Grow and diversify funding for prevention to boost the nation’s health and prosperity, urges landmark report
- OHE’s report lays out a clear case for investing in health prevention to reduce NHS demand and boost the economy
- Analysis shows that existing prevention efforts are failing due to lack of uptake, underfunding, and short-termism
- Highly cost-effective NHS diabetes prevention programme with an estimated 13.6 million eligible, only accessible to 200,000 a year
- New financing models, such as social impact bonds, and a government-mandated prevention investment standard, could unlock the necessary resources
A landmark new report from the Office of Health Economics outlines where existing prevention efforts are failing and proposes six areas for action. Their aim is increasing investment in prevention to yield a healthier and more prosperous nation.
Prevention in the healthcare system encompasses three stages: primary prevention, targeting health promotion before disease onset; secondary prevention, focused on early detection; and tertiary prevention, aimed at halting or delaying disease progression.
An analysis of 13 prevention measures, across all three stages of care, revealed a disconnect between the potential benefits that could be achieved and the scale of ambition in funding, implementation, and monitoring.
The report highlights the highly cost-effective NHS diabetes prevention programme, which has been shown to reduce the chance of developing diabetes by more than a third. Yet only 200,000 of an estimated 13.5 million eligible people in the UK can access the service each year.
The report identifies four critical gaps hindering effective health prevention:
- Low uptake of existing programs.
- Insufficient capacity to deliver ambitious prevention goals.
- Short-term investment focus.
- Inadequate funding.
Although prevention is a stated priority, it has not received adequate funding. Only 5% of NHS funding was allocated to preventative care between 2013-2019. The public health grant to local authorities has declined since 2015/16, resulting in a 26% real-terms cut per person by 2023/24. To meet historical funding levels and rising demand, an estimated £0.9 billion per year is required for the public health grant.
The report suggests six action areas to address these gaps and usher in a new era of optimized prevention:
- Long-term cross-party agreement.
- Innovative financing of prevention within NHS budgets.
- Financing prevention outside core NHS budgets.
- Improved monitoring.
- Embracing new opportunities, including precision medicine and digital health.
- Establishing an evidence-based clinical strategy with a focus on delivery.
The report calls on various stakeholders, including politicians, government agencies, healthcare professionals, industry leaders, economists, and the public, to take meaningful steps in advancing the prevention agenda.
Professor Graham Cookson, CEO of OHE and co-author of the report, said:
“With returns on investment averaging 14 to 1, health prevention efforts should be a major element of our health care system. But our analysis shows that even existing programmes are failing to realise their potential.
“A key hurdle is that prevention competes with treatment for funding. Understandably, the immediate demand to treat patients wins out, despite ample evidence that the long-term benefits of prevention will be greater.”
Grace Hampson, associate director at OHE and co-author of the report, said:
“One promising route to unlocking funds for prevention is to move outside existing budgets. Social impact bonds could raise capital from a range of organisations, including financial institutions and charities. If the benefits of the intervention are realised, as our evidence shows is likely to be the case, the investor receives a financial return.
“Within existing budgets, we recommend implementing a prevention investment standard to increase the proportion of spending on prevention. This would mirror the existing mental health investment standard, which stipulates that national and local spending on mental health must increase more than overall spending.”
Prevention benefits are broad
Investing in prevention generates substantial benefits compared to traditional healthcare investments. A systematic review of 52 studies found primary prevention, delivered through public health interventions, is highly cost-saving, with a median return on investment (ROI) exceeding 14:1. Additionally, prevention can be 3-4 times more cost-effective than treatment.
Prevention's benefits extend beyond healthcare, with the potential for significant savings across public spending areas and positive effects on productivity and economic growth. For instance, preventable ill-health-related absenteeism and presenteeism cost the UK economy an estimated £70 billion in 2019.
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