The effects of structure, process and outcome incentives on primary care referrals to a national prevention programme.

The effects of structure, process and outcome incentives on primary care referrals to a national prevention programme.
Health Econ. 2021 Jun;30(6):1393-1416. doi: 10.1002/hec.4262. Epub 2021 Mar 30. PMID: 33786914.

• A survey of local commissioners about their use of financial incentives linked to numbers of programme referrals and attendances from 5170 general practices in England between April 2016 and March 2018 found that financial incentives were offered by commissioners in the majority of areas (89%), with 38% using structure incentives, 69% using process incentives and 22% using outcome incentives. Outcome incentives were the only form of pay-for-performance to stimulate more participation in this national disease prevention programme.

The future of public health: the NIHP and other public health functions: Policy paper

The future of public health: the NIHP and other public health functions
DHSC 15 September 2020

• This Policy paper sets out the government's plans for protecting and improving the public's health, including the creation of the National Institute for Health Protection (NIHP). It describes the responsibilities and transfer of functions to the NIHP, the future of health improvement, prevention and wider PHE functions and transition to new structures and a timeline.

Timebanking and the co-production of preventive social care with adults

Timebanking and the co-production of preventive social care with adults; what can we learn from the challenges of implementing person-to-person timebanks in England?
Health Soc Care Community. 2020 Sep 14. doi: 10.1111/hsc.13166. 

• This research explores how timebanks were working, what contribution they can make to adult social care, and whether they are an example of co-production.

Embedding Public Health into Clinical Services eleraning programme

Embedding Public Health into Clinical Services elearning programme
PHE, HEE, NHS E/I

• This eL-fH programme is intended to support leaders and service managers to guide their teams through the process of re-designing services to support prevention. Designed as a 5-step process, the programme provides a practical toolkit of useful resources to help individuals and their multidisciplinary teams identify their unique contribution and then implement quality improvement initiatives to transform services.

Prevention in the age of information: Public education for better health

Prevention in the age of information: Public education for better health
IPPR 2 June 2020

• The government has recognised there needs to be action to reduce the burden of preventable illness. This is an opportunity to deliver a paradigm shift in preventive health policy in the UK and embed public education as a major tool for driving better health. The aim of prevention policy is to drive behaviour change: to help people make better health decisions. This report begins to set out how this might be achieved.

Health of the Nation National Strategy for Health of the Nation

Health of the Nation National Strategy for Health of the Nation
All Party Parliamentary Group for Longevity 12 February 2020

• A strategy and number of recommendations to meet the government ambition ‘for everyone to have five extra years of healthy, independent life by 2035 and to narrow the gap between the richest and poorest’.
• Recommendations include
• NHS must do more to prevent ill-health and manage its demand. The budget on prevention should increase from 5% to 15% by 2035. 
• Government needs to partner with the left behind places – to reduce health inequalities and support all places to agree health improvement goals with their public.

Health matters: life course approach to prevention

Health matters: life course approach to prevention
PHE 23 May 2019

• This resource for NHS and public health professionals focuses on the life course approach to preventing ill health, explores the evidence base and signposts to evidence-based interventions and tools, as well as to evaluation and monitoring techniques.
• Includes infographics (eg Life course inequalities chart) and references.

Evaluating preventative investments in public health in England

Evaluating preventative investments in public health in England
CIPFA 1 May 2019

• In this report, PHE and CIPFA argue that a culture change in the way local organisations evaluate long-term investment in prevention is key to making the most of the proposed shift to Integrated Care Systems by 2021. The overall ambition is to change the way that prevention is considered – it should be viewed and treated as an investment, and properly reported as such. Moving forward, PHE and CIPFA are interested in supporting and challenging finance professionals to pick up these ideas and integrate them into everyday practice.
• The report identifies existing tools and resources which could be utilised across different types of intervention, across different organisations and at local, regional or national levels to evaluate preventative investment. 
• The report concludes that:
• 1. Use of cost-benefit analysis (CBA) methodology can provide a balanced evaluation of the financial and conomic costs and benefits of preventative investment.
• 2. The Green Book/New Economy model is well-suited to judging the comparative merits of such investments and allows a whole-system view to facilitate decisions on a place-based basis.
• 3. Using International Public Sector Accounting Standards Board (IPSASB) guidance and the principles of the Prudential Code2 would allow for consideration of the impact of such investment, particularly on long-term financial sustainability, and would enable comparative assessment of investment across time and place.

Prevention before cure: prioritising population health

Prevention before cure: prioritising population health
BMA 27 March 2019

• This policy paper contains a suggested framework for a cross-government approach to prioritising population health. 
• The framework outlines four areas that should be considered: addressing the social determinants that influence health; increased and sustained funding for public health; prioritising prevention through the health service; and effective regulation to tackle key drivers of ill-health.

General health checks in adults for reducing morbidity and mortality from disease

General health checks in adults for reducing morbidity and mortality from diseaseCochrane Systematic Review 31 January 2019

• General health checks involve multiple tests in a person who does not feel ill. The purpose is to find disease early, prevent disease from developing, or provide reassurance. 
• Analysis of 17 trials concludes that health checks have little or no effect on the risk of death from any cause (high‐certainty evidence), or on the risk of death from cancer (high‐certainty evidence), and probably have little or no effect on the risk of death from cardiovascular causes (moderate‐certainty evidence). Likewise, health checks have little or no effect on heart disease (high‐certainty evidence) and probably have little or no effect on stroke (moderate‐certainty evidence).

NHS Long Term Plan

NHS Long Term Plan https://www.longtermplan.nhs.uk/
NHS England 7 January 2019
“how the NHS will move to a new service model in which patients get more options, better support, and properly joined-up care at the right time in the optimal care setting.”
The Long Term Plan contains aspirations, commitments, milestones and priorities for the NHS across the next ten years. It includes:

• A new service model for the NHS aims to increase primary and community based care, reduce emergency care in hospital, increase personalised care, increase use of digital technology and develop Integrated Care Systems (ICS) to support population health management.
• A renewed NHS prevention programme will prioritise smoking, poor diet, high blood pressure, obesity, and alcohol and drug use. In addition there will be a concerted and systematic approach to reducing health inequalities and addressing unwarranted variation in care.
• New and revised care quality and outcomes measures are presented relating to health and wellbeing of children and young people, maternity and neonatal services, learning disabilities and a number of major health conditions (cancer, cardiovascular disease and stroke (inc diabetes), respiratory conditions, dementias, and self-harm).
• A new Workforce Implementation Plan will underpin workforce development.
• The Plan places a strong emphasis on the upgrade and development of digital technology across the NHS.
• The Plan lays out five tests for NHS financial architecture, payment systems and incentives.
• There are a number of case studies demonstrating models and approaches outlined in the Plan.

Kings Fund : The NHS long-term plan:five things you need to know
Health London Partnership : The NHS Long Term Plan in summary

HSJ coverage here. [subscription required]

Read Cowper’s Cut: A brief history of NHS plans (HSJ 7 Jan 2019, subscription required) for a brief history of previous plans for the NHS.

Matt Hancock on social prescribing

The power of the arts and social activities to improve the nation's health
Matt Hancock speaking at Kings Fund, 6 November 2018

• Matt Hancock describes how he sees the arts and social activities as an integral part of the prevention agenda as outlined in Prevention is better than cure: our vision to help you live well for longer

Prevention is better than cure: Vision for prevention

Prevention is better than cure: our vision to help you live well for longer
DHSC 5 November 2018

• The document sets out the government’s vision for:
• stopping health problems from arising in the first place
• supporting people to manage their health problems when they do arise
• The goal is to improve healthy life expectancy by at least 5 extra years, by 2035, and to close the gap between the richest and poorest.
• A collection of case studies has been published, showing examples of good practice in preventing health problems from happening.

Read Matt Hancock's speech to the International Association of National Public Health Institutes (IANPHI) when he launched the policy.

Tackling multiple unhealthy risk factors: emerging lessons from practice

Tackling multiple unhealthy risk factors: emerging lessons from practice
Kings Fund 1 March 2018

• This report shares learning and insight from services that are using innovative ways to address the problem of multiple unhealthy risk factors in their populations. It draws on interviews and information from eight case studies in local authorities and the NHS and updates the evidence base on tackling multiple unhealthy risk factors.

Evaluating early intervention programmes:

Evaluating early intervention programmes: six common pitfalls and how to avoid them
Early Intervention Foundation 22 February 2018

• Guidance on addressing six of the most common issues we see in our assessments of programme evaluations, including explanations of how these problems undermine confidence in a study’s findings, how they can be avoided or rectified, case studies and a list of useful resources in each case.

Economic evaluations of local authority commissioned preventative public health interventions

A systematic review of economic evaluations of local authority commissioned preventative public health interventions in overweight and obesity, physical inactivity, alcohol and illicit drugs use and smoking cessation in the United Kingdom [Abstract]
Journal of Public Health, 16 February 2018

• The majority of the evaluations related to cost-effectiveness, rather than cost-benefit analyses or cost-utility analyses. These analyses found preventative interventions to be cost effective, though the context of the interventions differed between the studies.

From Healthcare to Homecare: the critical role of 5G in healthcare transformation

From Healthcare to Homecare: The critical role of 5G in healthcare transformation
Ericsson Consumer Insight Summary Report, May 2017

• This report explores the transformation promised by information technology, and the critical role of 5G, across three healthcare situations: preventative, routine and post-operative care.
• The report presents insights from an online survey of 4,500 advanced smartphone/mobile broadband users aged 18–69, an online survey of 900 decision makers across 6 industries – healthcare, insurance, medical technology companies, telecom operators, app developers/aggregators and government regulatory bodies, consumer focus group discussions in the US and the UK, plus in-depth interviews.
• Key findings:
• Healthcare becomes decentralised, moving from hospitals towards homes
• Patient data is centralised, turning hospitals into data centres
• Increasing dependence on wearables and remote treatments makes 5G essential to provide reliable and secure services

The return of investment for preventive healthcare programmes:

The return of investment for preventive healthcare programmes: A calculation framework for GSK's Partnership for Prevention (P4P)
RAND 30 May 2017

• The report outlines the drivers of successful workplace health promotion programmes, provides an overview of health and wellbeing interventions offered by pharmaceutical companies, and develops a framework to analyse the return on investment of such projects, applying it to GSK's P4P programme.

Working Together – how health, social care and fire and rescue services

Working Together – how health, social care and fire and rescue services can increase their reach, scale and impact through joint working
NHS England June 2016

• Fire and rescue services are being recognised as partners in the wider health and social care arena and, along with health and social care, are ready to meet the challenge of preventing avoidable illness, isolation and injury. 
• This report outlines ways of getting started, opportunities for joint working (including "Safe and Well" visits, work with children and young people and Community Risk Intervention) 
• The document aims to support the Consensus Statement which launched on 1 October 2015 by five organisations – NHS England, Public Health England, the Chief Fire Officers Association, Age UK and the Local Government Association.

Prevention in five Vanguards - case studies

New Care Models and Prevention: an integral partnership
NHS Confederation, NHS Clinical Commissioners, NHS Providers and the Local Government Association 31 May 2016

• This publication looks at how five of the vanguards are embedding prevention in their new care models.
• They are: 
• All Together Better Sunderland (MCP) 
• West Wakefield Health and Wellbeing (MCP) 
• Sutton Homes of Care (enhanced health in care homes) 
• Connecting Care – Wakefield District (enhanced health in care homes) 
• Solihull Together for Better Lives (urgent and emergency care).
• At this stage of the programme, what the vanguards are doing on prevention is very much emerging practice rather than evaluated practice.