Government health policy will end in failure unless we move from a national sickness service to a national health service

All the government's efforts to reform the NHS could be in vain unless there is a radical shift of attitudes and ways of working towards health improvement, across government, the public sector and independent institutions, according to a discussion paper from The King's Fund published today.

Ministers have recently acknowledged the threat represented by rising levels of obesity, diabetes and sexually transmitted disease and the extra costs they will bring to the NHS.

But in Prevention Rather Than Cure: Making the case for choosing health, The King's Fund argues that recent government initiatives to tackle public health epidemics, including the public health White Paper expected later this year, will have little impact unless they include practical measures to build a more effective health system. This would entail a move away from a preoccupation with health services that focused almost exclusively on treating illness, towards a broader approach that gives priority to maintaining health and reducing health inequalities.

The discussion paper sets out practical ideas for change, including:

  • A new dialogue between government and the electorate, which recognises that citizens are not just patients or consumers of services, but are actively engaged in safeguarding their own health.
  • Stronger leadership for health improvement at all levels. Cities to have high profile, executive health commissioners, similar to 'health mayors' in some EU cities.
  • New local health organisations that people could join to receive information, advice and expertise on how to stay well, as well as receiving treatment when they are ill. They would be more like 'health clubs' than traditional doctors' surgeries.
  • New incentives to encourage health professionals to give higher priority to preventing illness and reducing health inequalities.

The King's Fund chief executive Niall Dickson said:

'We need to develop a new kind of national health service that gives priority to promoting health rather than just caring for people when they become ill. We know a great deal about the extent and causes of ill health and have a range of well-intentioned policies for tackling them. The real challenge now is to make sure the right structures and incentives are in place across the system so that what we do really does make a difference.

'To achieve this we need a more coherent approach in which individuals, community organisations and government, as well as public and private institutions, all have a part to play. Individuals have a clear responsibility to take control of their own health and make the choices that will help them to live healthier lives. But they need support from a variety of sources and there is a strong role for government, not only in providing information but also in creating the conditions that allows people to choose healthy lifestyles regardless of their social and economic circumstances.'

The discussion paper marks the launch of a new programme of work at The King's Fund, Putting Health First, which aims to identify practical next steps to help develop a health system that enables people to choose health - not just to make choices about what happens to them when they are ill.

The King's Fund health policy director Anna Coote, report author, said:

'There are still powerful disincentives for governments to focus on health - as distinct from health services. The NHS has become a national icon. It is tempting for politicians to try to 'save' it, without looking very hard at ways of preventing illness. This temptation is even greater when they fear they will be accused of acting like a 'nanny state' if they intervene to encourage healthy lifestyles.

'It is clearly not the case that people only care about NHS waiting times and patient choice. New research commissioned by The King's Fund, which will be released in May, suggests that the public have a sophisticated understanding of the causes of illness and would rather choose health than health care. They want more action by government to make that kind of choice possible.'

Read the report: Prevention Rather Than Cure: Making the case for choosing health

Notes to editors: 

1. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through grants. We are a major resource to people working in health, offering leadership and education courses; seminars and workshops; publications; information and library services; and conference and meeting facilities.

2. Prevention Rather Than Cure: Making the case for choosing health, by Anna Coote, is available priced £6.50 from the King's Fund on 020 7307 2591, or by visiting our online bookshop.

3. The report marks the launch of a new programme of work at The King's Fund, Putting Health First: Changing attitudes, policy and behaviour. This programme involves research projects, development activities and events, including:

  • Understanding public attitudes With support from the Health Development Agency, we have commissioned new research from Opinion Leader Research to find out what people think about health, as distinct from health services (findings May 2004)
  • Devolved government The health and health care systems of the four countries of the UK are becoming more divergent. We have commissioned research to explore these differences, with the aim of learning what the different systems can learn from each other in terms of health improvement. (paper May 2004).
  • A new type of local health organisation Working with the University of Warwick, we will explore options for a new type of local health organisation - different from a conventional GP surgery - that provides individuals with appropriate knowledge and expertise on how to stay well, offering access to treatment as an additional role.
  • Incentives and regulation We have commissioned David Hunter, professor of health policy at Durham University, to look at how incentives within the health sector might be realigned to produce a stronger focus on keeping people well. He will also examine the impact of regulatory bodies (paper November 2004).
  • Local leadership for health Examination of the role of the health commissioner in Baltimore in the United States. We will examine this and other models for local leadership, such as 'health mayors' in other EU countries.


4. The discussion paper will be launched at a breakfast discussion to be held at the King's Fund, 11-13 Cavendish Square, London, W1G 0AN, between 8.15am and 10am on Thursday, 18 March. Speakers include King's Fund health policy director Anna Coote, Health Development Agency chair Dame Yve Buckland, while Lord Hunt of King's Heath will chair. Nigel Jackson and Deborah Mattinson from Opinion Leader Research will give a summary of early findings from King's Fund commissioned research into public attitudes towards health, as distinct from health services.

For further information, interviews with the author, review copies of the discussion paper or media passes to the breakfast discussion, please contact Daniel Reynolds in The King's Fund media and public relations office on 020 7307 2581 or 07831 554927, or Michael Moruzzi on 020 7307 2585.