MPs have scrutinised the Department of Health and Social Care’s decision to prioritise the NHS backlog over prevention health services, such as tackling issues like smoking or sedentary behaviour.
The Health and Social Care Committee questioned Helen Whately, the social care minister, in Parliament on the future of integrated care systems (ICSs) – the new structure within the NHS where organisations work together to provide health and care services for a local area. Forty-two ICSs were set up in England last year.
MPs asked why prevention services were not being funded adequately and scrutinised the fact that integrated care boards (ICBs) – the groups responsible for commissioning health services for each ICS – did not include a mandatory role for a public health expert.
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What do we mean by “prevention”?
Prevention health services focus on promoting good health for all citizens now and in the future. This can include: reducing future instances of disease and health issues by encouraging lifestyle changes; detecting early stages of disease and intervening before full symptoms develop; or helping people to manage long-term health problems to improve their quality of life and life expectancy. Examples include immunisation programmes, cancer screenings, sexual health testing and targeted healthy eating campaigns for people at higher risk of developing cardiovascular diseases. Prevention also involves looking at wider determinants of health such as poverty, housing, employment, education and access to green spaces.
How much is the government focusing on prevention?
Prevention services fall under public health – healthcare dedicated to preventing disease, reducing health inequalities and improving the population’s health. Since 2013 local authorities have received funding from central government via the public health grant to provide public health services for their communities.
According to the Local Government Association, English councils spent more than £3.2bn on public health in 2019-20. This has decreased by £50m since 2018-2019, and by £252m since 2016-2017. Analysis by the Health Foundation, a think tank, shows that the public health grant has reduced by over £1bn – 24 per cent – in real terms (accounting for inflation) since 2015-2016.
According to a 2022 report from the National Audit Office (NAO), NHS England has allocated £97m to improve prevention services across the 42 ICBs in England. This is compared with £200m to tackle health inequalities and £2bn to tackle elective care (non-urgent hospital care) backlogs. A survey of ICS staff in the NAO report found that more than three quarters (77 per cent) said that their ICS intended to invest in prevention, but less than a third (31 per cent) felt they currently had the capacity to do so.
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What did the committee say?
Rachael Maskell, Labour MP for York Central, said that the budget allocated to prevention was “significantly smaller” than that dedicated to tackling the NHS backlog, even though investment in prevention would “stop the system being pushed [even further] into crisis” in the future. “We know that the health service will not be able to cope with future capacity if we don’t pivot into looking at protecting people’s health and well-being into the future,” she said. “If the money isn’t flowing through for prevention, how are we going to see the ICSs prioritise prevention over all the targets and priorities coming out of government?”
She also raised how it is not mandatory for ICBs to include a public health lead, which she said showed how prevention was not being prioritised. “If prevention is so important, why is [a public health lead] not stipulated in the scope of regulations?” she asked.
“Once again, it’s going to be a sickness service we’re creating for the future, not a health service,” she added, saying that there was “a significant risk” of public health being a lower priority than “those immediate demands and crises that the NHS is having to address”.
What does the government say?
Whately said that the government should look “more broadly” at prevention beyond obvious areas of public health like smoking and obesity, to areas such as breast cancer screenings and vaccinations, where she claimed an additional £1.5bn was being invested. She said that prevention is “front and central” to the new ICS model.
In response to ICBs not having a mandatory public health lead, Whately said that if boards get “too big” it becomes difficult to “have effective conversations and make decisions”, but that there was an opportunity to include public health leads in ICBs if suitable for the local area.
Maskell called this a dereliction of duty, given that population health is one of the key objectives of ICSs, and that elective care recovery was “dominating the agenda”.
But Matthew Style, director-general for NHS policy and performance, another witness in the session, added that ICBs will have a “statutory duty” to seek advice from public health experts while local authorities will also have a duty to provide that advice, so ICBs would always have “access to expertise”.