Severely stretched public finances in a turbulent world mean the government is looking harder than ever at how it can raise, spend and above all, save money. This imperative has clearly shaped its welfare proposals and the spring statement, and is now looming over the forthcoming comprehensive spending review. Inevitably health, as the biggest spending public service, is feeling the squeeze as reflected by the decision to abolish NHS England and cut back ICB costs, while trusts search for unprecedented efficiency savings.
Against this background, the financial case for investment in prevention – helping people to stay well and catching disease early – is becoming ever more urgent and compelling. Not only does it offer huge potential benefits for individual wellbeing, for society as a whole, and for the NHS at a time when improvements in life expectancy have slowed and inequalities are widening. It could also provide a much-needed boost for the exchequer. The Tony Blair Institute recently estimated that a 20% reduction in incidence of six major disease categories could raise annual GDP by nearly £20billion in a decade while boosting tax revenues and reducing benefits payments.
NHS trusts and their partners are developing ways to deliver the shift from treatment to prevention. These include identifying and supporting people at risk in the community before they reach crisis point, improving mental health crisis care from the ground up, and working to address wider determinants of ill health.
These initiatives are making a difference, but we need to go further and faster. In the health service there is a real desire to develop this role and deliver the shift to prevention. Invitations to a recent NHS Providers event on this issue drew well over 100 responses from trust leaders.
However while trusts are keen to play their part, one of the biggest barriers has been the lack of dedicated funding or resources to support prevention. In a survey we carried out last year of trust chief executives and finance directors, 94% said they didn't have sufficient funding to invest in prevention and 85% felt that they didn't have the resources required to tackle health inequalities.
Government must recognise that it will take both time and resources before we see the true return on investment from preventative initiatives. This is a difficult message when finances are so stretched, but there will need to be a period of "double running" as the NHS continues to improve performance on key targets, while also investing more in measures to reduce demand in the future.
As part of the drive to improve performance and cut waiting times, it is vital to address inequalities in access to care, outcomes and experience. Shockingly, women living in the most deprived areas are twice as likely to die during pregnancy, and black women are four times as likely to die at this time compared to white women.
Government must do all it can to address health inequalities, provide equitable access to services and ensure all patients receive the same level of care. We have seen this can be done – for example, by taking an inclusive approach to recovering care backlogs. But it will require long-term funding streams, enabling trusts to channel sufficient investment into initiatives like this.
The public health grant has historically played an important role in targeting investment in schemes and initiatives to promote the health and wellbeing of the wider population, but in particular, children and young people. The recent £200m uplift to the grant was welcome and growth should continue in future years in order to reverse the strain that significant cuts to public health budgets have placed on NHS services.
The health service cannot improve population health by acting alone: many of the determinants of ill health are societal, such as poverty, poor housing, unemployment, poor educational outcomes, and structural racism. We need to see cross-government action to promote health and wellbeing.
Collaboration between public bodies offers the opportunity to tackle these factors more effectively. Without it, the NHS will be left to pick up the pieces. It is vital that changes to the role of integrated care boards (ICBs), with their designated remit to improve outcomes in population health, do not deflect attention away from this goal.
Trusts are a vital partner for government in supporting an approach which prevents ill health, tackles health inequalities and prioritises the health and wellbeing of the whole population. Great work is under way but more needs to be done. Trusts are ready to make a shared commitment with government to do all that is necessary to work for a healthier society and a sustainable NHS, delivering the performance and quality of care the public rightly expects.
This article was first published in Health Service Journal
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