Reaction to the NHS ten-year plan concludes that it “fails to live up to the promises” and lacks ambition when it comes to moving from illness to prevention, one of the government’s three fundamental shifts in how the NHS works.’
Matthew Bazeley-Bell, Deputy Chief Executive, Royal Society for Public Health (RSPH), noted:
“this was the moment for Government to back up the ambition for prevention. Instead, it fails to live up to the promises which have been made over the last year, and the challenge set by Lord Darzi last Summer.
The plan announced today focuses on the consequences, rather than causes, of ill health and needs to go much further than its conclusion which limits the ambition for the shift to prevention to having only ‘restarted progress’.”
There is no dispute as to why a shift from treatment to prevention is needed – the population of England is becoming more unhealthy, in contrast to other countries, an increasing number of years are lived in poor health, and life expectancy is stagnating. The UK’s life expectancy was the lowest amongst comparable countries in 2023.
Acute demand for the NHS is rising, the economy is suffering due to an increasing level of ill health in the workforce, there is a growing mental health crisis, widening health inequalities, and a social care system that is buckling under the pressure of demand.
As a joint statement from the Royal Society for Public Health (RSPH), the Faculty of Public Health (FPH), and the Association of Directors of Public Health (ADPH) notes:
“The success of the shift to prevention will determine whether the Government will truly be able to say they have ‘saved’ the NHS.”
The health think-tank, The Kings Fund had also hoped for something more “bold or radical” from the plan. What has been produced, it notes, is something that:
“feels far too much like an NHS plan – not a health plan – and the government must go much further on its original health mission if it is truly to ‘bend the curve’ and fix the nation’s population health crisis.”
The Health Foundation notes that:
“Without investment and reform of the threadbare social care system, or co-ordinated action to address the wider social and economic causes of ill health, the plan remains largely a vision for the NHS, rather than a plan for rebuilding the nation’s health.”
The plan includes several good ideas on prevention, such as improving vaccination uptake, reducing obesity, promoting a smoke-free generation, and expanding free school meals.
The King’s Fund noted that the measures “aimed at creating the healthiest generation of children are welcomed, including better access to dental care and mental health support, as well as children and young people being an early focus of the neighbourhood health service, particularly the commitment to expand the Start for Life programme.”
Furthermore, commentators are positive on the expansion of screening services, such as for lung cancer, and the testing of ‘prevention accelerators’ to tackle variation in the uptake of CVD and diabetes interventions.
But, there is disappointment over the lack of action on harmful alcohol consumption, in particular the lack of action on minimum unit pricing, first recommended by Public Health England in 2016. The Kings Fund noted:
“It is truly disappointing that the government has ducked out of anything that will shift and target harmful alcohol consumption.”
Adding that there is “also less on air pollution than many were expecting, and fewer overall signs of the role of other government departments than there needed to be, where we know much of the policy that drives our health sits.”
What is also disappointing is that the plan did not address the lack of funding for public health measures, which are widely known to provide good value for money with local government public health services 3–4 times as effective as the NHS in producing health gain. Over the past decade public health funding has fallen in real terms by 25%, but the plan contained no commitment to a significant increase in preventive spending even in the short-term.
The leading public health organisations (RSPH, FPH and ADPH) note in a statement:
“If the Government is serious, we need to see real commitment and transformation. The changes require increased spending on upstream preventative services, communities working together to address the causes of ill health as well as the symptoms.”
The ten-year plan is heavy on the use of AI and technology to push forward change, and the chapter on prevention is no exception. With a section on how revealing a baby’s personal genome will give “parents and clinicians the ability to unlock the secrets of a child’s future health” and that “AI will also be an early warning system, detecting subtle signs of health changes by analysing data from wearables, lifestyle and medical records to trigger timely interventions at an individual and a population level.”
Experts are highly sceptical about this approach and note that there are many more obvious risk factors that affect the health of a person: poverty, housing, and environment. These factors are well documented – living in deprived areas leads to lower life expectancy and healthy life expectancy. The government’s own documentation notes an annual mortality due to human-made air pollution in the UK roughly equivalent to between 28,000 and 36,000 deaths every year.
As Trevor Sheldon and John Wright note in the recent BMJ article – From genome to exposome: universal newborn genetic screening is the wrong focus if we want to improve population health – written after the announcement of the government’s screening plan:
“Given that a key objective of the programme is to prevent illness, it also begs the question as to why the government does not focus its attention and resources more on modifying more important, easily identifiable, risk factors which affect health throughout the life course?”
The overriding conclusion from the plan is that there are good things in there, but nothing that will really kick-start the government’s ‘overall ambition’, to half the healthy life expectancy gap between the richest and poorest regions.
There is a lack of any details on funding or delivery, but also a lack of ambition – indeed the last paragraph of the prevention chapter states that in ten years time the plan will only have begun narrowing health inequalities and “restarted progress” on longevity. As the Kings Fund notes this is “an unacceptably low ambition.”
Ultimately, public health is tied up with actions by many government departments, such as housing and environment. The Kings Fund hopes that there will be more to come on how the ten-year plan fits “into a bigger strategic cross-government strategy for population health and health inequalities, drawing the preventive contribution of the NHS together with action on child poverty, growth, housing and the other drivers of our health.”
The leaders of the three leading public health organisations (RSPH, FPH and ADPH) are also hoping for more details on actions as they note in a joint statement:
“The Government now needs to set out in detail how their plan will lead to increased investment in prevention, and action to tackle all of the commercial and social determinants of health. The delivery of the promises made today is critical.
Over the coming months and years, we need to see more action from the Government to make this a reality. From minimum unit pricing to investment in occupational health, there are interventions which we know will make a significant difference to outcomes if they are implemented properly.”
Recent government decisions on benefits and a delay in putting in place a planned ban on junk food advertising, however, are of concern to public health organisations. With the Faculty of Public Health deeply concerned about the risk of growing poverty and health inequity, following the UK Government’s plans to cut disability and health-related benefits. The ADPH is disappointed about the delay to the advertising ban, which was due to October, as there is “a wealth of evidence to say that this [ban] will work” and reduce the number of deaths due to avoidable disease.
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