For many years, the government has talked about prevention as a priority for public services, and particularly the NHS. In November 2018 Matt Hancock, the then Health and Social Care Secretary, launched a policy paper entitled ‘Prevention is better than cure’ which set out his vision to help people to live for longer. Prevention was also a theme running through the NHS Long Term Plan, published in 2019. On taking up the role of Health Secretary in November 2023, Victoria Atkins also supported prevention as having the potential to make a big difference. However, in early June, former Conservative Health Minister, Steve Brine, who will not contest his Winchester and Chandler’s Ford constituency in the forthcoming election, told the local dental committees’ annual conference that to truly push the focus to the causes of ill health and prioritise prevention more “political will” is necessary. If the politicians can see its potential, why then does it appear to be such a struggle to make it happen?
Political priority
Making prevention a “political priority” is the first recommendation from the Institute for Government (IfG) in its report, published in May 2024, ‘A preventative approach to public services’. The five-point plan for prevention also includes embedding prevention into the spending framework with funding that meets the prevention definition ringfenced once allocated, embedding prevention into the government’s performance framework, supporting local areas to spend preventative budgets how they see fit, and creating a more effective accountability and learning system for local areas.
Defining prevention
One of the problems with prioritising prevention is that there is no clear definition or agreement over what it means in the context of public services. As the IfG points out, government spending is designed to prevent something worse from happening, so a case could be made for many initiatives to be preventative, for instance, the ambulance service, which is designed to prevent someone dying or their condition worsening as they are transported to a hospital. However, by the time a patient needs an ambulance it could well be that many earlier opportunities for preventative intervention have been missed.
Another problem with defining prevention is that a service can be argued to be preventative or acute depending on the perspective from which it is viewed. The IfG cites adult social care funding, for instance, which is provided to those with the most acute need by the local authority but as far as the health service is concerned it is preventative through its potential to reduce hospital admissions.
The IfG also found disagreement over what a preventative programme should achieve, for instance, whether it should be measured in terms of cutting demand for acute services and in turn government spending, or whether it should be a means of improving outcomes, such as healthy life expectancy. Pursuing a preventative approach is clearly also a problem, with a wide disparity between possibilities, from small-scale programmes targeting people before the point of acute need, to a more overarching ambition to reduce poverty on a nationwide scale, or using regulation or taxation to influence behaviour. Some believe that prevention requires a new approach to designing and delivering services.
Overcoming barriers
Although there are many barriers to taking a more preventative approach to health, the IfG does not believe they are insurmountable. Change, it says, will require shifting the incentives faced by policy makers to favour prevention, and Ministers, whatever party comes to power in July, must lead from the front, favouring a long-term approach to policy making. However it is achieved, the IfG insists the next government must focus on prevention or risk worse public services.
Download and read the full report and its recommendations in more detail.
