Fast track plan to get Britain healthy

A radical plan to go further and faster in tackling today’s causes of premature death and illness and reduce health inequalities, with a public health service to make it happen, was unveiled today by health secretary, Andrew Lansley.

Public Health England will be created as a service that gives more power to local people over their health, while keeping a firm national grip on crucial population-wide issues such as flu pandemics.

The White Paper, Healthy Lives, Healthy People also sets out how funding from the overall NHS budget will be ring-fenced for spending on public health – a recognition that prevention is better than cure.

Early estimates suggest that current spend on areas that are likely to be the responsibility of Public Health England could be in the range of £4 billion.

For the first time in a generation, central government will not hold all the purse strings.

The majority of public health services will be commissioned by local authorities from their ring-fenced budget, or by the NHS, all funded from Public Health England’s new public health budget.

Mr Lansley said: ‘Too often in the past, public health budgets have been raided by the NHS to tackle deficits. Not any more. The money will be ringfenced to be used as it should be – for preventing ill health.

‘People’s health and wellbeing will be at the heart of everything local councils do. It’s nonsense to think that health can be tackled on its own. Directors of Public Health will be able to champion local co-operation so that health issues are considered alongside housing, transport, and education.

‘Everyone should have services tailored for them, at the right times in their life from the professionals closest to them. With local authorities in the driving seat, supported by the latest evidence on behaviour change from Public Health England, we will start seeing significant improvements in the nation’s health.’

What Government will and won’t do
The Government will take a less intrusive approach, staying out of people’s everyday lives wherever possible. This follows a model called the Nuffield Council of Bioethics Ladder of Interventions, which means that instead of reaching for choice-limiting regulations at every opportunity, the Government will employ a range of evidence based approaches to improve health. The ladder increases in intrusiveness as follows:

Do nothing or simply monitor the situation. Some behaviour trends are minor and fizzle out, so intervention isn’t needed.

Provide information. Giving people the information and education to make a choice for themselves based on evidence.

Enable choice. Give people a ‘nudge’ in the right direction so they can change their behaviour. For example, through access to public exercise facilities, cycle paths, or safe playgrounds.

Change the default to help guide choice. Using positive ‘social norms’ is a way of encouraging this.

Guide choice through incentives. A ‘points mean prizes’ approach, for example the more a child walks to school, they earn points for healthy prizes like an activity day.

Disincentives, such as taxation or other price related action, to discourage people from smoking or drinking.

Restrict choice, probably through regulation, such as raising the legal age for smoking or banning trans fats.

Eliminate choice altogether. Rarely used, but most common examples include making seatbelts compulsory and making dangerous drugs illegal.

Local control, better health
Directors of Public Health will be employed by the Local Authority and be the ambassadors of health issues for the local population.

In practice, this means that they will lead discussion about how the ring-fenced money is spent to improve health. This will include influencing investment decisions right across the Local Authority, with the goal of enhancing health and wellbeing.

Crucially, they will be able to make sure that public health is always considered when local authorities, GP consortia and the NHS make decisions.

To make sure that progress is made on issues like obesity and smoking, Public Health England will set a series of outcomes to measure whether people’s health actually improves.

Money where it’s needed, credit where it’s due
Under new arrangements, the flow of money will change so that: money will be allocated from the NHS budget and ring-fenced for public health; part of this will be used by Public Health England for population-wide issues; another part will provide a ring-fenced budget to local authorities.

The BMA’s director of professional activities, Dr Vivienne Nathanson, said that while it is encouraging that the government is seeking to create an environment where individuals can make healthy choices, doctors are also looking for concrete action from the government.

She said: ‘We agree that ‘nudging’ people to be healthy may be more effective than only telling them how to live their lives. However, if people live in an environment where they are surrounded by fast food advertising and glamorous alcohol marketing, nudging will have a limited effect. We need an environment that helps us make healthy choices and sometimes tougher action is needed to achieve this.

‘Smoking is still the leading cause of ill-health and premature death so it is extremely important to help people quit and discourage young people and children from starting in the first place. The BMA therefore urges the health secretary, Andrew Lansley, to implement the tobacco aspects of the 2009 Health Act now as this would end tobacco displays in large supermarkets from September 2011. We do not understand why he is not taking this decisive action to put cigarettes out of sight in shops.’


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