Thinking differently about health and care

The NHS Five Year Forward View called for a radical upgrade in prevention to ensure the future health of millions of children and the sustainability of our national health service.

Sustainability and Transformation Partnerships (STPs) are a golden opportunity for the NHS to get serious about prevention and to help transform the health of the communities it serves.  Of course, none of us is here to preserve our institutions, but to help people live healthier lives for longer.

Delivering big change with financial and operational pressures is hard, but the prize is great if we get it right – for individuals and families, for patients and for NHS staff.

There is much more work to be done to make the case for change to the public, and to ensure they are involved throughout this journey.

There is a positive story to tell. The proposals planned by local STPs offer a vital chance to use existing community services more effectively to ease demand on hospital care, to improve the quality and safety of care across services, and for the NHS and local government to engage meaningfully with staff, patients and the public and the voluntary sector about prevention and early intervention.

The outcomes should be healthier people with more control over their own health, more joined-up, effective services and a health system that is sustainable for future generations.

I congratulate the teams behind each of the 44 plans, which all include proposals to strengthen prevention and early intervention and help people to stay healthy for longer.

PHE’s menu of preventative interventions highlights at least six interventions that can improve health and wellbeing, as well as save money for the health and care system within five years:

  • Alcohol – identification and brief advice in primary care
  • Alcohol – alcohol care teams in secondary care
  • Tobacco – screening, advice and referral in secondary care
  • Hypertension – improved management of hypertension in primary care
  • Contraception – increase uptake of long-acting reversible contraceptives in general practice, maternity and abortion pathways
  • Falls – implement a fracture liaison service in secondary care

Many STPs have embraced these and others have come up with their own ways to improve the health of the communities they serve as well.

How can PHE help?

From pinpointing evidence to back local investment decisions to supporting implementation of locally-prioritised preventative actions, we will strengthen our support for STPs and tailor that service to the individual needs of local teams.

Alongside this, we continue to make the case for prevention right across Government. We want to see measures to improve health included in all policies – from education to transport to the environment – and we are building a world class public health system to support that, from analysing evidence to monitoring the impact on the ground.

We are also emphasising to government at national and local level that a healthy economy and a healthy workforce are intrinsically linked as part of what should be seen as a virtuous circle: improving people’s health boosts productivity and reduces sickness absence whilst having a good job helps ensure people are physically and mentally healthy.

And, we use our expertise in social marketing to nudge people across the country to think more about self-care and understand that there are often safe and effective alternatives to hospital.

The NHS of course has a vital role in promoting prevention, and can demonstrate leadership by becoming tobacco-free by 2019/20, as set out in the Next Steps on the NHS Five Year Forward View report. This would demonstrate that prevention is everybody’s business, with opportunities at every stage of the care pathway.

Adopting a new mindset

After decades working in the NHS I know the immense pressure that services are under and I also know there is a reality that urgent business crowds out important transformational change. We must ensure that the STPs are supported by the capability and resource required to implement changes that will ultimately ease these pressures in the longer term.

I urge all those working on local STPs to give themselves a moment to think, “How will this help to improve the health of the people?”

This way of thinking would naturally have an emphasis on preventing poor health and intervening early before things go terribly wrong, and despite the challenges, we must keep this in mind as we move forward.

Public health professionals also offer a unique skillset here in analysing available data and using it to help make the right decisions on how and where to invest precious resources. We will do all we can to see these plans succeed and to help turn the Five Year Forward View vision of joined-up, place-based care into reality.

Duncan Selbie

Duncan Selbie is Chief Executive, Public Health England

Prior to joining PHE on its formation in 2013, he was Chief Executive of Brighton and Sussex University Hospitals, the regional teaching hospital for the south east of England. From 2003 to 2007 he was the Director General of Programmes and Performance for the NHS and subsequently the first Director General of Commissioning. Prior to this, he was Chief Executive of South East London Strategic Health Authority and before that Chief Executive of the South West London and St George’s Mental Health NHS Trust. He joined the NHS on 1 January 1980.


  1. Yvonne Webb says:

    It is hugely important to look at Health and Care for everybody, not just when people are in need of the first line services. Health and Well-being are completely interlinked and we have to support each other with both. Completely agree about the link between a healthy economy and healthy workforce and improving people’s health boosts productivity and reduces sickness absence whilst having a good job helps ensure people are physically and mentally healthy. It is vital that we support people and each other when we are well; and not just when people are unwell. But we need to be honest about what is working and not working so that we can keep doing what is good and works and adapt or stop things that maybe are not positive and working. We tend not to listen enough, when that is such a good way of learning and getting things right.

  2. Dr P Badrinath says:

    I fully agree that this is a golden opportunity to put prevention on the top of the agenda as the NHS has committed to it through FYFV. As PH professionals, this is the time to make the maximum impact by pushing ahead with the prevention agenda and the NHS will be highly receptive of it. However, this has to be done in the most efficient way as resources are scare all around including in Local authorities who lead prevention closer to people. As SPTs do not follow local authority boundaries where majority of PH workforce is based this will require joint & innovative working across traditional boundaries.
    We also need to recognise and celebrate early success by “Team Public Health” be it nationally, regionally or locally and share good practice examples on prevention including real examples of return on investment.
    We are convinced that the only way to sustain the health & care system is by prevention. It is now our duty to convince the mighty & powerful – our political masters.

  3. John King says:

    We are involved in using simulation to engage in STP communities exploring, evaluating and communicating the benefits of new interventions. In your words, making the case for change with the public and to ensuring they are involved on the journey. Preventative interventions are of course central to new joined-up models of place-based care. Our particular focus is on using simulation to help communities make these plans real. Be good to discuss Diabetes.