Preventative healthcare – risks, benefits and opportunities

The NHS is 77 years old this year. Offering individualised, high quality, free healthcare, it is an organisation admired the world over. But it is in a critical condition: public finances are constrained, satisfaction is at an all-time low, and NHS staff are experiencing high levels of stress and burnout, as well as loss of confidence in the ability to always provide safe care. 

While the last decade saw meaningful strides in improving safety outcomes, recent trends paint a more troubling picture. The service is in crisis after a decade of austerity and is still recovering from the devastating effects of the COVID-19 pandemic.

The cracks are evident, and so is the need for change   but the practicalities of effecting NHS change are not straightforward.

Government focus

In 2024, the new Government pledged to build a health service fit for the future. The first step was Lord Darzi’s review to understand the scale of the challenge facing the health service. Following publication of his report the new Government launched Change NHS, to gather views from the public and stakeholders to help shape its future. The consultation remains open until 14 April 2025 and it remains to be seen what specific plans will be formulated.

Pending publication of the new ten year health plan, the Government’s stated aim is to achieve three main shifts:

1. Moving care from hospitals to communities 
2. Making better use of technology 
3. Focusing on preventing sickness, not just treating it 

Fiscal constraints continue to dominate healthcare planning and there is an acknowledgement that ‘everything’ cannot be a priority. Previous long-term plans have been derailed by policy changes, the global financial crisis and the pandemic. We are living through times of acute geopolitical uncertainty that may well impact domestic health policy moving forward.

In terms of specific transformational objectives, there will have to be some trade-offs and difficult decisions will need to be taken around prioritisation of initiatives. The stated aim of moving from to a system of preventative healthcare would be truly transformational, positively impacting health inequalities and patient outcomes, while also reducing spend on acute services and facilitating the planning of healthcare delivery in the medium to longer term.

This change will require focus, commitment and significant financial investment, and it remains to be seen whether there is the appetite and resource to fund the culture shift required.

The context for change

The Labour Government’s strategy is not an entirely new approach. At national level there have than three long term plans this century. The direction of travel is clearly towards tackling health inequalities and preventative (as opposed to reactive) healthcare.

The NHS Plan (2000) saw the Government committing to substantial funding increases focused on boosting capacity, new national targets, and shorter waiting times, alongside a vision for safer healthcare, greater patient choice, and reducing health inequality.

The financial crisis (2008) and the coalition government (2010) changed the weather for the NHS. A re-structure following the Health and Social Care Act 2012, followed by slowing public expenditure meant that the Five Year Forward View (2014), was characterised by tight restrictions on the NHS budget and cuts to other public services.

The Forward View focused on integrating services with the aim of moderating rising demands for care by focusing on prevention, early intervention, avoiding hospital admission and providing support for people to remain independent at home.

Then came the NHS Long Term Plan (2019) (published during growing pressure on services). It recognised that demands on NHS services would inevitably continue to increase due to a growing and ageing population, visibility and concern about longstanding unmet health needs and the expanding frontiers of medical science and innovation. It was also recognised that resources are not infinite, with steps to moderate demand, where possible.

To find a solution, the Long Term Plan focussed on the move from reactive care towards more active population health management. The aim was to ensure patients received the right care at the right time in the optimal care setting, avoiding emergency hospital admissions. A focus on enhanced community-based care and preventative medicine was expected to lead to long-term improvements and costs savings.

The Plan highlighted the need to prevent avoidable illness, with a focus on smoking cessation; diabetes prevention through obesity reduction; establishment of specialist Alcohol Care Teams; a five-year action plan on antimicrobial resistance; and a reduction of air pollution from all sources, not least by greater use of virtual appointments.

There was also inequality. While life expectancy continued to improve for the most affluent ten per cent, it had either stalled or fallen for the most deprived ten per cent. Premature mortality in the most deprived areas was twice as high as in the most affluent areas and BAME communities were particularly impacted.  

Only a few months after publication of the Long Term Plan, we saw the first death from COVID-19 and the disruption to the health service was unprecedented and prolonged. The plan to tackle health inequalities and focus on preventative medicine took a back seat.

As we continue to recover from and move on from the pandemic with a new government and a refreshed agenda, it will be interesting to see what the new plan will be and what it must it do.