Delivering the shift to prevention

Health inequalities peer learning event, held on 25 March 2025.

This event brought together trust and system leaders, alongside operational and equity leads, to discuss the role of providers in implementing preventative initiatives.

About the event

The government has committed to three shifts to reform the NHS – from analogue to digital, hospitals to communities, and sickness to prevention. The upcoming 10-year health plan aims to shift the focus of the NHS from reactive treatment to proactive prevention, to ease pressure on services and reduce the long-term costs associated with treatment.

This peer learning event provided an opportunity to understand existing work taking place locally to drive forward to the shift to prevention, hearing what challenges are preventing action, and how NHS Providers can support members to further embed this work. The event explicitly considered how an equity lens can encourage further action on prevention. Speakers reflected on the national policies driving forwards this work and shared impact of local initiatives – including the Cheshire and Merseyside 'Prevention Pledge'.

Chair: Claire Helm – head of policy, NHS Providers

Speakers:
Cathy Morgan - director of secondary prevention, Department for Health and Social Care
Ian Ashworth - director of population health, Cheshire and Merseyside Integrated Care Board (ICB)

Key themes from the event

This event offered an interactive discussion space for attendees to share their learnings, challenges and opportunities experienced at their respective organisations. The event was not recorded, however, anonymised key themes from the event are summarised below.

Discussions revealed the breadth and scope of preventative actions taking place among trusts, including the provision of joined-up services, smoking cessation, improving elective care pathways and developing community-based support alternatives. However, further progress is halted by ongoing operational pressures, limited resource, and limited evidence to demonstrate impact from preventative measures.

What actions are trusts taking on prevention?

Joined up services was a common theme among the discussions.
- One trust is exploring how local primary care services can be physically embedded within their acute trust, including shifting resources towards primary care.
- Another trust is also working closely with primary care, by sharing records of patients presenting at urgent and emergency care, for example if an individual presents in hospital with chest pain then their blood pressure readings are shared with primary care for review and onward support/referral. They have also shared records on patients with learning disabilities, to ensure that the hospital has an accurate learning disability register, which ensures patients can be appropriately supported during their stays in hospital.
- One acute trust was working collaboratively with their local mental health trust on drug and alcohol abuse by identifying patients with chronic obstructive pulmonary disease and respiratory disease to provide joint interventions.
- Collaboration with wider system partners – such as local authorities and voluntary organisations was recognised as a key enabler for preventative initiatives. For example, one trust has embedded preventative initiatives within local Family Hubs. A separate trust has created a health equity alliance with local stakeholders, including the police, universities and broader community sector organisations.
Making Every Contact Count (MECC) is a popular tool, which a number of trusts have trained their workforce in delivering. One trust noted that their MECC training is mandatory across their workforce.
Smoking cessation was mentioned by a few trusts – including examples of specific smoking services within maternity and targeting specific population groups.
One trust has developed a community-based, drop-in, outreach service located within their town centre. The initiative has been incredibly successful, with over 20,000 attendees in its first year.
One trust has embedded preventative initiatives within their elective care pathways, encouraging patients to 'wait well', which has increased patient confidence in self-management and reduced overall patient length of stay post-surgery. Initiatives include referring patients with high BMI to weight management services, identifying patients with high blood pressure or problem drinking/smoking and referring on appropriately. For the latter, the trust has employed alcohol outreach teams, who operate out of their mental health services.
One trust, as part of their broader place-based partnership, has created a population health hub. The service provides resource and support to help organisations within the partnership to think about prevention and population health. The group also provides oversight from health inequalities money provided by the ICB.
Another trust has developed a local population health data dashboard for staff to understand population variations in referrals and procedures, which has increased staff awareness on prevention and helped to target initiatives. They have also used AI to analyse their Did Not Attend (DNA) rates to identify where the population need for support is.
One trust has created an internal health inequalities self-assessment tool for services to measure their progress, which generates an improvement plan for each service. This has enabled the sharing of good practice across the trust.
Another trust has focused their preventative work on their workforce, exploring staff sickness rates and interventions to reduce staff absences.

What challenges are trusts facing when implementing preventative actions?

Limited long-term funding available for prevention.
Growing demand for services and increasing multi-morbidity of patients are driving current operational pressures. Without incentives to priorities a focus on prevention, it is difficult for trusts to focus on the long-term benefits of prevention when there are short-term pressures.
- Relatedly, staff burnout in light of pressures can limit the extent to which preventative initiatives can be effectively delivered.
Lack of clarity on where the responsibility for prevention sits nationally and within local areas.
- Some trusts highlighted that prevention is not prioritised within their local Integrated Care Systems (ICSs), which is needed to drive forward this work, and called for greater leadership around the agenda.
There are challenges in demonstrating impact and evidence of the effectiveness of preventative initiatives, alongside return on investment, especially when impact is expected in short time frames. Guidance on a common set of metrics to support trusts to monitor impact of initiatives would be welcomed.
Concern about financial cuts to local authorities and voluntary services, which limits the extent to which trusts can signpost people to community-based services. There is also a lack of funding that enables trusts and local authorities to co-deliver preventative services.
Further work is needed on patient education on healthy lifestyles and there is potentially a greater role for trusts to engage with education settings.
Trusts would welcome further support and guidance, particularly via communities of practice and peer-to-peer support on prevention.

Additional resources

Event slides
NHS Cheshire and Merseyside – Prevention pledge
NHS Providers and Health Creation Alliance – Health creation: achieving the shift to prevention together
NHS Providers, How are trusts using health hubs to tackle health inequalities?
NHS Providers and Ways to Wellness – How secondary care can benefit from the social prescribing revolution
NHS Providers – Providers deliver: new roles in prevention