Helen Undy, Chief Executive, Money and Mental Health

Five takeaways from the new prevention green paper

23 July 2019

Matt Hancock made prevention one of his top three priorities as Health Secretary, alongside technology and the workforce. So it was a surprise to see the prevention green paper published yesterday evening with no press announcement, after the Minister reportedly tried to delay publication until the new Prime Minister was in post. Given Boris Johnson’s public criticism of so-called ‘sin taxes’, it remains to be seen how much of this will survive his premiership – but there are certainly a few things that we hope will make the cut. Here are our initial reflections:

Understanding the problem

The paper gives a good account of the social determinants of health, and it’s encouraging to see debt and poverty mentioned throughout:

“We need to take urgent action to tackle the risk factors that can lead to poor mental health, such as adverse childhood events, violence, poverty, problem debt, housing insecurity, social isolation, bullying and discrimination.”

However, while the analysis of the problems is good, the paper is light on detail about what this ‘urgent action’ might look like. It is a consultation though, and if the commitment to act lasts the change in leadership, we have plenty of ideas about solutions that could fill these gaps.

Predictive prevention

The paper commits Public Health England (PHE) to working with NHSX (a new policy unit  launched this year to help the NHS harness new technology) on developing new models for ‘predictive prevention’, using data to help with tailored prevention programmes that take individual circumstances into account. The initial focus will be on a few ‘exemplar projects’ as well as scoping the larger scheme and building public trust in this use of data.

This has the potential to make a real difference, particularly if NHSX and PHE are open to working with partners and exploring the potential of non-health data to help predict health needs. For example, we are currently working on a research project with financial services firms looking at the role for financial transaction data analysis to identify people who may be struggling. With those in financial difficulty three times as likely to think about suicide, the potential to use this data to save lives is one that has to be explored.

As with all work using this kind of sensitive data, it’s important that it’s done with appropriate consent and designed with the involvement of people with lived experience of the issues involved. We will be reaching out to NHSX and PHE to offer our support.

Improving health checks

The paper commits the government to commissioning an evidence-based review of the NHS Health Checks programme, including exploring options to offer more tailored checks and advice to people based on their likely risks. Given we know that people with mental health problems are three and a half times as likely to be in financial difficulty, which in turn acts as a significant drag on mental health recovery, this presents an opportunity to ask people with mental health problems about their financial situation and ensure good, free money advice is made available to those who need it.

Suicide prevention plans

People in problem debt are three and a half times as likely to consider suicide, yet our research found that 42% of Local Authorities are not currently doing anything (or planning to do anything) to tackle this issue as part of their suicide prevention plans. It’s encouraging to see a focus in the green paper on improving those plans, and some funding (albeit a very small amount, £600,000) allocated to doing this. 100,000 people in problem debt attempt suicide in England every year – the sooner suicide prevention plans address this the better.

Health in all policies

Finally, a technical policy-making point, but one that could really make a difference. The paper states that the government will ‘improve the quality and coverage of health impact assessments of non-health policies’. Understanding the health – and crucially mental health – impacts of policies in areas from housing to benefits, employment to bailiff reform will help to ensure that the work of other government departments doesn’t undermine plans to improve health and wellbeing. If the government wants to keep to its ambition to consider the health of the nation as a key indicator of success along with GDP, this will be vital.

Overall, it’s good to see the direction of travel towards personalised prevention, understanding risk factors and, crucially, tackling the social determinants of health. The commitments in this paper on mental health remain a bit light – lots of campaigns and plans without much policy change. But if the commitment to act holds firm through the change in government we’ll be ready with plenty of suggestions for practical ways to make this a reality.