Public health issues
Important public health issues illustrated in the
Wanless report include:
· Smoking
· Health inequalities
· Salt intake
· Obesity
· Physical activity
· Falls
“Securing good health for the whole population:
Final report” is available on the Treasury website.
Submissions from pharmacy can now be made on the Department of Health’s
consultation on public health (see p266). |
Despite the scant mention of pharmacy, a long-awaited report
on securing the nation’s health could have a “significant
impact on community pharmacy”. So says Geof Rayner, chairman of
the UK Public Health Association and director of Pharmacy HealthLink.
The report, “Securing good health for the whole population: Final
report”, was produced for the Prime Minister, the Chancellor of
the Exchequer and the Health Secretary by Derek Wanless (ex-chief executive,
NatWest Bank Group). It highlights the role of community pharmacy in
the management of chronic conditions. But it omits pharmacists as examples
of primary care staff with a public health role.
However, Dr Rayner told The Journal that the first Wanless report published
in 2002 had already acknowledged the benefits of engaging the public
through community pharmacy. In his opinion, this second report concentrated
on the general context of engaging the public rather than the exact infrastructure.
He encouraged pharmacists not to be disappointed by the report, which,
he thought, could have a “significant bearing” on community
pharmacy’s role in public health.
The “fully engaged” scenario
Before the 2002 Spending Review, Derek Wanless was asked to assess
the resources required to ensure that the NHS could provide a publicly
funded, high quality service on the basis of clinical need.
The review recommended a significantly larger share of national
income for health care, with effective use of resources. The least
expensive scenario (cheaper by £30bn compared with the most
expensive), which also delivered better health outcomes, was a “fully
engaged” scenario in which the level of public engagement
in relation to health is high, life expectancy improves beyond
current forecasts, health status increases and the health service
is responsive and cost efficient.
The new report provides an update of the challenges in implementing
the fully engaged scenario. |
The report says that the NHS needs to be transformed from a “national
sickness service” which treats disease, to a national health service,
which focuses on prevention. Mr Wanless’s vision is of individuals “fully
engaged” in becoming responsible for their own health and that
of their children, well supported in making better decisions to promote
health. The report illustrates key threats to the nation’s future
health: smoking (see p275), diet and obesity, lack of physical activity,
falls and health inequalities.
These threats need to be tackled now, Mr Wanless says. Another priority
is the organisation and funding of research to ensure which approaches
are effective and what spending can be justified.
“The role of community pharmacists will need to be developed to
expand overall capacity in the increasingly important management of chronic
conditions and take pressure off traditionally skilled people”,
says the report summary. Proactive role
A spokesman from HM Treasury said that the “fully engaged” scenario
envisaged by Derek Wanless would require a proactive role from pharmacists
in terms of engaging the public in their own health, enabling them to
manage chronic disease, and providing access to preventive health care.
“The profession can also contribute to improving health literacy
by offering an additional channel for high quality information presented
on a user-friendly
basis, which will encourage the public to seek advice from pharmacists
as a recognised and routine part of the range of public health services
available at local level.”
Pharmacists are mentioned again specifically in a case study on falls, “a
major cause of disability and mortality in the over-75s”. The report
says that effective fall prevention and treatment highlights the importance
of an integrated approach between health and social care including medical,
nursing, pharmacy and social services.
Pharmacists are not mentioned in a chapter on the delivery of public
health, although health visitors, school nurses, practice nurses, midwives,
district nurses, GPs and dietitians are all cited as having a role in
primary care in relation to public health. The report calls for a co-ordinated
approach to developing a “public health workforce” and to
identify competencies for new roles, eg, “smoking cessation officers”.
Primary care trusts are identified as playing a significant role in a
fully engaged scenario, helping individuals to stay healthy. The electronic
patient record is cited as an infrastructure for mapping out the local
prevalence of disease and lifestyle risks and will allow enhanced targeting
of disease management.
The Government, it suggests, should develop a consistent set of national
objectives for the key risk factors. Primary care trusts and local authorities
should then agree joint local targets.
Hemant Patel, secretary, North-East London Local Pharmaceutical Committee,
suggests that pharmacy involvement in public health requires links with
local development plans and local public health reports. The pharmacy
role early in care pathways must be identified, be accessible and of
good quality, with evidence for its efficacy, he adds.
“Think about linking primary prevention with existing services (eg,
dispensing) and secondary prevention measures. For example, giving advice
on diet
and exercise for primary prevention in CHD, in tandem with dispensing
aspirin for secondary prevention.
“With medicines management in between, we could develop a one-stop
centre for health care,” he adds. Mr Patel also emphasises the importance
for pharmacy of understanding the difference between public health and
health promotion.
Eileen Neilson, head of policy development, Royal Pharmaceutical Society,
echoes these ideas: “The report highlights the need to expand the
role of community pharmacists in medicines management for chronic conditions.
This was a major point in the Society’s submission of evidence
to the review. We also highlighted the dearth of evidence on the cost-effectiveness
of interventions such as medicines management, and the report confirms
this.
“There are now opportunities to join with other organisations in
recommending the building of an appropriate research infrastructure for
public health
interventions, and specifically to call for more research funding to
evaluate pharmacy-led interventions.” |
The
Pharmaceutical Journal