Last week, the Department of Health & Social Care (DHSC) published an initial response to the Major Conditions Strategy consultation. We’re pleased to see the Government placing an emphasis on primary and secondary prevention – something we highlighted in the call for evidence. But we need more than just words.

• Government’s focus on prevention is welcome but words must be backed by investment and action.
• Preventing ill health is key to living longer and healthier lives and can bring many social and economic benefits too.
• If it wants to achieve its goal of an extra five years of healthy life by 2035, the Government needs to put its money where its mouth is – it should commit to spending 6% of its health budget on prevention.

Preventing ill health throughout the life course can lead to greater health outcomes, as well as many social and economic advantages. In an ageing society, this is more important than ever given that we’re more likely to live with multiple long-term conditions as we age.

On primary prevention, DHSC recognises that the wider determinants of health such as income, education, work, housing, relationships, families, and geography can all have a major impact on our health. It emphasises on levelling up and using population level interventions to improve health, such as improving people’s diet, getting people more active, improving air quality, encouraging active travel, and ensuring everyone is within 15 minutes of a green or blue space.

ILC has also stressed the importance of healthier lifestyles, as well as a “fifteen-minute place” – a community where our work, shops, health and education services are within a fifteen-minute walking distance. This could act as a model for helping people to live longer and healthier lives in the future.

Using secondary prevention to help stop or delay disease is also outlined by DHSC, which wants to:

• invest £645 million over 2 years so the NHS can expand services offered by community pharmacies, such as blood pressure services
• modernise the NHS Health Check programme through a new digital service, helping to improve the current programme which could prevent 2,500 heart attacks and strokes every year

In our A window of opportunity report, we call on governments to democratise access by utilising community pharmacists and other local health services, as well as using technology effectively to improve access to preventative healthcare. DHSC’s commitment to funding local health services and harnessing digital technology is a promising sign that preventative healthcare is being brought closer to citizens.

Democratising post-diagnostic support for conditions such as dementia is also vital. DHSC states “high-quality integrated and personalised support following a dementia diagnosis is crucial”, yet currently, people living with dementia are diagnosed through secondary care specialists like psychiatrists and neurologists. These services are often oversubscribed and face increasing demand. Ongoing support is provided by primary care such as GPs, but these services are under-resourced and often lack specialist knowledge.

Ongoing research by the Alzheimer’s Society-funded PriDem project led by Newcastle University suggests that better post-diagnostic support can be achieved by using existing resources more efficiently and effectively. This means shifting the coordination of post-diagnostic care from secondary to primary care services within our communities. Patients are then referred to secondary care specialist services, such as mental health services when more help is needed. This results in more personalised and timely care and could be up to 40% cheaper than specialist care.[1]

Preventing flu, pneumonia, and COVID-19 through vaccination to help individuals with chronic respiratory diseases is also outlined in the response. DHSC is working to improve uptake among people with chronic obstructive pulmonary disease (COPD) in the 20% most deprived communities with poorer than average health access. ILC’s Reducing the risk report also addresses the need to improve vaccination rates in clinical risk groups through condition-specific communication and better cross-sector collaboration between health and community leaders.

The response also suggests the need to empower people to create healthy lives, stating that “Creating healthy lives means encouraging healthy behaviours for both physical and mental health.” Reducing smoking and alcohol consumption, as well as tackling childhood obesity, are recognised as the key measures needed. It also calls for better mental health services in schools, as well as utilising digital services like apps that reward healthy behaviour. On smoking, ILC’s Up in smoke report urges policymakers to take tougher action to unlock greater economic benefits: if current and ex-smokers had never smoked, it would have boosted the UK economy by £19.1 billion a year.

Despite the ambitions laid out in this response, it’s clear that there is still a long way to go. Simply making pledges and acknowledging the value of prevention isn’t going to ensure longer and healthier lives. While it is commendable, DHSC commits to raising healthy life expectancy for all by five years by 2035. Last year, the Health Foundation projected this would take 192 years to achieve in men.[2] ILC raised concerns about accomplishing this goal back in 2020 in a letter to the then Health Secretary, Matt Hancock MP. We highlighted that policy decisions such as halting the Industrial Strategy and the Grand Challenge on Ageing would hinder efforts to achieve this goal.

Clearly, to reach its aims, the Government needs to put its money where its mouth is and commit to spending more on prevention. ILC argues that governments across the G20 should spend at least 6% of their health budgets on preventative healthcare.[3] And in an ageing society, there’re benefits to doing this: increasing preventative health spend by just 0.1% can unlock a 9% increase in annual spending by people aged 60+ and an additional 10 hours of volunteering.[4]

While our Healthy Ageing and Prevention Index places the UK 16th in the world, it lags on health span. The UK is ranked 28th at 70.1 years, yet if the UK met its target of five extra healthy life years in 2019, it would have jumped 27 places to become the best performing country – ahead of Japan, the healthiest country on the Index. Unless the UK increases its prevention spend from 4.8% to 6%, meeting the 2035 is increasingly unlikely. Now is the time for the Government to recognise the true value of prevention and put it at the forefront of its Major Conditions Strategy.

References

[1] https://www.alzint.org/u/worldalzheimerreport2016sheet.pdf

[2] https://www.health.org.uk/news-and-comment/charts-and-infographics/healthy-life-expectancy-target-the-scale-of-the-challenge

[3] https://ilcuk.org.uk/a-window-of-opportunity-delivering-prevention-in-an-ageing-world/

[4] https://ilcuk.org.uk/healthequalswealth/