blog, mental health professionals including the previous National Medical Director for Mental Health want to make prevention a priority, but they need resources to make this a reality.

4. The NHS should concentrate on strengthening community partnerships and integrating prevention into core services. Recurring barriers to successful prevention interventions were: a lack of integration into core services, lack of infrastructure to support prevention and cross-sector communication. The NHS actually does a lot of community preventative work including NHS Health Checks and the NHS Diabetes Prevention Programme. Though health professional opinion may be split on these programmes I would argue that it is how best to implement these programmes and make them successful that we should be working on. My own work in evaluating NHS Health Checks for Hertfordshire County Council highlighted that the NHS Health Check is great at diagnosing patients but not so good at delivering lifestyle changes and the published evidence corroborates this. We need to work with healthcare leaders to get staff and organisational buy-in to delivering such interventions in an integrated and collaborative way.

To read the full review click here.

We have recently shared this review with healthcare leaders who attended our 8 October workshop on the role of the NHS in prevention at the Health Foundation and we discussed their thoughts on our findings. We are now writing up a discussion paper from that workshop and look forward to sharing it with you soon.

Please stay tuned to the FPH blog and follow @FPH on Twitter to hear more about our progress. If you wish to comment, contribute, or donate to the campaign please contact policy@fph.org.uk or visit the public health funding page of the FPH website by clicking here.

Written by Ahmed Razavi, Specialty Registrar in Public Health