Today we’ve published FPH’s first major contribution to the national discussion about the role of the NHS in prevention.
Our discussion paper – the first of three we’ll be publishing – reflects many months of thinking and engagement with key NHS and public health stakeholders and the conclusions of an evidence review of prevention initiatives in the NHS.
It is also the first major ‘output’ from our Role of the NHS in Prevention project, which has been funded via an award from the Health Foundation.
We explore three main themes in the discussion paper:
1. What does the evidence tell us about what works?
We’ve discovered that there is lots of good evidence about what helps or hinders prevention in the NHS. But there are still far too many evidence gaps and there’s a very long way to go to make the evidence we do have as useful as possible for NHS leaders, local commissioners and providers. In the meantime they are all having to make ‘best guess’ decisions about which NHS prevention initiatives are likely to provide the most ‘bang for buck’ in their local area.
2. What are the different roles the NHS plays in support of the prevention agenda?
We heard that although NHS organisations are doing a lot of prevention, there is a sense that the NHS responsibility for and capacity to do prevention is poorly defined and poorly understood. This confusion can sometimes impact on service delivery. Based on our evidence-gathering about what prevention in the NHS currently looks like, we’ve come up with five descriptors that we think do a good job of summarising distinct NHS prevention activity:
i. Leader – e.g. commissioning services, providing governance and management, setting the national agenda, role-modelling.
ii. Partner – e.g. providing services, hosting services, working in collaboration to deliver services with local authority, statutory, or other voluntary sector entities.
iii. Employer – e.g. initiatives aimed at improving NHS staff health and wellbeing; NHS as a community employer and ‘anchor institution.’
iv. Advocate – e.g. lobbying governments on public health agenda, lobbying for prevention within individual institutions.
v. Researcher – e.g. funder and driver of new research.
It’s important to stress that we know these categories often overlap and are imperfect descriptors of a diverse range of activity. We’ll be looking to refine these as the project continues.
3. Where should the NHS focus its prevention efforts, now and in the future? In October FPH held our first NHS prevention stakeholder workshop. Over 40 healthcare leaders from across the UK came together to share their knowledge and ideas. Our discussion document sets out a shortlist of 11 prevention interventions that they said should be the focus of the NHS’s prevention efforts. But the majority of experts agreed that a collection of individual interventions alone will not deliver the kind of change we need to support the long-term sustainability of the NHS. A systems approach was identified as a crucial way of achieving change at a population level. We think the NHS should focus some of its effort towards this longer-term goal without losing sight of the fact that delivering more cost-effective prevention interventions could still be very impactful now if implemented in a place-based way and integrated into regular services.
As we set out the themes we will be exploring in more detail in future discussion papers, what’s already clear is that ill-health prevention is a significantly under-exploited way for the NHS to keep people healthy and better manage demand on services. The forthcoming NHS England long-term plan and the UK Government’s prevention green paper offer ‘once-in-a-generation’ opportunities to further promote prevention and make the step-changes we need to integrate prevention into the day-job of every healthcare professional. We hope these opportunities will be grabbed with both hands.
The whole point of a discussion document is to encourage more people to build on the ideas we’ve set out, to challenge them (please be nice!), and to inspire new thinking. We would be very interested to hear your comments and answers to the various questions we pose. You can do this in three ways:
- By tweeting us @FPH
- By emailing us via policy@fph.org.uk
- If you’re an FPH member, by joining our Public Health Funding Campaign ‘sounding board’ and getting involved in the further development of our thinking. Email policy@fph.org.uk to find out more
The final thing to say is a huge thank you to everyone who has contributed to the Public Health Funding project so far. We are extremely grateful for all your help and please do continue to get involved. Click here to read the discussion paper.
Written by Ahmed Razavi, Specialty Registrar in Public Health and member of FPH’s Public Health Funding Project Group, and Lisa Plotkin, Senior Policy Officer and FPH’s Public Health Funding Project Group Lead.
The Faculty of Public Health needs to urgently increase its collaboration with leaders in General Practice in particular, but also leaders in acute care services. With the massively increased pressures on general practice over the last decade or so, GPs seem to be shying away from their role in prevention. They hold a key position in the potential for effective preventative interventions. General practice needs to be enabled to work with public health on the prevention agenda.