Kevin Fenton

Getting serious about

prevention

March 2016

Professor Kevin Fenton

National Director, Health and Wellbeing

Public Health England

Twitter: @ProfKevinFenton

Email: [email protected]

ContentOpportunities to shift towards prevention

1. Understanding the context: The role of prevention in

addressing non-communicable diseases in England

today

2. The Five Year Forward View’s call for a radical upgrade

in prevention

3. Moving beyond the Five Year Forward View to

implementation and impact

2Opportunities for prevention and improving outcomes @ProfKevinFenton

Understanding the NCD challengeWhy prevention matters

Opportunities for prevention and improving outcomes @ProfKevinFenton

Understanding the NCD Challenge Life expectancy at birth, 1990 and 2013 for England and EU 15+

Opportunities for prevention and improving outcomes

Between 1990-2013, life expectancy in England saw a 5.4 year increase

from 75.9 to 81.3 years (one of the biggest increases in EU15+

countries). This is mainly due to falls in the death rate from CVD, stroke,

COPD and some cancers.

@ProfKevinFenton

Understanding the NCD challengeLeading causes of death in England

5 Getting serious about prevention

2013 figures

http://www.statista.com/chart/363/what-kills-english-people/

@ProfKevinFenton

Understanding the NCD Challenge Morbidity in England

• While life expectancy has increased, this hasn’t been

matched by improvements in levels of ill-health.

• So, as a population we’re living longer but spending

more years in ill-health. For several conditions, although

death rates have declined, the overall health burden is

increasing.

• For example, deaths rates from diabetes fell by 56%, but illness

and disability associated with diabetes went up 75%.

• Sickness and chronic disability are now causing a much greater

proportion of the burden of disease

• Low back and neck pain is now the leading cause of overall

disease burden.


Understanding the NCD Challenge GBD: Leading causes of DALYs 1990 & 2013


Understanding the NCD challenge Health Inequalities

• While life expectancy has increased overall, there has been little, if

any, improvement in inequalities:

• By 2013, those living in the most deprived areas are only just

approaching the levels of life expectancy that less deprived groups

enjoyed in 1990.

• More deprived groups are affected proportionally more by

disease risk factors than less deprived groups. The types of

disease and risk factor are roughly the same across all deprivation

areas however.

• While the data highlights regional differences in life expectancy and

disease burden, inequalities are actually greater within regions

than between them - so largely related to deprivation not geography.


Understanding the NCD ChallengeSocial and structural determinants

• Economic prosperity and a good start to life

• While individuals’ behaviours do matter (Eg. studies show half of

health inequalities between rich and poor are the result of smoking),

the reality is that our health is impacted by a range of wider

determinants including:

• good employment

• higher educational attainment

• safe, supported, connected communities

• poor housing and homelessness

• living on a low income

• social isolation, exclusion and loneliness

• stigma and discrimination


Understanding the NCD challengeSummary

• Addressing the health and wellbeing gap • Healthy life expectancies gap

• Increasing burden of preventable disease

• Persistent health inequalities

• Addressing the care and quality gap• Persistent variations in healthcare

• Addressing the financial gap• Opportunity costs of not having a prevention focus

The need for a system wide approach of communities

supported by their NHS, local authorities and voluntary

sectors.

10 Getting serious about prevention @ProfKevinFenton

The Five Year Forward View (5YFV) Calls for a radical upgrade in prevention

• A whole systems approach to tackling rising obesity rates

• Diabetes Prevention Programme – an intervention to improve

the health of patients at imminent risk of developing type 2

diabetes

• Population behavioural change through engaging and

activating patients to manage their own health

• Housing and health – ensuring the right home environment to

promote health and wellbeing across the life course

• Tackling health related worklessness – work as a clinical

outcome that benefits patients


Responding to the challenge NHS cannot tackle obesity alone

We need a broad range of actions

across a wide range of players:• Reformulation

• Fiscal measures to reduce unhealthy food

consumption

• Restrictions on advertising and promotions

• Enhanced planning powers

• Government Procurement Standards for

food in

public sector organisations

• Access to weight management services

• Public campaigns to support healthier

choices

• Promotion of activity (as part of healthier

lifestyle)

• Leadership to tackle the new social norms

• A wide coalition with industry and opinion

formers

Getting serious about prevention12 Getting serious about prevention @ProfKevinFenton

Responding to the challengeDiabetes Prevention Programme

• Commitment of the NHS Five Year Forward View

• Partnership between PHE, Diabetes UK and NHS England

• The NHS DPP aims to identify those at risk of type 2 diabetes early

and refer them into evidence-based lifestyle interventions,

underpinned by three core goals:

• Weight loss

• Achievement of dietary recommendations

• Achievement of physical activity recommendations

• Adults at risk of type 2 diabetes can be referred through:

• Existing GP practice registers

• NHS Health Checks

• Potential for opportunistic case finding


Responding to the challengePopulation behaviour change

• Behavioural insights: provide opportunities for new approaches in

health; recognising role of both automatic and reflective systems in

decision-making.

• MECC: uses day-to-day interactions to support people to make positive

changes to their physical and mental health and wellbeing.

• Patient activation: a measure of a person’s knowledge, skills and

confidence to manage their own health and care.

• Could help 10% of those with long term conditions in England (1.5m people)

• Up to 40% of the population have low activation levels

• Low activation: >30% more likely to have unmet medical needs

• Activated people are more likely to attend screenings and check-ups and have

greater engagement in healthy behaviours e.g. regular exercise


Responding to the challengeHousing and health

• Health begins at home

• The right home environment is essential to

health and wellbeing, throughout life.

• Key features of a home in which to

start, live and age well:

• Warm and affordable to heat

• Free from hazards, safe from harm

• Enables movement around the home and

is accessible

• Promotes a sense of security and stability

• Support available if needed


Responding to the challengeWork and health

• Good work is good for health; being out of work is bad for health

• 28% of the working age population have a health condition or

disability and 40% (4.5m people) of those are not in employment

• The NHS directly employs around 1.2 million people in England.

• Staff health and wellbeing has a direct impact on patient outcomes

as well as sickness absence and agency costs.

• PHE is working with NHS England and 12 NHS providers, including

CCGs and the GP federation, to develop a response:

• Using the Workplace Wellbeing Charter as the road map for implementing NICE

guidance

• Rolling out NHS Health Checks for NHS Staff through NHS Occupational Health

• Tackling the food and physical activity environment across NHS settings


Moving beyond the 5YFV

1. Prevention interventions to save the NHS

money

2. Sustainability and transformation plans

3. System leadership for health


18

Hypertension

Sexual health

Improve management of hypertensives, reducing

likelihood of stroke, heart attack and kidney failure

PHE carried out an assessment to identify the most effective preventative interventions,

focusing on areas of high spend in the NHS. If delivered at the anticipated scale of

ambition, the potential savings could be up to £500m each year by 2020/21.

Moving beyond the 5YFVInterventions to improve health outcomes and save money

Falls and

fractures

Increase take up of more effective contraception (LARC)

through GPs and maternity and abortion services

Increase coverage of Fracture Liaison Service in

hospitals

CCGs

CCGs

and

LAs

CCGs

and

LAs

Commissioned by:

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Diabetes and

obesity

Improved management and care of diabetes; and

primary prevention of obesityCCGs

and

LAs

Getting serious about prevention @ProfKevinFenton

19

Alcohol

identification

brief advice

Smokers in

secondary

care

Alcohol care

teams

Screen patients at next consultation spread over five

years, with GPs/nurses providing brief advice on alcohol

Expand 'identification and referral to improvement safety‘

programme in primary care to increase detection of

those suffering from domestic violence

Screen patients who smoke in secondary care, and refer

to stop smoking services

Introduce alcohol care teams (nurses) to manage

alcohol-related repeat admissions in all hospitals

PHE carried out an assessment to identify the most effective preventative interventions,

focusing on areas of high spend in the NHS. If delivered at the anticipated scale of

ambition, the potential savings could be up to £500m each year by 2020/21.

Domestic

violence

CCGs

CCGs

CCGs

and

LAs

CCGs

and

LAs

Commissioned by:

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Getting serious about prevention

Moving beyond the 5YFVInterventions to improve health outcomes and save money

@ProfKevinFenton

STPs should act as a vehicle for local health economies to develop and implement joined-up plans to

close the three ‘gaps’ in the 5YFV. They will be structured around these gaps and what footprints

propose to do to close them.

Local government is an essential partner in developing compelling STPs. They will provide valuable

public health advice to demonstrate how prevention can help to reduce demand for health and care

services across the whole local system.

Compelling plans, including a local, cross-partner prevention plan, will secure earliest funding

from the Transformation Fund (as early as April 2017)

Local Sustainability and Transformation Plan to close:

20

Health and

wellbeing gap

Care and quality

gap

Finance and

efficiency gap

Prevention Plan

Getting serious about prevention

Moving beyond the 5YFVSustainability and transformation plans

@ProfKevinFenton

Identifying roles of different organisations is important:

• Health Education England

Specialist training recruitment, funding, training standards

• Faculty of Public Health

Curriculum and standards for trainees, consultant appointments,

continuing professional development standards

• PHE

“To review and make recommendations on the current operation of

the public health system in relation to the future capability, skills and

experience of the public health workforce to operate across all the

public health functions…to feed into the planned review of the public

health workforce strategy” Remit letter, Department of Health

21 Getting serious about prevention

Moving beyond the 5YFVSystems leadership for health: Training and capability

building

@ProfKevinFenton

Conclusions

• Prevention is vital to addressing the health and wellbeing gap

• Prevention also makes a key contribution to other two 5YFV

gaps – financial and care and quality

• Need for a system based approach

• NHS, local authorities and voluntary sector are key players

• Recent NHS guidance on sustainability and transformation

plans presents further opportunities for action through

prevention plans and identification of joint priorities for NHS

and local authorities.


Getting serious about

prevention

March 2016

Professor Kevin Fenton

National Director, Health and Wellbeing

Public Health England

Twitter: @ProfKevinFenton

Email: [email protected]

Government & Nonprofit

Kevin Fenton