Prevention opportunity

by Sanjay Agrawal

21 July 2021

There has been lots of talk about the benefits of prevention, but new funding offers a chance to put it into practice.

Prevention is better than cure. It is an old adage, but it couldn't be more true as we have seen with the Covid vaccination programme. How many more deaths would there have been without vaccination?

So why do we not take this approach more with other preventable conditions? We know we end up treating lots of conditions in the NHS that could have been prevented. Simple examples are the diseases caused by smoking, obesity and alcohol, which include several dozen cancers, strokes, heart attacks, aneurysms, diabetes, high blood pressure, pancreatitis, hepatitis, liver failure and gastric bleeding.

Yet, for years, we have not systematically attempted to prevent the root cause of these conditions, possibly due to the belief that it ‘wasn’t our job’.

Thankfully the cavalry has arrived and we are now very much putting prevention into the heart of NHS planning, which should reduce demand on NHS services across primary care, secondary care, community services and the ambulance service. If implemented successfully, we will prevent hundreds of thousands of GP appointments and hospital attendances freeing up resource to cope with the ever-increasing demand in other areas of the NHS. 

As a rather large bonus, we will also address health inequalities, as smoking, obesity and alcohol misuse are usually most prevalent in our most deprived communities and have crossovers with other conditions such as mental health disorders.

Finally, this programme of NHS work will have an impact on the social determinants of health by reducing poverty. Many of these conditions end up costing individuals and families a significant part of their family budget. For example, we know that smoking alone puts around a million families, including a quarter of a million children, below the poverty line. And just stopping smoking would put £7bn back into families and local communities (see Smoking and health 2021; a coming of age for tobacco control. The Royal College of Physicians).

So, what are we doing about these specific conditions?  The NHS long-term plan has a very specific prevention component. This is funded and money has already been released to the lead clinical commissioning groups within integrated care systems (ICSs). 

The money covers setting up tobacco treatment services across every acute and mental health trust as well as across maternity pathways. It funds alcohol care teams and provides significant new treatment options for obesity in primary and secondary care. And as an added benefit many of these services include a staff offer. 

You might be wondering what all this has got to do with finance professionals. The finance function has an extremely powerful and influential position in our systems. If there is one group of people who know where the money is, it is (or should be!) the finance team. None of these services will start or flourish unless that money is identified and utilised by the clinical and managerial teams to set up these services. 

At a practical level, it would be great if finance teams in providers and at ICS level could identify the funding for these programmes within their CCG/ICS structure. It should be discussed with the health and equalities lead within their organisations. And make sure that the relevant clinical teams and steering groups have been alerted to this funding and plans are in place to use it.

This is a unique opportunity to prevent ill health in hundreds of thousands of people and the finance community has a big role to play. We should seize it with both hands.

Professor Agrawal is national specialty adviser for tobacco dependency for NHS England and NHS Improvement and an HFMA trustee