Better Health For All

This is the second in a two-part blog that lays out our thoughts on the recently-published #NHSLongTermPlan, and where the NHS could focus its prevention efforts. If you haven’t read the first part yet, click here to read it.

So to the assessment of how well the NHS Long Term Plan measures up against the latter six of 11 priorities. (The first five priorities were discussed here.) Like many assessments in blogs it is subjective (sorry) so please do let me know your own thoughts via policy@fph.org.uk.

6. NHS staff health and wellbeing

While noting that the NHS recently published the NHS Health and Wellbeing Framework, the Plan goes further by committing to “make the NHS a consistently great place to work” including the redoubling of efforts to address discrimination, violence, bullying and harassment. However, much of the detail is still to be set out in a workforce implementation plan to be published “later in 2019” with a new Chief People Officer leading the work. We hope the implementation plan not only talks about how it will improve the health and wellbeing of NHS staff but about how those 1.4 million people can model and champion healthy behaviours within their local communities.

Verdict: wait and see what the implementation plan contains.

7. Mental health and wellbeing

The Plan makes a renewed commitment that mental health services will grow faster than the overall NHS budget, with funding for children and young people’s mental health services growing faster still. This investment will enable further service expansion and faster access to community and crisis mental health services for both adults and particularly children and young people. We welcome the commitment for NHS-funded Mental Health Support Teams in schools and colleges but there’s still much more to do to encourage better mental health and wellbeing at a population level.

Verdict: clear and very welcome commitment to improving mental health services but more to do on the public mental health side.

8. Smoking

The Plan makes clear that smoking still accounts for more years of life lost than any other modifiable risk factor. It commits the NHS to ‘a significant new contribution’ to making England a smoke-free society with new support targeted at in-patients who smoke, expectant mothers, and their partners, who smoke and smokers using specialist mental health services or learning disability services. The change in tone in how the NHS should treat people who smoke is also welcome. Smoking isn’t a lifestyle choice. It is a dangerous addiction that not only kills but significantly impacts on the health and wellbeing of friends, family, colleagues and neighbours. Importantly, the Plan also states that funding and availability of smoking cessation services (and drug and alcohol services, sexual health, and early years support for children) in local government will directly affect demand for NHS services. That’s a pretty clear, if diplomatic, way of saying to the Treasury that the NHS would like to see more money going into local government public health services in the Spending Review.

Verdict: well done NHS!

9. Alcohol

The Plan identifies alcohol as a key priority for its NHS prevention programme and commits to ensuring that, over the next five years, those hospitals with the highest rates of alcohol dependence-related admissions will be supported to fully establish Alcohol Care Teams. As outlined above, the Plan also makes the case – in diplomatic tones – for more funding for alcohol services in local government. One of the key questions is whether the NHS needs to play a bigger role in encouraging behavioural change across the whole patient population, across the national population, and be more vocal in calling for national policy reform. For example, should the Plan have mentioned MUP?

Verdict: a focus on the ‘crisis’ end of alcohol treatment but more to do when it comes to establishing healthier relationships with alcohol amongst the wider patient and national populations.

10. Early years

The Plan commits the NHS to playing a crucial role in improving the health of children and young people while making clear that better healthcare can never compensate for the health impact of wider social and economic influences on children’s and young people’s health. There are a number of ‘public health’ commitments including the roll out and expansion of the Saving Babies Lives Care Bundle (SBLCB), reducing smoking rates during pregnancy, better access to mental health services, improving breast-feeding rates and childhood immunisation. But having highlighted the wide range of social and economic influences on children’s health, it is questionable whether the Plan does enough to integrate the NHS effort with these wider forces or to recognise the urgency and scale of the health challenge.

One of the more controversial aspects of the Plan was the announcement that the NHS would consider whether there is a stronger role for the NHS in commissioning health visitors and school nurses. The response from the public health community has been pretty universal. The issue is not about the quality of local government commissioning but simply the lack of funding.

Verdict: positive but more needed and the commissioning proposal sent the wrong signal, no doubt unintentionally, to the public health community.

11. Health promotion

The Plan highlights that every 24 hours the NHS comes into contact with over a million people at teachable moments in their lives. It sets out practical action to do more to use these contacts as positive opportunities to help people improve their health. For example, one of the ways set out in the Plan is a commitment to ensure staff on the frontline feel equipped to talk to patients about nutrition and achieving a healthy weight.

The commitment to do more to support secondary prevention is very welcome. The diplomatic call for more funding for the local authority public health grant as part of the Spending Review is also greatly appreciated. The NHS desire to draw a distinction between the role of the NHS vs the government, NHS England vs Public Health England, and the NHS vs local authorities is also completely understandable.

However, the scale of the prevention challenge, and the importance of the NHS as an ‘anchor institution’, means that the NHS can’t not play a clear leadership role in promoting and championing good mental and physical health in local communities and at national level.  The Plan’s commitment to work in partnership with the Health Foundation to identify and encourage the take-up of good practice in local areas across the country is welcome but the scope of the ambition feels limited (at least at this stage) for a ten-year, transformative plan.

A month after the Plan was launched, NHS England has been willing to make the case in public for greater social media regulation to protect the public’s health.  In some ways this makes it even more curious that it did not use the opportunity of the Plan itself to actively champion reform of key public health policies – particularly those policies directly related to the key risk factors identified in the Global Burden of Disease study.

Verdict: very welcome commitments but the NHS needs to play an even more significant role in championing action to keep people happy and healthy.

Verdict overall: the NHS Long Term Plan puts tackling health inequalities at its heart and for that alone it needs to be loudly applauded. But alongside this landmark commitment there are a host of other very positive and welcome proposals. What’s needed now is an even greater shared commitment from the NHS and the public health community to collaborate and co-create the specifics of how to narrow health inequalities and shift the NHS’s balance still further from curing illness to preventing it. If the Long Term Plan ends up being the ‘NHS’s plan’ and the forthcoming Prevention Green Paper becomes the ‘local authorities’ plan’ then we may well look back at 2019 as an opportunity missed.

If you haven’t already, please read the first part of my blog by clicking here and also consider sharing your thoughts via email: policy@fph.org.uk.

Written by Gus Baldwin, Director of Policy and Communications, FPH. You can follow Gus on Twitter @Gus_Baldwin.