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Prevention is better than cure – and actions speak louder…


Matt Hancock’s arrival at the Department of Health and Social Care was an opportunity for a refresh of the government’s priorities on health, beyond the budget settlement for the NHS secured as part of the NHS70 celebrations. All were watching eagerly then for a sign of his priorities, and many were pleased that prevention was signalled as one of them.

The prevention vision presented today is the first attempt by the Secretary of State to outline what that actually means. But those wanting lots of detailed commitments will be disappointed: this is not a fully formed strategy but a starting point, setting out the stall of what may develop in future. There is a welcome commitment to add more detail in a Green Paper in the first half of next year.

In outline then, the vision sets out the case for prevention – and the roles for individuals, the NHS and local authorities, urging them to ‘put prevention at the heart of everything they do’. It’s good on recognising the causes of ill health, including the role of work, homes, air pollution, social connections and the importance of community, and on the role of wider workforces in prevention, including fire, housing and leisure services. Readers will not be surprised to see a role for technology, including ‘predictive prevention’ to ‘prevent people becoming patients’, mental health, primary care, secondary prevention, including remote monitoring and video consultation. It also flags the important role of the criminal justice system. There are long lists of activities and existing commitments. In short, there is something for everyone in this vision; it’s hard not to like. The question is making it happen – coherently, at scale and with the right level of resources in the right place.

How far this moves from aspirational vision to action will be signalled by three key decisions. First is the local government settlement expected in December, when we are likely to hear about the trajectory for local government allocations from central government, including for the public health grant. Will the government do anything about the cuts we’ve already seen, and about the others planned? Second, and at around the same time or slightly before, we are also likely to get the NHS long-term plan, in which prevention is one of many themes (and bundled with health inequalities and ‘personal responsibility’). Will the long-term plan do better than the NHS five year forward view in prioritising prevention, alongside population health and health inequalities, as we have argued? The vision does signal the need to invest more in primary and community health services, let’s see if that’s borne out in the plan itself. Third is the Spending Review itself next year, and for which the Green Paper will be a vehicle for the Department of Health and Social Care to show just what it means to prioritise prevention against ‘cure’.

Intellectual effort should now focus on the Green Paper. Today’s strategy needs further work, turning the welcome recognition of what drives people’s health into changes in policy and cross-government action, and how exactly it will meet the government’s grand challenge of five years extra healthy life by 2035. There is nothing in here on that, and there is far too little detail on health inequalities, where we do know that concerted and consistent cross-government action can turn the tide on widening inequalities in health – as part of which the NHS needs to step up. We look forward to feeding in the work we have been doing over the past year on a vision for population health that will be launched at our annual conference at the end of this month.

In the words of Professor David Oliver (clinical vice president of the Royal College of Physicians and Visiting Fellow at The King’s Fund): ‘From now on, every time I hear people using policy rhetoric to make the case for prevention, I’ll ask them, “So, what policies and funding do we have in place to back the paper talk and make it happen?”.’ We truly welcome the Secretary of State’s focus on prioritising prevention. But we also wait for the answer to David’s question – before Christmas in the Green Paper, and in the Spending Review next year.