Comment / Failing to invest in prevention is a false economy

Recently I was walking my dog in the beautiful morning sunshine, while dutifully listening to the Today programme on Radio 4 (I acknowledge all very middle class), when I was struck by two news reports. The first was the announcement of a new lung cancer screening programme in England; the second discussed the poor outcomes of stroke, heart attacks and cancer in the UK compared to over a dozen similar countries in the developed nations.

All of these conditions are driven by modifiable risk factors, namely tobacco addiction, alcohol misuse and unhealthy weight leading to diabetes. To make matters worse, these risk factors are more common in our most economically deprived populations and account for over 50% of the health inequalities we observe.

My reflection, as I listened to these news stories, was that we are in a good place to tackle these causes of deprivation, healthcare utilisation, misery and poverty. The reason for my optimism is that the NHS long-term plan committed to tackling these modifiable risk factors by providing integrated care systems with dedicated funding to implement treatment services to tackle these three killer risk factors. And in my role as clinical prevention lead in the Midlands, I can see that the services have become established and are already making a difference to the patients I treat and to the communities they live in.

My optimism is reinforced by the development of integrated care systems which were developed to improve outcomes in population health, to tackle inequalities, to enhance productivity and value for money, and support broader social and economic development.

Other examples of prevention in action include reduced one- and two-year mortality, readmissions, emergency department and GP attendances in Ottawa Canada, with the introduction of a systematic hospital-based smoking cessation service, with similar results observed in Manchester.

The introduction of alcohol care teams in Sandwell in the Midlands resulted in a reduction in hospital length of stay and admissions. And a digital weight management programme, which has been operating across England since 2021, has resulted in thousands of people achieving significant weight loss.

To counter my optimism, I am aware that these new services are all already under threat as ICSs grapple with budget deficits. While it is acknowledged that funding cuts are difficult, it is also important that we do not make the wrong decisions that lead to a false economy.  

I’m reminded of the Royal College of Physicians 2018 report Hiding in plain sight, which deemed the system ‘failure to implement pathways to identify smoking and intervene as just as negligent as the failure of a GP to refer a patient with suspected cancer’.

Pathways to treat modifiable risk factors are inextricably linked to the work ICSs are undertaking to tackle health inequality. By implementing these treatment pathways we will be tackling health inequalities head on. The reverse is also true. By delaying, diluting or cutting prevention pathways, we will exacerbate poverty and inequality in our communities.

So, getting back to the news reports that I heard on the radio on lung cancer screening and the poor outcomes for people with cancers, heart disease and stroke. With timely investment in prevention, many people will be able to avoid the development of some of these diseases in the first place. I hope that as leaders in the healthcare community whether clinical, financial or management, we do the right thing with our planning and resources.

Professor Agrawal is clinical prevention lead for the Midlands