Re the article by Wes Streeting (I love the NHS: it saved my life, but the operation to rescue it must be led by the people and its staff, 21 October), the government’s health plan must devote serious attention to the public’s health. Focusing on individual lifestyle behaviour change because it’s the easier option will not result in sufficient progress in tackling preventable illnesses such as obesity. Nor is prescribing more weight-loss drugs the answer. Medicalising problems chiefly caused by health inequalities is not a long-term solution. Only by tackling the causes of much avoidable ill-health at source will sufficient and lasting progress be made. This means getting a grip on the commercial determinants of health, thus reducing the demand for addictive, ultra-processed foods.
As part of this crusade, attention needs to be given to the public health function, nationally and locally. It has been eviscerated by the previous government, as noted by the recent Darzi review. Restoring the funding cuts to local government and to public health is an urgent first step. The organisation of the public health function nationally also needs attention having been seriously weakened by the sudden abolition of Public Health England in 2021. The Office for Health Improvement and Disparities should be replaced with 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 desultory.
Prioritising the health of the population also means challenging the Treasury’s reductionist fiscal mindset so that public health funding is framed as an investment, not a cost. To this end, consideration should be given to establishing an office for population health, along the lines of the Office for Budget Responsibility, to improve fiscal and economic planning in order to strengthen the public’s health and wellbeing.
Emeritus Professor David J Hunter
Richmond, North Yorkshire
• It’s with dismay that I read the flow of ideas from Wes Streeting, many of which medicalise social issues like unemployment (Wes Streeting unveils plans for ‘patient passports’ to hold all medical records, 21 October). The belief that spending money on weight-loss jabs (which you may have to take forever), smartwatches (which may actually increase anxiety around sleeping and health) and that (contrary to evidence so far) a secure electronic patient record system can be created, will all “save the NHS” and make us healthier is disheartening. And that’s before we get to selling all the data collected to anyone who’ll take it.
Low-tech options such as subsidising fruit and vegetables, keeping open and funding sports centres and youth clubs, Sure Start, and even a 35-hour working week would give everyone the possibility of a healthier life. During the pandemic you’d often hear how people were “suddenly” exercising – it’s because they had time, not a smartwatch.
Jennifer Marshall
Birmingham
• In answer to concerns about privacy and cybersecurity, Wes Streeting proclaimed – as you’d expect an automaton to – that patient data will be “protected and anonymised”. Which begs the question: did Labour just plug him in last week? Did he miss every single one of the mass hacking scandals, huge data breaches and shambolic cyber failures of recent times?
Amanda Baker
Edinburgh
• While Wes Streeting is to be applauded for his drive to improve the NHS, his argument has two flaws. First, that healthcare costs will diminish with better preventive care and people subsequently living longer lives. Life expectancy has increased significantly over the last 50 years and this has led to many more living with long-term conditions such as degenerative neurological disease and cancer. These conditions are expensive to manage in contrast to the swift demise of many in the past from vascular diseases (heart attack and stroke) often in their 50s and 60s. Second, during my time as head of the National Clinical Advisory Team I learned that although care in the community had advantages over hospital care it was never cheaper, often the converse. Helping people to live healthier lives and caring for people in the community are the right things to do but are not the solution to controlling healthcare costs.
Chris Clough
Retired medical director, Royal College of Physicians, and consultant, King’s College hospital
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