A week after the UK’s chancellor of the exchequer promised an extra £20.5 billion for the NHS, the health secretary, Matt Hancock, called for more spending on preventative health. He is clear that the current spending pattern – a whopping £97 billion on treatment versus just £8 billion on prevention – must change. Moving money from treatment to prevention might be a political gamble for Hancock, but it could pay off if he carefully selects his investment portfolio.
Most long-term conditions and many non-communicable diseases, such as heart disease, stroke, cancer, chronic lung disease, diabetes and dementia, have no cure but must be managed. Almost one in three people in England have a long-term condition. The NHS spends over two-thirds of its budget treating these conditions, many of which can be prevented by changes in lifestyle. So a quick gain for Hancock would be to focus on preventative measures that are targeted at helping people change their unhealthy lifestyles.
Supporting the public
Evidence couldn’t be clearer on the health benefits of lifestyle changes, such as quitting smoking. Nevertheless, some argue that changing lifestyles, such as walking or cycling more, eating more fruit and vegetables, giving up cigarettes or consuming fewer sugary and alcoholic drinks, is the sole responsibility of the individual and not a matter for the state. But lifestyle changes, such as losing weight or quitting smoking, can be very difficult without support.
Breastfeeding is another area that could do with support. Breastfeeding protects babies from gut and respiratory diseases and women from breast cancer. Yet the UK has the lowest breastfeeding rates among developed countries. The reason is simple: new mothers find it very hard to continue breastfeeding when they don’t receive support.
Evidence shows that if people are provided with the right support, they can make healthy lifestyle choices or changes. So the state has a responsibility to provide support that incentivises people to take preventative measures.
Prevention portfolio
Over the years, Public Health England (PHE) has worked hard to put together an evidence-based list of what works in prevention and the amount of money it saves. For example, PHE found that every £1 spent on preventing teenage pregnancy would save £11 in abortion, antenatal and maternity costs.
A similar scale of payback comes from every £1 invested in cycling infrastructure. And alcohol care teams, which provide support to people who end up in hospital as a result of alcohol abuse, generate a net return of 86p for every £1 spent. In Australia, a media campaign to prevent alcohol misuse gave a payback of AUS$20 for every AUS$1 spent. And for child mental health, counselling services could generate seven times as much in benefits as it costs to run the service.
The rich and strong evidence that public health measures work and provide value for money, is on Hancock’s side. On average, every £1 spent on public health would generate a return of £14, plus the original investment back. Most of this payback comes from long-term health gains, but sizeable cash savings to the NHS are also likely.
We now know that supporting new mothers in breastfeeding their infant could save the NHS up to £40m as a result of fewer GP consultations and hospital admissions. Given this, Hancock’s priority should be twofold.
First, he should reverse cuts to those services that we know have worked in England. According to the King’s Fund, a health think-tank, cuts to public health spending is “the falsest of false economies”. The short-term NHS cost savings due to cuts would not be able to offset the long-term treatment costs due to an inevitable rise in disease. Hancock’s announcement is a clear step towards fixing this false economy that began shortly after the 2008 financial crisis and continues today.
Second, the priority should be to look at areas where the government could get more payback from public spending than it currently does. An example is improving the reach of smoking cessation interventions from GPs. Currently, just two in ten smokers use this service. Likewise, introducing new, effective but cheaper aids to help smokers quit, such as cytisine (a smoking cessation drug) provide better payback than the current practice used in stop-smoking services in England. Most of these changes, if implemented at the same time, would require more spending now, but the payback will be much greater.