27 February 2004
Government attempts to improve the health of the nation have been thwarted by the failure to set clear targets or to establish the cost-effectiveness of policies focusing on prevention, according to a major Treasury-commissioned report.
The lack of a clear framework within which public health issues such as smoking and obesity are tackled has meant little progress, despite years of initiatives aimed at stemming the rising tide of ill-health, it says.
The report's author, former Natwest chief executive Derek Wanless, was scathing in his assessment of successive governments' performance. 'Rigorous implementation and evaluation of solutions has often been sadly lacking,' he said.
Instead, he called for more evidence-based evaluations of the money being spent on public health. Wanless claimed he had identified areas where spending was ineffective 'and should be stopped', but would not name any.
'It would be invidious to give any specific examples of that,' he told Public Finance at the launch on February 25.
His report, Securing good health for the whole nation, says a framework, such as that used to evaluate the cost-effectiveness of clinical treatments, must be developed to measure the value for money of public health interventions. It also calls for more research to establish what works.
Wanless's report urges early action by ministers to sweep away the mish-mash of strategies and sometimes contradictory targets, to be replaced with a consistent set of national objectives for each of the major factors that influence public health.
Local authorities and primary care trusts should then set local targets based on 'these national objectives and local needs'.
'After many years of reviews and government policy documents, with little change on the ground, the key challenge now is delivery and implementation, not further discussion,' the report warns.
Altogether it makes 21 recommendations. Wanless's interim report, submitted to the Treasury last December, estimated that an effective public health strategy could save the NHS £30bn by 2022/23.
Wanless called on the Treasury to assess the role that 'economic instruments' could play in promoting public health, but he stopped short of recommending specific measures such as a 'fat tax' to tackle obesity, which has been proposed by some health campaigners. Instead, he said individuals must 'take responsibility for their own health'.
The Health Development Agency, the national body charged with improving public health, backed Wanless's conclusions. Chair Dame Yve Buckland said: 'There often isn't rigorous data to make a compelling case to those who are funding work on prevention. This work is vital to demonstrate the potential impact of preventing ill health.'
Responding to the report, Health Secretary John Reid said he would 'build on' Wanless's conclusions. 'After many years of discussion, the key challenge now is to draw up a plan of action and implement it.'
This is the second major report from Wanless into the NHS. His 2002 study into the future funding of health led to a rise in National Insurance contributions in 2003.