England must rid itself of “obsession” with hospital medicine, conference hears

BMJ 2013; 346 doi: (Published 19 March 2013) Cite this as: BMJ 2013;346:f1799
  1. Carol Harris
  1. 1London

Most of what matters about people’s health happens away from hospitals, Duncan Selbie, chief executive designate of Public Health England, told a conference mainly of health and social care staff in London last week.

“The biggest obsession we have as a country is our obsession with hospital medicine. We prioritise it and spend our money on acute hospitals and treatments. The way we use the NHS is not sustainable.”

Hypertension, obesity, and drug and alcohol misuse were major causes of death, and “despite all our efforts smoking is still the biggest killer,” he said. “We know that blood pressure is about diet and exercise. If we put a fraction of the effort that we put into [reducing] waiting times into reducing blood pressure, we will go forward,” he said.

Selbie told the conference, organised by GovToday, a PR agency that publicises government policies and news, that despite advances in healthcare and in treatments over the past 20 years people in the United Kingdom died younger and had fewer years of healthy life than people in similar countries.

Priorities for public health were about early intervention and prevention and tackling health inequalities, he said. Public health and wellbeing needed the broadest approach, integrating health and social needs to deal effectively with the root causes of poor health, such as homelessness. “Homeless people use the NHS eight times more than other groups and die at an average age of 47.”

Under the new arrangements in the NHS, local health and wellbeing boards will develop services to improve the health of their local populations. Selbie said, “For the Birmingham health and wellbeing board, homelessness is their number one priority. In Essex and in Kent it is the nine months before birth and the first year of life. So already they are looking and saying that these are the ways in which they can make a difference.”


Cite this as: BMJ 2013;346:f1799