Work is underway to produce a Green Paper this summer on prevention which will seek to be system-wide, identify how to reduce inequalities in health and outcomes and improve the health and wellbeing of the population. This is a potentially huge opportunity for local authorities, but only if we approach it in the right way, with joined-up thinking and a willingness to collaborate and work with partners and stakeholders across the board.
Our first task must be to put the NHS Long Term Plan into context – it is a plan for an NHS which has a poor track record in prevention, despite seeking to make step changes allied to some laudable ambitions. There is a clear need to understand that the plan and the NHS alone cannot, and will not, deliver the step change needed to ensure that our residents enjoy continued good health and resilience.
In other words, we need prevention, not as a means of saving the NHS, but as a key element in its own right. While commissioning services such as health checks and weight management services are important they can only provide part of the solution. If we are to make the steps we seek, we need system-wide action, allied to a coherent vision of how to build a society less reliant on services; residents staying healthier for longer, enjoying more disability-free years, with increased resilience and coping across the life-course. It is here that local government comes into its own.
Yes, we need a strong NHS with a strong and coherent narrative on restoring people to the highest level of function and health possible when they become ill, but that alone will not make a healthy, sustainable and self-reliant society. We need a prevention narrative with ambitions that go beyond a narrow focus on individual lifestyles and we need to galvanise real systemic change across the landscape.
Simply looking at lifestyles is not enough. The lifestyle story (behaviour, diet and so on) is one of the smallest contributors to the prevention equation; when you think that by some estimates the lowest income families would need to spend around 75 per cent of their total income to buy food entirely consistent with Department of Health healthy diet guidelines, you can see that lifestyle is but one small piece of the jigsaw
Good education, sustainable transport, meaningful employment, appropriate housing, and life skills for people which help them to be and remain resilient are arguably more important. A joined-up vision of what a good childhood or old age would be and the powers to deliver this, would be major contributors to a healthier society and a more financially sustainable public sector.
The LGA recently produced a diagram of what local authorities do (see below) and how these contribute to the wider determinants. We must build a narrative of what we need to see in a Prevention Green Paper which is meaningful, starting with the wider determinants. The role of local authorities in shaping a healthy place is the ground upon which good health or bad health for a population will be built. We need to emphasise our role in planning for more sustainable transport, the importance of planning houses with space for families to live, and the vital role that our leisure services play in the wellbeing of our communities. Simultaneously, we need to highlight the evidence that education, employment, freedom from poverty, a safe and high quality built environment, and access to services which underpin these, have far more impact on the health of the population across a life-time than the NHS and clinical care.
“The role of local authorities in shaping healthy places is the ground upon which good health for a population is built
We need to systematically articulate the narrative around why these contribute to prevention in a way which government can hear. Local authorities across the country are engaged in initiatives that are making an important contribution to the ongoing health of the nation. We recognise the importance, and the benefits, of doing so, in collaboration with our partners and stakeholders. We are key players in promoting the health of our nation and we need to be shouting this from the rooftops.
We should be core to the prevention vision using this analysis and narrative. We want a strong coherent vision of building a healthier society, not a retro-fitting of a bunch of things government departments were already going to do; to do that we need system-wide action, with local government at its core.
But local authorities have a significant interest in this Green Paper getting the tone right. Because if it does, we will have a strong role in delivering it and making it happen. If it doesn’t, we’ll end up with the same lack of joined-up, siloed and poorly visioned policy choices that have dogged prevention policy for the last 40 years.