Chapter 2: More NHS action on prevention and health inequalities

2.1. Demand for NHS services continues to grow, for at least five separate reasons. The first three are either desirable or unavoidable:

  • our growing and ageing population, inevitably increasing the number of people needing NHS care and the intensity of support they require;
  • growing visibility and concern about areas of longstanding unmet health need (for example in young people’s mental health services);
  • expanding frontiers of medical science and innovation, introducing new treatment possibilities that a modern health service should rightly be providing (for example, new cell and gene therapies).

2.2. But the second set of demand drivers are potentially modifiable by:

  • action set out in the previous chapter to redesign healthcare so that people get the right care at the right time in the optimal care setting (for example, providing better support to people living in care homes to avoid emergency hospital admissions; providing better social care and community support to slow the development of older people’s frailty; and fundamentally redesigning outpatient services so that both patients’ time and specialists’ expertise are used more appropriately);
  • improving upstream prevention of avoidable illness and its exacerbations. So for example, smoking cessation, diabetes prevention through obesity reduction, and reduced respiratory hospitalisations from lower air pollution. This can also be achieved through better support for patients, carers and volunteers to enhance ‘supported self-management’ particularly of long-term health conditions.

2.3. This Long Term Plan sets out new commitments for action that the NHS itself will take to improve prevention. It does so while recognising that a comprehensive approach to preventing ill-health also depends on action that only individuals, companies, communities and national government can take to tackle wider threats to health, and ensure health is hardwired into social and economic policy. Indeed, the extra costs to the NHS of socioeconomic inequality have been calculated as £4.8 billion a year in greater hospitalisations alone [19].

2.4. Action by the NHS is a complement to, but cannot be a substitute for, the important role for local government. In addition to its wider responsibilities for planning, education, housing, social care and economic development, in recent years it has also become responsible for funding and commissioning preventive health services, including smoking cessation, drug and alcohol services, sexual health, and early years support for children such as school nursing and health visitors. These services are funded by central government from the public health grant, and funding and availability of these services over the next five years which will be decided in the next Spending Review directly affects demand for NHS services [20]. As many of these services are closely linked to NHS care, and in many case provided by NHS trusts, the Government and the NHS will consider whether there is a stronger role for the NHS in commissioning sexual health services, health visitors, and school nurses, and what best future commissioning arrangements might therefore be.

2.5. The Global Burden of Disease (GBD) study quantifies and ranks the contribution of various risk factors that cause premature deaths in England [21]The top five are: smoking, poor diet, high blood pressure, obesity, and alcohol and drug use. Air pollution and lack of exercise are also significant [22]. These priorities guide our renewed NHS prevention programme.

2.6. As described in Chapter One, our new integrated care systems (ICSs) will help deliver these programmes as the NHS continues to move from reactive care towards a model embodying active population health management. ICSs – including the devolved health and care systems in Greater Manchester and Surrey Heartlands – will also provide stronger foundations for working with local government and voluntary sector partners on the broader agenda of prevention and health inequalities. They will in turn be supported by expanded teams across groups of neighbouring GP practices who work together under the primary care network contract and with local NHS, social care and voluntary services, funded by the new Long Term Plan investment guarantee for primary and community services.

2.7. The role of the NHS includes secondary prevention, by detecting disease early, preventing deterioration of health and reducing symptoms to improve quality of life. Every 24 hours, the NHS comes into contact with over a million people at moments in their lives that bring home the personal impact of ill health. This Long Term Plan sets out practical action to do more to use these contacts as positive opportunities to help people improve their health. This will contribute to the government’s ambition of five years of extra healthy life expectancy by 2035.


19. Asaria, M., Doran, T. & Cookson, R. (2016) The costs of inequality: whole-population modelling study of lifetime inpatient hospital costs in the English National Health Service by level of neighbourhood deprivation. J Epidemiol Community Health. 70 (10), 990-996. Available from:

20. Finch, D., Bibby, J. & Elwell-Sutton, T. (2018) Briefing: Taking our health for granted. The Health Foundation. Available from:

21. Steel, N., Ford, J., Newton, J., Davis, A., Vos, T. & Naghavi, M. et al. (2018) Changes in health in the countries of the UK and 150 English Local Authority areas 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 392 (10158), 1647-1661. Available from:

22. Institute for Health Metrics and Evaluation (2018) GBD Compare Data Visualization. Accessible from: