Meeting: Health Scrutiny Sub-Committee (County Hall, Durham - Committee Room 1a - 29/03/2004 10:00:00 AM)
Item: A7 The Wanless Report: Securing Good Health for the Whole Population
| Health Scrutiny Sub-Committee
29 March 2004
The Wanless Report: Securing Good Health for the Whole Population | |
| Report of Head of Overview and Scrutiny |
Purpose of Report 1. To explain the final report produced by Sir Derek Wanless on the provision of Health Services in the UK.
Introduction 2. This report is based upon a briefing produced by the Democratic Health Network.
3. In 2002, Sir Derek Wanless was commissioned by the Treasury to examine the future demands on the NHS and to recommend ways of improving public health and reduce health inequalities. His first report,
Securing Our Future Health: Taking a Long-Term View, assessed the resources necessary to provide health services on a par with other developed nations. In this first report, it underlined the significant differences in the cost of providing health services to a “fully engaged” population (in which individuals are actively engaged in improving, protecting and promoting their health) and a population in which large sections of the population are not “fully engaged” (such is the case in the UK evidenced by relatively high rates of smoking, obesity, binge drinking and other harmful behaviours). Clearly, unless more was done to promote good health and prevent ill-health, more and more of the UK’s resources would be spent on “running to keep up” with demand for health services.
4. On 25 February, the government published the second and final report produced by Sir Derek Wanless.
Securing Good Health for the Whole Population sets out the agenda for improving public health and reducing health inequalities. It also focuses on the need for a sound evidence base to health promotion and public health so that we can be confident that such interventions are cost effective.
Findings 5. The key findings are summarised below:
· Efforts over the past three decades to improve the nation’s health and transform the NHS from a “national sickness service” into a body which promotes good health and prevents ill-health have failed. Despite action at national and local level, rising rates of obesity, failure to reduce smoking rates significantly, high levels of teenage pregnancy and sexually-transmitted diseases, and poor nutrition have contributed to high rates of illness and premature death. The report acknowledges that there have been public health successes: notably protection against infectious diseases, and the compliance by the vast majority of car users in relation to seatbelt wearing.
· The report focuses on how individuals can be supported, by central government, local government, the media, businesses, society at large, their families and the voluntary and community sector, in becoming fully engaged to make healthier choices. But this must be done within a coherent framework of action, strongly supported by evidence of what interventions and actions are effective. The report also identifies the strong correlation between socio-economic inequalities and health inequalities and recognises the urgent need for them to be addressed.
· The evidence base for identifying effective public health interventions must be improved at national and local level. The report suggests that this is due to the low priority given to public health intervention research which makes it difficult to secure funding to determine what works in relation to public health. There is also a need for economic evaluation of public health interventions, in much the same way as the National Institute for Clinical Excellence evaluates the effectiveness of clinical interventions.
· Health data, essential for monitoring the health of the population and for monitoring the effects of health interventions, is often poor and unreliable.
· National targets relating to public health and health inequality are often inconsistent and narrowly focused on behaviours rather than addressing issues such as improving educational attainment and reducing poverty which, by reducing socio-economic inequalities may have a greater long-term effect on health inequalities.
· Government needs to work closely with local government, health organisations and community and voluntary groups to set national and local objectives for all major determinants of health. These objectives will need to be reviewed on a regular basis to establish what progress is being made.
· The report acknowledges that there is a significant problem with public health capacity. For example, each PCT is required to have a Director of Public Health which means that the existing resource is being spread more thinly. The prospects for making best use of resources are good in those areas that have made joint appointments in public health between the PCT and the local authority but we still need evidence that such joint arrangement deliver benefits and cost effectiveness.
· The NHS should support its employees to make healthy choices since there is a strong business case for reducing staff absence due to illnesses or accidents.
Recommendations in the Report 6. The report makes 21 specific recommendations, all of which are summarised below. It also recommends that all new public health policies are considered against a “checklist” to ensure that they are evidence-based, represent best value and take into account that, ultimately, the choice is up to the individual. The 21 recommendations are as follows:
· the Treasury should develop a framework to guide ministers on what economic policies might promote better public health
· the government should draw up consistent national objectives for public health, with a three or seven year deadline, including targets for specific population groups
· PCTs, local authorities and other local agencies should develop local targets, based on national targets, but taking into account local health profiles
· all public health interventions need to be evaluated for cost effectiveness
· it should be the responsibility of the Secretary of State for Health to ensure that the cabinet assesses the health impact of all major government policies
· national service frameworks should include details on the cost-effectiveness of different interventions, particularly in relation to ways of improving patients’ lifestyles
· performance indicators for the NHS should be based on the benefits of interventions rather than the number of operations carried out, with the emphasis on prevention of ill-health
· the Department of Health’s (DH) review of health quangos (currently underway) should ensure that there are no gaps or overlaps between the responsibilities of the various public health bodies
· the DH review should also look at how such bodies engage at a local level with PCTs
· the effectiveness of a national public health strategy should be regularly monitored
· pilot schemes need to be established to assess the benefits of electronic patient records to detail and monitor the health risks of individual patients
· there needs to be more cooperation between academics and public health professional to improve public health research
· the government’s forthcoming White Paper on public health should tackle the barriers to obtaining public health data posed by patient confidentiality
· we need more investigation into how to improve public understanding of health information, especially for those people with poor literacy
· the forthcoming consultation on the White Paper on public health should address the balance between an individual’s right to choose his or her lifestyle and the impact this has on the wider society
· the government should set up a web site and a national telephone help line to give advice on healthy living
· there should be an annual report on the state of the nation’s health
· there should be an assessment of public awareness of public health advice and the level of support for controversial policies to tackle behaviour which is harmful to health
· the Commission for Healthcare Audit and Inspection should draw up performance indicators to assess the public health work of PCTs and strategic health authorities
· there is a need for a public health workforce strategy which would address the role of specialist public health practitioners and the wider health workforce
· the NHS should do more to improve the mental and physical well-being of its workforce.
Comments by the Democratic Health Network 7. By and large, the report has been welcomed as a “wake up call” for the government, the NHS, public agencies and individuals that urgent action needs to be taken to reduce ill-health and premature death caused by unhealthy behaviours. The DHN welcomes the report’s recommendation that there needs to be a national strategy for public health to support individuals to make healthy decisions. They also welcome the recognition that public health interventions need to be based on sound evidence and regularly monitored in order to ensure that they are working.
8. There are, however, real concerns about the remit of the report. Many commentators, such as the Consumers’ Association, have expressed disappointment with the lack of concrete proposals in the report. The widely discussed “fat tax” (extra taxes on foods that are high in fat and sugar) is not mentioned in the recommendations. Neither is there a recommendation on the banning of advertising “junk foods” aimed at children. The report does not recommend any curbs on businesses as a way of improving health, even though many public health experts have urged the government to take such steps.
9. The report has also been criticised for ignoring sexual health, even though the UK has far higher levels of sexually transmitted diseases and unwanted pregnancies than most other developed countries.
10. In the view of the Democratic Health Network, the most significant flaw in the report is the emphasis on individual personal behaviour and choices, without any consideration of the way these choices are constrained by socio-economic circumstances. This report, which was widely trailed as a landmark report in the history of public health, has many positive recommendations but it is flawed by the lack of understanding of how socio-economic factors limit an individual’s choice in making healthy choices.
Recommendation 11. You are asked to note this information which provides background for the Health Scrutiny Sub-Committee’s work.
| Contact: Ian Mackenzie Tel: 0191 383 3673 |
Copies of Securing Good Health for the Whole Population can be downloaded from the HM Treasury website at
http://www.hrm.treasury.gov.uk/ Attachments
The Wanless Repport - 29 March.dot