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Prevention before cure: Securing the long-term sustainability of the NHS

Advances in diagnosis and treatment have meant that as a society we are all living longer. Yet despite average life expectancy increasing for both men and for women, the number of years we spend living in ill-health is also rising. Patients are suffering from an increasing number of complex conditions – one in three patients has five or more health conditions compared to one in 10 patients a decade ago. Despite this there have been significant cuts to public health budgets and services that are vital in supporting people’s health and wellbeing. Doctors and their patients are seeing the effect of these systematic pressures across the NHS. Recent data show a 4.9% increase in attendances at A&E in the last year, and a 15% increase in general practice consultations between 2010/11 and 2014/15 in England. And yet, a significant proportion of this pressure is avoidable by investing in ill-health prevention – particularly primary prevention.

Preventable ill-health accounts for an estimated 50% of all GP appointments, 64% of outpatient appointments and 70% of all inpatient bed days. Moreover, it is estimated that 40% of the uptake of health services in England may be preventable through action on smoking, drinking alcohol, physical inactivity and poor diet. More recently, the 2018 PHE (Public Health England) health profile for England showed the impact of these factors on life expectancy. These drivers of preventable ill-health are in turn underpinned by wider societal factors – the circumstances into which we are born, grow up, live, work and age (the social determinants of ill-healthb), the combination of which contribute to the increasing prevalence of a number of long-term conditions.