- Public health directors will join the NHS’ seven integrated regional management boards
- Tobacco control will be headline output from long-term plan prevention workstream
- However, efforts to reduce the burden on hospitals from alcohol-related diseases will have to be more targeted to meet cost limits
Public Health England will integrate with the new NHS England structure by adding a director of public health to each of the seven new regions, PHE’s chief executive has said.
The public health directors will continue to be paid by PHE but report directly to the NHS England regional directors, Duncan Selbie told HSJ in an exclusive interview.
Each of the seven regions will integrate NHS Improvement and NHS England’s operations with the directors being “a single reporting line from each region” to both NHS bodies.
PHE currently divides the country into four regions, each subdivided into centres, that are responsible for local public health operations.
The national body, set up as part of the Lansley reforms, has “organised our regions and centres around how local government [is] organised, and that will remain,” Mr Selbie explained.
“Local government has been absolutely the right focus for PHE in our first five or six years” and the regional directors will continue working with local authorities, he said.
“It’s not a full-time separated role,” Mr Selbie continued. “It’s about integration between PHE and the new NHS management structures.”
“This is us repurposing our existing people. PHE is one third cheaper than it was five years ago. No one’s coming along and giving me new money for PHE so we’re using what we have because we think this really, really matters.”
This application of limited resources will extend into spending on prevention by public health services in England and by the NHS in the long-term plan, Mr Selbie added.
The new health and social care secretary Matt Hancock last week set out his vision for prevention, while the NHS leadership has made it clear prevention will be at the heart of NHS planning over the next decade.
Mr Selbie said: “The words I’m trying to get across [are] how we help people to stay well for longer; to use the NHS less and later, so not first resort; to help people when unwell to stay in their own homes for longer – so not coming into hospital or going into social care; and clinically, to help people stay in work for longer, which speaks to the great loss of productivity from pretty common mental health problems and musculoskeletal problems – basically joint pain and depression, which accounts for about half of all reasons why people are off work. And with an ageing population and slowing birth rate, folk are going to have to stay in work for longer.”
He said these issues meant the public’s health was “an inseparable part of the economic future of the country” adding: “It’s inconceivable to me that you’d have a prevention vision from the secretary of state that puts the public’s health – if you like health in its broadest understanding, how we help people to stay well, how we use the NHS in a more sustainable way – it is inconceivable that you would then be reducing expenditure on prevention. But those are matters for the spending review and the Treasury.”
Mr Selbie has been co-lead on the prevention workstream, helping develop the NHS long-term plan. He has also been involved in the other workstreams, trying to instil the importance of prevention into their output. “What I’m hoping for is that the net of all of this will be a much bigger emphasis on prevention and more spending on prevention,” he said.
While the NHS is getting an extra £20bn investment over the next five years, Mr Selbie’s workstream has been “fairly ruthless about what we’re focussing on, and then [will] be absolutely ruthless on its implementation”.
Tobacco control has been a priority for the prevention workstream and will be the headline intervention when the plan is published, he said.
The health secretary’s vision for prevention cited the “Ottawa model” for creating a tariff for smoking cessation throughout hospital care pathways, which will be adopted in England.
Reducing demand on healthcare from excessive alcohol consumption has been another priority area for the prevention workstream. As recently as 1 November, PHE has told the NHS the long-term plan should create specialist alcohol care teams in every hospital. But “there’s not enough money to do everything so I’m talking with Simon [Stevens, NHS England chief executive] about how we can be targeted about that,” Mr Selbie explained.
This could mean a quarter of hospitals see investment in specialist alcohol teams, focused on the top quarter of hospitals with the most alcohol dependent patients. This will hopefully “land an affordable investment where we can demonstrate that further investment… can be made,” if more resources become available, he said.
The other areas of work in the long-term plan have prioritised specific ambitions to prevent further health demand downstream, Mr Selbie added. He gave an example of increasing the number of speech and language therapists working in early years with the most vulnerable children in the most deprived areas of the country.
“Language development is one of the best predictors of future academic success, getting jobs and things like that,” he explained.
Update: this story was corrected on 16 November to say PHE divides the country into four regions, each subdivided into centres, and not the other way around as previously stated.
Interview with Duncan Selbie