Exploring the economic and social value of vaccinations

Matthew Taylor

Hello and welcome to the latest edition of Health on the Line brought to you by the NHS Confederation. 

A few episodes ago on this programme, we talked to Steve Russell, who amongst other things is heading up the national vaccination strategy for NHS England. It was a really fascinating conversation and we got quite a lot of feedback. So we thought we’d stay on the issue of vaccination.

And partly because there’s been a number of other really interesting publications around vaccination, the value of vaccination, how we best go about it. So we’ve got two great guests for our conversation today. The first is Lotte Steuten, who’s a deputy chief executive at the Office of Health Economics. Lotte is a health economist by training, primarily interested in health technology assessment and decision analytics, modelling of health, innovations. Lotte has published over a hundred peer reviewed papers. She’s visiting honorary professor at City University of London amongst many other things. 

And we’re also joined by someone I’ve been working with a lot over the last year or so. I’m a member of the IPPR Health and Economy Commission and the lead for that at IPPR is Chris Thomas, who’s a principal research fellow at IPPR and leader of that Health and Prosperity Commission. Chris, it’s great to have you joining us. Your expertise really is in healthcare funding, workforce reform, health inequality, public health, and as I say, the interaction of health and economy.

Now, both of you have been involved in really interesting publications around vaccination and that’s what we’re going to look into. So first of all, welcome to Health on the Line. 

So Lotte, let's start with you. You've recently published a report undertaken jointly by GSK - the pharmaceutical company - and the Office of Health Economics. And this is a report that looks in some depths at the economic value of vaccinations to the NHS. Tell us a little bit about where the report came from and then we can delve a bit into its findings. 

Lotte Steuten

So first, I would like to confirm that we worked together with GSK and that this report was sponsored and fully funded by GSK. And we work together as the Office of Health Economics - we are the world's oldest independent health economics research organisation; and we try to inform better healthcare policies by providing insightful economic analysis of critical issues. And prevention and life course vaccination are such issues. So we were very pleased when GSK asked us to really look into the value that vaccines can bring to help reduce the pressure on the NHS and also to which extent they could provide productivity benefits to the national economy. 

And then we focused particularly on the role they could play in helping clear up the elective waiting lists for the NHS. And so we did that by bringing together and modelling various data from four vaccination programmes in England. England has a full schedule of 18 vaccination programmes, so we only looked at four and those four are influenza, meningococcal, pneumococcal and rotavirus. 

Matthew Taylor

And why did you choose those four, Lotte? 

Lotte Steuten

We chose those four because these provide a very interesting mix of diseases. If you look at the differences in their incidence, but also populations affected, for example, children and or adults, and also the differences in potential severity of their consequences.

Data availability was also another more pragmatic consideration, of course. So we thought these were a very good mix of programmes that would allow us to get a fairly balanced view of the value of vaccination across the different programmes. But we also do not claim that these results are generalisable to all programmes. But this is a very interesting mix. 

Matthew Taylor

And the headline of your findings, which is that the money spent on vaccination is extremely good value for money is no surprise. We know that. But tell me Lotte, in terms of what you found out as someone who is a health economist. Were you surprised? Were there particular subtleties to what you discovered in this research, which you think added to our understanding? 

Lotte Steuten

So yes, on the headline, I think people who've worked in the vaccine space will not be surprised to hear that vaccination provides very good value for money within healthcare systems, but also to society more broadly. So our results basically showed that the productivity value of the vaccination programmes are up to 65 million, and that's only from these four programmes. But what we also looked into is that the savings of this value does not only stem from avoiding people needing to go into hospital and avoiding people to need to see their GP in primary care, for example, when they have severe symptoms, but also that when we are able to keep people that do not get a vaccine preventable disease because they are vaccinated, if they do not end up in the hospital, we will be generating a lot of additional value because that will help allow to admit patients who need elective care. 

And the NHS of course has long waiting lists and that would provide an additional value. And we basically, we only looked at, we combined data from a previous study that said if we can get people off the elective waiting list, there would be an X amount of productivity gains with that. So we multiplied those numbers. And that value was really surprising to me because that amounts to another 63 million worth in value to the economy. So that is not something that is directly felt within the NHS. So the 65 million of cost savings within the NHS by avoiding hospitalisations and GP visits, another 63 million to the wider economy because of productivity gains. 

Matthew Taylor

And is that a net benefit, Lotte? Are you factoring in the cost of these vaccination programmes?

Lotte Steuten

Yes, so this is the savings that will be generated. You would then of course have to look like what are the cost of those programmes. But we also looked into that and based on a broader literature research and we do see that the return on investment from public health interventions like these is about 14 pounds for every pound invested. So the net benefits for vaccination programmes including these is extremely high.

Matthew Taylor

Great. Now, Chris, turning to you, I guess there's nothing in these findings that is surprising to you. But when you listen to what Lotte is describing, does it fit absolutely with the analysis that IPPR has done on vaccinations? 

Chris Thomas

Yeah, it really does. It really does. So the findings Lotte is describing attest to our findings that health has an incredibly economic benefit. So when we've looked at vaccines in the past, there are a couple of channels that that works through. So entirely agree that one of those is clearing the very immediate challenge of the NHS waiting list. Our study in 2022 found that if we could make progress in line with what at the time the NHS England Recovery Plan had outlined on that waiting list, then there were over £70 billion worth of productivity gains on offer. And so the finding Lotte describes, that vaccines can help clear that and that there is a value within that feels very well aligned.

But the other channel that really stands up to me is this kind of interaction with the labour market and people's employment that has kind of kept Treasury awake at night for the last couple of years. And I think it particularly speaks to the challenges the economy is facing with not just the kind of headline-grabbing economic inactivity question - people out of work because of sickness - but actually the rise in in-work sickness that we've seen over the last few years. 

It's a slightly more understated problem, but the UK has since 2019, since the pandemic happened, had a very large increase in the number of sick days taken, perhaps more worryingly, a very large increase in presenteeism. And presenteeism is a particular challenge because it's contagious. 

Matthew Taylor

Do you want to just define presenteeism for us, Chris? 

Chris Thomas

Absolutely. So presenteeism, I mean people coming to work with a sickness and that experience having an impact on their productivity during the working day. And so when I talk about presenteeism being contagious, it's worth saying that when people do come to work sick, that that has a knock on impact on other colleagues and that could be because they catch the illness or it can be because if I'm not performing at my best, perhaps other people have to compensate. 

And that is astronomically where the cost is for in-work sickness in the UK economy. And it's also very well aligned with the benefits that vaccines can have. So I think absolute alignment from the findings we have with what Lotte is describing. 

Matthew Taylor

Lotte, was that something that you factored into your study, that presenteeism issue? 

Lotte Steuten

We factored in the actual sick leave that was taken. So the presenteeism is not factored in. So to that extent, our estimates are very much an underestimation. And to that same level, we also, in our very focused analysis, we did also not factor in the productivity gains that you can expect from people that are vaccinated and therefore not have to go into the hospital. So our productivity estimate, which amounted to 63 million, is only from the people who are currently on the elective waiting list and therefore cannot be as productive. 

But as soon as they would get treatment afterwards, they would recover to work again, is only stemming from that element of vaccine. So it's a very focused and also therefore not representative of the broader full value of vaccines, which is much higher even.

Matthew Taylor

Although you didn't study it, you find Chris's argument credible in relation to these wider effects? 

Lotte Steuten

Yes, absolutely. And we've seen this in many other studies that we've done at the OHE. Yeah, absolutely. 

Matthew Taylor

So Chris, going back to you, the whole issue of vaccines have been at the front of our mind, particularly since the covid pandemic. How do you think covid has kind of changed things? Because I guess there seems to be upsides and downsides here. 

The upside is its grown awareness of vaccine, the power of vaccine and something which we'll get into a bit later in this conversation, which is possible development of new vaccines. 

But on the downside, it's also, of course, contributed to the kind of conspiracy theories, the kind of anti-vaxxer movement, the kind of fallen into a kind of culture war, a kind of vortex. So what's your assessment of how covid has changed the conversation around vaccines, Chris? 

Chris Thomas

Yeah, I think a polarisation is absolutely accurate. So let's start with the good. I think the awareness of vaccines is not just one, but an incredibly important public health tool is very, very positive. I think that there's probably been a change through the COVID-19 experience in how we approach vaccine uptake. 

So we started the pandemic, I think, with this very hesitancy -focused, individualistic, approach to vaccines where really the government saw its role as purely offering the vaccine and then leaving it up to people whether they took it. 

And there was a lot of talk about hesitancy that I think as we saw how that was playing out on the ground began to melt away into a more structural understanding of what the barriers are to people getting vaccines. And there are definitely bits in the recent vaccine strategy that speak to breaking down the barriers people have to uptake properly, which I think is positive.

But our research does also show that there is still a fairly persistent minority of people for whom the COVID-19 experience has entrenched a mistrust of vaccination, a mistrust of the institutions that provide vaccinations. And that's quite worrying. And we'll need a solution to deal with that, particularly in the context that, if we do a vignette of people being offered the flu vaccine this winter, as many as a quarter of them talk about reluctance to get that vaccine, which is worrying. 

We also see childhood immunisation programmes not performing at quite the level we'd want them to. So most childhood immunisation programmes in England at the moment are behind World Health Organisation targets and their performance is dropping. So we do still have some pretty sizeable, significant issues for all those positives that I think if we want to get health and prosperity to the place we want them to be, that we'll need to have further responses to. 

Matthew Taylor

And Lotte, vaccination rates have flattened out and in some areas they've actually declined since the pandemic. Just to be clear, how much headroom is there for us if we were to be able to invest more in vaccination, how much scope is there for us to significantly increase vaccination rates? 

Lotte Steuten

In the research we did, we analysed that a 10 per cent point increase in coverage across these four vaccination programmes would realise about 14 per cent increase in the cost savings in primary and secondary care and also the number of patients treated from the elective care waiting list. 

So again, it sort of pays for itself if you sort of want to put it like that. So a 10 per cent increase equates to a 14 per cent increase in the value that is generated from vaccination. So there is a really, really large scope. And I think maybe sort of, coming back to the COVID-19 pandemic and what we've learned, is that before the pandemic, in much of the research we did, we have been calling for this greater recognition of this broader value of vaccination. So not only to the healthcare system, which is already very high, but also more broadly in society as Chris was also talking about. 

And I think during the recent pandemic, we all experienced how disruptive infectious diseases can be and therefore how large this value of vaccination can be. And therefore, and I think it's really important to keep that in our minds when we're now doing value assessments, but also think about spending on vaccination programmes. We see that the impact is much wider than the NHS.

It's huge in the NHS and it's much wider beyond that. But if we spend a bit more on that, it pays back more than it costs. So I think it's really too important for people to sort of, you know, keep that message in their mind. Also when thinking about efforts to deal with vaccine hesitancy and potential misinformation, et cetera.

Matthew Taylor

You've both very convincingly made the argument for investing more. So there is a financial element to this, which you might want to refer to in answer to the question I'm going to pose to you. But I guess the issue is, well, you know, how do we go about increasing vaccination rates? As I said at the beginning, we talked to Steve Russell, who's one of the architects of the government's national strategy. And the Confed indeed is working with NHS England in its kind of programme of identifying a number of kind of champion places, areas to try to push ahead with that vaccination strategy. 

But Chris, with that national strategy in mind, what do you think are the key things that we need to do to increase vaccination rates, but also are there things that we shouldn't do? I know that you are not a fan, for example, of kind of increasing a kind of compulsion element to this. 

Chris Thomas

Yeah, that's right. That's right. So lots in the national vaccine strategy that I think is good. So the increase in ease of booking appointments, I think is an excellent idea. Joining up how we do vaccines with other neighbourhood prevention programmes, I think also a really excellent idea. 

But there are some barriers, I think, that are probably not quite broken down by that strategy so far. So if I just take us through a couple of places that we see in our research that there are particular barriers. 

The first remains people's perceptions of what vaccines are for and it's still the case that people see vaccines through a slightly individualistic lens, ie that the vaccine is something they get so that they don't fall sick rather than it protects us all. So when we ask people a follow-up if they're reluctant to get vaccines, routine vaccines, say the flu vaccine, why then the leading reason is they're confident enough in their own health. So I think communicating and normalising what vaccines are for is still a pretty decent priority. 

The next factor that comes up for a pretty significant minority of people is how getting a vaccination interacts with their work. So there are lots of people who can't get time off to go to a vaccine appointment at all. It's quite striking even in the kind of 2021 peak of the COVID-19 pandemic, the peak at which we were talking about vaccines, I'd say evidence was that a quarter of people still weren't being offered time off to go and get their vaccine. And so that barrier persists, there's some work with employers to do there.

And that's particularly profound if people are also worried about any symptoms that might emerge from the vaccine. And in fact, people are worried about symptoms even for vaccines that are very unlikely to cause symptoms. So this really is a mix of practical and perception challenges. But we know a lot of people aren't eligible for sick pay, certainly not eligible for sick pay from day one of falling sick, given that that actually starts from day four. So there's a sizeable number of people for whom they're employer and their workplace will be a barrier to getting vaccinated, even though in turn we know that if they were vaccinated, that that would have very tangible benefits for their employer. 

So I think there's something that we can do around that space to make sure that - we talk a lot in the vaccine policy space about how we need to coordinate across government departments and the different arms of the state, but in fact coordinating with industry, employers and businesses, particularly that employment question, feels really important to me.

Matthew Taylor

I wonder, do you agree with Chris that this combination of more education and emphasis on the kind of the social value of vaccination, that that's where we should be putting our energies. And I'm wondering when we look at international evidence, those countries that do this best, what can we learn from them? 

Lotte Steuten

So, yeah, I fully agree with Chris that this social value is really important and it's very big. And I think if we first look within the UK, if we see how we think about the value of vaccines. Like I said before, that's mostly focusing on the health benefits of the individual that is vaccinated themselves. That's incorporated into these assessments, as well as the value to the healthcare system. 

But this broader economic and societal value is not typically considered a productivity value, but also, for example, grandparents being able to take care of their children. All these kinds of elements help us as a society to be as productive and also as social as we want to be, right?

So I think that's really important. So there are some countries close by, one country, the Netherlands, where I'm from, as you may hear from the accent, they take a societal perspective when they evaluate a vaccine. So they take this value into account in their analysis. And then that also determines how much they would spend on vaccination. So we can see there are some sort of differences between countries. Nevertheless, in all countries, typically spending on prevention and vaccines is very low compared to more acute treatments.

So yeah, this is just sort of one element, but it's really important because I think if people don’t even explore, analyse that value, this small percentage that we're spending, and then in the UK, I think that's 0.7 per cent of the NHS budget, that may seem enough while it actually is not appreciating the full social value of vaccines. 

Matthew Taylor

Lotte, turning to the future, there is a lot of excitement about the scope for new vaccinations. We saw, I think in America last year, approval for a new vaccination for children in relation to respiratory illness, which could be a real game changer when you think about pressures on A&E departments in winter. Do you think we're likely to see a lot more vaccines starting to emerge, which could be of real significance? 

And I'm also interested, Lotte, in the relationship between the conversation about vaccine uptake and a different conversation which is around drug uptake. That is to say, people who could benefit from particular drugs, I think of cardiovascular, for example, related drugs, where we again have issues around low take up and particularly low take up in particular kinds of communities. 

Interested in your comments on both the kind of new vaccines, but also how we can learn from discussing vaccines around this broader question of people taking the drugs which might be most beneficial to them? 

Lotte Steuten

Very good questions. And of course, indeed, I cannot predict the future, but we can look at the pipeline for vaccines. And when we're looking at that, we see more and more vaccines coming to the market over the coming years, also including vaccines that are for adults. You mentioned the vaccine against RSV for children. There's also one for adults now. And I think that's a very important sort of change in how many people think about vaccinations

Of course we know the flu vaccines, we know the covid vaccines, but there's increasingly, we're looking at ageing populations in this world and therefore it is important that we sort of stay as healthy as we can and as productive as we can throughout our life course. And as part of that, we also see that in our ageing societies, we also see higher rates of chronic conditions and not only in older people, but also in young adults. 

So I think that comes back to the point on the need for people to sort of take up treatments, drugs that they would need, for example, for cardiovascular disease. So I think we see loads of new vaccines coming to the market. And it's really important, I think, for health policy, for everyone working in health and healthcare, by thinking, how can we make sure that uptake of these products is as optimal as possible, given the high value that they bring? 

And often that comes to indeed talking about maybe longer-term value to that. Like if you make sure you're healthy enough, if you take your vaccinations, if you take the medicines for cardiovascular disease or other conditions, that will help you to stay as healthy as possible for a longer time. 

But quite often, of course, people are focused on the here and now and want to solve problems that are right in front of them. And it's very hard to sort of convince people to take the sort of longer-term viewpoint, I guess. So, yeah, there's lots of different elements that would have to come together to really make this work. But I think we definitely have lots of tools now to make sure in aging societies that we can do that.

Chris Thomas

If I could jump in on that point from Lotte Matthew, just to underscore how important I think it is. And it does strike me that the innovation that's out there in vaccines is as exciting as it's ever been. And that pipeline is so strong if we look across things that are coming through, ranging from, as you say, in the cancer space to vaccines that can be delivered by stickers, all kinds of exciting innovations.

And I think what that will mean is that it becomes incredibly important that we understand more proactively what's coming through the pipeline, because the system reactivity to lots of that is going to be really important. And it might mean that in terms of horizon scanning, that actually at the moment the kind of annual system of paper-based horizon scanning that we have probably isn't quite adequate for making sure that, say, ICSs have the proactive information they need to budget for and prepare for some of those things coming through the pipeline, because all those different innovations are going to need slightly different approaches.

They're going to need adaptation to local context, and they're going to need real plans to both budget for them and to make sure that the investment's in place. That opportunity to tie it into things like uptake of medicines. Just one case study, but really excitingly in Ealing during COVID-19.They essentially had a community led vaccine uptake strategy. They had pop-ups that were led by the community. They had outlets in supermarkets, they had things on buses. Community designed, entrenched in the neighbourhood, really, really effective. Little bit of money from national government to support that. Community champions were recruited, but it was really community led and community located. 

And it was just your point on cardiovascular disease, because we’re talking about things that are in that space very routine, very well known, it’s things like uptake of statins and blood tests. And I think there’s a huge lesson in terms of how you can harness the power of communities to lead and design these things in a way that reflects the community that’s being served to make sure that there’s a trusted path to uptake for all these things probably at once in a coordinated way from a neighbourhood level. So I think there’s some really exciting potential there.

Matthew Taylor

Let me just follow that point up, Chris, because I think that obviously we in the Confed encourage as much devolution to system, place, trust level as possible, but whilst also recognise the important role of national strategy and accountability. I've been doing some work looking at inclisiran, which has not been a great story in the sense that there was some very ambitious national targets for take up which haven't been achieved. And I think some quite big lessons to be learned from what has gone wrong, even though actually in comparison to other drugs, take up has been pretty rapid. It's not been anything like what the aspiration was. 

But what I find interesting about inclisiran is that when I look at the two places that seem to have done best or to be amongst the places that have done best and that I know a bit about, Manchester and Buckinghamshire, what's interesting is they've got completely different approaches. So Manchester is a kind of primary driven approach, a lot of emphasis on health inequalities. Buckinghamshire's a more kind of technocratic, more secondary driven approach; sort of more aligned to a kind of research and innovation strategy. 

What I derive from that, Chris, is a view that when it comes to innovation, the approach we need to take is one that is tight in terms of aims and principles - the aim of increasing take up, the principle of tackling health inequalities. But relatively loose in terms of the way in which you need to go about this, which reflects you know, local assets and local needs. And sometimes I have to say in the health service, it feels like we get the reverse. But I'm interested in your reflections on how we think about the balance between national and local when it comes to something like vaccinations. 

Chris Thomas

You're right. It's almost a legacy of some of the historic ways that we've tried to solve things in times of crisis for the NHS. And I'm thinking that an approach that kind of defines the problem that you're talking about is the kind of late 90s, early 2000s focused on things like national strategic frameworks. And in fact, the approach then was set a target and then really prescriptively in a very detailed multiple pages of very detailed instructions, try to define how everyone goes about doing that. 

And that can work a bit in some places in the short term, but it's very rarely a good approach to delivering basically long-term outcomes consistently across all places that we care about and building system capacity to do that autonomously. 

So I think the centre needs to have a clearer role and a clearer sense of what its role is and what its levers are in articulating prioritisation and a sense of mission. I'm not sure it's quite nailed how to create that sense of mission at this stage. 

And then a recognition that the ways in which different places go about doing that might be slightly different. 

It might be wholly different to go to your Buckinghamshire and Manchester example exactly as you say, because they will have different assets, they'll have different needs, they'll have different populations, different levels of trust, all those things will play into what the right approach looks like in delivering good uptake of anything from vaccines to public health interventions to medicines and drugs. 

I think the one extra ingredient in that for me is that we probably need to have a recognition that if we want to have local places using their strengths and their assets to deliver different strategies, we probably also need to recognise that some places just have fundamentally less assets, less partners, less charities, less civil society active in them than others. It's much harder for a charity or a cooperative or a social enterprise focused on health to run in more deprived parts of the country, particularly, you know, kind of with the bite of austerity and COVID-19 combining. 

And I think that probably means that as much as there's a need for giving power away to systems within the NHS, there's probably an onus then on those systems to develop the health ecosystem that they're working in. And inevitably, that probably has to mean a flow of funding to some of those organisations as well, because if we want a strength-based approach, then we probably need to use the strengths we have, but we also need to build some of those strengths in some places too. 

And I think that comes to mind, because that's something the Greater Manchester have done very successfully, working to good outcomes and actually outcomes quite a bit above when we look at their outcomes, what you'd expect from the level of deprivation, the kind of population they're working with. It's a really good model for others to follow. 

So I think those are the three components: How does the national get its sense of purpose and mission right? How do we give systems freedom to adapt their approach? But how do we build ecosystems in all places that mean that that's genuine partnership working and that there are people to work with all across the country?

Matthew Taylor

Yeah, thanks, Chris. And just to be clear, I also recognise that there are certain areas, I'm a great fan of the GIRFT programme, where there is one best way of doing things. And also that even if you do devolve, as I think we should do more, you still need accountability. 

And I want to ask you both the same question just to finish with. 

When we talk about health at the moment, we tend to talk about it very much in the context of the problem being demand. But actually the future of primary care seems to me to be one in which population health management, the capacity of primary care to proactively reach out into communities, to identify the people who haven't been vaccinated, to identify the people who aren't taking the drugs, haven't had the tests they should have is absolutely critical. 

So do you agree, Lotte, that this conversation about vaccination also points us to the fact that we need to view the challenge of the health service less as being about demand management, more being about increasing public engagement? 

Lotte Steuten

I think that's definitely very important part of this. I think vaccination and prevention and also like sort of secondary prevention, making sure that people are adherent to the medicines they have to take and all of that are incredibly important for our societies, for individuals, for the healthcare systems, et cetera. So we've talked about that at length, I think. So these are really important tools and they're also very central to economic productivity and growth. So they benefit all of us. 

So it's not only indeed focusing on trying to make sure you don't need to see a GP or have to go to the hospital because of some potentially avoidable illness, but making sure that we see health as sort of central in our lives and how we can manage that. 

But it's also very important of course to mention that there's big differences within many countries and between countries like to the extent people are able to do that also depending on elements as social economic class, et cetera. 

So there’s loads that has to be done to sort of achieve that because there's really important differences there that cannot be solved by just telling people you have to take better care of your own health because you need to know what that means and how to go about that and have the tools and the education to do so. So it's not a simple thing. 

It's a simple thing to write down a thing and many people will agree with that but achieving it has proven very very hard and therefore I think this always has to be a very close view what we can do with the supply of healthcare we have available and making sure we allocate that as wisely as possible. And then again, vaccines are a very good choice as with other preventative interventions. 

Matthew Taylor

Thanks, Lotte. 

And Chris, the final word to you. And also I wonder whether in answering my question, we kind of think about Chris Whitty’s very powerful CMO report last year, in which he said in very clear terms - and I'm surprised in a way it hasn't been picked up more broadly - that the health system is simply, not just health system actually, but our whole society and economy is unsustainable unless we can move our focus more from keeping very sick people alive for as long as possible at the end of their lives and into keeping people healthier for longer. 

It seems to me that at the heart of that is this shift from thinking about a relationship with the public being around how do we manage their demands, thinking about the challenges, how do we increase our engagement, their engagement? 

Chris Thomas

Yeah, absolutely. I think the chief medical officer put it brilliantly. He's absolutely right. Fundamentally, we are entering an age, I think, that the kind of brilliant focus, but probably now, kind of unachievable focus on longevity has to give way to a focus on quality of life. And certainly when we research public attitudes, they want that focus to be on quality of life as well. So the public really up for this shift. It's what they prioritise too. 

And I think there are two questions that lie ahead of us. The first is the question you posed, Matthew, on rationing. And I think the fundamental question we have to ask ourselves is: are people getting enough health interventions at the moment? Are they healthy enough? Have we got that balance right? And I think all the evidence that we see on what the onset of much avoidable illnesses is costing people in terms of their earnings, their job prospects and therefore the labour market, the national GDP productivity. All those challenges point towards the fact that we're not managing to allocate the right interventions at the right scale to the right people. So we're not getting that balance right and we need to think about health less as how do we ration what we already have but more about how we expand our ability to give more interventions, more effective interventions in an earlier stage of life to more people that need it. 

And then once you get away from that rationing question, that's where you start to get into the allocative question, which is: once we've recognised that people aren't getting enough health interventions, we can start to think about what the best point to give that intervention looks like. And that's where I think we get into the prevention conversation, because if we've decided that our population isn't as healthy as it should be, and that's doing all kinds of damage to people's lives and the economy, then in thinking about the most effective way to change that, then surely we have to get to the prevention question. 

We have to get to vaccines. We have to get to meeting challenges like obesity. We have to get to working out what we do about mouldy housing and the fact that alcohol deaths are up 30 per cent from 2019. It's partially how do we expand the interventions on offer and how partly how do we work out what the most effective way to stratify those are. 

Matthew Taylor

Well, it's been a fantastic conversation. 

Thank you Chris. If you want to know more about the IPPR's work on health and prosperity, then check out their excellent website. 

And Lotte, thank you as well. Lotte, your report, is it on the Office of Health Economics website? 

Lotte Steuten

It's not yet. So yes, we have many reports on the website that basically give similar messages. So I would still welcome every person hearing this to sort of check that out. And we will let you know as soon as this report will be available as well.

Matthew Taylor

Great. Well, thank you both. And also the Confederation will be doing a lot more work, I think, on vaccination, as I say, hopefully partnering with NHS England on a set of initiatives in particular places to demonstrate what can be done to improve vaccination rates. So watch this space. 

Thank you, Chris. Thank you, Lotte. And most of all, thank you for listening.