Key Takeaways

  • Despite being recognised as a priority, only 5% of total NHS funding was allocated to preventative care between 2013 and 2019.
  • The public health grant to local authorities has declined since 2015/16, being cut by over a quarter (26%) in real terms per person by 2023/24.
  • Primary prevention through public health interventions is substantially cost-saving, with a median return on investment (ROI) of more than 14:1.
  • Investing in prevention can be 3-4 times more cost-effective than investing in treatment.
  • Welfare payments to individuals with (partially) preventable conditions, like obesity, are substantial (£3.6 billion annually).
  • Recommendations for improvement include long-term cross-party agreement, innovative financing both within and outside NHS budgets (e.g., social impact bonds, dedicated prevention fund), and exploring new opportunities (precision medicine, digital health).

Despite recognition of prevention’s importance by the Office for Health Improvement and Disparities (OHID) and the NHS, funding has not matched ambition. From 2013-2019, only 5% of NHS funding was devoted to preventative care, and the public health grant has plummeted by 26% per person in real terms since 2015/16.

A systematic review reveals a median return on investment (ROI) of over 14:1 for primary prevention. The cost-effectiveness of public health investment, illustrated in Figure 1, indicates a 3-4 times advantage over treatment, with each Quality-Adjusted Life Year (QALY) costing £3,800 through prevention versus £13,500 through NHS budget expenditure.

Figure 1: Cost-Effective Impact of Public Health Investment: A Comparison of Quality-Adjusted Life Year (QALY) Costs and Thresholds

Prevention rises above the healthcare system, impacting areas such as government spending, welfare, and economic productivity. Reductions in preventable ill health could lead to increased tax receipts, decreased welfare payments, and savings across public sectors. Notably, annual unemployment benefits for individuals with obesity are estimated at £3.6 billion.

The report identifies four critical gaps

  1. Low uptake of existing programs
  2. Insufficient delivery capacity
  3. Short-term investment focus
  4. Chronic underfunding

These gaps contribute to missed opportunities for a healthier and more prosperous nation.

To bridge these gaps, the report proposes a coordinated, long-term approach. Key recommendations include:

  1. Elevate prevention above political cycles.
  2. Introduce prevention investment standards and explore social impact bonds.
  3. Consider dedicated prevention funds.
  4. Monitor indicators beyond uptake for increased accountability.
  5. Leverage precision medicine and digital health for targeted prevention.
  6. Develop a multi-year strategy backed by consensus for effective execution.

While primarily focused on NHS England, the recommendations are adaptable to other parts of the UK and internationally. The report underscores the broad societal benefits achievable through a well-orchestrated prevention strategy.

The report concludes by highlighting the economic and health benefits of prevention and urges stakeholders to collaborate in ushering in a new era of proactive, predictive, and personalised prevention guided by evidence-based strategies and long-term commitment.

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