Public health, wellbeing and prevention
Under the new NHS and a personalised social care system, promoting public health and wellbeing, as well as ensuring preventative approaches are fundamental to the commissioning endeavour.
What is public health?
The Government accepts the Faculty of Health’s definition as:
The science and art of promoting and protecting health and wellbeing, preventing ill health and prolonging life through the organised efforts of society (Healthy Lives Healthy People Department of Health 2010).
There are three domains of health: health improvement (including people’s lifestyles as well as inequalities in health and the wider social influences of health), health protection (including infectious diseases, environmental hazards and emergency preparedness) and health services (including service planning, efficiency, audit and evaluation) (Healthy Lives Healthy People Department of Health 2010).
What is wellbeing?
The Government has set out definitions of wellbeing:
We use a broad definition of health that encompasses both physical and mental health, as well as wellbeing. This means we are not only interested in whether or not people are ill or have a health condition, but also in how healthy and well they are (Our Health and Wellbeing Today Department of Health Nov 2010).
[Wellbeing is] a positive physical, social and mental state; it is not just the absence of pain, discomfort and incapacity. It requires that basic needs are met, that individuals have a sense of purpose, that they feel able to achieve important personal goals and participate in society. It is enhanced by conditions that include supportive personal relationships, strong and inclusive communities, good health, financial and personal security, rewarding employment, and a healthy and attractive environment. (Our Health and Wellbeing Today Department of Health Nov 2010).
The Government wants to improve the wellbeing of the nation as they see a direct link between wellbeing and improved social and health care outcomes. For example:
There are huge opportunities to improve health and wellbeing in England. People living in the poorest areas die on average seven years earlier than people living in richer areas, and have higher rates of mental illness; disability, harm from alcohol, drugs and smoking (Our Health and Social Care Act 2012; factsheets. (Overview of the Health and Social Care Act factsheet).
What is prevention?
Prevention is a broad concept and refers to a range of meanings and actual interventions. Prevention includes:
- Protecting vulnerable people, including the elderly, from preventative harms such as falls prevention, potential impacts of seasonal weather extremes and providing vaccinations such as the seasonal flu jabs;
- Promoting health and wellbeing with a view to preventing or delaying the need for more costly services at a later date;
- Providing low level services to maintain peoples independence;
- Preventing the need for institutional care;
- Avoiding crises which might lead to hospital admission / readmission;
- Reducing the impact of long term conditions.
Who is responsible for public health, wellbeing and prevention?
The Government perceives there to be many levels of responsibility for public health, promoting wellbeing and developing preventative services. These include:
- Individuals and communities
- GP consortia
- Local Authorities
- Directors of Public Health
- Local Health and Wellbeing boards
- Public Health England
- Chief medical officer
- NHS Commissioning Board
For more details about each level refer to Healthy Lives, Healthy People: our strategy for public health in England and The Health and Care System April 2013.
Implications for Commissioning
Responsibilities for local public health are now firmly placed with local government as set out in The Health and Social Care Act 2012. Local authorities are in charge of driving health improvement, collating evidence on public health and public health interventions and ensuring that the right mix of arrangements and services are in place to meet population health and well-being outcomes. This means that local government has to ensure good partnerships with and between key players such as NHS, social care, housing, environment of health, leisure and transport as well as service users, carer’s and the local population.
Health and Wellbeing Boards (HWBB’s) are the forum where key leaders from the health and care system work together to improve the health and wellbeing outcomes of their local population and reduce health inequalities. They will undertake a Joint Strategic Needs Assessment (JSNA) and develop a Joint Health and Wellbeing Strategy for their population which will inform planning and consequent commissioning. This information should be developed with service users and providers and shared with the market so providers and communities can develop responsive and good quality services that meet specified outcomes. This is shared through a Market Position statement (MPS). HWBB’s will also liaise and work with CCGs and the electorate.
Promoting public health, well-being and developing preventative approaches requires conceptualising and working more holistically, which inevitably means working with other organisations, professionals and sectors. Developing good partnerships is fundamental, notwithstanding the duties placed on the NHS Commissioning Board (NHS England), CCGs, Monitor and HWBB’s to promote and enable integration as enacted by the Health and Social Care Act 2012. The draft Social Care and Support Bill also sets out a similar duty on the local authority to promote the integration of services.