Investing more in prevention could deliver £11 billion return on investment
Better targeting of existing money spent on prevention could deliver an extra £11 billion annual return on investment (ROI) and hold the key to the government achieving its goal of increasing the impact of prevention, a new report suggests.
The analysis by the by NHS Confederation and CF (Carnall Farrar) also found that if the upper quartile ROI was achieved across all interventions, then the financial impact could be up to £22 billion per year – an increase from the £11 billion per year estimate that comes from the £5b per year of current spending.
The analysis is the latest in NHS Confederation and CF’s ‘The Value in Health series’, and explores the ROI of 146 interventions spanning primary, secondary and social settings, and their implications for the health and care sector.
The government has pledged to move more care from hospitals into the community and to shift from tackling sickness to improving prevention.
This new report shows investing in preventative measures including improving health education and housing can pay dividends in the long run.
It recommends increasing investment in prevention – in particular around children and young people, exercise and smoking, diabetes and cardiovascular interventions. It calls for considering ROI when commissioning services – and hence investing more on high value interventions.
Many preventative services in England are funded through the public health grant to local authorities, but this has effectively been cut by 28% per person in real terms since 2015/16.
The analysis found that the top 20 interventions by ROI were all community based and in areas such as housing improvements, smoking prevention and exercise initiatives, with a range of returns from £6.90 to £34.75 (per £1 spent).
This new report highlights the significance of wider collaboration outside of the NHS, with the local government and other partners.
The areas with the highest median ROI were education at £6.60, followed by reducing worklessness, substance abuse schemes and vaccination programmes which all had an ROI of £4.
The top five interventions with the highest ROI were:
- Adapting 100,000 homes where a serious fall is otherwise likely to occur - £34.80
- By training healthcare professionals, via clinical champions, to provide physical activity brief advice - £23.70
- Birmingham City Council’s scheme to provide free leisure services to its residents – £20.70
- Suicide / self-harm prevention (restrict access to means, making transport safer & reduce harmful drinking) - £19.60
- Adapting 100,000 homes where residents are likely to require treatment due to the excess cold - £17.10
The report comes after the independent Darzi investigation, which revealed that spend on acute care has risen from 47% in 2002 to 58% in 2022, while primary care has fallen 27% to 18%.
Combined with the new CF and NHS Confederation analysis, this highlights the stark need for health service and local authority leaders to invest more in prevention, and to focus on the highest-impact interventions.
The findings are based on a systematic literature review and expansive evidence review of 96 papers with 146 unique ROIs across primary interventions, secondary interventions and social determinants of health.
The report recommends three key steps for national government, NHS England, integrated care systems and local partners:
- Invest more in prevention, particularly where we know it has impact, for example children and young people.
- Take an evidence-based approach to commissioning services that considers ROI as part of holistic assessment.
- Use data to systematically evaluate and benchmark interventions, leveraging the longitudinal data available to the NHS and the investment in secure data environments and the federated data platform.
The report also suggests the need to more systematically evaluate and apply an approach that incorporates both population needs and getting the very best value for money.
The findings highlight the wide variance in ROI between different interventions, both within intervention categories and between studies of the same intervention type stressing the need for an evidence-based and tailored approach for different population bases.
The research also further echoes the focus placed recently on children and young people by policy makers within and outside the health sector. There was no ROI variance by age, implying that investment in children and young people returns at least as much as with older people and is highly likely to exceed the stated ROI given the lasting effects of childhood health on adult health, employment and socioeconomic status.
Matthew Taylor, chief executive of the NHS Confederation, said:
“As our recent State of Integrated Care report shows, health and care leaders are committed to the government’s plans to shift more care out of hospitals, but are concerned that a lack of long-term investment and planning is holding them back. The current financial situation the NHS is facing means our members are having to prioritise short-term funding and performance over the long-term changes they know are necessary to put the NHS on a sustainable footing.
“So it is poignant that this new report sets out yet more evidence that investing in prevention is not just good for patients and improving public health, but also the economy. It is clear that an initial investment in preventative schemes can pay back dividends for people’s health and the economy.
“Supporting people to stay healthy and preventing illness is a vital part of boosting the economy, with economic inactivity in the UK having risen by 900,000 since 2020 – much of this due to those who are long-term sick.
“Our members have welcomed the government’s pledged to transfer more care into primary and community services as well as to shift from treating sickness to preventing sickness. This is not just about improving NHS performance but will require a whole-government approach because only 20% of our health is determined by healthcare, with the remaining 80% affected by wider determinants.
“What we want to see is cross-government co-operation, collaboration and investment on health policy, recognising that that most policy that impacts people’s health is made outside the NHS.”
Ben Richardson, CF Managing Partner, said:
“There has never been a greater need to take a systematic approach towards prevention given the pressure the NHS is under. While much emphasis has been put on the topic of prevention, our report highlights the need for a transformative approach. It is essential to thoroughly evaluate decisions and implement pragmatic, evidence-based measures to validate investments, considering the comprehensive range of services and interventions across both the NHS and local governments.
“We need a more business-like approach to seeking Return on Investment from spending on prevention interventions. With half of interventions delivering low levels of returns and a small number delivering extraordinary results, better selection of interventions could more than double the impact of current spending on prevention. Increasing spend on prevention could further increase this impact. This may hold the key to enabling greater impact from spending on prevention in a financially constrained environment.”
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