If the NHS were better at preventing stuff. 10 thoughts.

I got asked a q today about “how might the NHS address “prevention” more strategically. 10 off the cuff thoughts.


These thoughts are NHS focused…….and medical model focused. Maybe I’ll write more about NHS and social model stuff in the future



In many cases screening doesn’t prevent anything. It finds disease. Often for limited gain and lots of work
I Remain grumpy about low value screening – health checks is a particular ire of mine
There are better, more efficient ways of reducing immediate CV mortality by better population management of clinical and lifestyle risks. Matt Kearney knows this and need to get on with it


Still need to shift the narrative away from screening and “treating” individual risks (emptying an ocean with a teaspoon) and move towards policy focused stuff.
“screening individuals at low risk – SO much easier than population focused policy” ( Steve Laitner line)


I remain grumpy about the DPP and the basic discreditaiton of this in evidence terms

See the recent BMJ paper on screening.

Im not really suggesting that interventions to encourage folk to sweat more and eat less pies is a bad thing (and maybe better value than some stuff we spend vast sums of money on with less evidence)….

There are better, more efficiency and equitable ways to prevent diabetes – policy eats interventions delivered individual by individual for breakfast (low fat, low sugar breakfast)


I can sense my blood pressure rising now…. So I will move on




Need to really focus on hospitals, wider NHS and smoking.

1) focus on an ambitious pop prevalence target, 2) go completely smoke free, 3) implement the issues picked up in Duncan’s ace letter, 4) use the (awesome) London clinical Senate stuff as practical help

Need to keep up pressure there

Will need some resource.



Probably need to focus more attention on the economic (non NHS) impact of prevention. 

Less folk having heart attacks and strokes = more lost productivity and working days, lower benefit bill. Ie its not all about health and social care costs

Impact of smoking prevalence shift on poverty, local economy (££ not spent on fags but on other goods – £4k a year for 20 a day etc), productivity and health / care costs

The narrative is too narrow + little analysis in wider economic terms

Needs sorting




Get someone to think about a redo of Wanless. As far as I can see it’s a burning issue.



Change the performance framework for the NHS to focus in on disease incidence and burden

What’s driving cost is disease incidence and prevalence not “ageing”….(I’ve blogged on this a lot, can send if u want)

Thus to solve it, the “system” needs to focus on this…..


Interesting observation from Ben Bray – How many of the problems of the NHS are due to poor policy? Eg – the new CCG Information and Assessment Framework misses high impact areas


System needs to refocus its effort on how resourcing works

Focus ££ on most disadvantaged pops

Focus on resourcing of prevention first, not waiting for scraps to fall of the table where the big hospitals play

Focus on investment in primary care and social care as demand management mechanism.




Focused effort on population risk management as prevention

Heard great story around renal care in ?West Mids. (I don’t know if data bears out)

But basically turned round a crisis in dialysis capacity be relentless focus on population risk management in the large pop of people with CKD3, and focus on pinch points and risky times in terms of transition from CKD3-4, 4-5 etc etc…..

That would be a good “prevention” story



9) need to completely shift the narrative away from “high risk” to population wide

Spin on the Rose hypothesis

Spin on all the above

Skills and focus in changed conversations, making contacts count etc, moving away from gadget  and gizmo based model to a behaviour change  and person centred care model

I know full well that’s easy to say, and hard to deliver! I’ll come back to this.

These were all off the cuff, written quickly

Others will hopefully have cleverer views……



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