Intended for healthcare professionals


NHS plan calls for new models of care and greater emphasis on prevention

BMJ 2014; 349 doi: (Published 23 October 2014) Cite this as: BMJ 2014;349:g6430

Re: NHS plan calls for new models of care and greater emphasis on prevention

We welcome some of the proposals in the new national blueprint, particularly the suggestion that there needs to be a “radical upgrade in prevention and public health” and that they will support “comprehensive and hard-hitting” action to tackle priorities such as obesity, diabetes and inequalities.(1) However, we do hope that lessons will be learnt from the past and that effective action is will be instigated.(2,3)

We believe that an approach which focuses only on individuals rather than the external forces that influence an individual person may result in victim-blaming and be ineffective.(3) A seminal document of the new public health provides direction for success.(4,5) It recommends that diverse but complementary approaches including: developing personal skills; creating supportive environments; and re-orienting health services so that they move increasingly in a health promotion direction.(4,5)

In addition, it is important to note that past reviews of national initiatives have been critical of their NHS focus.(6) What is needed is a strategic approach that is co-ordinated across many settings including schools, hospitals and workplaces. Public health professionals need to be active at local and national levels facilitating action so that health promoting environments are created.

We support the proposal in the blueprint that workplace health should be improved. It has been known for a long time that the workplace can have an influential effect on the health of individuals, both physical and mental, and guidelines are available for making the workplace more conducive to health.(7) But, it is essential that a planned approach is undertaken and that steps are taken to deal with the “hidden curriculum”. For example, hospitals that promote exercise for staff and run relaxation classes also need to be aware of the potential obesogenic environment and staffing levels.

Nurses are just one group that could have a greater influence on the health of the country. The Royal College of Nursing has a membership of around 400,000 and daily nurses will have contacts and potential opportunities for promoting health with patients, family members and individuals in the community. We believe that they have key roles to play both at an individual and community level. Examples of excellent nurse-led public health initiatives are growing, but with support, more could be achieved.(8)

NHS England’s Five Year Forward View outlines some titanic public health challenges and in agreement with both Wanless and Marmot it recommends that there needs to be an increased investment in primary prevention and health promotion.(9,10) One crucial area that needs further investment is public health departments, as public health professionals are vital for motivating and supporting the vast array of current and potential health promoters. We think such investments are urgently needed and that they would have health and economic benefits, as a healthier more equal population would result in for example, fewer treatment costs and lower welfare payments.

1) NHS England, Public Health England, Monitor, Care Quality Commission, Health Education England. Five year forward view. October 2014.
2) Whitehead M. Swimming Upstream. London: King's Fund, 1989.
3) Tones K and Tilford S. Health Promotion: effectiveness, efficiency and equity. Cheltenham: Nelson Thornes, 2001
4) World Health Organization, Ottawa Charter for Health Promotion. Copenhagen: World Health Organization, 1986.
5) Watson, M., Going for gold: the health promoting general practice. Quality in Primary Care. 2008; 16:177-185.
6) Universities of Leeds & Glamorgan and the London School of Hygiene & Tropical Medicine. The Health of the Nation - a policy assessed. London: The Stationery Office, 1998.
7) Faculty of Public Health and the Faculty of Occupational Medicine. Creating a healthy workplace: A guide for occupational safety and health professionals and employers. London: Faculty of Public Health, 2006
8) Royal College of Nursing. Going upstream: nursing’s contribution to public health. London: RCN, 2012.
9) Wanless D. Securing our future health: taking a long-term view. Final report. London: HM Treasury, 2002.
10) Marmot M, chair. Fair society, healthy lives (the Marmot review). UCL Institute of Equity, 2010.

Competing interests: No competing interests

27 October 2014
Michael C. Watson
Associate Professor in Public Health
Dr Mark Forshaw (President, Institute of Health Promotion and Education. Subject Leader in Psychology, Natural Sciences and Psychology, Liverpool John Moores University.)
University of Nottingham, Faculty of Medicine and Health Sciences, D86, Queen's Medical Centre, Nottingham. NG7 2HA