The NHS Confederation has released new analysis suggesting that better targeting of existing money spent on prevention could deliver an extra £11 billion annual return on investment (ROI) and hold the key to the government achieving its goal of increasing the impact of prevention.
The report also found that if the upper quartile ROI was achieved across all interventions, then the financial impact could be up to £22 billion per year – an increase from the £11 billion per year estimate that comes from the £5 billion per year of current spending.
It explores how investing in preventative measures including improving health education and housing can pay dividends in the long run.
The government has pledged to move more care from hospitals into the community and to shift from tackling sickness to improving prevention.
It recommends increasing investment in prevention – in particular around children and young people, exercise and smoking, diabetes and cardiovascular interventions.
Many preventative services in England are funded through the public health grant to local authorities, but this has effectively been cut by 28 per cent per person in real terms since 2015/16.
The analysis found that the top 20 interventions by ROI were all community based and in areas such as housing improvements, smoking prevention and exercise initiatives, with a range of returns from £6.90 to £34.75 (per £1 spent).
Some of the interventions with the highest ROI were adapting homes where a serious fall is otherwise likely to occur, training healthcare professionals to provide physical activity advice, and Birmingham City Council’s scheme to provide free leisure services to its residents.
Cllr David Fothergill, chairman of the Local Government Association’s Community Wellbeing Board, said: "NHS leaders are right to recognise the vital role councils – working with people and partners – can play to address the wider determinants of health, through their role in public health, care and support, housing, green spaces, youth services, and the local economy.
"However, with resources under intense pressure, council spending is increasingly used to meet growing demand and cost pressures in acute, frontline services. This is leaving less and less for the preventative support that helps people live independent, healthy lives, boost life chances, prevent homelessness and help people avoid reaching crisis point.
“Councils know how to maximize funding by partnering locally to create effective, preventative health services. With proper funding, prevention can become a core part of health and care and not a luxury extra when budgets allow.”
The report recommends some key steps for national government, NHS England, integrated care systems and local partners.
One of these is to invest more in prevention, particularly where we know it has impact, for example children and young people.
The report also suggests the need to more systematically evaluate and apply an approach that incorporates both population needs and getting the very best value for money.
Matthew Taylor, chief executive of the NHS Confederation, said: “As our recent State of Integrated Care report shows, health and care leaders are committed to the government’s plans to shift more care out of hospitals, but are concerned that a lack of long-term investment and planning is holding them back. The current financial situation the NHS is facing means our members are having to prioritise short-term funding and performance over the long-term changes they know are necessary to put the NHS on a sustainable footing.
“So it is poignant that this new report sets out yet more evidence that investing in prevention is not just good for patients and improving public health, but also the economy. It is clear that an initial investment in preventative schemes can pay back dividends for people’s health and the economy.
“What we want to see is cross-government co-operation, collaboration and investment on health policy, recognising that that most policy that impacts people’s health is made outside the NHS.”
