Authors:

• William Roberts, Chief Executive, Royal Society for Public Health
• Mathew Taylor, Chief Executive, NHS Confederation
• Nicola Close MBE, Chief Executive, Association of Directors of Public Health
• Paul Ogden, Senior Adviser, Local Government Association

The Health Secretary has started a national conversation on what people want to see change about the NHS in England. Change is sorely needed after Lord Darzi’s review of the NHS announced what we all know – that the NHS is broken, and we cannot afford to let this situation continue. That ‘business as usual’ simply cannot go on has been being said for years, but it is particularly stark when it comes from a government-commissioned report.

Lord Darzi’s review is clear that things need to change within the NHS. But, as it has identified, simply changing how we treat illness is not going to be sufficient to get us out of this crisis. With more people living longer with complex health problems, it is prevention which must be at the heart of any plan to make Britain healthier. This is not a new ambition, but there is a renewed urgency to deliver on it, lest we find ourselves with a health system unable to even stumble on.

The current social care and health system is unsustainable and will buckle under the weight of demand unless we re-engineer our planning and service provision to protect health, prevent sickness and intervene early to minimise the need for costly hospital treatment and care. Focusing on treatment alone is not the answer. We need preventative strategies – not just because they mitigate or defer the need for costly interventions but because they deliver better outcomes for individuals.

As leaders from across public health and acute healthcare, we know what is needed to realise this ambition. As the Government presses ahead with its national conversation, we need to develop bold but workable solutions, which go beyond tinkering at the edges of the NHS and putting out the most urgent fires. It is through preventative measures – which range from immediate to long term – that we can make the greatest difference. If we are serious about a shift from sickness to prevention, this is what we need to see happen.

The most important change is one we are already seeing – putting health at the heart of everything Government does. Mission-driven Government is aiming to do this, but we need to see it turbo-charged through a Health in all Policies approach – every Department has the potential to boost public health, whether that is through school sport, high quality housing, active transport schemes or action on air pollution.

This is not just about health care. Too often, health is seen as being primarily a concern for, and the responsibility of, the NHS rather than local government or communities. Given the role of place in driving health outcomes, and the need for cross-sectoral working to address this, the role of local councils in delivering better health outcomes cannot be overlooked.

This means that the expertise of Directors of Public Health and their teams must be harnessed to maximise and extend the impact of existing local partnerships which support local communities across every element of their lives to live healthier lives.

These partnerships - which bring together local NHS structures, councils and their elected members, voluntary and community organisations, and local businesses - are vital to delivering the Government’s health mission. By building on these partnerships which already exist between the NHS and local government, we can ensure a broader definition of integrated care, rather than pretending these two elements can be easily disentangled. Social prescribing is the tip of this iceberg – the difference that could be made by a GP being able to refer someone for housing repairs, or a work coach being able to bring in occupational therapists, is enormous.

For this to work, we need to take robust action to tackle the drivers of poor health. The Tobacco and Vapes Bill and the Government’s commitments on obesity are a good start. However, further regulation of harmful products and tackling child poverty would, in a short time, begin to bring down many of the most serious health inequalities which we currently see. There are a raft of other measures that, if introduced, would help influence the social and commercial determinants of health to tackle the rising numbers of people experiencing avoidable ill health and disease.

At the same time, a modern, functional mental health system and properly-funded social care would mean that people are able to live full lives, rather than seeing their wellbeing suffer because of a lack of basic support.

Much of this requires national action, but there is important work which can be done alongside Westminster. Local areas can and do deliver innovative approaches to vaccination, health screening and maternity support – we just need to encourage these and enable them to scale up across the country. Getting this right then means we can focus NHS prevention services on areas where it will have the greatest impact – preventing and identifying risk-factors for the most damaging health conditions, whether that is cancer, heart disease, respiratory conditions or communicable diseases. This requires a robust partnership with local government to target the upstream determinants of health, such as housing and employment.

Finally, we need to recognise that none of these services are delivered in a vacuum. The only way change happens is if the millions of people working across public health are supported to deliver change. Whether it is training, recognition – or simply internal support to do their jobs in the best way possible – it is by backing our workforce that we will see results.

Later this year, the Mission Delivery Board for the Government’s health mission will meet and decide how to meet the challenge which Lord Darzi has set them. In doing this, they will be presented with a huge number of interventions – ranging in both impact and cost.

Given the state of public finances, their first step has to be look at how they can have the greatest impact for the least cost. Those of us who work in public health every day know what that looks like – giving the sector the backing and resources they need to deliver, in the knowledge that prevention is always cheaper than cure. Intelligent, joined up working bringing together the clout of national government and the expertise of local actors has to be the first step – anything else is letting us all down.