Investing in digital prevention: A conversation with…

In this Q&A, we speak to Dr. Johnny Marshall, who sits on the Senior Leadership Team of the National Association of Primary Care.

The NHS 10 Year Health Plan presents an ambitious and urgent challenge: shifting from treating sickness to prevention, and improving lives for generations to come. We believe in the power of bringing together our experts, NHS leaders, and communities to solve problems once thought unsolvable. Our Q&A series supports this mission by bridging the gap between policy and practice, turning vision into action.

These insights, alongside a survey of senior leaders, shape our digitally-powered prevention report.

What do you see as the biggest challenges to achieving the government’s digital prevention vision?

We tend to look at prevention as avoiding disease and never really discuss how we can create health. Changing the debate to creating health rather than preventing disease might be the biggest challenge.

For cardiovascular disease, if we looked at sleep, diet, movement, and belonging, not only do you prevent cardiovascular disease, but you also prevent cancer and mental health problems. By creating health, you have a massive impact on almost every long-term condition. You get a bigger gain for your investment in supporting people through digital prevention. If you think about creating health as a positive, rather than preventing disease as a negative, you shift the whole debate and start to look at digital coaching to deliver benefit. With the 10 Year Health Plan focusing on genomics, it’s important not to lose sight of the fact that, except for single gene disorders, your lifestyle is about three to four times more important than your genes in terms of your health.

Once you start thinking about health, you end up focusing on all of the things that support health – how we sleep, how we eat, how we move, our sense of belonging. Suddenly you find this prevents virtually every long-term condition.”

How can digital tools help to achieve the digital prevention agenda?

Technology can make healthcare really accessible and inexpensive. You’ll still benefit from a sense of connection with a person, but technology can also deliver peer-to-peer connection. Some people might feel quite isolated at times, and digital technology can give them a sense of being part of something bigger, even if it’s digital. If the NHS App could coach you wherever you are in a very personal way that activates you, it’s impact would be immeasurable. You need to have a digital exclusion option as well, but the more people you get to use it, the more resources you can use to support people in in other ways.

What role does community connection play in protecting population health?

Everyone needs to see what’s going on, which is a cultural element that strengthens almost any advice and support. But the other really important connection is with assets within your community. If you look at eating healthily, for example, what we tend to do is eat the food our parents gave us. If you’re going to support people, a community resource can provide information about would be practically healthy for you as an individual to eat.

Connection with the ecosystem is not just between people and healthcare, but also with the wider community.”

The government needs to think about the investment that unlocks all of that, rather than focusing on making healthcare more efficient. You’ve got to create health, not just efficient healthcare. If the NHS isn’t going to take that on board, we need another organisation with a separate budget specifically designed to creating health.

Funding is an ongoing challenge for digital prevention. Why do you think this is, and how could funding streams be reimagined?

I don’t think there’s an issue in terms of how quickly prevention delivers return. The benefits of prevention are fairly immediate. Through activating people, 12 months later, you reduce demand on acute services. The issue is how the NHS financial structure allows you to invest to deliver the benefit while still covering the fundamental costs of running an acute sector. The challenge is less ‘prevention takes too long’ and more that our financial system doesn’t enable us to invest. How can a multi-year approach to investment allow us to prove that prevention delivers benefit quickly?

It would be great if we could nail our colours to the mast with a clear five-year plan – this is what we’ll invest and how we’ll measure success – so nothing is going to deviate us from it. One of the biggest risks with prevention is that everyone starts out with a great idea but it gets blown off course. But if we see metrics and multi-year investment in prevention, that would be heading in the right direction.”

The work that we’ve done at the National Association of Primary Care demonstrates that just by giving your workforce positive messaging and getting them activated, you deliver a productivity benefit for no or very low cost at all. Look after them. Make them feel valued. Give them support and headroom to deliver value. If you then get people working together in neighbourhood teams and cut out unnecessary hand-offs, they deliver a productivity gain. To make this happen, the level of investment needed is much smaller than people imagine.

If you could design a digital prevention pilot, what would it be?

I would like to see a defined marker of metabolic health. BMI is a really simple measure of our metabolic health, but not the problem itself. So, we should look at BMI, and give people digital coaching support based on that number. You’ll activate people almost immediately and deliver a measurable gain in a 12-month cycle.