The ROI of digital prevention: A conversation with Rachna Vyas

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 hurdles need to be overcome to achieve successful digital prevention?

The first is the short-term culture of decision-making. Long-term investment in digital prevention is the right thing to do, but having a one-year planning cycle with a return on investment in 10 years makes it impossible to fund initiatives. The medium-term planning framework seeks to go beyond this, which is great to see.

Second, we’re not necessarily aligned across the NHS and local government. If the public health framework, adult social care framework, and the NHS framework were better aligned on a strategic footing, they would be much more powerful at place and system level to identify preventative solutions for specific areas.

Thirdly, there’s funding itself. Almost every system up and down the country will face financial challenge over the next few years. Over the course of the last 10 years, the vast majority of new funding has been required for acute services which impacts resource allocation. I’m not suggesting that we need new money. I’m suggesting we need to look at financial modelling in a more sophisticated manner, which should free up money for prevention, when done in partnership – just as the Neighbourhood Health programme is trying to do. The current financial model is system by system, and everybody comes up with a different answer, which doesn’t help to make the economic case to move investment around the system. This would make the single biggest difference – a solid evidence base of ROI which is tailorable to a specific set of local circumstances.

Finally, there’s something important about societal shifts and understanding how the next generation – 18 and below for example – want to consume health, because it’s very different to how I and my parents consume health. But we still largely design services without taking this into consideration or deliberately ensuring co-design across generations.

Do you think there could be better alignment between the NHS system as a whole, and local government?

Take vaccinations. NHS England is responsible for some parts of the pathway and local systems are responsible for others. It’s already fragmented, and we’re trying to bring all of it together for next year. But public health has a vast amount of data and local intelligence to look at and report on. It’s different to what I have to report, and it’s different to what my colleagues report. We’re all trying to do the same thing, which is vaccinate as much of the population as possible. But we’ve all got a slightly different way of measuring it, which means by the time we cut the data for each of these, we’ve lost a lot of time and resource. That said, when it works, it works really well. We’ve demonstrated this through local campaigns in Leicester, jointly delivered across the NHS and local government and we have had the right results – take measles for example.

Leicester, Leicestershire, and Rutland has some of the highest deprivation in the country, but also some of the highest affluence. It’s a diverse sub-region. You could test whatever you wanted here, and it would be applicable up and down the country. However, the events and discussions are usually London-centric, and it’s very difficult for all systems to take a day out to attend, which is a shame because you lose the richness from populations across the rest of the country. The other thing, of course, is that generally when you’re in those rooms talking about digital, it’s generally with people who are very digitally literate and up to date with policy and tech. Sometimes you need to throw a couple of people who struggle with such tech and get immediate end-user feedback. The challenge of proactively navigating technology and your own health information is one of the key reasons behind the current health crisis.

What role do digital tools and products play in delivering the prevention agenda?

It’s about getting information to people who need it and want it in a way that works for them, so they can hone down on future risk factors and targeted information. For example, if someone knew what their risk factor was for cardiovascular disease given their family history, once they reach their 20s and their 30s, they could start to track their blood pressure and engage with tailored digital prevention tools embedded in wearable tech they’ve already got. We have more information about our own health than we’ve had in generations, but we aren’t exploiting it.

There’s something about making the NHS App accessible and relevant to people regardless of age, so everyone knows it’s the place to go to get information in the way they want to get it. If it’s a video, they’ll get a video. If they want to hear from somebody who looks like them and speaks like them, then that’s what it will allow. We’ve come a long way with the NHS App, which is great to see, and the potential for direct impact still remains significant.

How can people be encouraged and empowered to manage their own health?

The most powerful way to get people to do something is for them to believe in it. When we get to our 40s and 50s and we start thinking about ageing well, but nobody’s talking about muscle mass and bone density at an earlier stage to help prepare for that. It’s about information, activation, and patient empowerment as opposed to doing things ‘to’ people and assuming that only the NHS can do them.

For example, the QRISK tool is a simple cardiovascular health risk assessment tool if you’re digitally literate, but if you’re not, you wouldn’t know how to fill it in. We’ve been working locally to simplify this so that the information is gathered automatically via a wearable or app, and provides a risk score. If a certain threshold is met, it triggers a conversation with the right health professional. It makes it much easier for people to understand what they need to do and where to go for help, early on.

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

Leicester, Leicestershire, and Rutland has some of the lowest vaccination and screening rates in the country. We know that getting those basics right would have an enormous effect not only on this generation’s health, but also to the next generation’s health through health literacy. But we don’t have the digital tools that we had during COVID-19 to tell someone they’ve done everything they’re supposed to have done. The NHS App gives you a list of your immunisations, but it doesn’t tell you what you haven’t had. This basic information could support people who don’t necessarily have information at their fingertips. And then there are those who could access all of their information to be empowered to self-manage their health across all major disease areas.

For example, one of my local communities in Leicester were unsure about younger women in the community getting the HPV vaccination because of the societal perception in some quarters that women had to be sexually active to have the vaccination. We tackled this misinformation by engaging with a local GP, who spoke to local elders in the dialect that is prevalent in Leicester. If a digital system could communicate that the HPV vaccination is due, with information tailored to that community with societal norms in mind, it would maximise uptake. You could also upload local videos to hit local markers based on local knowledge. Coupled with the power of big data sitting behind the NHS App, this is probably the ideal place that we should get to.