Will Spending Cuts Wreck Govt's Health Prevention Strategy?

Peter Russell

November 05, 2018

The Government has set out a vision to put prevention at the heart of its future health strategy for England.

Matt Hancock, the Secretary of State for Health and Social Care, said it did not make sense that the nation spent more than 10 times the amount on treating disease and ill health than preventing it.

He announced a shift in focus to primary and community care services as part of the forthcoming long term plan for the NHS, in order that people could be supported to prevent them becoming ill in the first place.

There would also be plans to reduce health inequalities.

Health experts have welcomed the Government's ambition but have warned that the effects of years of austerity, including large cuts to local authority budgets, will need to be addressed before it can be translated into reality.

An Extra 5 Years

Health improvements over the past few decades have meant that people are 80% less likely to die from cardiovascular disease than they were in 1948, while cancer survival rates have been steadily improving.

However, recent evidence has suggested that in recent years, life expectancy gains have become harder to achieve, while around 20% of people's lives today are spent in poor health, often with comorbidity.

In its document, Prevention is Better Than Cure, the Department of Health said it wanted to improve life expectancy so that, by 2035, people in England could expect at least 5 extra years of healthy, independent life.

In a speech to the International Association of National Public Health Institutes, Mr Hancock said it "sets out how we need a radical shift in how the NHS sees itself, from a hospital service for the ill, to a nationwide service to keep us healthy."

He signalled a shift from the current climate in which £115 billion a year is spent on NHS acute care, compared with only £11 billion on primary care.

Mr Hancock highlighted a combination of genomics and artificial intelligence which had the potential to transform medicine. "In Cambridge, we're at the cusp of sequencing the 100,000th genome, and are now aiming to sequence five million so we can diagnose rare diseases, more quickly and with fewer painful tests for patients," he said.

He continued: "The world-leading Moorfields Eye Hospital is working with the world-leading AI company Deepmind. Their AI system has made the correct diagnosis on over 50 different eye diseases with 94% accuracy – at least matching the best human experts. And that figure is only going to improve."

Taking Personal Responsibility for Health

However, Mr Hancock emphasised the need for a cultural change to ensure that people took more responsibility for their own health. That would include staying active, stopping smoking, drinking less alcohol, and reducing salt intake.

Mr Hancock highlighted new digital technologies coming on-stream that would guide people towards making healthier decisions, combined with greater access to primary care and more 'social prescribing'.

The Government also acknowledged the need to improve homes and neighbourhoods, tackle air pollution, and encourage employers to take more responsibility for the health of their workforce.

The strategies would form the basis of a government Green Paper in 2019.

The Health Secretary said that among the main ambitions and plans would be:

  • Increasing access to specialist mental health services to a further 30,000 women during pregnancy and during the first year after they have given birth, by 2020-21

  • Halving childhood obesity by 2030

  • Reducing loneliness and social isolation, and making social prescribing available in every local area by 2023

  • Diagnosing 75% of cancers at stages 1 and 2 by 2028

  • Sequencing 5 million genomes in 5 years, and offering whole genome sequencing to all serious ill children and those with cancer by 2019, as well as to adults with rare diseases or cancers

  • Widening access to whole genome sequencing to NHS patients from 2019

  • Putting forward by Easter 2019, "realistic but ambitious goals" to reduce salt consumption

A 'Seminal Moment' for Health

Duncan Selbie, chief executive of Public Health England (PHE) described Mr Hancock's strategy as "a seminal moment for the public's health".

He said it was well known that good health underpinned a healthy economy.

"With affluent people enjoying 19 more years in good health than those who are poor, carrying on as before is not an option and good health in a modern, caring nation should not be income dependent," he said in a blog on the PHE website.

Spending Cuts

The Health Foundation think-tank called for clear goals to address the social and economic conditions that affect people's health.

Jo Bibby, its director of health, said: "This vision rightly identifies local authorities as playing a vital role in leading local health improvement. Their ability to deliver on this role, however, has been jeopardised by substantial cuts to local services and investments over the past decade of austerity."

The Foundation highlighted its own analysis that suggested there had been £700 million of real term cuts to the public health grant since 2014-15, while wider local authority budgets had fallen by a third between 2011/12 and 2016/17.

Ms Bibby warned that "if this ambitious prevention vision is to become a reality then it will need to be matched with long-term investment."

The British Medical Association (BMA) said a focus on prevention was a win-win strategy in the impact it would have on population health and the long-term savings to the NHS. However, Dr Peter English, the BMA's public health committee chair, commented: "While the plans outlined in this paper are a welcome step, the government must be realistic about what must be required in order to deliver this.

"There is a need to reverse the cuts to public health budgets, as in many areas, public health services do not adequately meet the health needs of the local population. Reductions to services such as smoking cessation and sexual health in some areas are directly contributing to unacceptable variations in the quality and quantity of care available to the population.

"Making the necessary improvements in areas such as mental health will require significant investment in the workforce."

Patients 'Do Not Deserve Blame'

The Doctors' Association UK (DAUK) said the Government's plans were at odds with last week's budget statement that suggested that there would be more cuts to public health funding.

It said doctors were also concerned that asking people to take more responsibility for their own health would put the blame for diseases such as diabetes, heart disease, and cancer onto patients, who do not choose to develop those illnesses.

Dr Alan Woodall, a GP, and spokesperson for public health at DAUK, said: "Personal responsibility is the main driver for improvement in health. Without funding and policy change to reduce the obesogenic environment, further reduce smoking and drug use, improve social cohesion, and recognise wider political policy impacts on health, this strategy [is] unlikely to succeed."

The Royal College of Paediatrics and Child Health (RCPCH) said tackling child obesity and promoting mental wellbeing were important components of a wide-ranging prevention strategy.

Improving Children's Health and Outcomes

Russell Viner, RCPCH president, said: "Tackling health inequalities too, is essential to ensure that every child has the healthiest possible start in life.

"We know that children born in the most deprived areas of the country are more likely to have negative health outcomes than their more affluent peers, so [the] Government’s vision to narrow the gap between the experiences of the richest and poorest people in society is welcome."

Mr Hancock's priorities were challenged by dentists for missing an opportunity by making only one passing reference to improving oral health in children.

Mick Armstrong, chair of the British Dental Association (BDA), commented: "The Health Secretary says he wants to champion prevention. Sadly he's had more to say about broccoli than wholly preventable oral diseases that are costing our NHS millions.

"When tooth decay remains the number one reason for child hospital admissions, treating dentistry as an afterthought looks more than careless.

"England’s huge oral health inequalities are fuelled by poverty and the lack of a coherent strategy. The starting point for any solution won't be 'Big Data' or Apps, it requires political will from Westminster and an end to year on year cuts."

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