The latest analysis in ‘The Value in Health series’ from NHS Confederation and Carnall Farrar (CF) suggests that better targeting of existing money spent on prevention could hold the key to the government achieving the ‘big shift’ from tackling sickness and instead increasing the impact of prevention.
The analysis also found that if the upper quartile return on investment (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 £5bn per year of current spending.
The report explores the ROI of 146 interventions spanning primary, secondary and social settings, and their implications for the health and care sector. It shows how investing in preventative measures, including improving health education and housing, can pay dividends in the long run.
It recommends increasing investment in prevention – in particular around children and young people, exercise and smoking, diabetes and cardiovascular interventions. It calls for considering ROI when commissioning services – and hence investing more on high value 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 person in real terms since 2015/16.
The analysis found that the top 20 interventions by ROI were all community based. It highlights the significance of wider collaboration outside of the NHS, with the local government and other partners.
The report comes after the independent Darzi investigation, which revealed that spend on acute care has risen from 47% in 2002 to 58% in 2022, while primary care has fallen 27% to 18%. Combined with the new CF and NHS Confederation analysis, this highlights the stark need for health service and local authority leaders to invest more in prevention, and to focus on the highest-impact interventions.
Recommendations
The report recommends three key steps for national Government, NHS England, Integrated Care Systems and local partners:
• Invest more in prevention, particularly where it is known to have most impact, for example children and young people
• Take an evidence-based approach to commissioning services that considers ROI as part of holistic assessment
• Use data to systematically evaluate and benchmark interventions, leveraging the longitudinal data available to the NHS and the investment in secure data environments and the federated data platform.
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, says: “Our members have welcomed the Government’s pledge to transfer more care into primary and community services as well as to shift from treating sickness to preventing sickness. This is not just about improving NHS performance but will require a whole-government approach because only 20% of our health is determined by healthcare, with the remaining 80% affected by wider determinants.
“What we want to see is cross-government co-operation, collaboration and investment on health policy, recognising that most policy that impacts people’s health is made outside the NHS.”
