Better Health For All

Earlier this month we held our second of three planned half-day workshops examining the role of the NHS in prevention. Building on the findings from our first workshop, this session brought together experts from Public Health England, NHS England’s strategy and innovation directorate, commissioning groups, local authorities, and NHS trusts. Having such expertise in the room contributed to a thoughtful, sometimes provocative, and constructive discussion on NHS prevention. 

We gave attendees a sneak preview of some findings from our recent polling of NHS leaders about prevention and asked attendees for their initial analysis about what we found. We polled NHS leaders about a wide range of prevention aspects, including: their prevention priorities now and for the future, how much they spend on prevention versus how much they would ideally like to spend on prevention, and the barriers they encounter when their teams try to ‘do’ prevention. 

We’re really excited about sharing the findings with you in the next few weeks and hope they will illuminate how NHS leaders see prevention and its importance to their work, along with how they think prevention should be delivered. It was heartening to see the priority given to prevention by NHS leaders outside of public health and this underscored the recognition that preventing ill-health is key to a sustainable NHS.  

FPH’s response to the NHS Long Term Plan was also outlined with a special emphasis on how FPH can contribute to its implementation. I’ll just touch on one of the topics discussed here. Workforce development is one of FPH’s core functions. Through this project, we’ve been hearing that public health input into acute settings varies widely from locality to locality and this has been identified as a critical gap in registrar training. Crucially, we heard, this is not just about FPH trying to increase the footprint of the core public health workforce – although that would be welcome. It’s also about ensuring that clinicians in other specialties, such as general practice and paediatrics, have the public health skills they need to help deliver the prevention agenda.  

The workshop also had a particular focus on untangling some of the thorniest governance challenges NHS organisations face when trying to integrate prevention into ‘business as usual’. We heard in our first workshop that getting the governance for prevention interventions right should be an immediate priority for any NHS organisation seeking to take a systems approach to prevention delivery. Subsequent feedback from FPH members – along with a survey of the healthcare public health workforce – has revealed that ‘governance issues’ are a top barrier to prevention.  

Good governance matters because it leads to more efficient use of public health spending. Making the healthcare system accountable for the health of their local population instead of dealing with disease as and when it arises would help refocus the healthcare system around preventing ill-health from happening in the first place. At our workshop we heard from the team in the East Midlands leading some of the investigative work into what makes the ‘governance machinery’ of the NHS function better for prevention and discussed collaboratively some of the governance challenges teams are facing and the solutions they are looking to implement.  

We will be exploring these topics further, including the opinion polling findings, in a discussion paper due to be published in the next few weeks. Your feedback and comments are what help us shape this work and – as always – we hope you will take a moment to get in touch and let us know what you think. Thank you so much in advance.  

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