This is the first in a series of blogs about how the proposals in the newly published 10 Year Plan measure up against some of the most pressing health concerns in the UK.
“Sickness to Prevention” is one of the foundational shifts at the heart of the NHS 10 Year Plan. Although early detection and prevention are stated core missions of the government’s ambitions for the NHS, they will not come without significant challenges.
This is the first in a series of blogs about how the proposals in the newly published 10 Year Plan measure up against some of the most pressing health concerns in the UK. The series serves as a countdown to our Annual Lecture 2025: Ten years to turn it around: The economic reality of NHS reform.
What does a shift to prevention mean for the NHS?
Shifting from treatment to prevention is a complex and multifaceted challenge for the NHS. Prevention encompasses a vast range of interventions across the entire healthcare system. It includes primary prevention (e.g. preventing disease occurrence through vaccination and lifestyle changes), secondary prevention (e.g. early detection and diagnosis of a disease) and tertiary prevention (e.g. preventing complications in existing conditions). Each category, across different types of disease areas, requires different decisions around resource allocations, implementation strategies, and with varying impacts on health outcomes.
Proposed government plans such as the genomic population health service which commits to universal newborn genomic testing, demonstrates a complex intervention spanning primary (identifying genetic risks), secondary (early detection) and tertiary (personalised treatment) prevention, which will also require coordination across laboratories, specialist care and community services.
There is additional complexity added to this issue by the need to address social determinants of health: housing, education, employment, and environmental factors. Many of these determinants fall outside the remit of the NHS but significantly impact health outcomes.
Our report “Reimagining Prevention for a Healthier, More Prosperous Society” sets out the case for prevention, identifying gaps and proposing solutions to usher in a new era of prevention.
Misaligned incentives: the system and the individual
The NHS payment system historically incentivises reactive treatment over prevention. Primary care contracts and hospital payments are structured around treating existing conditions rather than preventing future ones This creates misaligned incentives where providers are rewarded for prioritising the management of disease rather than encouraging improved health.
While low prevention budgets are acknowledged in the Plan (citing that the NHS prevention budget has been cut by 28% in real terms over the past decade) relatively little is mentioned about specific innovative payment schemes to encourage prevention over treatment. Year of Care Payments (YCPs) are a potentially promising payment incentive structure which allow for capitated yearly budgets for patients. Value-based contracts are also mentioned to promote payment for health outcomes, rather than service volume. However, there is a lack of detail defining prevention-specific performance metrics, and how prevention outcomes would be rewarded in practice.
Our ongoing research into innovative financing for prevention speaks to these issues (publication forthcoming). Meanwhile, our ‘Netflix and Pill’ paper explores innovative financing across a range of treatment therapy areas.
Misaligned incentives are not only present at the system level, but at the individual level. Prevention differs fundamentally from treatment, because it requires behavioural change from (perceived) healthy individuals who may not view immediate benefits from participating in preventative activities or behaviour. This creates unique economic challenges around moral hazard and individual decision-making where individuals may engage in riskier behaviours, believing that healthcare will be available to treat resulting conditions.
We see the impact of discounting issues both politically, where favour is given towards policies with immediate impact during short-term political cycles, and at the individual level, as individuals heavily discount future health benefits compared to immediate costs. This time preference (immediate costs vs distant benefits) creates systematic incentives to avoid preventative behaviours from an individual perspective.
The Ten Year Plan acknowledges individual behaviour challenges through initiatives such as digital weight management services and use of the NHS app for AI-powered personalised health guidance. However, largely technology-focused interventions create additional issues around uptake and adherence of these tools, especially in disadvantaged communities.
Cost-effeniveness of prevention interventions
Prevention interventions are generally found to be highly cost-effective across a variety of disease areas which are addressed in the Plan, including mental health, obesity, cardiovascular disease, cancer and HIV.
The success of a health intervention varies depending on the target population, intervention type, implementation design and time horizon considered. Prevention studies typically require longer follow-up periods to capture the full economic benefits of avoided disease outcomes. In general, more targeted prevention interventions focusing on more high risk groups (e.g. those exhibiting specific risk factors of a disease), improves cost-effectiveness, as this maximises the probability of preventing future costly health events.
Our work on the socio-economic value of adult vaccination shows that adult vaccines can return up to 19 times their initial investment to society.
5 A’s of Access
For an intervention to be (cost-)effective in practice, it must be used. So what makes for effective uptake in prevention interventions?
Increasing access to preventative healthcare services isn’t just about providing preventive services. Access involves multiple dimensions: availability (e.g. sufficient services), accessibility (e.g. geographic barriers), accommodation (e.g. organisation of services for the individual), affordability (e.g. financial barriers) and acceptability (e.g. patient attitudes and cultural factors).
Vaccine uptake rhetoric vs. the reality, and the 5 A’s framework
The discrepancy between high level targets, and the reality of implementation challenges, resource constraints, and behavioural barriers is exemplified in prevention plans surrounding vaccination.
The goal
Vaccines alone don’t save lives – vaccination does. Although we have safe and effective vaccines available in the UK, uptake is too low to unlock the large societal benefits that vaccination can bring.
The 10 Year Plan outlines several commendable steps in advancing towards a healthier population through immunisation, including:
- Increasing uptake of HPV vaccines to support the aim of eliminating cervical cancer by 2040
- Delivering 10,000 cancer vaccines to patients in clinical trials in the next 5 years, and scaling this up further as new vaccines are shown to be clinically effective
The reality and the 5 A’s framework
As it stands, the UK is facing increasingly low rates of immunisation uptake, across adult, adolescent and childhood vaccines, for almost every vaccine – raising alarm bells for population safeguards against preventable infectious diseases.
Even healthcare workers show poor uptake – only 32.4% received influenza vaccines in 2024 . This is despite healthcare workers witnessing first hand the impact of low vaccine rates and the strain on already overburdened health systems, as multiple NHS trusts exceeded capacity due to overwhelming winter flu cases in 2024.
Effective vaccine delivery requires addressing all dimensions of access. The UK’s school-based HPV vaccine programme for adolescents has been especially successful in increasing uptake, demonstrating how expanding availability and improving accessibility through non-healthcare settings can successfully increase uptake by incorporating interventions as part of their daily routines, while also freeing up primary care capacity.
The 10YP’s proposed community health visitor model is a commendable step in building on this and improving accommodation by encouraging vaccinations in people’s own communities.
However, significant barriers remain. Poor acceptability persists even among healthcare professionals who understand vaccine benefits, suggesting increased information alone cannot address hesitancy and mistrust. Affordability, while not a direct cost barrier in the NHS, will especially impact individuals with high costs for time off work, travel and childcare, who are disproportionately found in disadvantaged communities.
Part of the challenge of implementing programmes like this is the lack of long-term planning. The 10 Year Plan has promised the use of multi-year budgets and financial incentives to enable investment in better outcomes, including outcome-based targets – but the way this will work in practice, particularly for immunisation, remains to be seen.
Vaccination related benefits are also on offer for employers. Access our ‘Employer Costs from Respiratory Infections’ report here.
Specific recommendations for the shift from “Sickness to Prevention”
1.Be targeted- and evaluate success!
Prevention interventions should target high-risk populations with tailored interventions, that address specific barriers within communities.
The government’s commitment to end all HIV transmissions by 2030 illustrates this issue. The reality in the UK is that HIV diagnoses have increased by over 30% since 2022. As part of the government’s HIV action plan (to be released later this year) over 20,000 self-testing and self-sampling kits will be made available, backed by £1.5 million in government funding. But the success of this rollout will rely on ensuring uptake in high-risk groups, addressing multiple barriers such as individual stigma, healthcare access and regional inequalities.
Access our report on “Altering the trajectory of HIV in Europe” here.
Success should be measured by meaningful health outcome and health equity improvements, needing robust evaluation frameworks that can capture both short-term indicators and long-term population health impacts. Furthermore, there is a need to allow for the adaptation of interventions based on real-world effectiveness.
2. Consider individual behaviours in implementation design
Many prevention initiatives require people to change their behaviour, with much less visible impact compared to disease treatment. Successful prevention programmes should invest in behavioural science and behavioural economics research to optimise intervention design, and develop standardised approaches for addressing vaccine hesitancy and health misinformation.
Use of technology-based tools to incentivise preventative behaviour is a potentially powerful tool, but there must be consideration of how these will be used in practice, and whether unequal access to technology will worsen existing health disparities.
Our related work on incorporating the patient voice in Health Technology Assessment can be found here.
3. Be proactive in addressing inequalities
Prevention interventions can inadvertently widen health inequalities if they are more easily adopted by higher socioeconomic groups, or there is easier access in affluent areas. To reduce this, interventions must be actively targeted at the communities that need them most.
The Plan’s commitment to establishing Neighbourhood Health Centers first in areas with lowest healthy life expectancy shows recognition of this challenge, and it is acknowledged that the areas with the highest need for the NHS generally have the lowest provision and quality of services. Specific plans making the most of targeted resources in these areas must be sufficient to avoid exacerbating existing inequalities.
4. Commit to sustained prevention funding over the long term
A substantial barrier to effective prevention remains the fundamental time lag between investment and measurable health outcomes. Prevention interventions require consistent prioritisation and funding over multiple political and budget cycles for outcomes to be fully realised.
Our ongoing research on innovative financing for prevention will explore specific mechanisms for securing long-term prevention funding commitments.