Matt Hancock has made a typically energetic start to his time as Health Secretary. Unlike many cabinet colleagues, Hancock has been on the front foot with a steady stream of new policy announcements since he took on the role.
And one theme has emerged as a unifying thread through much of his public commentary on health: Prevention – the idea that if you stop the causes of ill health early, you won’t have to pay the larger costs of treatment further down the line. Simple in theory; harder in practice.
This week, DHSC launched Prevention is Better than Cure, a vision document outlining the government’s direction of travel on prevention, to be followed up with a Green Paper in the first half of 2019. Matt Hancock followed this up with a keynote speech to the Social Prescribing Summit, a term which has come to embody Hancock’s health philosophy.
Over the past decade, the warmth of words on this topic would have sufficiently heated several Whitehall buildings, but Hancock is turning that rhetoric into action. Here are four takeaways from Matt Hancock’s prevention drive:
In focusing in on prevention (and technology) Hancock has been able to apply some of his strongest-held political principles to the health brief. Integrated communities, the role of culture, music and sport in health, and personal responsibility all feature highly in his political back-story. They’ve now come to the forefront in his prevention vision and are likely to feature in the coming Social Care Green Paper too.
As an economist by trade, he is naturally drawn to the nudge theories of behavioural change, and the big savings that, theoretically, are delivered through early prevention.
Since the Health and Social Care Act there is no need for the Secretary of State to be involved in the minutiae of NHS decision-making, and Hancock has been content to say to Simon Stevens et al “Here is your extra £20bn, keep the NHS running,” as Hancock focuses on other projects.
This is good news for those organisations – providers of leisure, sports, arts, voluntary and community groups – who will be the ultimate delivery vehicle of the prevention agenda.
Although, as many have pointed out, the very real issues of winter crisis, staffing shortages and impact of Brexit mean Hancock’s time spent on ‘pet projects’ may be short-lived.
The NHS has just received a funding boost, but public health (where prevention currently sits) has not. The opposition, and many commentators, focused their response to Hancock’s (as yet unfunded) prevention vision around the £700m cut to public health budgets.
If Hancock is to truly deliver a prevention agenda, it must be funded. That means diverting more NHS funding to support prevention through the integrated care systems, or securing a major uplift in public health funding at the spending review.
Unfortunately for Hancock, neither of these outcomes are within his gift. CCG leads and local authority chiefs will decide how money is spent at a local level, and the funding gaps for things like social care are so extreme that prioritising social prescribing will be a bold choice. Meanwhile the Treasury is in the driving seat for the Spending Review, and currently sees more value in investments in infrastructure and digital technology than public health.
Some of the language around personal responsibility and the call on employers to ‘do their part’ from the prevention vision document suggests Hancock recognises this agenda will not be flush with new cash. The same old cries of ‘warm words not action’ will resurface if Hancock cannot manage to drum up new funding for this policy.
The use of genomic testing to determine future likelihood of medical need may be reminiscent of a Black Mirror episode, but it is here, and it works.
The government says predictive prevention – understanding who needs what intervention and when – will be a crucial part of the UK’s 21st century health system. Innovation in public health tends to be limited compared with other areas of the economy, but predictive prevention could kick-start a new industry and put an end to a ‘one size fits all’ approach to healthcare.
The DHSC and Public Health England will convene an expert group to explore how digital services and personalised genomic testing kits can tell what kind of treatment a person is likely to respond to.
Of course, the use of personal health data has been a controversial topic, not without its challenges. There are references in the government’s prevention vision to ‘safeguards in place’ but these will need to be sufficiently robust before any public roll-out.
The life sciences sector (once regularly described as a ‘jewel in the crown’ of British Industry) is largely on the outside looking in to this debate.
Matt Hancock has made no secret of wanting to cut the medicines budget, and has been far more vocal than his predecessors in publicly dressing-down pharma companies on pricing. With PPRS and Brexit to deal with, the Health Secretary that doesn’t appear to be in-step with the life sciences sector’s needs.
What is more, Hancock’s prevention vision has little time for pharmacological interventions. Speaking at the Social Prescribing Summit this week, he called out industry for trying to ‘convince us drugs are better than free social cures’ and said he wanted better outcomes for patients ‘without popping pills.’
The rhetoric in this debate is currently one-sided. Bizarre as it may seem, life sciences has to remake the case about the fundamental role of medicine in health, and the value of medical interventions in a fully-fledged prevention pathway.
So far, Hancock has proven that he’ll stick to his guns in focusing on his three main priorities -workforce, technology and prevention. For the time being, engagement and communication on those issues will be the way into Hancock’s good-books.