Incentivising Wellness shows how the NHS can save tens of billions of pounds while also taking better care of one of the UK’s fastest-growing diseases – diabetes.
The report calls for new business models to be introduced to the NHS in a bid to harness modern technology like insulin pumps and telemonitoring that can help diabetes sufferers stay out of hospital and stop their condition getting worse.
Press coverage • Health Service Journal • Public Service
http://www.policyexchange.org.uk/publications/publication.cgi?id=218
A radical plan to go further and faster in tackling today’s causes of premature death and illness and reduce health inequalities, with a public health service to make it happen, was unveiled today by Health Secretary, Andrew Lansley.
Public Health England will be created as a service that gives more power to local people over their health, whilst keeping a firm national grip on crucial population-wide issues such as flu pandemics.
The White Paper, Healthy Lives, Healthy People also sets out how funding from the overall NHS budget will be ring-fenced for spending on public health – a recognition that prevention is better than cure. Early estimates suggest that current spend on areas that are likely to be the responsibility of Public Health England could be in the range of £4 billion.
For the first time in a generation, central Government will not hold all the purse strings. The majority of public health services will be commissioned by Local Authorities from their ring-fenced budget, or by the NHS, all funded from Public Health England’s new public health budget.
Mr Lansley said:
“Too often in the past, public health budgets have been raided by the NHS to tackle deficits. Not any more. The money will be ringfenced to be used as it should be – for preventing ill health.
“People’s health and wellbeing will be at the heart of everything local councils do. It’s nonsense to think that health can be tackled on its own. Directors of Public Health will be able to champion local cooperation so that health issues are considered alongside housing, transport, and education.
“Everyone should have services tailored for them, at the right times in their life from the professionals closest to them. With local authorities in the driving seat, supported by the latest evidence on behaviour change from Public Health England, we will start seeing significant improvements in the nation’s health.”
What Government will and won’t do
The Government will take a less intrusive approach, staying out of people’s everyday lives wherever possible. This follows a model called the Nuffield Council of Bioethics Ladder of Interventions, which means that instead of reaching for choice-limiting regulations at every opportunity, the Government will employ a range of evidence based approaches to improve health.
The ladder increases in intrusiveness as follows:
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Do nothing or simply monitor the situation. Some behaviour trends are minor and fizzle out, so intervention isn’t needed.
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Provide information. Giving people the information and education to make a choice for themselves based on evidence.
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Enable choice. Give people a ‘nudge’ in the right direction so they can change their behaviour. For example, through access to public exercise facilities, cycle paths, or safe playgrounds.
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Change the default to help guide choice. Using positive ‘social norms’ is a way of encouraging this.
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Guide choice through incentives. A ‘points mean prizes’ approach, for example the more a child walks to school, they earn points for healthy prizes like an activity day.
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Disincentives, such as taxation or other price related action, to discourage people from smoking or drinking.
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Restrict choice, probably through regulation, such as raising the legal age for smoking or banning trans fats.
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Eliminate choice altogether. Rarely used, but most common examples include making seatbelts compulsory and making dangerous drugs illegal.
Local control, better health
Directors of Public Health will be employed by the Local Authority and be the ambassadors of health issues for the local population. In practice, this means that they will lead discussion about how the ring-fenced money is spent to improve health. This will include influencing investment decisions right across the Local Authority, with the goal of enhancing health and well-being.
Crucially, they will be able to make sure that public health is always considered when local authorities, GP consortia and the NHS make decisions.
To make sure that progress is made on issues like obesity and smoking, Public Health England will set a series of outcomes to measure whether people’s health actually improves.
Money where it’s needed, credit where it’s due
Historically, money for public health has disappeared into other services. Under new arrangements, the flow of money will change so that: money will be allocated from the NHS budget and ring-fenced for public health; part of this will be used by Public Health England for population-wide issues; another part will provide a ring-fenced budget to Local Authorities.
A new health premium will take into account health inequalities and reward progress on specific public health outcomes, and we will consult on how we do this to get the detail right. The premium will be simple and driven by a formula developed with key partners. Disadvantaged areas will see a greater premium if they make progress, recognising that they face the greatest challenges.
Details of the outcomes framework and funding will be consulted on separately in the next few weeks.
National support for local delivery
At a national level, a new core public health service - Public Health England – will combine experts from public health bodies such as the Health Protection Agency and the National Treatment Agency as part of the Department of Health. This will integrate leading expertise, advice and influence into one organisation.
Public Health England will focus on national resilience against things like flu pandemics and other health threats, as well as being a ‘knowledge bank’ for the best and most up to date evidence on behaviour change techniques and monitoring data.
The public health responsibility deal will be driven forward by the Secretary of State, working with industry, charities, and leading experts from the field. The outcome will be to make it easier for people to make healthy choices. For example, through better food labelling, more information about alcohol harms, and much bigger contribution from industry around campaigns like Change4Life.
Regulation of public health professionals
Alongside this White Paper, the Department of Health is publishing a review of the regulation of public health professionals. The Government believes that statutory regulation should be a last resort, so the preferred approach is to ensure effective and independently assured voluntary regulation for unregulated public health specialists. This would be overseen by the Council for Healthcare Regulatory Excellence, as provided for in the legislation currently before Parliament. This is now offered for consultation.
Chief Medical Officer (Interim) Professor Dame Sally Davies said:
“We need a strong and protected public health system to tackle our public health problems, and protect the public. So I welcome this public health white paper which sets out how a new core public health service, Public Health England, will integrate public health expertise, providing national support and advice, for local delivery.
“By joining up the local work done by the NHS, social care, housing, environmental health, transport and leisure services and focussing on public health at a local level, this paper lays out a strategy to improve the health and wellbeing of the nation, and addresses the issues of health inequalities.”
Professor Lindsey Davies, President of the UK Faculty of Public Health said:
“This is a tremendous opportunity to put health at the heart of public service. We see the Public Health White Paper as a significant opportunity to deliver an effective local public health system, which has at its heart people’s health and wellbeing. Government's recognition of the central role of the Director of Public Health in realising this vision is welcomed. We recognise that there is still further work to be done during this critical period of transition and look forward to working with government to ensure that a quality public health workforce is in place to deliver lasting improvements to the health of the public.”
Notes to editors
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The White Paper, Healthy Lives, Healthy People, can be downloaded here: www.dh.gov.uk/healthypeople - Accompanying documents to the White Paper are:
- Our health and wellbeing today – evidence document
- Review of the regulation of public health professionals (Dr Scally's independent review)
- The Impact Assessment and Equality Impact Assessment.
http://nds.coi.gov.uk/content/detail.aspx?NewsAreaId=2&ReleaseID=416821&...


Introduction
Today the government is asking the Office for National Statistics to devise a new way of measuring well-being in Britain.
From April next year we will start measuring our progress as a country not just by how our economy is growing, but by how our lives are improving…
…not just by our standard of living, but by our quality of life.
This is something that is important to our goal of creating a more family-friendly country – and it’s something I’ve been calling for for years.
But I know there are some people in this country who take a different view.
Over the past couple of weeks a few objections have become clear:
There is the worry that this is a distraction from the urgent economic tasks at hand.
There is the criticism that we cannot hope to improve people’s well-being – that this is beyond the realm of government.
And there is the suspicion that, frankly, the whole thing is a bit woolly and impractical; that you cannot possibly measure well-being, so don’t bother trying.
I want to take each of these on directly today.
Growth
First and foremost, people are concerned that talking about well-being shows this government is sidelining economic growth as our first concern.
At a time when we are recovering from the longest and deepest recession since the war, they say all our energies should be focussed on driving up GDP.
Let me be very clear.
Growth is the essential foundation of all our aspirations.
Without a job that pays a decent wage it’s hard for people to look after their families in the way they want, whether that’s taking the children on holiday or making home a more comfortable place.
Without money in your pocket it’s difficult to do so many of the things we enjoy, from going out in the evening to shopping at the weekend.
So at this time I am clear that our most urgent priority is to get the economy moving, create jobs and spread opportunity to everyone.
That’s why we’re clearing up the mess left by the last government – because if we let our debts spiral out of control, interest rates will go up, mortgage rates will rise and people will be hurt.
It’s why we’re doing everything possible to drive a new economic dynamism in our country – making it easier for people to start their own business, cutting corporation tax, getting behind entrepreneurs.
It’s why we’re taking practical steps to rebalance our economy, with a Regional Growth Fund to stimulate enterprise and help create jobs right across the country.
And it is why we’ll continue to measure GDP as we’ve always done.
But it is high time we admitted that taken on its own, GDP is an incomplete way of measuring a country’s progress.
The big problem is that it doesn’t show you how growth is created.
When a country is hit by an earthquake, that can increase GDP – because of the extra spending on re-construction afterwards.
When a city is torn apart by crime and disorder, that can increase GDP – because of all the extra locks and security people buy.
When a person falls seriously ill, that can increase GDP – because the cost of buying drugs and paying for care counts as economic activity.
Destruction, crime, disease – in a very crude way all these things can amount to progress in terms of GDP.
The point is that all of life can’t be measured on a balance sheet – and no one put that better than Robert Kennedy more than forty years ago.
GDP “does not allow for the health of our children, the quality of their education, or the joy of their play…
…It measures neither our wisdom nor our learning; neither our compassion nor our devotion to our country; it measures everything, in short, except that which makes life worthwhile.”
Simple and profound words – but we haven’t heeded them in this country.
We’ve seen an immigration free-for-all justified on the argument that it was good for growth – with little thought about the impact on public services and social cohesion.
We saw a cheap booze free-for-all justified on the argument that it was good for growth – with little thought about the impact on law and order.
We saw an irresponsible media and marketing free-for-all justified on the argument that it was good for growth – with little thought about the impact on childhood.
It’s because of this fundamentally flawed approach that for decades Western societies have seen the line of GDP rising steadily upwards – but at the same time levels of contentment have remained static or even fallen.
Now there are some who leap on this as evidence that capitalism has failed and that money is the root of all misery.
I think that is naïve.
But we have got to recognise, officially, that economic growth is a means to an end.
If your goal in politics is to help make a better life for people – which mine is…
…and if you know, both in your gut and from a huge body of evidence – that prosperity alone can’t deliver a better life – which I do…
…then you have got to take practical steps to make sure government is properly focussed on our quality of life as well as economic growth, and that’s what we are doing.
Government’s Influence on Well-Being
Now let me answer the charge that government can’t affect how people feel, or do very much to improve well-being.
It’s the argument that the business of government is mechanistic and highly practical, that what happens in Whitehall cannot reach into people’s personal lives or feelings.
It’s interesting that the people who most often rail against the negative impact that government can have on people’s well-being…
…who campaigned against the closure of Post Offices for the loneliness it could cause for the elderly in rural areas…
…who criticised top-down targets in the public sector for the damage they did to workers’ morale…
…are often the ones who do not accept that it can work the other way – that the actions that government takes can make people feel better as well as worse.
Of course you can’t legislate for fulfilment or satisfaction, but I do believe government has the power to help improve well-being.
I’m not alone in that belief.
A whole host of world-leading economists and social scientists – including Nobel Prize winners Joseph Stiglitz and Amartya Sen – have developed a new school of thought about government’s role in improving people’s lives in the broadest sense.
Here with us today we have Lord Layard, Professor John Helliwell, Professor Felicia Huppert and academics from all over the world.
The contention is that just as we can create the climate for business to thrive – by cutting taxes, slashing red tape and so on…
…so we can create a climate in this country that is more family-friendly and more conducive to the good life.
That’s why I reject the criticism that government policy has no role in this area.
To those who say that all this sounds like a distraction from the serious business of government…
…I say finding out what will really improve lives and acting on it is the serious business of government.
Practical Application
Finally, let me address the suspicion that all this is a bit airy-fairy and impractical.
Of course you can’t capture happiness on a spread-sheet, any more than you can bottle it.
If anyone was trying to reduce the whole spectrum of human emotion into one snapshot statistic I would be the first to roll my eyes.
But that isn’t what this is about.
Just as the GDP figures don’t give the full story of our economy’s growth – but do give a useful indicator of where we’re heading…
…so this new measure won’t give the full story of our nation’s well-being – but will give us a general picture of how life is improving.
And that has a real practical purpose.
First it’s going to open up a national debate about what really matters – not just in government but among all the people that influence our lives:
In the media. In business. The people who develop the products we use, who build the towns we live in, who shape the culture we enjoy.
And second, this information will help government work out, with evidence, the best ways of helping to improve people’s well-being.
Of course we already have strong instincts about what will improve people’s lives – and we’re acting on those instincts.
Our instinct that people who feel in control of their own destiny feel more fulfilled – that’s why we’re giving parents real choice over schools and patients real choice over where they get treated.
Our instinct that having the purpose of a job is as important to the soul as it is to the bank balance – it’s there in our hugely ambitious Work Programme to get people off welfare.
Our instinct that most people have a real yearning to belong to something bigger than themselves – it’s leading our plans to bring neighbourhoods together, to increase social action and build the Big Society.
These are instincts we feel to the core – but it’s right that as far as possible we put them to the practical test, so we really know what matters to people.
Every day, Ministers, officials, people working throughout the public sector make decisions that affect people’s lives.
This is about helping to make sure those government decisions on policy and spending are made in a balanced way, taking account of what really matters.
I’ve said before that I want every decision we take to be judged on whether it makes our country more or less family-friendly – and this new focus on well-being will be part of achieving that.
Parents need to know that the concerns they feel about the kind of country their children grow up in are felt and acted on by their government too.
That’s why anyone who cares about community, about civility, about making this country more family-friendly should welcome what the Office for National Statistics is doing.
Conclusion
So this measure that we are setting out today reaffirms the fact that our success as a country is about more than economic growth.
It will open a national debate about how together we can build a better life.
It will help bring about a re-appraisal of what matters.
And in time it will lead to government policy that is more focussed not just on the bottom line, but on all those things that make life worthwhile.
http://www.number10.gov.uk/news/speeches-and-transcripts/2010/11/pm-spee...