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Advancing our health

Advancing our health: Prevention in the 2020’s

The Green paper (out for consultation) announces that the coming decade will be a period of proactive, predictive and personalised prevention that will require a new prevention model. This Green paper is important when considering both primary and secondary care based physical activity interventions as it gives a structure to support physical activity interventions within a wider prevention strategy.

At the heart of the Green paper is the premise that health is a shared responsibility.

The vision for prevention in the 2020s is one of participatory, rather than passive health, where people are challenged and enabled with the skills, knowledge and confidence they need to lead healthy lives.

Ultimately, the paper argues that health is a shared responsibility, just as much as it is an opportunity.

The Green paper focuses on quality of life, arguing that as more people live with long term conditions than die of them, the symptoms of disease (pain, anxiety, depression and other symptoms of disease like breathlessness and memory loss) are as important to patients as causes of death. It heralds a move away from the NHS focusing on lifespan to the NHS focusing on ‘Health span’.

The Green paper offers a series of opportunities and challenges through which an improved preventative strategy will be delivered. The most relevant of these to the physical activity agenda are presented below:

Use of intelligent public health

Predictive prevention

The use of advances in digital technology to improve both population and personal health interventions is integral to the green paper. For example:

  • Use of population based IT systems to bring together health information across primary and secondary care to provide a population level dataset with a greater power to predict and prevent adverse health outcomes at both an individual and a population level
  • Better integration of personal datasets eg information collected on exercise levels from smartphones with health care, enabling health care professionals to consult and advise on the basis of patient collected data on, for example exercise levels and sleep quality.

There is an opportunity, when designing new physical activity interventions to collaborate with local and national digital strategy experts to ensure that data collection on physical activity is uniform and useable across the integrated care system.

MM-Icons-Digital and technology investment
Focused support and advice

NHS Health checks are currently used in primary care to target those at greatest risk. These checks underpin the ambition of the Long Term Plan to prevent 150,000 new cases of stroke, dementia and heart disease and to double the diabetes prevention programme. They target people between 40 and 74 years every 5 years.

There is an opportunity to embed physical activity data from smartphones, for example, into routine ‘intelligent’ health checks in order to target those at the highest risk. For example, as inactive people have a higher risk of cancer, heart disease and stroke, routine health checks which incorporate physical activity information could be used to target services (including screening services) to those at the highest risk.

It is probable that these checks will become more focused on people reaching key milestones in life, for example, pregnancy, retirement or at diagnosis of a new long term condition.

Staying active

The Prevention paper specifically supports the physical activity agenda through 3 targeted approaches:

This will ask ‘how can we use digital to support the public to do regular activities to increase their strength and balance?’. The challenge will be focused on older people, those living with long term conditions and those on low income and in deprived areas.

  • Support for :

PHE: Moving Health Professionals forward programme to move to phase 2. Moving Medicine and the Active Hospital pilot are key components of this programme.

Sport England ‘We are undefeatable’ campaign which encourages those with long term conditions to increase their physical activity.

Prevention in the NHS

Changing the NHS from a ‘ National Treatment Service’ (focusing on illness) to a National Wellness Service (focussing on creating good health). The NHS is already working to give more people control of their care. For example, their Comprehensive Model for Personalised Care will support up to 2.5 million to benefit from personalised care by 2023 to 2024 (including 900,000 people receiving a social prescription referral and 200,000 personal health budgets)

The Green paper aspires to do this by:

  • allowing people to connect their own data into the whole record if they choose
  • giving people personalised advice based on aggregated data
  • giving people the tools and motivation to make informed choices
  • Social prescribing: This is a way of GPs and other healthcare professionals referring people to ‘activities’ or services in their community instead of offering only medical solutions.

A new Social Prescribing Academy is being set up to help to champion social prescribing and support national plans to make it available throughout England. By 2020 to 2021, over 1,000 trained link workers will be recruited, so that over 900,000 people can benefit from social prescribing by 2023 to 2024.

The Social Prescribing Academy will help by brokering relationships across health, local government, justice, arts and culture, sport and the outdoors, and other sectors, to increase the range and availability of community-based activities and support that people can be connected to, including people living with dementia

Creating healthy places

The Green paper focuses on the importance of maintaining a healthy workforce. It particularly highlights the importance for employers to promote and encourage work behaviours which promote good musculoskeletal and mental health. To support this it is due to launch a consultation on musculoskeletal health in the workplace in late 2019.

Active aging

The Green paper heralds 2020’s as a ‘decade of active aging’. This is in recognition of an aging population who stand to gain most from adopting active lifestyles. The government have commissioned a consensus statement from PHE and the Centre for Aging Better and other national organisations, to set out key principles and ways of working together on this agenda.

World class research

The Green paper states an ambition to make the UK a world leader in public health and prevention research. It states a set of principles to arm the research environment to become more focused on prevention.

Local action

The Green paper highlights the importance of integrated working between the NHS and local authorities to provide action on the prevention agenda. It acknowledges the role of health and wellbeing boards in the integrated care system working on prevention. It highlights case studies to illustrate tangeable changes in population health as a result of integrated care working well. Importantly, it highlights the vital role the NHS must play on the public health agenda through integrated care systems.