Putting prevention at the heart of the 10-year plan would save the health of the public and of the NHS

One of the largest contributions to sustained increased demand for NHS acute services is the growing number of people living with multiple long-term conditions in the UK.

These health challenges not only drive demand on services but also contribute to wider societal issues—economic inactivity, falling tax receipts and rising fiscal costs, particularly through health-related benefits and reduced productivity. On current trends, chronic disease is set to bankrupt the Exchequer. Yet much of this cost to taxpayers is preventable.

Much is made of the promise of prevention, both primary (to avoid disease onset) and secondary (to prevent deterioration or complications), but it remains undervalued. Incentives [for prevention] are misaligned; we lack a dedicated body to evaluate the multidimensional benefits of prevention as well as delivery mechanisms that match the scale of the opportunity. Despite this, the public are ahead of policy makers; supportive of structural changes that make the healthy choice the easy choice across big public health challenges such as smoking and poor diet.

Primary prevention is often the most effective and most equitable, with the smoking ban and soft drinks industry levy both being highly effective and equitable in achieving behaviour change –  with health and broader economic impacts. Minimum unit pricing of alcohol would seem to be a prime policy for adoption in England given the positive evaluation of Scotland’s rollout. However secondary prevention, a lever in the NHS’ toolbox, is too often under-utilised especially given the breadth of evidence of it’s impact – both health and economic.

Why prevention matters: the case of obesity

Obesity is a vivid example of the promise, and failure, of our current approach to prevention. Prevention spans three goals: preventing obesity onset, slowing BMI progression and averting complications such as cardiovascular disease, osteoarthritis, and diabetes. While it’s often framed as public health versus clinical medicine, the reality is more complex: effective solutions require integrated, multi-sector approaches.

New treatments are transforming our ability to tackle obesity at an early stage. Recent estimates have put the potential productivity gains of obesity medications at £4.3 billion for the UK if those eligible under current guidance (BMI>35 and one obesity related condition) received medication, while the fiscal cost of obesity-related welfare payments may be as much as £10 billion annually. Meanwhile, policy-focused reports such as Nesta’s obesity blueprint have highlighted the untapped potential of environmental interventions like food reformulation and advertising restrictions to halve obesity.

However, the benefits of this life sciences revolution are likely broader than just weight loss and other clinical outcomes. Many patients using GLP-1 medications for obesity report functional improvements: reduced joint pain, better sleep and focus, the ability to play with children or engage in daily life again. A frequently cited effect is a reduction in “food noise”—the relentless cognitive effort of resisting food. Many of these functional outcomes are not currently captured in traditional cost-effectiveness models but matter deeply to patients, to society and in the onset of other diseases such as dementia.

Despite these benefits, our system struggles to act. Why?

First, prevention doesn’t fit neatly into the Treasury’s, Office for Budget Responsibility’s, or the Department of Health and Social care’s frameworks for short-term returns or single-department spending. The biggest prevention benefits—economic activity, welfare savings, improved educational outcomes—often emerge years after the initial investment, and outside the NHS.

Second, no one “owns” prevention. The Department of Health and Social Care has limited levers to shape the obesogenic environment. The NHS is held accountable and incentivised for healthcare delivery, not health creation. Local government holds key powers but faces chronic underfunding. Other departments, such as DWP and DfE, while set to benefit from improved health, are rarely involved in planning or investing in the nation's health.

This misalignment plays out in real time. NICE recently approved Tirzepatide as cost-effective and identified around 3.4 million people with obesity to meet the clinical indication. Yet NHS England will make only it available to approximately 220,000 people over the first three years due to budget impact concerns and capacity constraints. That’s fewer than 1 in 10 of those eligible. The result: millions of people who could benefit—clinically, socially, and economically—will miss out, and so will the NHS, employers, and the hard-pressed taxpayers.

Public demand is moving faster than public provision

While the system hesitates, the public is moving. More than 1.5 million people in the UK have already accessed GLP-1s out of pocket—compared to approximately 200,000 through the NHS. This is unprecedented and signals a significant shift in how taxpayers and voters value their health and seek care. It raises significant questions about the social contract on health.

This shift is expected to exacerbate existing inequalities. Without equitable access, we face a two-tier system in which those with means benefit from new treatments while those who cannot, and are often in greater need, fall further behind. This exacerbates gaps in healthy life expectancy, reinforces multi-morbidities and creates new barriers to health-driven prosperity.

Already, women in the most deprived areas experience 18.8 fewer years of healthy life expectancy than those in the least deprived areas. If new innovations in prevention are not equitably distributed, this gap will grow—not just in health, but also in education, employment, and opportunity.

The politics of health are changing. Trust in the NHS has deteriorated whilst engagement in private treatments is rising. Recent research by the Institute for Public Policy Research (IPPR) indicates that a significant majority of voters across the political spectrum support stronger government interventions to improve health outcomes. This includes backing for measures such as junk food advertising bans and holding landlords accountable for poor housing conditions that affect tenants’ health. Notably, the public places more responsibility for the nation’s health on the food industry than on the NHS, challenging the notion that such interventions are viewed as ‘nanny state’ overreach.  

If the benefits of prevention are multi-sectoral, should funding and delivery also be multi-sectoral?

Now is the time for new models for health interventions, medicines, technologies or preventive programmes, which have broader value to society and the economy to be introduced at scale in the 10-Year Plan. These could include: 

• Co-investment by Government Departments: e.g., DWP investing in prevention to reduce welfare dependency.
• Employer Partnerships: Large organisations could fund access for workers to reduce absenteeism and boost productivity.
• NHS-Partnered Delivery: A “white-label” NHS model where trusted branding and oversight is combined with third-party delivery.
• Voluntary or Out-of-Pocket Options: Expanding ethical access points for those who wish to self-fund.

Combining our existing assets with predictive analytics

The UK has unique assets to support a new prevention ecosystem. Data platforms like HDR UK, linked real-world datasets, and strong research-industry collaborations (like the Manchester–Lilly partnership) offer the foundations for a real-time, responsive R&D system. The NHSE Health and Growth accelerators are promising first steps—but need faster iteration, scaled ambition, and cross-sector engagement. Building actuarial techniques and predictive analytics on top of these data assets would be a meaningful step towards embracing true population health approaches.

Crucially, local systems must play a central role. Local authorities and Integrated Care Systems (ICSs) are best placed to understand the contextual drivers of poor health and to co-design community-responsive interventions. They can bridge health, housing, education, and employment in ways national systems cannot. But they need sustainable funding and strategic authority, not just implementation mandates. Empowering local systems to trial new models, including cross-sector pooled budgets or local prevention bonds, could drive innovation at the scale and speed we need.

The NHS’s forthcoming 10-year plan will face immense pressure to prioritise urgent care, workforce, and digital transformation. If we reduce proven prevention models to pilots and modelling, then we will see no change in health outcomes in this political cycle, and we will waste another generation.

A different approach is possible. These changes take sustained reform over many years, so the 10-Year Plan could make a start by constituting an NHS Prevention Unit which could get the ball rolling:

• Create a framework for assessing the multidimensional value of prevention.
• Invite public, private, and academic partners to scale effective models.
• Prioritise proportionate investment for communities facing the highest burdens.

This would shift prevention from a rhetorical afterthought to a national imperative.

If we treat prevention as a luxury, we will continue to pay the price in poor health, lower productivity, and deepening inequality. We need new models, new partnerships, and new incentives. Prevention, done properly, is not just good for health—it is an engine for prosperity. The 10-year plan must realise this if it is to truly turn the tide on the health of both the public and the NHS.