Prevention must be the heart of the NHS long-term plan
If we get the NHS long-term plan right, we will prevent 3 of the biggest killers, says CEO of Public Health England
Public Health England (PHE) say the NHS can ensure we all enjoy old age in good health by prioritising the prevention of smoking, cardiovascular disease (CVD) and obesity in the new long-term plan.
The NHS long-term plan should commit to achieving a smokefree society by 2030 and a population prevalence of less than 5%.
Smoking should no longer be seen as a lifestyle choice, it is an addiction that warrants medical treatment. Everyone who smokes must be offered the support they need to quit and NHS trusts should be instructed to step up their efforts in establishing a smokefree NHS by 2020.
Reducing smoking rates is the single biggest thing we can do to improve the nation’s health. It will reduce CVD, respiratory conditions and cancer, meaning people can live longer in better health. And it will save the NHS up to £890 million a year.
Since the launch of the tobacco control plan and awareness campaigns like Stoptober smoking rates in England have dropped. We are currently on track to have as few as 8.5% of smokers in England by 2030, but we cannot become complacent. To stagnate or risk even a slight increase will have a profound effect on health.
CVD is the leading cause of disability and death in the UK. Yet an estimated 50 to 80% of CVD cases are preventable.
PHE says the long-term plan could save 250 to 500 lives each year across England by prioritising the identification of people who are at risk of developing CVD. Better detection and management of high blood pressure, high cholesterol and atrial fibrillation could prevent more than 9,000 heart attacks and at least 14,000 strokes from happening in the next 3 years.
High blood pressure continues to be the biggest single known risk factor for CVD and the third for premature death. It also reinforces health inequalities, with people from the most deprived areas in England 30% more likely to have high blood pressure.
Almost 7 million people have benefitted from the NHS Health Check since 2013. It is one of the biggest prevention programmes in the world and the long-term plan must continue to encourage its uptake and follow-up if we are to reap the benefits. The NHS should also work to normalise the conversations we have about blood pressure, striving for a nation where everyone can recall their blood pressure numbers as easily as their pin number.
We are facing an obesity crisis. One in 3 children leave primary school overweight or obese and new figures show the levels of severe obesity in children aged 10 to 11 are higher than ever before. The childhood obesity plan has a commitment to halve the rate of childhood obesity by 2030.
The NHS long-term plan should build upon this to target adult obesity. One way to achieve this is by increasing weight management support provided.
Making it routine for people to have their body mass index (BMI) measured and recorded in primary care and pharmacy settings will provide an opportunity for healthcare professionals to give advice, promoting national guidance on diet and physical activity.
The NHS long-term plan should also renew our commitment to the NHS Diabetes Prevention Programme (NDDP). Type 2 diabetes, for which obesity is a key driver, is a major contributor to kidney failure, heart attack, and stroke. It costs the NHS around £8.8 billion every year.
The NDDP currently covers around 100,000 people. PHE wants the long-term plan to build on this success.
Duncan Selbie, chief executive of PHE said:
"With the right long-term plan in place we can remove smoking from England, halve childhood obesity and the number of avoidable deaths from cardiovascular disease.
"These 3 priorities are where the NHS and PHE should focus efforts. It is not that other priorities won’t matter, but these will need to matter most.
"Successful delivery will require action from every part of civil society. We must pull together to use our resources and we must engage the public directly in the choices they are making about their own health and wellbeing."
Our population is aging, living longer in ill health and stubborn inequalities persist. For patients and the sustainability of the NHS we must increase our efforts to prevent illness instead of waiting to treat it.
Speaking at NHS Expo today, Thursday 6 September 2018, Duncan Selbie will say previous plans (such as the Five Year Forward View) have made good progress, but they have not delivered the promised radical upgrade in prevention.
He will call for more decisive action in the new long-term plan, saying there is an urgent need to prevent – not just treat – ill health, and the time has come to be ruthless in our prioritisation and investment in preventative strategies.