Sunak should lead ‘national mission for health improvement’

Patricia Hewitt’s review of integrated care systems also says the English NHS should adopt “payment models that support and incentivise a focus on health”.

The former Labour health secretary says the proposed funding uplift will be “challenging” for many systems but it is “essential if we are to avoid simply another round of rhetorical commitment to prevention”.

She says a working group should be established by the Department of Health and Social Care to agree a “straightforward and easily understood framework” for defining what is meant by prevention.

Following this, the government should lead and convene a “national mission for health improvement” that shifts the focus away from treating illness to promoting health and wellbeing. She suggests this could be led “personally by the prime minister”.

Ms Hewitt, who chairs Norfolk ICS, told HSJ: “Because prevention can mean different things to different people, I’m recommending a fast exercise… to agree a broad definition of prevention and a simple method of reporting so that every system, by next April, can report its baseline of investment in prevention and do that in a way which then enables you to benchmark across all systems and measure progress over the next five years.”

The report states: “Many health systems in other parts of the world, including those that are entirely or largely taxpayer funded, are developing payment models that support and incentivise a focus on health. Meanwhile, NHS funding remains over-focused on treatment of illness or injury rather than prevention of them and ICS partners struggle to work around over-complex, uncoordinated funding systems and rules in order to shift resource to where it is most needed.”

It cites international examples of successful public health initiatives, such as the Medicare system in the US, which has a payment system geared at the overall needs of a population group, encouraging an “upstream approach” to screening and other programmes. It also cites the use of data in Australia which reports on the underlying health of the population.

The report says a government and NHS review should explore a range of models, including:

• incentives for individuals or communities to improve health behaviours
• an incentive payment-based model – providing payments to local care organisations (including social care and the VCFSE sector) to take on the management of people’s health and keep people out of hospital
• bundled payment models, which might generate a lead provider model covering costs across a whole pathway to drive an upstream shift in care and technical efficiency in provision at all levels
• payment by activity, “where this is appropriate and is beneficial to drive value for populations”

The funding streams for public health and prevention services are complex, with the main funding stream for locally commissioned and delivered services being the public health grant, which the DHSC gives to local councils.

This has been cut by around 26 per cent in real terms since 2015-16, and is planned to be around £3.7bn next year. This represents around 3.5 per cent of the value of total ICS allocations, meaning a percentage point increase would take the share to 4.5 per cent.

Children’s services, drug and alcohol, and sexual health services make up the largest elements of this.