Prevention is better than cure – Matt Hancock's speech to IANPHI
Health and Social Care Secretary Matt Hancock addressed the International Association of National Public Health Institutes about his vision to help people make healthier choices
We’re here to talk prevention. And if there’s one thing that everybody knows it’s: ‘prevention is better than cure’.
When I was thinking about prevention I looked into where this comes from. I’m told it was Erasmus, the 16th century Dutch philosopher, who coined the insight.
The irony was that Erasmus died suddenly from an attack of dysentery, which we now know is a wholly preventable condition.
The other person who can lay claim was Benjamin Franklin, who said: ‘an ounce of prevention is better than a pound of cure’.
And Franklin founded the first fire brigade in Philadelphia and made it one of the safest cities for fires in the world.
So prevention works. As the founding fathers knew.
Prevention saves lives and saves money.
Two of the biggest health successes of the 20th century had prevention at their core: vaccination and cutting smoking.
In the UK, both were achieved by careful and considered government intervention.
We didn’t outlaw cigarettes because blanket bans curtail personal freedoms and often have the opposite effect.
We encouraged better behaviour through informing the public and by stopping smoking in public places where it could affect the health of others.
We didn’t compel people to vaccinate against their will. We helped them see it was in their interests and everybody else’s too.
Ultimately, at the heart of our public provision for healthcare there’s a social contract. A social contract at the heart of our NHS.
We, the citizens, have a right to the healthcare we need, when we need it, free at the point of use.
But, we have a responsibility to pay our taxes to fund it, and to use the health service carefully, with consideration for others, and to comply with medical advice to look after ourselves.
Because the NHS is not just a service – it’s a shared stake in society.
Too much of the health debate in England has been about our rights: what we deserve, and what the NHS can deliver. And, of course, those rights are important.
But, I think we need to pay more attention to our responsibilities, as well as our rights.
Today, I want to talk about those responsibilities, and our task for the National Health Service to help empower people to take more care of their own health.
I want to talk about how we need to focus more on prevention to transform our health and social care system, save money, eliminate waste and make the extra £20.5 billion we’re putting in go as far as it can.
Because only with better prevention can our NHS be sustainable in the long term.
Over just the last year, emergency admissions at A&E have increased by 6.6%. This rate of growth of demand is simply unsustainable.
But, of course, it’s not just about the finances. I want to talk about how preventing ill health can transform lives, and transform society for the better too.
That might sound radical. It is intended to.
The government-wide plan we are publishing today sets out how we need a radical shift in how the NHS sees itself, from a hospital service for the ill, to a nationwide service to keep us healthy.
Where those who work on the front line of the NHS including the GPs, who are its bedrock, feel confident to remind people of their responsibilities too.
So first, let’s talk about those responsibilities.
At the core of my political philosophy is a belief that the state has a duty to protect the most vulnerable in society, and an equally firm belief that we must empower people to fulfil their potential to be the best they possibly can be. From the education they receive in school, to the freedom they have to achieve in work.
And nowhere is this more true than with health.
Given this duty, our starting point is to ask: what contributes to living longer in good health?
The Prime Minister has set this question as part of the Ageing Grand Challenge – to seek 5 years’ longer healthy life expectancy by 2035.
The best evidence points to a 4-factor breakdown.
Around a quarter of what leads to longer healthier life is acute care – or what goes on in hospitals. The second factor is genetics. The third factor is environmental – things like air quality that an individual can’t control.
And the final factor is what people do – the choices they make, the lifestyle they choose.
Different people put different proportions on these 4 factors: but suffice to say they’re all important.
Yet currently, we spend the overwhelming majority of the £115 billion NHS budget on acute care.
Last year, we spent just £11 billion on primary care where the bulk of prevention happens.
Yet the combination of prevention and predictive medicine have more than twice the impact on length of healthy life.
That isn’t just the difference between life and death, it’s the difference between spending the last 20 years of your life fit and active, or in a chronic condition.
So our focus must shift from treating single acute illnesses to promoting the health of the whole individual. And from prevention across the population as a whole to targeted, predictive prevention.
So as the government is spending £20.5 billion more of taxpayers’ hard-earned cash over the next 5 years – the single, largest cash injection to the NHS ever – we must see the proportion of funding on primary and community care in the NHS rise. And that is exactly what will happen in the long-term plan.
But it isn’t just about the quantum of money. It’s also about reform.
I want to see people taking greater personal responsibility for managing their own health. For looking after themselves better, so staying active and stopping smoking.
Now, I want to address head on how we can do this without undermining people’s liberty.
Take alcohol. Like many people, I enjoy the odd glass of wine.
I support the budget in which we froze duty on scotch and beer. I don’t believe in punishing the masses to target those who need help.
Yet alcohol abuse puts a huge burden on the NHS. High-risk drinkers make up less than 5% of the population, but consume over a third of all alcohol.
They’re more likely to end up in A&E. And drunk people are more likely to be responsible for abuse and violent attacks on NHS staff. I’ve seen it for myself. So we need action on alcohol that targets those who most need our support, without punishing those who don’t.
Likewise, we know that smoking contributes to 4% of all hospital admissions in England each year. And smoking costs the NHS around £2.5 billion each year. And this is despite the massive reduction in smoking over the past 30 years.
For smoking, the next step towards a zero-smoking society is highly targeted anti-smoking interventions, especially in hospitals.
If someone is admitted as a heart patient, and we know that stopping smoking could save their life, then we will do everything we can to help them quit, as they do in Ottawa.
This is a Canadian model I like the look of. I want to see bedside interventions in our hospitals so smokers who are patients are offered medication, behavioural support and follow-up checks when they go home.
And we need to fulfil our commitments to the obesity strategy, and set ambitious targets also on salt.
Salt intake has fallen by 11% in under a decade, but if salt intake fell by a third it would prevent 8,000 premature deaths and save the NHS over £500 million annually. So we are working on new solutions to tackle salt and will set out more details by Easter.
Because focusing on the responsibilities of patients shouldn’t be about penalising people but about helping people to make better choices.
How do we do that? How can we empower people to take more care of their own health?
By giving people the knowledge, skills and confidence to take responsibility for their own health.
By using new digital technologies, to help people make informed decisions, with more access to primary and community care, and with more social prescribing, all aimed at stopping people from becoming patients in the first place.
So the second thing I want to talk about is how we must focus more on prevention to transform our health and social care system to save money, eliminate waste and get the best return on our extra £20.5 billion.
This isn’t just about empowering people to take more personal responsibility. It’s about reforming the system and harnessing new opportunities.
There are 2 new technologies in particular with the potential to change everything: the combination of artificial intelligence and genomics.
They promise the potential to unlock our genetic codes; and allow us to apply those codes to how we live our lives. To predict which of us are susceptible to which illnesses, to diagnose those already ill, faster, and to develop new tailor-made treatments to bring people back to health.
Together, they will transform medicine. We are finally now able to crack that genetic factor of our health.
We can intervene earlier. Save money on unnecessary and invasive tests. Eliminate waste by prescribing the right medication or the right treatment the first time round. And save NHS resources for people who really need it.
And this isn’t something that’s far off in the future. It’s already happening.
The new NHS Genomic Medicine Service is expanding.
In Cambridge, we’re at the cusp of sequencing the 100,000th genome, and are now aiming to sequence 5 million so we can diagnose rare diseases, more quickly and with fewer painful tests for patients.
The world-leading Moorfields Eye Hospital is working with the world-leading AI company Deepmind. Their AI system has made the correct diagnosis on over 50 different eye diseases with 94% accuracy – at least matching the best human experts. And that figure is only going to improve.
These technologies, and other new digital services giving targeted health advice, are starting to transform global medicine.
As it has been with every wave of technology for the last 70 years, the NHS must be at the forefront, embracing these new technologies and shaping them as they evolve and improve.
The NHS must go from being the world’s biggest buyer of fax machines to the tech pioneers of the future. And I know we can do it. Because we’ve done it before.
From 1796 when Edward Jenner developed the first smallpox vaccine, to 1928 when Alexander Fleming discovered penicillin, to 1950 when Richard Doll proved the link between smoking and cancer.
The next frontier of prevention is using the data at our disposal to predict who will be ill with what, and to get in there early.
The Prime Minister has spoken with great eloquence about the power of artificial intelligence to save lives by spotting cancer earlier – and we must do that.
But predictive prevention has a far broader application.
From diagnosing a susceptibility to dementia due to a vitamin deficiency, to motivating activity to tackle obesity, we can have better, more targeted interventions than ever before. Again, giving better results, and helping the NHS eliminate waste and save money.
Our aim is to prevent people becoming patients through personalised advice and intervention. Public Health England are leading the way on predictive prevention. They are bringing together a range of experts so we can scale up this pioneering work to a national level.
Now, I’ve talked about acute care, genetics, and choices. So let’s turn to the final factor in determining a healthy lifespan: the environment.
And this is linked to my third and final point: how getting prevention right will transform society for the better. Right now, we tend to think of things in isolation.
Pollution is seen as an environmental problem. Employment is something for the Treasury to worry about. And housing is either a public good or a private investment.
But health can’t work in isolation. Our health is affected by each and every one of those.
So a true focus on prevention means tackling the environmental factors that affect a person’s health too. It means a new drive for clean air, building on the successes of recent years in cutting emissions. Secure employment, building on the record number of jobs available now. Higher quality housing.
And it also means our GP surgeries, our hospitals, our care homes, our entire health and care system working more closely with local authorities, schools, businesses, charities and all the other parts that make up our communities.
It means employers playing a bigger role in helping their staff stay healthy and to return to health after illness. And we can learn from the excellent work of our military here.
Soldiers have an 85% return-to-work rate after a serious injury, and they obviously have some very serious injuries. The equivalent rate for civilians is only 35%. The reason why the military is better at getting people back to work is because they are more engaged in their workers’ recovery at every stage of the process.
Civilian employers must do the same. Employers have a responsibility to help improve the health of their staff and the nation. Each of us has a stake in our health and care system so each of us has a responsibility to work together to build a sustainable system. So, I want us to be open to new ideas and learn from other countries.
Like the Netherlands, for example. Where companies must demonstrate due diligence in their approach to the rehabilitation of sick staff and helping employees return to work.
To achieve this we need to strengthen the links between employers, their unwell staff, and the NHS.
That way, the challenge – for I never think of people as problems – doesn’t present itself at 3am at A&E.
Good health starts with the right pre-natal care, immunisation, nutritional support, fitness advice, minimising social media and mental health harms, secure employment, financial independence, safe housing, help with bad habits, friends and family to fight loneliness, careful and considered interventions at every stage of life into old age.
From cradle to grave, not just for the NHS, but for the whole of society.
Giving people responsibility for their own health. Empowering them to make the right decisions.
The best help when they need help. That is what getting prevention right means. That is the potential of prevention. That is the promise that it offers: a healthier, happier future for us all.