Paving a new pathway to prevention: leveraging increased returns on our collective investment

Key points

• The Value in Health series from the NHS Confederation and CF explores the investment potential of the health and care system through understanding, researching and modelling the positive relationship between increasing NHS spending, health outcomes and economic activity.

• This fourth report in the series pushes further into understanding return on investment (ROI) at intervention level and the implications for the health and care sector.

• The headline finding is that there is an opportunity to have much bigger impact from prevention by selecting interventions with the highest returns. The conservative estimate suggests this could be equivalent to £11 billion a year, based on the £5 billion that is currently spent on the public health grant by local authorities and on health inequalities by the NHS. 

• The top 20 interventions by ROI were all community-based with a range of returns from £6.90 to £34.75. This further reinforces the key messages from the previous Value in Health research and highlights the importance of consistent working across NHS, local government and other partners.

• The other critical finding is that there should be efforts to more systematically evaluate and apply an approach that incorporates both population need and getting the very best value for money. There is significant variance in ROI between interventions, both within intervention categories and between studies of the same intervention type. The intervention that is chosen for a certain place or population base is therefore of material importance and an evidence-based approach is essential. 

• One particular area of note was the impact of intervention on children and young people – including those related to education. When considering ROI by age, there was no variance by age for interventions, with many studies not considering the impact of the intervention beyond more than five years. The implication of this is that investment in children and young people returns at least as much as older people and is likely to exceed the stated ROI given the lasting effects of childhood health on adult health, employment and socioeconomic status.

• The report summarises three recommendations for national government, NHS England, integrated care systems and local authorities:

• 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.

• We believe the underpinning research and evidence base in this report should inform decision-making for health and local government leaders in everyday decision-making on prevention. To support this, the NHS Confederation and CF have developed a six-case framework for those working in health and care to consider the economics of health in investment decisions. 

• If the current approach taken to investment is not changed, we believe the current pathway will lead away from the evaluative learning health system approach that is a critical part in delivering prosperous, preventative places and improving population health outcomes.