Better Health For All

It’s been a little over a month since we published our first discussion paper on prevention in the NHS. If you’re one of the many people who have responded to our request for feedback – thank you! We’re very grateful to all of our members and others who have taken the time to answer the questions we pose in the paper and send us their general reflections and thoughts.  

While the feedback has touched on a variety of topics, a good portion of it has focused on what is helping NHS staff and organisations do more prevention or what is getting in their way. It’s pretty clear from the combined feedback that our work needs to not only look at the ‘what’ of delivery, but – and perhaps more importantly – it needs to examine the ‘how’ of delivery.  

Our evidence review into prevention in the NHS identified 15 enablers and over 30 barriers to delivering prevention regardless of the sector in which programmes were implemented or the exact type of programme. Below we pull out some of the key ones that FPH members have told us helps or hinders their work.  

Enablers of good prevention delivery 

1. Good partnership working – We received a lot of feedback about the importance of partnership working to deliver effective prevention and the role that the NHS can play as a partner to others in the community, voluntary, commercial, or statutory sectors and that more should be done to facilitate this type of working. Several people highlighted that within Scotland, the advent of Health and Social Care Partnerships has moved many prevention programmes to a shared responsibility and suggested there was learning from those partnership successes that needed to be explored further.  
2. Using a targeted approach – Having a systematic and individually tailored process for prevention works much better than impersonal messages. Targeting sub-groups with specific needs and ensuring that the initial approach is made by a familiar face can also help. This can be something as simple as ensuring prevention advice is delivered by someone with an established relationship with the patient. Tools like the Heart Age Test where advice is more personalised also seem to work better than generic healthy living campaigns. 
3. Content, access, and location – Making prevention accessible in terms of location, the use of non-technical language, and the use of technology improves uptake and delivery. We heard it’s important to ‘go where people are’ and always seek to address the individual holistically. This is especially important to bear in mind as a lot of prevention programmes exacerbate health inequalities because they are inaccessible to more disadvantaged groups. For example, we heard about Drug and Alcohol Services providing seasonal influenza vaccinations to heroin-dependent service users as part of their routine services – this proved successful in vaccinating a group of people who were considered hard to reach with traditional influenza vaccination programmes.  

Barriers to good prevention delivery 

1. Lack of clarity about who is responsible for prevention – This is a key piece of feedback we’ve heard throughout this project: ‘If prevention is everybody’s business it’s often usually nobody’s job.’ This lack of clarity can often mean that prevention is not integrated fully into core services. This is exacerbated we heard by a lack of clarity around governance for prevention.  
2. A lack of funding – We heard that although funding is not the silver bullet for prevention delivery challenges, many agreed that current remuneration models and a lack of financial resources allocated to prevention were significant barriers to doing more prevention.   
3. Complexity and co-morbidity – Around 25% of us have two or more long-term conditions. This has been flagged as a key implementation issue when it comes to prevention programmes. We’ve been challenged to consider which condition the health and public health system should look to address first in order to ‘unlock’ the most improvements for people with co-morbidities.

We’d love to hear from you 

If you recognise some of these challenges or have examples of some of the enablers in action that you’d be willing to share, please email us at policy@fph.org.uk. Thank you for your feedback so far, it has really helped to shape and progress this work and as always please stay tuned to this blog for further updates.  

Written by Ahmed Razavi, Specialty Registrar in Public Health and member of FPH’s Public Health Funding Project Group.