The creation of a “pre-NHS” focusing on preventive healthcare could unlock billionsfor the UK within two decades, according to the head of a taskforce investigating radical new improvements to the nation’s wellbeing.
Prof John Deanfield, the first-ever government champion for personalised prevention, has concluded that a parallel health service is required to save an NHS struggling to heal an increasingly unhealthy public.
Deanfield, who was asked by the previous secretary of state, Steve Barclay, to set up his taskforce, said: “The NHS still operates according to its traditional, founding principles of 75 years ago, which is disease care. But we need to move to a system of upstream, preventative health intervention.”
He added: “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.”
The “size of the prize” for prevention was huge, Deanfield added. “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.” That, according to an estimation made by the previous Conservative government, could create a GDP increase of about £320bn over 20 years.
Deanfield wants to move prevention services, such as weight, cholesterol and blood-pressure checks, into the places people live, work and socialise. “In this way, we normalise prevention as part of every day life,” he said.
He also wants healthcare personalised through a new “prevention portal” – developed as part of the NHS app – that would allow people to access their health data and individualised prevention plans, and signpost them to digital and face-to-face services.
Deanfield is recommending a new, national openness to the testing and adoption of medical innovations. He points to drugs including inclisiran, the cholesterol lowering drug which is now only offered to those who have high cholesterol or have suffered a cardiovascular event.
David Prior, the chair of the NHS until 2022, said Deanfield’s recommendations would help mend a “broken system”, have a profound impact on the country’s growing health inequality and improve instances of NHS giving substandard care.
A new, preventive model would quickly become as integral to the nation as the NHS itself, Lord Prior said, and rather than provide a challenge to the service, would be welcomed by health experts.
He added: “A preventative system offers us hope that we can actually crack the current healthcare crisis. Go to any NHS hospital and you see it is full of people with chronic, long-term conditions. But hospitals are the worst places to be treating people with those kinds of conditions: much better to treat them outside hospital before they get too bad.
“But we would be asking too much to expect the NHS to take on this preventative work. The current system is broken and will continue to deliver poor quality care and growing inequalities without this sort of help. The NHS would welcome a preventative healthcare system running alongside it, if that led to a reduction in demand for their facilities, which are creaking at the seams.”
Deanfield’s recommendations have also been backed by Sir John Bell, the regius professor of medicine at Oxford University who headed the national Covid testing scientific advisory panel and chaired the government’s test approvals group.
“The dream is to have a system similar to when we all had our Covid jabs: there would be a tent erected in the Sainsbury’s car park, and we would queue up to get jabs for Covid, flu, pneumococcus, shingles all at the same time,” said Bell, who is chair of the Office for the Strategic Coordination of Health Research.
“Then we’d be given blood tests, genetic tests and our family history would be scrutinised – and then those with any risk, even if they didn’t yet have symptoms, would get a long-acting injectable for lowering cholesterol, reducing blood pressure or weight management.”
Martin Marshall, the chair of the Nuffield Trust and an emeritus professor of healthcare improvement at UCL, who was chair of the Royal College of General Practitioners until 2022, said GPs would welcome the proposals. “We need to shift the model because GPs can’t deal with this issue on their own and would be delighted to get help with it,” said Marshall, who was previously the deputy chief medical officer for England and director general in the Department of Health.
The NHS and National Institute for Health and Care Excellence (Nice) declined to comment on Deanfield’s recommendations. Nice said its committees could only recommend medicines depending on the population stipulated in the marketing authorisation and if they were also cost-effective.
