Dame Sally Davis, Chief Medical Officer, calls for more investment in prevention & end to silos

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Two quotes from Dame Sally Davis, the Chief Medical Officer:

The rise of lifestyle diseases and chronic disease means we should probably put any rises of money we get into prevention rather than into more acute care. But we’ll only get that if we build the evidence base while using economic modelling to make the case.

We have absolutely got to build the case for investment, but we have got more economists in the department working on the job and we are commissioning more economics on prevention.

And:

We can, in fact, crack lifestyle diseases. But we need to stop tackling them in silos with a tobacco cessation clinic here, a contraception clinic there and alcohol treatment somewhere else. We need a broader cultural change across society to achieve that, and one that embraces Public Health England, schools and the health care system.

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GOV.UK, archiving and the policy priority for drugs and alcohol

The government have decided that having different websites for different parts of government is too complicated and so they’re collecting everything under GOV.UK this includes the Department of Health and the Home Office along with the majority of other departments (the DfE is to join soon).

They’ve also taken the view only to migrate content that has been developed since the change of government in 2010, and those pages that had high user visits.

I happen to know this because I was looking for the Chief Medical Officer’s guidance on alcohol and young people and when I couldn’t find it had a twitter conversation with the department who said:

I was left wondering whether this meant that the guidance was no longer considered current, so again I’ve asked and been told (much to my relief):

So if you’re looking for the CMO’s guidance it’s still around and may even make it back to the main DH web pages.

The other thing that has struck me in looking around for the drug and alcohol pages is the fact that the Home Office seems to be much less the lead department than has been the case.  At least that’s my reading of the taxonomy of the site where the focus is on public health rather than policing or criminal justice.  

Update: Just remembered this presentation I did for the Drug Education Forum about the CMO guidance and thought I’d give it another lease of life.

‘On the state of the public’s health’ – CMO’s annual report

The Chief Medical Officer for England has produced her first annual report, Professor Dame Sally Davies says:

Fair Society, Healthy Lives notes that only 4% of NHS funding is currently spent on prevention. Given the health burden attributable to risk factors, there is a clear case for arguing for this proportion to be increased. This is not new: the final report of the review led by Sir Derek Wanless looking at the resources required to provide high quality health services in the future, projected that a substantial reduction in costs could be achieved by an increased emphasis on prevention, coupled with higher levels of public engagement in relation to their health.

However, while she does talk about preventative services quite a lot in Chapter 6 of the report when it comes to tobacco, drug and alcohol services the focus is treatment and recovery rather than upstream interventions.  Interestingly she does call for much more focus on alcohol which she says has been a poor relation to drug services.

This is also reflected in Chapter 3 where she highlights risk factors for poor health including the abuse of drug, alcohol and tobacco, but again the focus is on over 16s rather than on younger adolescents.

That said Dame Sally does set out her reading of a life course model which describes the influences on health.  As you’ll see from the graphic representation (above) there is a strong recognition that we need to build skills and knowledge during childhood and adolescence which she describes as including:

all life skills (from social skills and resilience, to vocational skills), and knowledge gained through all forms of direct and indirect education.

From my perspective the way that Dame Sally has set out her thinking suggests that for those of us focusing on preventing drug and alcohol misuse still need to find a way of describing how we can make a contribution to better health in ways that will encourage those in public health to invest in the sorts of interventions we’re trying to develop.  At the moment there is some sympathy for increasing the role of prevention, but what is meant by that seems quite different to the way that we might think of it.