According to Wes Streeting’s article (I love the NHS: it saved my life, but the operation to save it must be led by the people and its staff, October 21), the government’s health plan must pay serious attention to public health. Focusing on individual lifestyle behavior change because it is the easier option will not result in sufficient progress in tackling preventable diseases such as obesity. Prescribing even more weight loss medications is also not the solution. Medicalizing problems primarily caused by health inequalities is not a long-term solution. Only by tackling the causes of many preventable health problems at their source can sufficient and lasting progress be made. This means getting to grips with the commercial health determinants that reduce demand for addictive, ultra-processed foods.
As part of this crusade, attention must be paid to the public health function, nationally and locally. It has been eviscerated by the previous government, as evidenced by the recent Darzi assessment. Restoring cuts to local government and public health is an urgent first step. The organization of the public health function at national level also needs attention as it has been seriously weakened by the sudden abolition of Public Health England in 2021. The Office for Health Improvement and Disparities should be replaced by a more visible and independent body. The government could look to Wales and Scotland for models. Without a strong public health function, independent of government and able to speak truth to power, progress risks being hopeless.
Prioritizing the health of the population also means challenging the reductionist budget mentality of the Ministry of Finance, so that public health financing is seen as an investment and not as a cost. In view of this, consideration should be given to establishing a public health agency, along the lines of the Office of Budget Responsibility, to improve budgetary and economic planning and thus strengthen public health and well-being.
Emeritus Professor David J Hunter
Richmond, North Yorkshire
I have read with dismay the flood of ideas from Wes Streeting, many of which medicalise social issues such as unemployment (Wes Streeting unveils plans for ‘patient passports’ to hold all medical records, October 21). The belief that spending money on weight-loss shots (which you may have to take forever), smartwatches (which may actually increase anxiety around sleep and health) and that (contrary to the evidence to date) a secure electronic health record system can be created, will all “save the NHS” and make us healthier is daunting. And that’s before we start selling all the data we collect to anyone who wants to use it.
Low-tech options such as subsidizing fruit and vegetables, keeping open and financing sports centers and youth clubs, Sure Start and even a 35-hour working week would give everyone the opportunity for a healthier life. During the pandemic, you often heard how people ‘suddenly’ started exercising – because they had time, not because they had a smartwatch.
Jennifer Marshall
Birmingham
In response to concerns about privacy and cybersecurity, Wes Streeting announced – as you would expect from a vending machine – that patient data will be “protected and anonymized”. Which begs the question: did Labor just join him last week? Did he miss all the massive hacking scandals, massive data breaches and shabby cyber failures of late?
Amanda Baker
Edinburgh
While Wes Streeting is to be commended for his drive to improve the NHS, his argument has two shortcomings. First, health care costs will decrease due to better preventive care, which will help people live longer. Life expectancy has increased significantly over the past fifty years and this has resulted in many more people living with long-term conditions such as degenerative neurological diseases and cancer. Management of these conditions is expensive, in contrast to the rapid death of many in the past from vascular disease (heart attack and stroke), often in their 50s and 60s. Secondly, during my time as head of the National Clinical Advisory Team, I learned that while community care had advantages over hospital care, it was never cheaper, and often the opposite. Helping people live healthier lives and caring for people in the community are the right things to do, but they are not the answer to controlling health care costs.
Chris Clough
Retired Medical Director, Royal College of Physicians, and Consultant, King’s College Hospital