The Government has today announced the creation of the Office for Health Promotion, endorsing a blueprint for the future public health system set out by those at Future Health.

Baroness Dido Harding, executive Chair of Test and Trace and Professor John Newton, Director of Health Improvement at Public Health England were main speakers at a conference last week chaired by Richard Sloggett, Founder and Programme Director of Future Health on the future public health system. The discussions focused on what can be learnt from Covid and how a more resilient public health system can be built for the future.

In the second half of the conference, Richard delivered a keynote speech on how to build back a better public health system. This included a recommendation for a dedicated unit within the Department of Health and Social Care to focus on public health issues, working across Government, NHS and local government to deliver improvements in public health.

The five pillars identified for a stronger system:

Setting a clear ambition for improved health – improving healthy life expectancy by five years by 2035 is a good target for Government to re-double efforts towards

Leadership – Bringing public health responsibilities into the Department of Health and Social Care and building a dedicated team/institute to focus on the issue

Funding – Protecting the public health grant with a triple lock linked to the NHS, GDP or inflation and funding catch-up payments for areas where health inequalities have worsened during the pandemic

Structures – Keeping public health as a local authority commissioned service, and ensuring NHS ICSs put dedicated resource into prevention and into partnership working at ‘place’ level

Data and measurement – Using new opportunities such as the ONS health index and new health data strategy to improve data collection on health outcomes and to measure progress against improvement

The points are summarised by Richard on the Future Health Youtube channel: https://www.youtube.com/watch?v=DMnNSKRLy3U

The full speech is available below.

Westminster Health Forum public health policy conference

25.03.21

Building back a better public health system

 

The scale of the challenge

 

Forty. It is forty years since Sir Douglas Black, author of the Black report said:

 

“Achieving a high standard of health among all its people represents one of the highest of society’s aspirations. Present social inequalities in health in a country with substantial resources like Britain are unacceptable, and deserve so to be declared by every section of public opinion[1]”

 

This statement feels even more salient today.

We know that Covid has had a devastating impact on our nation’s health, exposing our health inequalities.

90% of those who died with Covid had significant prior poor health[i].

The most deprived places had double the Covid mortality rate of the least deprived.[ii]

In 2020 and just before the pandemic struck Sir Michael Marmot returned to his own health inequalities review, 10 years on, to issue a damning statement on England’s faltering healthy life expectancy.

 

Research and analysis conducted by those at the Future Health Research Centre has found that the Government’s ambition of achieving five additional healthy life years by 2035 is way off track.

 

Indeed the studies, done before Covid, show that it would take 33 years or until after 2050 to meet the target for males. For females the target would not be reached until 2085, fifty years after the set date.

 

We know what needs to be done to tackle this.

 

But we struggle to deliver it.

 

Today I briefly want to explore why.

 

And what can be done about it.

 

 

 

 

Getting away from NHS first

It was the great German philosopher Frederick Hegel who said: “The only thing we learn from history is that we learn nothing from history.”

We have an opportunity as we move through and beyond this pandemic to learn something.

The question is do we want to?

The 2015 Spending Review, which saw NHS spending ‘protected’ whilst other areas of public health, social care, capital and workforce were cut back was a major political misjudgment.

 

More money for the NHS is needed against rising demographic and societal needs; but when it is not complemented with adequate investments in those supportive areas it leads to stagnation and decline.

 

We are right to laud the success of our NHS during this pandemic. But our NHS is only a small part of what keeps us healthy and well.

 

We have to begin a revolution in the way we look at our health.

 

It is a revolution that is focused on building healthier and more resilient people, places and communities.

 

This year we face a fork in the road for our health policy.

 

The Government’s multi-year Spending Review will provide a choice.

 

A choice to continue with our NHS first approach or to try something more transformational.

 

The Budget’s lack of voice on health, was a worrying sign that this change will not happen.

 

There will be money for NHS backlogs, some more to keep the social care system afloat and a new institute for health security and more pandemic testing.

 

But the fundamentals of a properly funded public health grant and moves towards a prevention led healthcare system will remain as unfulfilled goals.

 

This will be a wasted chance for change.

It will see health inequalities widen.

It will leave us exposed to future pandemics.

And Building back better needs to mean much more.

 

 

What can be done

 

Over-turning our NHS first orthodoxy for health is of course much easier said than done.

 

A public health led healthcare system won’t just happen. And certainly won’t happen any time soon.

 

But we need to use this window of opportunity to start to make changes.

 

To make a case for health improvement as part of our national renewal.

 

To do this will require building a new consensus.

 

Indeed when one looks at the NHS, one can see a route through.

 

The NHS is no longer a row between privatisation on the one hand and continued nationalisation on the other.

 

Only the very fringes of political debate now advocate for charging or top-ups on the right; or removing private providers on the left.

 

It is after all a Conservative Government that is bringing in reforms to reduce competition and more closely integrate the different parts of the NHS.

 

With moves to abolish Public Health England, the Government is now forced to bring forward a new public health strategy and system.

 

This is the chance to build a new consensus on what needs to happen next.

 

And there are five building blocks that could form this consensus.

 

 

 

First, ambition.

 

We need to set a new national ambition about our nation’s health. Life expectancy has stalled in the last decade and inequalities have widened.

 

The Government should publish a new public health strategy that sets out the path to increasing healthy life expectancy by 5 years by 2035. The plan should form the cornerstone of the response to the Prevention Green Paper from 2019 and set clear and measurable milestones of progress.

 

Second, leadership

 

We need greater political leadership for improved public health. Public health does require strong political oversight and decision making. The decision to decommission Public Health England should see the creation of a new National Institute for Health Improvement within the Department of Health and Social Care.

 

The new institute should have links through joint working agreements and secondments to other Government departments that reflect the cross departmental nature of public health and what works to improve it.

 

Third is funding.

 

The Government should establish a public health grant triple lock to ensure continued investment in the prevention agenda, linking increases in the grant to GDP, the NHS or inflation whichever is greatest.

 

In addition the Treasury should assess the health impacts of all fiscal events, such as budgets and Spending Reviews ensuring that UK Government spending is delivering improved health and wellbeing. Government must also look at the impact of Covid 19 on public health inequalities and consider ‘premium’ or catch up payments for areas where inequalities have risen.

 

Fourth, structures.

 

Local authorities should continue as lead public health commissioners, taking steps to find the right structures to work collaboratively with changing NHS systems.

 

Regional public health leaders should be maintained within NHS regional offices. New NHS Integrated Care Systems should set out how they are ensuring the voice of place in their regional plans and set ambitious targets on health improvement and prevention in priority policy areas.

 

Fifth, data and measurement.

 

The new National Institute for Health Improvement should have stronger working relationships with local authority public health leaders to ensure an acceleration of improvement in public health as a result of increased funding. New population health data captured through NHS and public health outcomes frameworks, underpinned by the new NHS data strategy and the ONS health index should be used to improve performance and outcomes.

 

For too long public health has been the forgotten part of our healthcare system.

 

Covid has been devastating.

 

We need to build back better.

 

For public health we need a revolution.

 

Building a new consensus and starting the journey are more important than ever.

 

Will we learn from Covid?

 

We are about to find out.

 

Thank you

 

 

 

[1] https://www.sochealth.co.uk/national-health-service/public-health-and-wellbeing/poverty-and-inequality/the-black-report-1980/introduction-inequalities-and-health/

 

[i] Data from hospital-based deaths recorded in the Covid-19 Patient Notification System within 28 days of a positive Covid-19 test, in England from March 2020 to January 2021. Data on people with significant prior health conditions as at 01.01.2020, from NHSEI Bridges to Health National Segmentation Dataset.

[ii] Deaths involving COVID-19 by local area and socioeconomic deprivation – Office for National Statistics. Ons.gov.uk. 2021. https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsinvolvingCovid19bylocalareasanddeprivation/deathsoccurringbetween1marchand31may2020 (accessed 3 March 2021).