Local government organisations and industry thought leaders have slammed the UK government’s decision not to increase funding for prevention.
The Hewitt Review: an independent review of integrated care systems (ICS), published earlier this year, made a recommendation to increase the proportion of public resources spent on prevention.
The review – led by former Labour health secretary, Patricia Hewitt – set out to consider the oversight and governance of the ICS network.
In the report, Hewitt said: "I recommend the share of total NHS budgets at ICS level going towards prevention should be increased by at least 1 per cent over the next five years.
"Given the constraints on the nation’s finances, this is my most challenging recommendation," she said, "but an ambition of this kind is essential if we are to avoid simply another round of rhetorical commitment to prevention."
Now, in its response to the Hewitt Review, the UK's Department of Health and Social Care said: "The government agrees that... the focus for the NHS should increasingly shift towards implementing evidence-based interventions to help improve prevention and support healthier life expectancy, however, we do not agree with imposing a national expectation of an "essentially arbitrary" shift in spending.
The government has instead committed to a review of methodology for "developing definitions for preventative healthcare spending" and also to "exploring options for local baselining".
Once this process has concluded it has said it will consider publishing this information, but it stopped short of a commitment to do so.
Sir Muir Gray, author of How to get better value health care, said: "This is an incorrect value judgement. We could get more value from taxpayers' money if less was spent on tests and treatments that do no good, and more was spent on prevention.
"A UK government report – Good for you, good for us, good for everyone – a plan to reduce overprescribing, concluded that at least 10 per cent of all drugs prescribed either don't work or cause harm and that 20 per cent of hospital admissions are as a result of drug side-effects. All this costs £1bn a year that could be redeployed for prevention.
"Doctors are currently not allowed to shift spending from drugs to prevention, so they end up prescribing drugs because they don't have the option to refer people for preventative services – such as physical activity. If they had prevention-related options, less would need to be spent on drugs, reducing the likelihood of side effects and freeing up resources.
"I agree that the 1 per cent recommended by the Hewitt Review can be seen as arbitrary, but that's not the point – the Hewitt Review was seeking to establish an important principle regarding shifting resources. Once that principle is agreed, the actual amount needed can be nailed down.
"The current system isn't giving us what we need: it's wasteful and is using resources that would give better value if used for prevention," said Gray.
Liz Terry, editor of HCM magazine said: "We know that around 85 per cent of all disease is lifestyle-related and so a government agenda based on prevention would not only deliver dramatically better value to UK taxpayers, it would also transform lives as people would not succumb to preventable, life-shortening health conditions in the first place.
"We call on the UK government to review this unfortunate decision, accept the principle that prevention must be an important part of the health agenda and take action to make it happen, in partnership with the physical activity and wellness sectors."
The Local Government Association (LGA) described the government's decision not to focus on prevention as "disappointing".
"We're disappointed that the Government has rejected the Hewitt Review's suggestion to grow spending on prevention by 1 per cent per year," said David Baines, vice-chair of the LGA's community wellbeing board.
"Historically, prevention has always been overshadowed by the immediate funding challenges for acute and hospital care, but without resources specifically earmarked for prevention, we won't see the radical step change in NHS investment that's required to turn the curve on a growing burden of ill-health and long-term conditions."
The Hewitt Review
Each ICS has an integrated care board – a statutory organisation responsible for developing plans for meeting the health needs of the population, managing NHS budgets and arranging for the provision of health services in their area.
In the report, Hewitt said: "We are currently not creating the best health value that we could from the current investment in the NHS. Instead of viewing health and care as a cost, we need to align all partners, locally and nationally, around the creation of health value.
"NHS funding remains over-focused on the treatment of illness or injury rather than prevention of them and ICS partners struggle to work around over-complex, uncoordinated funding systems and rules to shift resource to where it is most needed.
"Instead, it is essential to identify the most effective payment models, nationally and internationally, to implement a new model with population-based budgets, which will incentivise and enable better outcomes and significantly improve productivity.
"There should also be a review of the NHS capital regime to address the inflexibility in the use of capital and the layering of different capital allocations and approvals processes. NHS England should also ensure that systems can draw upon a full range of improvement resources to support them to understand their productivity, finance and quality challenges and opportunities.
"Many of us have talked over many decades about the need to focus on prevention, population health and health inequalities. We have called for a shift from a top-down, centralised system of managing the NHS to a bottom-up approach responsive and responsible to local communities and engaging the enthusiasm, knowledge and creativity of staff along with patients, carers and volunteers.
"The creation of primary care trusts and then clinical commissioning groups were attempts to do exactly that, but each was reorganised and swept away in their turn.
"Prevention, population health management and tackling health inequalities are not a distraction from the immediate priorities: indeed, they are the key to sustainable solutions to those immediate performance challenges," she concluded.
To read the Hewitt Review, click here.
To read the UK government's response, click here.