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The Research Brief: the case for preventing rather than treating ill health

Your weekly dose of policy thinking.

By Spotlight

Welcome to the Research Brief, where Spotlight, the New Statesman’s policy section, brings you the pick of recent publications from the government, think tank, charity and NGO world. To see more editions of the Research Brief click here.

What are we talking about this week? Major Conditions Strategy: Case for Change and Our Strategic Framework, the policy paper laying out the government’s plans for its highly anticipated Major Conditions Strategy.

What’s a “major condition”? Good question, and no, it doesn’t include particularly bad hangovers. The Department of Health and Social Care has highlighted six groups of diseases that drive more than 60 per cent of mortality (death) and morbidity (disease) in England. Increasingly patients experience “multimorbidity”, meaning two or more of these conditions at the same time. These include cancer, chronic respiratory disease (such as asthma), cardiovascular disease (such as stroke and diabetes), dementia, mental ill health, and musculoskeletal disorders (such as arthritis).

So, is this the strategy or…? At over 20,000 words and six chapters, you’d be forgiven for thinking so, but no. This is an “interim report” based on research so far, a recent call for evidence, and engagement with citizens and stakeholders. It will help to formulate the final strategy, which will be published in 2024.

Got it. What’s the gist? People are living longer but they’re also getting sicker. Most people in the 55-64 age group and older have at least one long-term condition. This affects individuals, the NHS and the economy – people with two or more conditions make up half of the NHS’s overall costs and 50 per cent of hospital admissions, while there are now 8.65 million economically inactive people in the UK, according to the report. Better prevention strategies are needed to reduce disease rates in an ageing society.

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What’s the government going to do about it then? The report lays out a five-pronged approach: “primary prevention”, as in reducing the risk of disease in the first place by tackling lifestyle factors such as obesity, smoking and exercise levels; “secondary prevention”, halting the progression of diseases by doing things like increasing uptake of routine NHS health checks; earlier diagnosis, by increasing screening programmes and other measures; prompt care; and long-term treatment and care that helps people live better with health conditions.

What else? Rather confusingly, other gargantuan topics are chucked into the mix of this report, including, but not limited to: staff shortages, health disparities and narrowing the healthy life expectancy gap, medical innovation, AI, research and clinical trials, better integrated care between physical and mental health, and more personalised healthcare. Phew.

That seems like an awful lot. Yes, it does feel a bit like a “Fisher-Price My First Health Strategy”, and critics there are aplenty. The Major Conditions Strategy is the amalgamation of many more specific policy papers that were sadly destined for the bin.

The shadow mental health minister, Rosena Allin-Khan, recently expressed dismay that the government’s ten-year mental health plan had been rolled into this one, while Dr Richard Simcock, chief medical officer at the cancer charity Macmillan said he was “hugely disappointed” that the same had happened with the ten-year cancer plan. The president of the doctors’ union, the British Medical Association (BMA), called it “appalling” that the health disparities white paper was scrapped during a cost-of-living crisis.

However, others are happy just to be included. Sarah Woolnough, chief executive of the charity Asthma + Lung UK said she’s “very pleased” that respiratory diseases are in the strategy, given that they have been historically “neglected and deprioritised” despite being the third biggest cause of death globally.

So is one strategy going to fix all of the UK’s health problems? It’s too early to say. The report recognises the link between health and wealth, highlighting the wider inequalities that contribute to poor health outcomes, such as poverty, pollution, housing and job quality. But these policy areas span beyond the Department of Health and Social Care across Whitehall and local government, so there will need to be significant cross-departmental collaboration. This is easier said than done, as many great ministers have found out, to their despair.

As David Buck, senior fellow at the King’s Fund, told Spotlight, an important part of any prevention health strategy will be assessing how funding flows from Whitehall to local services based on deprivation levels. But will it “be brave enough to get into this debate”, he asks. “Or will it stay ‘in-lane’ and focus on just what the NHS can do?” We’ll have to wait and see.

In a sentence? If we want a healthy population that contributes to the economy, we need to reduce the rate of avoidable disease by shifting from treating sickness to preventing sickness.

Read the full report from the Department of Health and Social Care here.

If you have a report, briefing paper or a piece of research that you’d like featured in the Research Brief, get in touch at spotlight@newstatesman.co.uk.

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