7The role of the NHS in public health
Summary
141.Although public health teams have moved from the NHS to local authorities, the NHS—both its commissioning organisations and providing organisations—still has a major role to play in the delivery of improved public health. For CCGs, this role might involve planning services to ensure they meet local health needs, and redesigning service specifications to ensure vulnerable sub-groups within that population are able to access services. Within NHS organisations it can include getting health professionals actively involved in promoting healthier lifestyles to the patients they see for other reasons—the Making Every Contact Count initiative is an example—as well as wider initiatives to promote health amongst NHS staff, and the communities they serve.
142.Public health professionals working in provider organisations attended the Committee’s roundtable, and were unanimously of the view that the NHS was not doing enough in this area:
![The NHS is a huge organisation and it has got off lightly a little bit, in relation to the preventative agenda in the past few years. I would like to see a prevention and public health strategy being something that all big trusts have to undertake. With a little bit of specialist public health input, that could make a huge difference.
[Medical director, mental health and community trust, informal session]](IDExport-web-resources/image/78.png)
143.Eugene Milne, DPH in Newcastle, put it in similarly strong terms:
![One great difficulty we see at the moment is the sense that prevention is no longer the responsibility of people practicing in the NHS. I know that is not universal, but it is an issue for us. Although the Five Year Forward View makes some real commitments in the direction of secondary prevention, it is not strongly
carried through into the guidance that is being put into place now. My feeling is that there is an awful lot of perception across public health practitioners generally that, for example, “Tobacco is no longer our problem, it is in the local authority now and we do not need to do that”. We need to emphasise the necessity for people in the NHS to continue to be active players in prevention with us.
[Dr Eugene Milne, Director of Public Health, Newcastle City Council, Q125]](IDExport-web-resources/image/79.png)
144.The NHS must get involved in the prevention agenda “to a much greater extent than they are at the moment…if it is going to get anywhere near to dealing with the financial challenge is has in the next few years…”78
145.Health Education England described work that it was doing to support the ‘Making Every Contact Count’ initiative by providing information and training to health professionals. This initiative is designed to encourage all health professionals to see health promotion and prevention as part of their everyday work.
146.As well as the potential for NHS staff to improve the health of their patients, the NHS is a major employer and as such has the potential to improve the health of its own staff, as Simon Stevens described:
![The NHS as an employer, as the biggest employer in Europe, has a responsibility to put our own house in order when it comes to workplace health, which traditionally we have not done. This year,which we are now in, we have the world’s biggest incentive programme for employee health in our
health system, with up to £450 million of incentives tied to improving workplace health for nurses, therapists, ancillary workers and others across the NHS.
[Simon Stevens, CEO, NHS, Q390]](IDExport-web-resources/image/80.png)
147.However, despite these positive initiatives, we felt that in evidence to us, Simon Stevens and other senior leaders placed insufficient emphasis on the role that the NHS itself must play in public health, and we are concerned about how this may play out in practice. When we asked whether NHS trusts should have a strategy committing them to pursue the public health agenda, rather than viewing it as no longer their business, Simon Stevens agreed:
![Simon Stevens: Yes; I absolutely agree that it continues to be their business, and if you think about what we are doing, as Duncan said earlier, through the local implementation process for the Five Year Forward View, we are focusing, in all 44 of the communities that have come together in England to do
this, on the health and wellbeing gap as well as the care and quality gap, and the financial sustainability and efficiency challenge.
[Simon Stevens, CEO, NHS, Q390]](IDExport-web-resources/image/81.png)
148.Sustainability and Transformation Plans may be a potential mechanism to lock public health targets into the delivery of improvements to local health systems, and guidance has been issued to local areas highlighting the need to factor public health into their plans. However with plans only just being finalised, it is too early to say whether this guidance has been built into plans effectively. We have a concern that of the three gaps referred to by PHE in its evidence to us—the health gap, the efficiency gap, and the care gap—the health gap risks being marginalised by the focus on the efficiency and care gaps. While the new STPs being planned have prevention as a central part of their remit, the focus at present is largely appears to centre on the issues of funding and the deficits in the social care sector arising from public spending cuts in local authority budgets.
149.Simon Stevens and Duncan Selbie told the Committee that it was a positive development that some NHS Trusts now employ their own directors of public health. However, the evidence we received from people in these positions was that not enough is being done to embed public health across the NHS as a whole.
Conclusions and recommendations
150.We were concerned to hear that despite the importance attached to prevention and public health in the NHS 5 Year Forward View, following the move of public health to local authorities, there is a growing sense that prevention is no longer the responsibility of people practising in the NHS. We heard this view from public health specialists working both in local authorities and in the NHS. This issue must be addressed urgently.
151.We have recommended that the Government should set out clear, measurable milestones of what it expects public health spending to achieve, and by when. Locally, this needs to be underpinned by clear information for the public on the actions local authorities are taking to improve public health, underpinned by a benchmarking framework that allows for informed comparison and challenge. The system of enhanced public health accountability must be extended into the NHS, forming part of a broader national strategy to systematically and demonstrably implement the radical upgrade in public health called for in the Five Year Forward View.
152.The NHS has an important role to play in prevention, and developing the skills of its workforce to deliver preventative advice as part of routine care is central to that. We will follow up progress on this issue when we next review the public health system.
78 Q144
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30 August 2016