Independent report

Making prevention everyone’s business: a transformational approach to personalised prevention in England

Published 24 May 2024

Applies to England

When I was appointed as the Government Champion for Personalised Prevention in 2023, the then Secretary of State, Steve Barclay, asked me to develop a vision for a modern, personalised cardiovascular disease prevention service.

Over the 6 months between March and September 2023, I worked closely with a multi-disciplinary taskforce of experts - and consulted widely with stakeholders across and beyond government - to develop that vision.

This is a summary of my vision not just for cardiovascular disease, but for a modern, personalised prevention service that could address all the major conditions and prove transformational for health and the economy.

At the heart of this vision is my belief that we must make prevention everyone’s business.

Our current approach to health is unsustainable, both for the health of the population and for the economy. A reorientation towards prevention is the only way to avert the growing health and wealth crisis.

Healthcare demand is at an all-time high, with more money being pumped into the NHS than ever before. Thanks to remarkable medical advances we are living longer but, crucially, the amount of time we spend living in good health has not kept pace.

Ill health is not just a health problem; it has major economic consequences too. Increasing numbers of people are out of the workforce due to ill health and more still see their productivity in work reduced as a result of illness, stifling economic growth.

All this is set to worsen as our population ages and our health needs become increasingly numerous and complex.

The ‘size of the prize’ for prevention is huge. It is estimated that applying known, evidence-based preventative interventions earlier and more broadly could add 20 more healthy days per person, per year, in the UK - a 33% reduction in ill health - unlocking a $401 billion (around £320 billion) rise in GDP over 20 years.

Upstream, preventative health interventions have proven cost-effectiveness and are known to be more efficient than downstream care. The ubiquity of digital technology means we are now able to do prevention in a personalised way and at scale.

Central to the success of this transformation in approach will be a new social contract for health - one where responsibility is shared between government and the people.

To make prevention everyone’s business will require a shift from a ‘do to’ to a ‘do with’ mentality - something we are already seeing in parts of the healthcare system, with an increasing emphasis on patient choice.

This marks the start of a new social contract for health - one in which there is shared ownership of and responsibility for staying healthy and preventing ill health between people and government (including through the healthcare system). Business and communities will have important roles too.

We cannot rely on the old model of government and health professionals telling people what to do. Rather, we must empower people to take control of their own health. We must give people the ability to do more for themselves, normalising self-care instead of defaulting to the NHS for every health need.

Government will ensure - through the NHS - that people receive the crucial care they need, when they need it. But government will also expect that people proactively engage with and take responsibility for their own health. Government will support people to do this by:

• informing: putting people’s health data in their hands, presenting them with the risks they face alongside the benefits they can expect to see if they take action
• empowering: making services - both digital and physical - available where they are needed, so people can make use of them
• rewarding: offering incentives for people to achieve and maintain health goals

Digital technologies are the key to delivering personalised prevention at scale, and should be harnessed to create a digital-first National Prevention Service.

We should take advantage of the success of the NHS App, and of the raft of digital health services available to the population, to create a more holistic, joined-up digital prevention pathway.

A new ‘prevention portal’ - developed as part of the NHS App - would allow people to:

• access and interact with their health data
• make and receive assessments of their health and personalised prevention plans
• be signposted to the services they need, both digital and face to face

The portal would be a ‘one-stop shop’ for digital prevention.

The accurate calculation and effective communication of personalised risk and benefit will be crucial to this endeavour.

We can make this vision a reality by accelerating and expanding the development of the NHS App. We should start with the inclusion of the digital NHS Health Check, already funded by government, and connect it to a range of existing digital prevention resources and services. We should then look to add further prevention-focused functionality to the app and, over time, increase the level of personalisation, including through the use of incentives.

With more than 33 million people already signed up, the NHS App is a golden opportunity to expand prevention at scale.

The digital-first National Prevention Service could evolve to support people from youth to older age, encouraging regular self-assessment, providing personalised feedback and action planning and/or goal setting, and reminding people about screening and vaccination opportunities.

There are other ingredients that will make this vision work. Alongside the new digital service, we should continue to:

• move prevention services, such as blood pressure checking, out of traditional healthcare settings and into the places people live, work and socialise, so we normalise prevention as part of everyday life
• create an environment in which the testing and adoption of medical innovations for prevention is encouraged and enabled, meaning everyone can benefit from the latest advances

While we must seize the opportunities digital innovation affords us, it is imperative that we ensure that no one is left behind and that everyone in our country can access the services they need.

This approach will require up-front investment which will take time to produce significant financial and economic returns. But the risks of not acting are greater: an economy stunted by ill health and a health service on its knees.

The logic is sound. We know ill health is a major cause of lost workforce productivity; if we can improve the nation’s health, productivity should follow. And we know we can improve health by improving the application of evidence-based preventative interventions.

It will take time for the financial and economic returns to come, but we won’t need to wait years to know that it is working. Important health indicators can be expected to be changing for the better within 12 months, a clear sign that we are on the path to success.

The pivot to prevention is clearly the only way forward: we should be asking not ‘why should we do this’, but ‘why are we not doing it’.

There is no question that we must act now to avert the impending health and wealth crisis. The alternative is unviable. My vision is to provide an enduring infrastructure to establish a transformational programme for prevention that will change healthcare delivery for the better.

It should be adopted as a top priority for government, championed by the Secretary of State for Health and Social Care, the Chancellor and the Prime Minister, in order that it forms part of the key deliverables across all relevant government departments and, crucially, the NHS and local government.