From April 2013, the NHS will no longer be responsible for public health in England: Instead, public health control will pass to local authorities, who haven’t managed this important function since the mid 1970s – a period many readers will fail to remember in great detail. Part of the local authority remit will be to commission NHS health checks for 20 per cent of the eligible population, as part of wider efforts to reduce health inequalities.
Public health has always been known as a ‘Cinderella service’ in the NHS – the first to be pushed back if cuts were required or budgets exceeded. However, public health has an increasingly important role in reducing health inequalities throughout England. For starters, more needs to be done to boost the average lifespan of a man living in County Durham (77 years) to nearer the 82 years of his counterpart living in The Royal Borough of Kensington and Chelsea.
The obesity and diabetes epidemics we are now witnessing are a clear case in point. Currently, ten per cent of the entire NHS budget goes to treat diabetes, many cases of which, had they been prevented, would have meant major cost savings. Diabetes UK suggests that if the NHS Health Checks programme had been implemented effectively in 2011-2012, 9,500 people could have been diagnosed with Type 2, and started managing their condition to prevent further complications. When properly implemented, public health policies and actions create tangible health benefits and provide cost savings in the long term.
NHS health checks have been available to everyone between the ages of 40 and 74 since 2009, to assess their risk of stroke, kidney disease, diabetes, and cardiovascular disease (CVD). Patients identified as high risk receive medical treatment or are referred to smoking cessation programmes, weight loss groups, and the like. Obviously, after that, it is up to the patient to take up these options. However, Heart UK estimates that only half of England’s PCTs are offering the checks in GP surgeries, and delivery rates in pharmacy have been disappointingly low. That said, there has been a big push in certain pockets of England, such as the North East, with health checks are offered in non-medical, locally targeted settings such as sports grounds, supermarkets, shopping centres, industrial estates, and so on.
With socio-economically deprived or ‘hard to reach’ groups (such a travellers) in particular, health checks – but also subsequent help – must be clearly signposted, and made accessible. Types of help can include ‘Better Health At Work’ schemes, courses for physical activity, smoking cessation and healthy cooking courses. Behaviour change is key, and there is a strong argument for starting health checks at an earlier age. Health Diagnostics, a client of ROAD, has helped NHS County Durham provide ‘Mini Health MOTs’ for 16 to 40 year olds, the aim being to ‘catch’ this age group whilst they are still teachable, rather than waiting until they’re older when habits and lifestyles are harder to change.
With financial cutbacks of around 25 per cent faced by many local authorities in England, sceptics would argue there is limited room for improvement on public health. However, innovation, thinking outside the box, and local knowledge will all be deciding factors in public health’s success or failure within local authority control. Fortunately, the digital revolution will mean local knowledge can be woven into health strategy, so campaigns can be tailored and targeted at the local, or even the personal level, through web and social media content, increasing the chance of success.
The question remains, Will Cinderella ever get to go to the ball? Predicting the answer, as ever, is a complex task, but if local authorities pick up the wand and run with it, the carriage might just get there on time.
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