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Securing good health for the whole population A Treasury report February 2004

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Submitted to the Prime Minister, the Chancellor of the Exchequer and the ... public health leadership difficulties due to NHS reorganisation ... – PowerPoint PPT presentation

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Title: Securing good health for the whole population A Treasury report February 2004


1
Securing good health for the whole population A
Treasury report February 2004
  • Briefing for Wandsworth PCT Board Lindsay Forbes
  • Consultant in Public Health Medicine
  • March 2004

2
Securing good health for the whole population
final report February 2004
  • A Treasury report
  • Submitted to the Prime Minister, the Chancellor
    of the Exchequer and the Secretary of State for
    Health
  • Author Derek Wanless, a former banker

3
Securing good health for the whole population
  • What I will cover
  • History
  • Contents of report
  • Recommendations
  • Health in Wandsworth

4
History
  • Wanless 1 Securing our future health taking a
    long-term view
  • commissioned by Chancellor before Spending Review
    2002
  • UK fallen behind in health outcomes and health
    service performance
  • recommended more resources for health but a
    radical rethink of how used
  • resources should be targeted at reducing demand
    for health services i.e. towards public health
    and prevention

5
Securing good health for the whole population
  • Wanless asked to make recommendations on how to
    take this agenda forward

6
Securing good health for the whole population
part 1
  • First part of Wanless 2 Securing good health for
    the whole population published December 2003

7
Securing good health for the whole population
part 1
  • Showed that the main determinants of health are
  • poor nutrition and obesity
  • smoking
  • physical activity
  • income
  • education
  • employment
  • environment
  • for some health outcomes, for example, infant
    health, quality of health and related services

8
Securing good health for the whole population
final report
  • Reviewed
  • public health policy over last 30 years
  • the delivery of public health
  • evidence on public health interventions

9
Securing good health for the whole population
final report
  • Review of public health policy
  • Growing recognition that health services have
    little impact on health
  • The social and physical environment and
    behavioural factors are the major determinants of
    health
  • Public health policy
  • has been too focused on NHS activity
  • has not led to directing resources away from
    health care

10
Securing good health for the whole population
final report
  • Review of the delivery of public health
  • Barriers to success
  • public health leadership difficulties due to NHS
    reorganisation
  • difficulties with linking leadership with the
    wider public health workforce
  • lack of shared understanding, priorities and
    performance management arrangements (within and
    between organisations)
  • PCTs priority emphasis on targets (usually
    little to do with public health)

11
Securing good health for the whole population
final report
  • Review of evidence on public health interventions
  • gaps in the evidence base
  • low status in research community
  • university funding rewards clinical research

12
Recommendations
  • Key messages
  • National policy
  • Local delivery

13
Recommendations Key messages
  • We have been talking about this for years
  • We have a national sickness service
  • TIME FOR ACTION
  • We must focus on preventing disease, not treating
    it
  • Otherwise, the outlook is bleak

14
Recommendations Key messages
  • the need for action is too pressing for the lack
    of a comprehensive evidence base to be used as an
    excuse for inertia
  • If they the recommendations are not addressed
    by the government, ….. the health care services
    will continue to run faster and faster to stand
    still

15
Recommendations National policy
  • performance management of PCTs and local
    government to include progress on tackling
    broader determinants of health
  • improve ways of evaluating cost-effectiveness of
    public health interventions
  • improvements in national target setting
  • health impact assessment of major policy
    developments
  • rethink role of Health Protection Agency

16
Recommendations National policy
  • National bodies to be responsible for
  • developing the evidence base on public health
  • a single source of information and advice on
    health behaviour issues
  • advising the government on tobacco regulation

17
Recommendations National policy
  • CHAI to performance assess PCTs and SHAs on
    impact on determinants of health
  • national plan to strengthen public health skills
    and engage the wider public health workforce
  • NHS should support improving the health of its
    workforce

18
Recommendations Engaging individuals
  • research into improving individuals health
    behaviour
  • engage the public in the debate on the balance
    between individual rights and social impact of
    behaviour
  • develop ways of engaging the population,
    including expanded NHS Direct
  • feedback from the public

19
Recommendations Local
  • Broadly
  • PCTs should invest in sustainable action to
    promote and improve the publics health
  • PCTs should focus on promoting and maintaining
    good health rather than services for established
    disease

20
Recommendations Local
  • Does not recommend structural change
  • Combining PCTs forces on public health issues
    encouraged
  • PCTs should innovate, evaluate and disseminate
    information
  • Improve primary care information systems
  • Working in partnership
  • Annual public health reports available to the
    public

21
Recommendations Local
  • Cannot be tackled by continuing traditional
    service delivery and commissioning patterns
  • Debates on health impact and cost-effectiveness
    extended across all PCT activity
  • Must rethink services emphasis
  • Bigger picture e.g. tobacco control, not smoking
    cessation

22
Securing good health for the whole population
final report
  • Next steps nationally
  • Consultation Choosing Health
  • Available on http//www.dh.gov.uk/Consultations/Li
    veConsultations/
  • The Public Health White Paper

23
What are the determinants of health in Wandsworth?
  • poor nutrition and obesity
  • smoking
  • physical activity
  • income
  • education
  • employment
  • environment
  • for some health outcomes, for example, infant
    health, quality of health and related services

24
Health in Wandsworth
25
Health in Wandsworth
Children in workless households Wandsworth
wards London 24, Wandsworth 22, England and
Wales 17
26
Health in Wandsworth
  • Deaths in Wandsworth 2001
  • Total deaths 2000
  • Cardiovascular disease deaths 700
  • Cancer deaths 500
  • Number of premature deaths from cardiovascular
    disease above national average

27
  • Cardiovascular disease and many cancers are
  • PREVENTABLE

28
Health in Wandsworth HIV prevalence
29
Health in Wandsworth MSW Young Peoples Drug Use
Survey, 2000-01
30
Health in Wandsworth
  • Unique demography
  • Unique threats
  • Unique opportunities

31
Health in Wandsworth Where should resources go?
  • Smoking
  • Obesity/nutrition
  • Physical inactivity
  • Sexual health
  • Substance misuse
  • Others

32
Health in Wandsworth Where should resources go?
  • Improvements cannot be achieved through primary
    care, or even the NHS, alone
  • Broader approach needed socioeconomic and
    environmental causes of ill-health
  • Enabling people to change behaviour
  • Smoking
  • Obesity/nutrition
  • Physical inactivity
  • Sexual health
  • Substance misuse
  • Others

33
  • Most health success stories are related to
  • improvements in the broader
  • determinants of health
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