England urged to learn from Wales’ approach to public health

Mark Mansfield

England should look to Wales for lessons on public health policy despite the country continuing to suffer some of the worst health outcomes in the UK, according to a leading English think tank.

The King’s Fund says Wales has taken a more coherent and long-term approach to public health than England, using legislation and cooperation between public services to try to improve people’s health and wellbeing.

David Buck, senior fellow for public health and inequalities at the think tank, highlighted policies ranging from minimum alcohol pricing and smoking restrictions to the Well-being of Future Generations Act and the creation of Public Health Wales.

Writing for the King’s Fund, Mr Buck said devolution had allowed the four UK nations to pursue different approaches to public health since 1999 and argued there was “much to learn from Wales”.

He acknowledged that Wales “faces some of the worst health outcomes in the UK” and has an NHS which struggles to meet key targets.

But he said those challenges had partly contributed to “a history of innovative and far-reaching policy ideas which are often seen internationally as progressive for public health”.

Among the measures highlighted is the Well-being of Future Generations (Wales) Act, introduced in 2015, which incorporated the UN’s sustainable development goals and created the Future Generations Commissioner.

The legislation was intended to encourage public bodies to take greater account of the long-term consequences of their decisions and place more emphasis on prevention.

Mr Buck also pointed to Wales’ national wellbeing indicators and Public Services Boards, which were established to encourage organisations including health boards, councils, fire and rescue services, police and probation services to work together.

Wales has also diverged from England on specific public health measures.

It followed Scotland in introducing minimum unit pricing for alcohol and initially adopted a more cautious approach towards e-cigarettes and vaping than England.

Wales also established a national public health agency before England and Scotland and has retained Public Health Wales. Public Health England, by contrast, was abolished following a decision announced during the Covid-19 pandemic and its responsibilities divided between other organisations.

Speed limits

The King’s Fund also cited Wales’ approach to 20mph speed limits around schools as another example of different policy choices.

Mr Buck said: “Overall, there has been a stronger emphasis in Wales than England on longer-term thinking and action in public health policy development, pursued through legislation.”

The think tank also highlighted policies pursued before May’s Senedd election, including regulations expanding the use of health impact assessments and Wales becoming the first “Marmot nation”, committing to principles aimed at reducing health inequalities.

Attention is now turning to the approach of the new Plaid Cymru Welsh Government.

Plaid’s election manifesto proposed a cross-government minister for public health, which the King’s Fund said would be the first such role in the UK and could signal that improving health was regarded as a responsibility extending beyond the NHS.

The party also pledged to examine the feasibility of a Preventative Departmental Expenditure Limit, designed to identify and monitor spending intended to prevent problems rather than respond to them later.

Outcomes

However, Mr Buck warned that ambitious policies had not necessarily translated into improved outcomes.

He said the Well-being of Future Generations Act had “not made as much difference to date as hoped for”, while significant work remained to improve Wales’ poor health outcomes.

The new Welsh Government has committed to reviewing implementation of the Act.

Mr Buck said England faced similar problems in turning commitments on prevention into practical change, describing progress under its 10 Year Health Plan as “frankly unconvincing”.

He concluded: “The most important lesson England can learn is how Wales has used coherent legislation to set up the framework for improving the wellbeing of the Welsh population, and provided the tools and expectation that this needs to be a true partnership endeavour across public services.

“This is clearly not sufficient on its own, but it is more coherent and complete than what we currently see on this side of Offa’s Dyke.

“So, while perhaps we should not look across the border to Wales with envy, we certainly should do so with curiosity.”

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