Next week, health and local government leaders will come together for a second meeting to discuss the relationship between new models of care and prevention.  The event is co-hosted by NHS Providers, the NHS Confederation, NHS Clinical Commissioners and the Local Government Association as part of our joint work to help spread the learning from the vanguard programme across the health and care sector. 

Preparing for the event, which I will chair, my mind turned to the vexed and long running question of “why can’t we get the prevention agenda to work when we’ve been trying for long enough?” It’s a question I’ve heard repeated many times in the three and a half years I’ve been in the NHS.

It can’t be for want of a clear rallying call and a powerful intellectual argument. Fourteen years ago the Wanless report warned that unless the country took prevention seriously we would be faced with a sharply rising burden of avoidable illness. That warning went unheeded. One in five adults still smoke. A third of people drink too much alcohol. A third of men and half of women don’t get enough exercise. Almost two thirds of adults are overweight or obese.

The Five year forward view repeats the case: “if the nation fails to get serious about prevention then recent progress in healthy life expectancies will stall, health inequalities will widen, and our ability to fund beneficial new treatments will be crowded out by the need to spend billions of pounds on wholly avoidable illness”. That’s difficult to disagree with.

So how do we get traction?

I’ve found it fascinating to talk to integrated healthcare providers from other systems who seem to be making more progress than we are in this space. It’s clear that they have four things that we don’t, all of which could be part of new care models in the NHS.

Firstly, healthcare is consistently put in the context of whole population health management. These organisations see themselves as being responsible for the managing the health and wellbeing of their whole population. Not just, for example, treating acute episodes in an acute hospital. Or pretending that prevention is the sole preserve of the public health experts and parts of the primary care system. Everyone in the healthcare system is geared to ensuring that people live healthy lives and stay well. Indeed, the artificial barriers between primary and secondary care, that seem so prevalent in the NHS, start to dissolve.

Secondly, these organisation are growing very expert at using data to risk stratify their populations. They can identify who is at most at risk and then deliver targeted interventions that prevent risks turning into illnesses or conditions that require treatment. These organisations take advantage of rapidly advancing technologies to continually improve their risk identification.

Third, because these organisations are paid on whole population health outcomes, rather than by activity or episode of care, there are significant financial incentives on them to get upstream and focus on preventing illness rather than treating illness where it occurs. This feels very different to the NHS where secondary care, which consumes the lion’s share of resources, is largely paid per episode of illness treatment.

Fourth, these organisations realise that it is citizens themselves (and note the use of the word citizen, not patient) who are best equipped to manage their own health and wellbeing. So they spend large amounts of time and energy working out how to best support and enable citizens in this task. Again, they help citizens make really effective use of the growing range of health and wellbeing monitoring and recording devices and apps. They offer serious financial incentives to lose weight, quit smoking and exercise more.

Vanguards offer the opportunity to deliver all of these innovations in a single defined community...

What I find particularly fascinating is that these organisations think that, in the NHS, we have two key building blocks to enable this approach that are often missing in other healthcare systems. We have the GP list system which, in theory, should enable us to do whole population health management really well. This is also why the stability and success of general practice and wider primary care are so important. We have to invest in and support them to become effective whole population health managers and risk stratifiers, not just overworked and increasingly precarious gateways to accessing secondary care.

The other key advantage is that we have much better and richer data than most other healthcare systems. We’re just not very good at combining it across primary, secondary and social care or then using it to risk stratify our population and act accordingly.

Many of these themes will, no doubt, be familiar. But what I think is particularly exciting is that the vanguard programme offers the opportunity for the NHS to fast track towards these outcomes. Vanguards offer the opportunity to deliver all of these innovations in a single defined community: creating an integrated healthcare system; combining data sets; risk stratifying properly; moving to capitated, health outcome based, payment systems; developing a new relationship with citizens focussed on supporting them to manage their own health and wellbeing; and making much better use of new technology.

There is considerable cause for optimism here, as long as we can balance meeting the challenge of today’s operational pressures with the move to new models of care. The reality is that we have to deliver both.

Chris Hopson is chief executive of NHS Providers