• NHS should use tariffs and the GP contract to expand isolated good practice on cardiovascular disease and smoking cessation, says PHE
  • Duncan Selbie says public health grant must remain with local authorities
  • National diabetes programme will be expanded in the long term plan

The NHS must do more to stop people smoking and Duncan Selbie thinks the best way to do it is to implement a national tariff for smoking cessation.

Public Health England believes introducing national tariffs for public health outcomes is the best way to improve the nation’s health, its chief executive told HSJ.

In an interview Duncan Selbie said the best thing NHS England and NHS Improvement can do is set a tariff in all relevant clinical pathways, “from respiratory medicine to cancers,” for helping people to quit smoking because hospitals treat the consequences of smoking but do “very little when they’ve got someone in a hospital bed” to help them stop.

This is one of four areas he will be pushing on for action by the NHS - cardiovascular disease, tobacco use, mental health and obesity.

There is good practice in hospitals and primary care around measuring and controlling blood pressure but it is not widespread, he explained. He wants to see the GP contract and tariff system used to “enhance the visibility of the things that we measure”.

Mr Selbie, who has led PHE since 2012, said: “If we measure [high blood pressure] in the same way we measure A&E performance and cancer waiting times then we believe that change can be possible.

“This for the NHS is ‘physician heal thyself’. It’s not about what others should be doing but what you should be doing in those four areas”.

Of the workstream he is co-leading in the development of in the long term plan, he “will be advising [the government] to focus on a very few things where you can take action, where you can have actionable objectives that are about the NHS itself,” he said.

To see this through he’d like to see mental health and primary care get a greater share of investment. If the plan only focusses on treatment it will fail. “If it all goes into the hospitals we’ll be in exactly the same place in three or five years,” he said.

But, ultimately, the health service and government must find a balance between what the NHS can do to help improve the health of the nation and what government and the public can do.

“People conflate good health with the NHS. And we need to see the NHS properly invested in. We need to see it back on its feet, confident and thriving. But putting more money into the NHS won’t of itself improve the health of the people.”

To that end, he said responsibility for public health must remain with local government, where it stands the best chance of influencing all the factors that improve the public’s health, such as housing, air quality, and job creation.

PHE’s statutory duty is to “protect the nation’s health and address health inequalities”. It coordinates screening programmes, develops evidence for public health interventions, and working with the NHS and local government.

“The main impact on health in life is income: money in your pocket, having a job, followed by decent housing, and friendship and companionship,” he explained.

“Talk of [putting] the [public health] grant back in the NHS is to fundamentally misunderstand how you go about improving the health of the people,” Selbie said.

He added: “In the forty years that the NHS held responsibility for public health, from 1974 to 2012-13, there were major improvements in those things that the health service could influence. But there was no change at all in the health profile of the poor and the affluent.”

Selbie spoke exclusively to HSJ at PHE’s annual conference earlier this week.

He outlined how he thinks the NHS can contribute to prevention in cardiovascular disease, mental health and obesity, as well as tobacco control.

For cardiovascular disease, the focus should be on high blood pressure. “It’s the third biggest risk after smoking and poor diet,” he said. But “most people don’t know their blood pressure.”

There are two areas the NHS can focus its attention when it comes to fighting obesity. First is an expansion of the national diabetes prevention plan, where people at risk of developing type 2 diabetes are referred for exercise and education sessions.

It is a collaboration between NHS England, PHE and the charity Diabetes UK. Services are run at present by three private providers and one collaboration between a social enterprise and a community trust.

It has had great success so far, Selbie said. He is “absolutely certain that the long term plan will speak to a major expansion of that programme”.

The NHS can take more direct action in the welfare of its workforce, working out “what can we do to help NHS staff with eating healthier and moving more”, he added.

On mental health, Selbie espoused secondary prevention. People with mental health problems “on average die 20 years earlier, and this is multifactorial”. But they are also more likely to smoke and be overweight, and less likely to have their blood pressure checked. “So, if we pay attention to those conditions and risks with a particular focus on people with mental health problems then we can close the gap.”