Prevention – how much money will you save in out STP by next week Fell. Volume 2

I keep being asked for a figure. How many £ will be saved then fell, I’ve done that. You’re welcome to have it. It is bespoke to our STP and heavily caveat end.

Here are the caveats

There are six principal issues to contend with that should be considered as significant caveats: 

1) made up numbers to feed the beast. Im not going to lie about this, the question that is needing to be answered is want to be answered is basically impossible without a gargantuan exercise that we have the time nor the appetite for.

 Also there are so many moving pieces many of which are not in direct control of anyone and all of which interact it may make the effort meaningless. 

Wanless tried to do this 16 years ago. He did a pretty decent job and it’s never been bettered. I’m unconvinced about whether we can better it this time round with basically insufficient time and resource to do the job properly…….see below.
2) the issue of the distinctions between a financial approach to this in short time horizons and an economic approach in a longer time frame. 
3) some of the interventions we’ve identified for eg employment / work & health hasn’t been implemented before, certainly not robust economic evaluations. 

We just don’t know the acute (or any other) return on those investments……that’s the issue of innovation I guess. Further – some of the very measurable return on investment will not be to “hospital beds” or even the NHS but to other parts of public spend. For eg employability will benefit DWP financially. There most certainly “health” benefits, these will down stream and will be diffuse and difficult to measure.

This point is def bespoke to our STP.
4) the obvious issue of counting what doesn’t happen (inherent in all prevention initiatives) and attribution – was it due to the smoking, the blood pressure, the statin, or some social factor. For sure there will be overlaps and double counting but there’s science behind these individual figures (of course!), which is better than you’ll get for the rest of the STP analysis!
5) precision. It is difficult to be precise about the scale of the impact of a diffuse set of interventions. the issue of a package of interventions rather than a discrete, simple intervention. This programme will be delivered as a package.
6) the way in which the estimation is done, and the available science.

Lastly – Some difficult qs

1. Is the evidence on this any more or less robust than the evidence underpinning the financial assumptions in the rest of the STP?
2. Would you like your PH dept to test the evidence underpinning all the the financial assumptions across the whole of the STP?

3. Whilst Im told nobody believes the ‘case’ for preventing stuff. Whatever data I can produce and shiny evidence, it won’t make a difference to that fundamental beleif. It’s a belief thing, not a data thing.

4. The impossible conundrum re managing the immediate, in your face here and now issues versus a shiny happy future where if we do x now, y will be less likely to happen in the future.

Ps you’re more than welcome to have my actual analysis, but it’s a bit bespoke to the prevention stuff in our STP. Email me


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