PJ view: A coherent strategy, with investment, is needed to truly shift healthcare from ‘sickness to prevention’

The ‘NHS five-year forward view’, published in 2014, included a very clear message on prevention: If the country doesn’t “get serious about prevention”, then health inequalities would widen and the NHS would not be able to pay for new treatments owing to the money that would be needed to treat “wholly avoidable illness”.

Now, 11 years on, the shift from ‘treating sickness to prevention’ outlined in the NHS ten-year health plan, published in July 2025, is aiming to “enable a truly transformative approach that will ensure a service that is fit for the future”.

However, in order to transform the health service into a prevention-focused service by 2035, bold action — particularly around funding for preventative services, such as vaccination programmes and digital technologies that support patients to manage their own health — is urgently needed.

There is plenty of evidence that supports both the clinical and cost effectiveness of investing in prevention, but there is a time lag for positive results. Research has suggested that most benefits of public health investment are realised within four to five years, while almost all benefits are realised after eight years.

Many preventative services in England are funded through the public health grant, paid to local authorities by the Department of Health and Social Care, but this has effectively been cut by 26% per person in real terms since 2015/2016, and funding structures are currently poorly set up to invest and incentivise preventative health. 

A report published by the Office of Health Economics in 2023 analysed 13 existing prevention measures, including stop smoking services, NHS health checks, weight management services and diabetes support. It concluded that too many are failing because of a lack of uptake, underfunding or approaches that are too short term. Consequently, there was a “disconnect” between the potential benefits that could be achieved and the scale of ambition in funding, implementation and monitoring.

A 2024 analysis by NHS Confederation and CF (Carnall Farrar) found that better targeting of existing prevention funding could deliver, at a minimum, an extra £11bn annual return on investment.

If prevention is to be truly prioritised, elements of prevention-focused policy must be evident in the autumn budget plans, due to be announced on 26 November 2025. A coherent strategy, supported by investment, is needed, focusing on high-impact interventions alongside systematic evaluation and benchmarking.

Prioritising and increasing prevention activities and services alongside “keeping the rest of the NHS running” will be difficult given the challenging economic climate, but severe problems require radical solutions.

The government recognises that pharmacy’s role in prevention and community pharmacy provides many direct services, including vaccinations, health screening and management for minor ailments. 

Through its successful delivery of the discharge medicines service, community pharmacy has shown it can prevent a significant number of hospital readmissions, with several reports highlighting the potential impact on GP appointments and other cost savings if more investment was made in community pharmacy.

We have seen the creation of Pharmacy First, the inclusion of pharmacy in provision of more vaccination services, and a commitment to negotiations on a national community pharmacy prescribing service from 2026.

However, additional funding is required to fully implement and take advantage of the potential — for example, not just ‘maximising’ Pharmacy First but expanding this on a par with Scotland — alongside clarity on what would be nationally versus locally commissioned. A shift is required here to align with the ambitions in the NHS ten-year health plan. 

For community pharmacy in England, it’s unclear whether a single-year settlement will be agreed in the next contract negotiations. However, it is clear that multi-year settlements are urgently needed to provide sufficient funding that halts pharmacy closures and provide clarity on the direction of travel, in order to ensure that future provision can be planned and delivered effectively to truly shift from sickness to prevention.

There is widespread agreement that the nation’s health and the NHS needs to be prioritised; however, the challenge is in shifting from a model that tackles acute need towards one that provides sufficient investment in prevention activities — this is imperative. 

It was acknowledged 11 years ago and it is still the case now.

The NHS ten-year plan does promise a significant overhaul in how funding is allocated to support its three big shifts, including a much bigger emphasis on prevention, and it is long overdue for this to be implemented. PJ