Prevention Green Paper: What is it and what's in it?

Sally Greenbrook joined the BGS in April 2019 as Policy Manager. She has more than a decade of experience in the UK health policy sector, having worked for the Department of Health and, most recently, as Policy Manager for Breast Cancer Now. She has for many years had an interest in the health and care of older people, having written her MA thesis on housing for older people. She tweets at @SallyGreenbrook

On the evening of Monday 22 July, in what would turn out to be one of the final acts of Theresa May’s Government, the Cabinet Office and the Department for Health and Social Care very quietly published a Green Paper. No, not the Social Care Green Paper I’m afraid but the Prevention Green Paper which appeared on the gov.uk website at 7.20pm with no accompanying press release or other fanfare.

The Government’s focus on prevention was made clear in November 2018 with the publication of their ‘vision’ document Prevention is better than cure and the Green Paper outlines how the Government intends to ensure that people have the skills, knowledge and confidence to take responsibility for their health and prevent illness.

What is a Green Paper?

So, I hear you ask, what is a Green Paper and why does it matter? Put simply, a Green Paper is the first tentative step towards legislation. It’s a consultation document in which the Government outlines its proposals about an issue and stakeholders have the opportunity to feed back. It sets out the Government’s thinking without committing them to doing anything. A Green Paper may lead to a White Paper which includes firmer proposals which will also be consulted on before a Bill is presented to Parliament. Conversely, a Green Paper may not lead to anything – it is a mechanism through which the Government can test the waters with its proposals but not lose face if said proposals are not carried through. And so, while a Green Paper may be one of the more toothless Government documents, it matters because, if the proposals do go forward, it is at this stage that they are most likely to change and so there is an opportunity for stakeholders like the BGS to comment on the proposals.

So what’s in it?

The first thing to note about this Green Paper is that it is about prevention of ill health across the board – across conditions and across age groups. It is therefore, by necessity, a very broad document. The consultation questions cover inequalities, smoking, breastfeeding, healthy eating, strength and balance exercises, mental health, sleep deprivation, water fluoridation and sexual health, to name but a few.

And what is there for older people? The Green Paper reiterates the Government’s commitment to the Ageing Society Grand Challenge, the aim of which is to ensure that people can enjoy at least five extra healthy, independent years of life by 2035, while narrowing the gap between the experience of the richest and poorest. The Green Paper includes very little detail about how this is to be achieved.

There is a section on Active Ageing which acknowledges that as a society we do not make the most of the opportunities afforded by an ageing population and, that all too often, our attitudes towards ageing and later life are negative and unhelpful. The Green Paper claims that this attitude exists both among older people themselves and among health and care professionals. In order to support a shift from ageist stereotypes to a more positive and nuanced view of older age, the Green Paper has announced that Public Health England will be working with the Centre for Ageing Better and other organisations, to develop a consensus statement on Healthy Ageing as well as carrying out a review of how we can focus more attention on older people’s issues.

The paper also suggests that a government office for healthy ageing could be created to co-ordinate the cross-government work needed to deliver the Ageing Society Grand Challenge.

And what does BGS think?

There is some positive content for older people and we welcome the commitment to changing the dialogue around ageing and the idea of a government office to promote healthy ageing. However, there is very little in the Green Paper that is specific to older people and even less about older people’s healthcare. Older people are not recognised as one of the five key themes of the Green Paper (the themes are: Getting it right in the early years, Closing the gap on physical and mental health, Empowering better public health, Going smoke free and Moving to a healthy weight) and out of 21 consultation questions included in the Green Paper, there is only one that is specific to older people:

• What is your priority for making England the best country in the world to grow old in, alongside the work of Public Health England and national partner organisations?
  
  • Support people with staying in work
  • Support people with training to change careers in later life
  • Support people with caring for a loved one
  • Improve homes to meet the needs of older people
  • Improve neighbourhoods to meet the needs of older people
  • Other:

Of course, many of the other questions are cross-cutting and will apply to older people as well as other population groups. However, given the Government’s repeated commitment to the Ageing Society Grand Challenge, we are disappointed that the Green Paper did not include more that is specific to older people. In addition, given this is a ‘prevention’ Green Paper, we would have liked to have seen more of a focus on the prevention of ill health in older people including, preventing frailty or preventing mild frailty from becoming more severe. There is only one mention of frailty in the document (in relation to having a suitable home) – something we think is a significant oversight.

What next?

There are various aspects of the Green Paper that we are really interested in – we will for instance be looking to be involved in the work with Public Health England and the Centre for Ageing Better to help to develop the consensus statement on healthy ageing.

More immediately however, the Green Paper is a consultation document with the consultation period open until October. BGS will be responding to that consultation to make the case for an increased focus on prevention policies that will impact upon the health of older people.

We would really value the thoughts of our members in developing our response to the Green Paper – if you would like to feed in your thoughts, please do contact our Policy Manager, Sally Greenbrook, at s [dot] greenbrook [at] bgs [dot] org [dot] uk.