Moving on from Darzi’s diagnosis

Earlier this month, Lord Darzi published his independent investigation of the NHS in England. It confirmed what many of us interested in health care policy have been saying for decades: the NHS delivery model has simply not kept up with epidemiological shifts that mean the vast majority of ill health is now caused by mostly avoidable factors.

Darzi’s diagnosis was bleak. Now, the pathway to recovery needs to be mapped out and implemented and, although the report mainly focusses on the role of the NHS, it included a clear call for more to be done to support people in the community, as well as to prevent people from ever needing treatment.

Shifting from hospital to community, and from sickness to prevention are two of the three ‘big shifts’ announced in response to the report, and we heard again this week from the Secretary of State in his party conference speech about the need to build a healthier society.

The importance of these primary and secondary prevention methods must not be underestimated, and the recognition that the answer does not solely lie with the NHS is very welcome. In fact, 80% of health is determined by factors other than health care, so we need to create an environment where the building blocks of good health like good education and jobs, access to healthy food and drink, and access to open spaces and affordable leisure options are available for everyone.

The NHS is not – and should not be – held responsible for these wider determinants of health. It is essential therefore that any ‘major surgery’ the Government plans to perform looks beyond the NHS, and that the role that Directors of Public Health (DsPH) and their teams have in promoting and protecting health and wellbeing at a local level is given sufficient weight.

As we outlined in our manifesto for a healthier nation, a cross-government approach is absolutely critical – every department has responsibilities for things that have an impact on our health. It doesn’t just stop there though, local government too has responsibilities for factors which impact our health, as do businesses, schools, universities, communities, and families.

There is of course significant cross over between Labour’s five missions – in order to kickstart economic growth, we need to address the soaring rates of people unemployed as a result of ill health. To do that, we need to create opportunities for good work for all. To do that, we must address the inequality our children and young people face in education. We also need to improve our health and social care system. To help with those missions, we need to cut down on the number of people needing treatment for avoidable conditions, including that caused by violent crime. Meanwhile, cutting our carbon footprint and addressing climate change will also have a huge beneficial impact on health, both in the short and long-term, contributing further to all the other missions.

What these ambitious missions need is the political leadership and managerial structure to bring them all together to be able to deliver a coherent, consistent and effective set of strategies that really work.

Part of doing that also involves imposing a set of tests for any policy – will it positively or negatively impact people’s health? Will it help to close the gap in health outcomes? What are the trade-offs and compromises being made?

While this may feel quite radical at national level, at a local level, a lot of this work is already being done. We have health and wellbeing boards in England that provide a forum for DsPH and other local leaders to work together to improve the health and wellbeing of their communities, and in Scotland, the Care and Wellbeing Portfolio Board provides cross-government oversight to the delivery of care and wellbeing. Meanwhile in Wales, the Wellbeing of Future Generations Act requires all public bodies to consider the long-term impact of their decisions on health.

It is really important then not to reinvent the wheel. Duplication of roles should be avoided and – and the public health profession does this well – we need to learn lessons from where these partnerships and strategies are working well (and not so well) to make sure we can replicate good practice efficiently and effectively across the whole country.

However, in order for local partnerships to be able to implement effective strategies that will keep people well, more should be done to resource existing public health networks. Only by bolstering this preventative arm of our health and social care service can our communities become more able to support people and prevent such high levels of demand for NHS treatment.

As Darzi notes in his report, the public health grant, which funds a whole raft of public health measures that help prevent ill health, has been subject to consistent real-terms cuts for nearly a decade. These cuts must be reversed as a matter of urgency.

As the Government moves forward in shaping its plans, ADPH will continue to make the case for a health in all policies approach and provide the local public health perspective. Only by working together, across all political parties and sectors, can we meet the Government’s very necessary target of shifting from treatment to prevention, and supporting people to live healthier lives for longer.