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Last year I compiled a rapid review of the health, work and wellbeing field.  I noted that welfare reform, the Work Programme and rising unemployment have transformed the environment.

So how should the NHS best respond?  Before saying how, it is worth repeating what I often say to people new to the organisation.  If you turn some switches on - national targets, say- the NHS lights up like a Christmas tree.  In other areas, such as employment, you get some lights come on, large areas stay in darkness and a few lights fizz on and off.   The reasons for this lie partly in terms of priorities, with acute care tending to be higher profile than community care or prevention, and, in terms of organisation, due to each NHS Trust acting as its own employer, albeit as part of a national framework.

On top of this of course, the NHS reform is still in progress with commissioning functions being reorganised, and many other reconfigurations under way, such as the proposed merger of Barts and the London, Newham University and Whipps Cross University NHS Trusts. In late December further guidance was issued in respect of moving the Public Health function to Local Authorities

So any recommendations in this quarter come heavily qualified by these factors.  Nonetheless I think we can see a clear rationale for continued engagement in health, work and wellbeing.  Firstly, the cost of health is escalating.  Whilst some of this is unavoidable, with people tending to live longer, many hospital admissions and other treatment relate to avoidable illness.  Getting people to adopt better health behaviours means addressing socio-economic factors such as unemployment, child poverty and decent housing.   Whilst the NHS cannot affect much of this, it needs to be an active player in the arena.  For example, with rising youth unemployment, it can and should do more to offer routes into employment.  Reducing treatment and admission rates are not only good for the individual, they enable scarce resources to be better targeted.

Secondly, the interface between health and work needs to move on from the scratchy relationships around assessment and benefits to a more positive promotion of work and similar activity as a part of a healthy lifestyle.  Just as "making every contact count" is becoming the mantra of how healthcare professionals should promote healthy behaviours, work or volunteering should be promoted when appropriate.   This should be matched on the side of the welfare to work industry by a fuller engagement with health.  The industry need its clients to be healthy to sustain employment, and this is a shared prority that needs fuller investigation.

Thirdly, the development of local Clinical Commissioning Groups and Health and Wellbeing Boards gives an opportunity to join up health services with their local communities.  The Public Health move should, at least in theory, help this, and Foundation Hospital status at least implies local ownership of services. I think this is a fertile field for further work, and would allow the first two themes a chance to develop better services in real communities.