Research and analysis

Chapter 6: the 3 shifts - sickness to prevention

Published 17 December 2025

Applies to England

Summary of findings in this chapter

Both staff and the public want the 10 Year Health Plan to address a much broader, more holistic conception of prevention than was defined in the engagement and that the NHS can provide alone. This includes changes needed from other public sector bodies (for example, improving the quality of housing stock), the private sector (for example, the food industry) and wider public attitudes and behaviour.

Both the public and staff support the shift to prevention. They feel it has the potential to improve the health of the population and as a result reduce pressure on the NHS. Staff hope that it will enable the NHS to be less reactive, focusing less on urgent healthcare needs and more on ensuring patients live healthier and longer lives.

The perceived scale of the shift raises significant concerns about its delivery for staff and public. Both audiences question if sufficient staff and financial resources can be allocated to ensure its success. There is also an acknowledgement, particularly among staff, that the benefits from this shift will take time to be realised. They therefore worry that, in the context of squeezed public service finances, this shift will be abandoned before it has time to lead to real, positive change.

Public and staff are worried that this shift could widen health inequalities. There are concerns that if addressing barriers to making healthy choices are not at the centre of implementation, then key patient groups will be left behind. Seldom heard audiences also worry about its potential to stigmatise those with health conditions.

The public see education as critical and prioritise interventions which tackle the root cause of illness and detect or prevent disease early. They feel these interventions will deliver benefits to both individuals and the system. Despite many acknowledging that behaviour change is challenging, there is resistance to the use of medical interventions to tackle what are seen as issues arising from lifestyle choices. For example, neither the use of statins nor weight loss medication won widespread support among the public in deliberative events.

Staff’s recommendations focus on the systemic changes required within the NHS to make this shift a success. For example, they want strong and coherent leadership and emphasise the importance of filling gaps in workforce capacity and capability.

6.1 Benefits of focusing on preventing ill health, rather than treating it

This engagement largely focused on secondary prevention, which was defined as action the health and care system can take to prevent or delay the progression of disease throughout our lifetime, focused on individuals and delivered with their consent.

The perceived benefits resulting from the shift to prevention were consistent across audiences, with the positive impact on the population’s health being the most prominent. While there were nuances between the responses of the public and staff and within some seldom heard audiences, these were differences in emphasis, rather than contradictions or tensions.

In particular, staff were better able to identify the specific potential benefits of this shift in relation to reducing pressure on NHS services and healthcare costs overall. Seldom heard audiences were excited about the potential of this shift to deliver better quality, more tailored preventative services within their community.

Improving the health of individuals and the population

Public, staff and partner organisations saw improved health outcomes as the most important benefit likely to result from the shift to prevention. Both public and staff felt that a preventative model, if successfully implemented, would result in more effective treatment of disease, individuals living healthier lives, and the avoidance of some health issues altogether.

If we had early intervention, treatments would be less complicated when they’re needed and ultimately would be cheaper too.

(Public deliberative event participant, East of England)

A significant part of the appeal of the preventative model is that, for many participants, there are a number of ways in which they can easily see it leading to better health outcomes. For example, in response to an open text question, participants on the Change NHS website spontaneously identified a range of prevention measures that could help people stay healthy and independent for longer. These included education, early screening, addressing poor diet, childhood interventions and supporting physical activity.

Figure 18: chart showing public views on how prevention could help people stay healthy for longer on the Change NHS website

Shows percentage of participants on the Change NHS website selecting the top 5 coded responses to the question: ‘In what ways, if any, could an increased focus on prevention help people stay healthy and independent for longer?’

	Percentage
Education, awareness or advice	21%
Screening, testing or early detection	18%
Address poor diet or support healthy eating or nutrition	17%
Educating children, schools, or childhood interventions	12%
Support physical activity or exercise	11%

Base: all those who answered this question in the ‘Start here’ survey (number equals 64,898). The survey was live between 21 October 2024 and 14 April 2025.

Figure 19: chart showing the biggest opportunities of a greater focus on prevention in the nationally representative survey

Shows percentage of nationally representative survey participants selecting answers to the question: ‘Which of the following feel like the greatest opportunity?’

	Percentage
Better access to screening, helping detect and diagnose illness sooner	59%
Reducing the strain on the healthcare system by keeping people healthier	40%
Supporting people’s mental health and wellbeing	37%
Improving people’s diets and supporting healthy eating	29%
Improving access to community services and facilities	28%
Improving people’s physical activity and exercise	27%
Supporting people to stop smoking or vaping	18%
Better tailored information and advice to help people make healthy choices	16%

Base: all those who answered this question in the nationally representative ‘Start here’ survey (number equals 2,025). The survey was live between 13 and 17 December 2024.

Many of these themes were repeated across other strands of engagement. For example, public, staff and partner organisations felt that services and interventions designed to detect disease early are highly beneficial in improving the physical health of the population. In the public deliberative events and in the community engagement, participants discussed how earlier identification of health issues would enable a greater range of treatment options and a higher chance of success from treatment. This was particularly true of participants with long-term health conditions, as well as people with cancer or stroke in the community engagement, many of whom said that they would have benefitted from earlier diagnosis through a preventative model.

Similarly, interventions in childhood and the education of children were also strongly associated with better health outcomes, including by several partner organisations. Participants in the public deliberative events and on the Change NHS website felt that a focus on prevention in childhood would help diagnose health issues in childhood and foster healthy behaviours from an early age. Linked to this, staff at the deliberative and online events emphasised the importance of maternal care, vaccination, early years health services and supporting parents to provide a healthy start for their children.

For many public participants and staff, a truly preventative approach would also take into account mental health. For example, some staff said that a focus on prevention could mean integrating mental health support into other aspects of care, which they saw as beneficial.

A selection of ideas for change focusing on the theme of improving the health of individuals and the population

The NHS is a sickness service. It could be a health service if we truly invested in prevention and health creation […] At the very least every contact with the health service should enhance someone’s ability to improve their own physical or mental health.

(Staff Change NHS website participant)

If we are to prevent people getting sick it is not about diagnosing and treating as many people as fast as possible (there’s simply not enough [money] for doctors and nurses to do that). Instead, we need to create communities and environments that stop people getting sick in the first place.

(Public Change NHS website participant)

Reducing pressure on NHS services

All audiences believed that the shift to prevention will reduce pressure on NHS services by reducing the demand for services and the number of people who become seriously ill. This in turn was expected to free up resources and staff time. This was seen as highly desirable and a powerful reason to focus on prevention.

Participants in the public deliberative events primarily related this benefit to hospitals and GPs. They hoped that the preventative model could reduce waiting times in A&E and make it easier to get a GP appointment.

People would lead a healthier lifestyle and would not fall sick - hospitals and GPs would not be overstretched […] The pressure will reduce.

(Public deliberative event participant, Midlands)

Staff at deliberative and online events, and particularly those working in acute care, were also highly positive about the possibility of prevention reducing pressure on services.

Staff in management and leadership roles noted that the NHS will need to continue to deliver curative care to a high standard, even in a preventative model, and that managing that balance will present its own challenges. They emphasised that while the preventative model has the potential to reduce pressure in principle, the transition will need to be managed effectively to make sure this benefit is realised.

Moving upstream to prevent ill health will reduce demand on acute services and create better outcomes for people.

(Staff deliberative event participant, North West)

Cost saving to the NHS

There was an expectation across audiences that the shift to prevention could save money for the NHS. Participants in public deliberative events believed that diagnosing and treating health conditions earlier should be cheaper than treating them when they have already become more advanced. They thought that the subsequent cost saving would, in turn, help improve NHS services.

Staff at deliberative and online events believed that by preventing illness and complications, the NHS could reduce expenditure on expensive treatments, hospital admissions and long-term care. They hoped that this would result in more ‘balanced’ resource allocation, with preventative and community-based services able to receive a greater proportion of funding as a result.

Early intervention would mean that treatments are less complicated and cheaper ultimately.

(Public deliberative event participant, East of England)

[Prevention is] more cost-effective in the long run.

(Staff deliberative event participant, North East and Yorkshire)

All audiences were concerned about the long-term funding of the NHS. Given this, the shift to prevention appealed in part because it was seen as a way for the health service to remain financially viable in future.

Promoting a more community-based NHS

The provision of more community-based services was seen as key to the delivery of a preventative health service. This was seen as positive, not only as a means to an end, but as a desirable mode of engagement with the NHS in its own right.

Participants in the public deliberative events expected that a preventative health system would require more services to be ‘in the community’, by which they meant outside traditional healthcare settings and in local community venues instead. They hoped this would, in part, address some of the difficulties they have accessing healthcare, such as long waits at A&E and for GP appointments.

This sentiment was shared when it was explored on the Change NHS website and in the nationally representative survey. An overwhelming majority said they were happy to speak to a healthcare professional in a mobile screening clinic (85%) or community centre (74%). A smaller majority of participants in the nationally representative online survey felt the same.    

Table 5: settings in which participants would be happy to speak to a healthcare professional in, compared with the nationally representative survey

	All participants on the Change NHS website	Nationally representative sample
A mobile screening clinic	85%	64%
A community centre	74%	55%
Pharmacies	68%	60%
Faith buildings	31%	21%
Schools and colleges	26%	17%

Base: all participants the Change NHS website who answered this question in the ‘Your priorities for change’ survey (number equals 21,199). This survey was live between 24 February and 14 April 2025. All those who answered this question in the nationally representative ‘Your priorities for change’ survey (number equals 2,015). This survey was live between 17 and 20 March 2025.

More community-based services were particularly important for some seldom heard audiences who took part in the community engagement. They hoped that this would help address health conditions that are particularly prevalent in their communities, promote healthy behaviours, encourage increased engagement with health services and improve outcomes.

Prevention could be transformative if it is early enough, holistic and accessible for all communities.

(Community engagement, people from an ethnic minority)

Some staff at deliberative and online events also saw more community-based services as a benefit resulting from the shift. In particular, staff currently working in community care described the potential for these services to make a positive impact on health outcomes for patients if given more resource.

Creating a more prosperous economy

A minority across all audiences noted that a focus on prevention would benefit the economy. They thought this would arise as a result of a reduction in the amount of time people spend out of work due to ill health. Nonetheless, this benefit was seen as less important than other benefits outlined above and was not in itself seen as a reason to shift to prevention.

This shift might help the country’s economic situation as a whole.

(Public deliberative event participant, Midlands)

6.2 Concerns about the focus on preventing ill health

Across all strands of the engagement, concerns about this shift focused mainly on implementation, with significant worries about the degree of change within the NHS that would be needed to deliver it. While public concerns in this area were generalised, staff had specific worries about workforce size and capability, and whether existing structures, including in relation to incentives and collaboration, are set up for success.

Staff and the public also emphasised the difficulty of changing attitudes and behaviours of the public - something they knew would be essential to achieving this shift. Both identified structural barriers to behaviour change that will need to be addressed. Seldom heard audiences raised fears about the potential for a shift to prevention to increase stigma related to health conditions and therefore have a negative impact on care.

These concerns were reflected in the Change NHS website responses to an open text question. Participants on the Change NHS website spontaneously listed a potential negative impact on personal freedom and the potential for blame as concerns about the shift (albeit these were only mentioned by a minority of participants overall).

Figure 20: chart showing public concerns about an increased focus on prevention on the Change NHS website

Shows percentage of participants on the Change NHS website selecting the top 5 coded responses to the question: ‘What, if anything, concerns you about the idea of an increased focus on prevention in the future?’

	Percentage
Personal freedom, or that individuals have the right to choose or to privacy	8%
The NHS carrying out its role or providing quality treatment or care	8%
Potential for blaming and shaming or punishment of those with health issues	7%
Engaging the public to participate, or the public would not be interested	7%
Equity concerns, or that everyone can access or adopt preventative measures	6%
I have no concerns	30%

Base: all those who answered this question in the ‘Start here’ survey (number equals 54,354). The survey was live between 21 October 2024 and 14 April 2025.

The NHS’s role in prevention is limited 

Initially, this engagement sought to focus on the NHS’s role in delivering secondary prevention. While participants agreed that the NHS could do more on earlier diagnosis and preventing conditions from developing and worsening, they felt that it can do little to tackle the wider determinants of health. Public, staff and partner organisations emphasised that a truly preventative approach would involve organisations beyond the NHS - for example, schools and food manufacturers. Some worried that in isolation the NHS will not be able to deliver this shift.

Until we do prevention properly, including primary prevention, we’ll be treading water and won’t make progress.

(Staff deliberative event participant, Midlands)

There was support for a broader range of organisations to help people manage their health and wellbeing from participants on the Change NHS website. In particular, participants saw a role for employers, local government and education institutions. Only around 1 in 8 (12%) said that keeping people healthy should only be the responsibility of the NHS.

Table 6: participants on the Change NHS website’s views on who should have a role in supporting health and wellbeing, aside from the NHS

	All participants on the Change NHS website	Nationally representative sample
Employers (providing good working conditions, access to healthy food, access to health apps, wearable tech, access to a work-health adviser and so on)	56%	43%
Local government (councils, local services or elected local leaders)	45%	36%
Education organisations (schools or universities)	40%	31%
Voluntary organisations (charities that provide support on conditions and health - for example, cancer and so on)	22%	24%
My family and friends	19%	34%
Fitness organisations (gyms, personal trainers or parkrun)	15%	23%
Public figures (for example, sportspeople or social media influencers)	4%	10%
None - it should mainly be the responsibility of the NHS and healthcare staff	12%	14%

Base: all participants on the Change NHS website who answered this question in the ‘Your priorities for change’ survey (number equals 21,117). This survey was live between 24 February and 14 April 2025. All those who answered this question in the nationally representative ‘Your priorities for change’ survey (number equals 2,015). This survey was live between 17 and 20 March 2025.

The NHS is not set up to deliver prevention

One of the most significant concerns from both public and staff participants related to how well the shift can be delivered in reality. This concern was also shared by partner organisations. All audiences saw this shift as a major change in how the NHS operates and expected that significant resources would need to be allocated to ensure its success. However, there was scepticism that these resources would be made available.

Public participants in the deliberative events expressed concerns about whether there will be sufficient funding to deliver this shift. While they hoped the preventative model would be more cost-efficient in the long term, they expected there would be high ‘set-up costs’ to deliver such a substantial change to the way the NHS operates. Many lacked confidence that sufficient funding will be provided. Some also cautioned that the shift to prevention must not deprive non-preventative services of the funding they need.

My only concern is the funding for preventative care. Is that funding going to come from existing care practices or is it going to be a separate budget allocated, essentially taking investment away from services? So then you’re kind of slowing it [the other services] down.

(Public deliberative event participant, North East and Yorkshire)

Staff at deliberative and online events and partner organisations also worried about insufficient funding, but their concerns were more specific. They said that insufficient funding and a focus on the short term have hindered a move to prevention in the past and will need to be addressed moving forward. Staff identified a need for funding in 2 areas.

Firstly, resources to address gaps in workforce capacity and capability. As with other shifts, this was a major practical concern for staff. They felt that they already face staffing shortages and capacity constraints and that these would make it harder for staff to deliver the shift to prevention alongside the existing service. This was particularly true for staff in primary care who felt they have very little bandwidth to deliver prevention alongside their current responsibilities. Many said that without sufficient additional capacity for prevention work, the shift will not succeed.

Secondly, resources to address skills gaps in the current workforce. Staff felt that currently there are insufficient prevention skills across the workforce. They described healthcare professionals as primarily trained to treat illness. The move to a preventative model will therefore require significant upskilling that many doubted would be provided. For example, staff said they would need to be trained in behaviour change skills to encourage uptake of preventative services.

There is a lack of capacity within the system to make changes when the frontline services need to be delivered.

(Staff deliberative event participant, North West)

In addition, staff at deliberative and online events and partner organisations pointed to entrenched ways of working within the NHS which they felt will present a barrier to delivery of the shift.

Firstly, staff noted that currently, operational targets focus on acute care. This means that in a context in which staff need to decide how to prioritise competing pressures, focus and resources flow to acute care. If the shift to prevention is to succeed, structures will need to support its prioritisation over other elements of delivery.

Secondly, they also felt the system does not promote the collaboration which will be required to succeed. For example, staff said that silos between the NHS and public health, as well as across the NHS, will need to be addressed. As with the investment in resource, staff were not confident this will happen.

Need to move away from organisations adopting a ‘them and us’ approach to truly collaborate.

(Staff deliberative event participant, North West)

Staff emphasised the importance of leadership and strategic direction from the top of the NHS. This means prioritising prevention, setting clear objectives and providing practical support. This focus from ‘the top’ was seen as particularly important, because staff thought that staff mindsets would have to change under a preventative model, and that a ‘culture of prevention’ would need to be fostered at every level.

It will require the public to change their attitudes and behaviour

There was acknowledgement across audiences that for the shift to prevention to be successful, many members of the public will need to make significant changes to their attitudes and behaviour.

In the first instance, both public and staff recognised that this shift will require a fundamental change in the public’s relationship with the NHS. All audiences said that the public currently assume that the NHS is there to ‘treat you if you’re ill’. Changing this assumption was felt to require a shift in understanding of the purpose of the NHS and education on the possibilities of preventative healthcare. Staff at deliberative and online events felt strongly that this understanding does not exist currently among the public, suggesting substantial changes to attitudes are needed. While public deliberative event participants shared this view, they also noted that concerns about overburdening the NHS can result in patients feeling reluctant to engage with the system until it is ‘too late’. The public wanted this too to be addressed.

Concerns about the difficulty of changing behaviours and habits were widespread. When prompted with a list of options, respondents in the nationally representative survey were most likely to select ‘changing people’s habits and behaviours can be very hard to do’ as the biggest concern about the shift to prevention.

Figure 21: chart showing public concerns about prevention, from the nationally representative survey

Shows percentage of nationally representative survey participants selecting answers to the question: ‘Which of the following feel like the biggest concerns?’

	Percentage
Changing people’s habits and behaviours can be very hard to do	45%
Funding may be diverted from treatment	36%
Prevention may take time to have an impact, and the impact might be hard to measure	33%
Support and resources to help live a healthy lifestyle may not be spread equally across the country	29%
Some people or groups may be less able to change their lifestyle and habits than others	27%
People with health issues could feel blamed or discriminated against	23%
Prevention may not work or have less impact than hoped	20%
Protecting people’s freedom to make choices about their lifestyle	18%

Base: all those who answered this question in the nationally representative ‘Start here’ survey (number equals 2,025). The survey was live between 13 and 17 December 2024.

Public, staff and seldom heard audiences in the deliberative engagement shared this view that behaviour change is challenging, albeit this was a less prominent theme than concerns regarding implementation. Many felt that the success of a preventative model will rely on behaviour change that is difficult to affect, unpredictable and outside the control of the NHS. They worried about a situation in which the NHS has done all it can to move to a preventative model, but the shift fails because of persistent unhealthy behaviours among the public.

Staff and the public identified 2 issues that they felt would make it difficult for the public to change their behaviour.

The first of these was a lack of motivation. Staff at deliberative and online events were particularly concerned about this and felt that the public are likely to resist calls to change their behaviour. Public participants in the deliberative events shared this concern. Some acknowledged that they personally would be unlikely to change habits they admitted are unhealthy. They assumed others would act in the same way.

It’s difficult to engage the public in prevention messages.

(Staff deliberative event participant, North West)

The second issue identified by the public and staff was structural barriers to making the healthy choice and therefore long-term behaviour change. Some of the barriers participants raised could potentially affect people from any background - for example, caring responsibilities which could make it difficult to find time to exercise. However, in the staff online and deliberative events, the public deliberative events and the community engagement there was widespread agreement that barriers to making healthy choices are higher for disadvantaged groups. In the community engagement, many seldom heard audiences identified a wide range of barriers as particularly challenging for them. These included:

• economic barriers to behaviour change: the cost of things like healthy food and exercise equipment and facilities - these were particularly concerning for ethnic minorities, asylum seekers and refugees, young people, and people experiencing homelessness
• cultural and social barriers to behaviour change: unhealthy habits resulting from ingrained cultural norms, such as exercise being less common among some groups - these were particularly concerning for ethnic minorities, asylum seekers and refugees, and the Gypsy, Roma and Traveller community
• health barriers to behaviour change: existing health conditions which make it harder to practise healthy behaviours such as exercise - these were particularly concerning for people with multiple long-term health conditions, people with a learning disability and/or autism and people with hypertension

Staff - particularly those working in public health and community settings - recognised many of these structural challenges. They worried that prevention efforts which focus solely on individuals without addressing the wider social determinants of health could exacerbate inequalities.

The potential to increase stigma

There were concerns across public audiences that the shift to prevention could stigmatise people with ill health.

Participants in public deliberative events worried that a preventative approach that moves more responsibility for health onto the individual could inadvertently encourage the view among healthcare professionals and society at large that it is patients’ fault if they are unwell - for example, because they have made poor choices. Some participants felt it is already more difficult for obese patients to get the care they need due to an attitude from staff that obese patients need to lose weight before they can get help for other issues.

This concern was particularly prevalent among some seldom heard audiences in the community engagement. For example, people with multiple long-term health conditions, people with a learning disability and/or autism and people who have had strokes, all worried that the shift would exacerbate their existing difficulties in getting the NHS to understand the unique challenges they face. They felt that a wider understanding of the barriers their communities face is needed before this shift is implemented. Otherwise, the shift to prevention could lead to increased stigmatisation of people who are unable to take as many personal preventative measures as others might be able to.

It could be seen as victim blaming, telling people off for their medical issues. Other factors can cause health problems.

(Community engagement, those experiencing drug or alcohol dependence)

The potential to widen health inequalities

As mentioned above, public and staff audiences recognised that some people might find it difficult to engage with prevention due to wider structural barriers to making healthy choices. Many therefore worried that if preventative measures are not designed with the needs of underserved groups in mind, these groups might not be able to access the interventions, widening health inequalities.

In this context, accessibility was mentioned as a concern by both the staff and public. In public deliberative events, participants cited rural or deprived communities as particular examples of groups who risk being ‘left behind’.

Seldom heard audiences reinforced this view, with many noting that they already have issues accessing NHS services - and questioning whether any future preventative services would be any different. In particular, people experiencing digital exclusion, people with low or no literacy, people living in coastal communities, and people in contact with the justice system all expressed doubt that marginalised communities would have proper access to preventative measures.

Many preventative healthcare measures are difficult for marginalised communities to access. There is a lack of awareness, digital exclusion and lack of understanding about how to navigate the system or difficulties with entry into the system.

(Community engagement, digital exclusion)

6.3 Public recommendations for the delivery of the sickness to prevention shift

Across Change NHS, members of the public were asked to give their recommendations for what should be prioritised to make the shift to prevention a success, as well as to respond to intervention ideas.

The most common suggestions made across the public deliberative events were to prioritise education, early detection and screening and mental health support. The public were much less likely to recommend medical interventions such as statins or weight-loss drugs.

On prompting, participants on the Change NHS website were more likely to prioritise tests and diagnostics, regular check-ins with healthcare professionals and easier access to health records. These were more likely to be seen as priorities than reminders in the NHS App, signposting to activities in the community or access to fitness and mental health apps.

Figure 22: chart showing public views on what preventative measures would help participants stay healthy on the Change NHS website

Shows percentage of participants on the Change NHS website selecting answers to the question: ‘Lots of people say that more could be done to support them with their physical and mental health. Which 3 things would help you most to stay healthy?’

	Percentage
Easier access to tests and diagnostics	74%
Regular check-ins with a healthcare professional	63%
Easier access to your health record with personalised health information	50%
Reminders from the NHS App to support you to manage your health	24%
A healthcare professional signposting to activities in the community	23%
Access to fitness and mental wellbeing apps	14%
None of these	3%

Base: all those who answered this question in the ‘Your priorities for change’ survey (number equals 21,168). The survey was live between 24 February 2025 and 14 April 2025.

During the community engagement, seldom heard audiences echoed the importance of education, early detection and mental health support. In addition, these audiences emphasised that community-based services will need to be prioritised if the shift is to be a success.

This was reflected in the responses of seldom heard audiences who engaged through the Change NHS website. For example, ethnic minority participants and those living in coastal communities were more likely to say that ‘a healthcare professional signposting to activities in the community’ would help them stay healthy (29% and 27% respectively, compared with 23% for all participants on the Change NHS website - see figure 22). Participants with disabilities on the Change NHS website were particularly likely to say that ‘regular check-ins with a healthcare professional’ would help them stay healthy, with 67% of these participants saying so, compared with 63% of participants on the Change NHS website without a disability.

Prioritise education and building skills from a young age

Across all modes of engagement, the public consistently emphasised the importance of education in delivering the shift to prevention. This included education of the entire population, through public health campaigns, and of children from a young age. The education of children and young people was particularly salient and seen as a priority across audiences. The public did not see education as the role of the NHS alone, but felt that it should also come from schools, parents and community leaders and start as early in life as possible.

The topics participants in the public deliberative events described as most important to focus on included nutrition and diet, exercise and physical activity, the dangers of smoking, alcohol and drug misuse and the harms resulting from obesity. Less commonly, some highlighted the importance of education about interventions such as vaccines and screening, with a focus on raising awareness and tackling misinformation.

I’m a teacher. We’re the third generation that hasn’t had food education […] It needs to come back in [to the curriculum] so we are educating children about how to cook healthily, sustainably. You cannot get the food teachers at the moment.

(Public deliberative event participant, North East and Yorkshire)

Education was also important for many seldom heard audiences taking part in community engagement events. Children and young people and LGBTQIA+ people were particularly likely to prioritise it. Both groups often referred to the importance of education to raise awareness of screening for lesser-known conditions and in the promotion of responsible health behaviours.

If prevention was made a bigger priority, young people could be empowered to take control of their own health […] Providing earlier education on common health conditions, so that young people know when to seek help.

(Community engagement, children and young people)

A selection of ideas for change focusing on the theme of education from a young age

I think that we should have NHS lessons in primary school and teach children about in importance of nutrition, sleep, exercise and all the major factors to ensure they have the tools to grow up health strong individuals.

(Public Change NHS website participant)

Improve and increase education around a healthy diet and lifestyle. This would result in significant long-term saving for the NHS. This could start with meals at every school, only natural food, no processed and ultra-processed food. Explaining to kids where things are coming from and making them enjoy meal time from preparing it to savouring it.

(Public Change NHS website participant)

Prioritise mental health support from a young age

Participants in the public deliberative and community engagement events consistently linked mental health support to a successful preventative model. The prioritisation of mental health support was driven by a perception that poor mental health has a significant impact on quality of life, physical health and the health of family members. Public participants felt doing more to support mental health would have a positive impact on all these other areas.

They felt it would be particularly beneficial to address mental wellbeing early in life to help individuals set healthy habits early on and make healthy choices into adulthood. There was a strong view that mental health support should be rolled out in schools to help achieve this.

Mental health support, and in particular support at a young age, was emphasised by many seldom heard audiences during community engagement events, particularly children and young people and LGBTQIA+ people.

A selection of ideas for change focusing on the theme of prioritising mental health support

Mental health difficulties are something a large portion of the public have to face on a day-to-day basis. A significant rise in young people needing to be referred to Child and Adolescent Mental Health Services is a growing problem, with absurd wait times to even get an initial appointment with a psychiatrist. I propose all age mental health hubs set up in communities across the UK, where people are able to seek advice, support, and/or immediate help. The hubs would also focus on prevention by giving out information to schools, workplaces and social media campaigns.

(Public Change NHS website participant)

Have fully trained mental health nurses in every primary and secondary school who are able to provide immediate, targeted and appropriate medical support to children with mental health needs. They should also be trained enough to be able to triage those who require further assessments (for example, for ADHD / autism) and more enhanced support from Child and Adolescent Mental Health Services.

(Public Change NHS website participant)

Prioritise the early identification of disease

Although early identification of disease was not as spontaneously raised in deliberative events as education and mental health support, it was seen as highly desirable and effective when prompted.

When prompted with examples of prevention activities, 3 in 4 (74%) participants on the Change NHS website said easier access to tests and diagnostics would help people stay healthy, and over 3 in 5 (61%) said the same about regular check-ins with a healthcare professional (see figure 22), the most of any options presented. Similarly, in the public deliberative events, participants reacted positively to ideas focused on screening services and sexually transmitted infection (STI) tests.

Participants in public deliberative events felt that early detection of disease has benefits for patients and for the health system. They felt that it is a cost-effective way to deliver positive change. As a result, many recommended aiming to widen access to screening services as far as possible - for example, by widening eligibility age brackets.

The case studies which appealed most to the public during deliberative events were cervical and bowel screening services and STI testing. The majority were supportive of delivering tests at home to increase uptake and reduce stigma.

Screening programs for cancers like prostate, lung, and colon cancer save lives by catching diseases early and providing timely interventions.

(Community engagement, multiple long-term health conditions)

A selection of ideas for change focusing on the theme of early identification of disease

I have terminal cancer. I wasn’t old enough for screening. Early detection of cancer means cheaper treatment and a better chance of recovery. The NHS should provide free home testing for any disease; it can screen for anyone of any age if requested. Frankly, I’d pay for it. It would save lives and likely lower costs.

(Public Change NHS website participant)

Some countries have public health systems that include regular health screenings for their populations. These screenings can help identify potential health problems early on, when they are often easier to treat. The NHS could benefit from adopting a similar approach. Regular health screenings could help identify and treat health problems early, potentially leading to better health outcomes for the British population.

(Public Change NHS website participant)

Widening access to community-based preventative services

Both participants in public deliberative events and seldom heard audiences in community engagement highlighted the need for improved access to healthcare services to facilitate the shift to prevention and make sure everyone has access to early detection and intervention. The primary way they thought this could be achieved was by increasing community-based health services to provide healthcare at a local level.

This recommendation was a particular focus among some seldom heard audiences in the community engagement strand. Audiences with access issues such as people experiencing digital exclusion, people with low or no literacy, people living in coastal communities and people in contact with the justice system recommended that new prevention services be rolled out in areas that are underserved by the existing healthcare system. Audiences with a history of discrimination or unequal health outcomes, emphasised the importance of preventative services bridging the cultural divides that they feel exist between their communities and the NHS.

Training NHS staff in culturally competent prevention strategies, making services more approachable for diverse communities.

(Community engagement, people from an ethnic minority)

Among participants on the Change NHS website, there was support for measures that would redirect resources to areas and people most in need. Over half of participants on the Change NHS website (55%) said they supported ‘targeting more resources on prevention and healthcare to people and areas who are more in need than others’. More than 3 in 5 (64%) respondents in the nationally representative survey felt the same. Ethnic minority participants on the Change NHS website (63%) and those who have worked in health and care (65%) were particularly likely to support this measure.

Medication is acceptable as a last resort, but only if work has been done to address the root cause

Participants in public deliberative events reacted negatively to interventions which were perceived to prioritise medication over tackling the root causes of illness. These interventions were seen as ‘quick fixes’ which do not address the lifestyle factors that may lie at the heart of health conditions. An approach based around medications was not therefore seen as truly preventative.

For example, statins and weight-loss drugs were seen as much less preferable than making changes to diet and exercise. Scepticism was particularly strong with regards to weight-loss drugs. Many were concerned that these interventions will not be effective in the long run because people will revert to unhealthy behaviours and become ill again in future because they will not have addressed the lifestyle reasons for their conditions.

We’re looking at solutions without knowing cause. Without research, the reasons people are overweight, you’re offering someone a one-fix solution for something that could be a lot more nuanced.

(Public deliberative event participant, East of England)

In contrast, there was widespread support for vaccination programmes because vaccines prevent disease from happening in the first place. There was a strong sense that vaccine misinformation needs to be addressed. Only a vocal minority were sceptical of vaccines.

Over the course of deliberation, many members of the public grew more comfortable with the idea of medication being one part of preventative healthcare provision. However, they stressed that medication should be used only as a last resort and if work has also been done to address the root cause.

Empower individuals to stay healthy, but respect choice

The public wanted to retain the freedom for individuals to make their own choices regarding their healthcare and how they live their lives. They felt that the healthcare system should encourage patients to take preventative action. However, in line with feedback across the engagement, they ultimately wanted individuals to maintain the right to choose. There was little sense that individuals owe a responsibility to the NHS or wider society to engage with preventative healthcare.

Related to this wider point and reflecting their concerns about the shift, many seldom heard audiences in the community engagement stressed that a preventative approach must avoid stigmatising those with poor health. People with multiple long-term health conditions, people with a learning disability and/or autism, people experiencing drug and alcohol dependence, people experiencing homelessness, people who have had strokes and sex workers all wanted a preventative healthcare system to recognise the particular challenges they face and be sensitive to the notion that not all health conditions can be prevented.

If they [the NHS] are providing the education, put the choice back onto the individual. They have got all the information to make that informed choice.

(Public deliberative event participant, South West)

6.4 Staff recommendations: what needs to change for the shift to be a success

As shown in figure 23 below, staff at deliberative and online events agreed with the public that education and screening services will be key to making the shift to prevention a success. However, staff also emphasised many more practical considerations in relation to implementation. These chiefly related to the NHS workforce, system and funding.

Figure 23: chart showing staff views from online events on potential ideas to deliver the shift to prevention

Shows the average (mean) score of each answer to the question: ‘Based on your experience, rate each idea below on its potential to help achieve the shift out of 10’

	Average (mean)
Prevention and education from a young age	8.6
Educating the public on preventative approaches	7.8
Training and development for staff in preventative approaches	7.7
Increased screening services	7.5
Increasing digital health tools	6.7
Weight management programmes	6.7

Base: all those answering this question in the staff online events (number equals 825), which took place between 19 November and 3 December 2024.

Strong and coherent leadership and strategic vision

Staff across the workforce at deliberative and online events emphasised the need for NHS leaders to drive the shift to prevention. They wanted leaders to ‘lead from the front’ by setting direction, aligning incentives across systems, and committing to the shift in the long term.

There was a sense among non-managerial staff that they have heard NHS and political leaders articulate the need to move to a preventative model before. In this context, staff called for leaders to demonstrate their commitment to prevention in their decision making and priorities.

Offer truly compassionate and caring leadership and management.

(Staff deliberative event participant, East of England)

Investing in and developing the workforce

Many staff felt that the shift to prevention will be impossible to achieve without them and their colleagues. Therefore, at deliberative and online events, they emphasised the importance of equipping staff with the skills, knowledge and support required for the workforce to deliver preventative healthcare effectively.

Staff felt that comprehensive training and upskilling are required. They wanted formal training for existing staff and for prevention to be embedded in core training and education curricula for new joiners. Moreover, many felt that existing roles would need to change to focus more on prevention and for new roles to be created and filled. In practice, many assumed this would entail better use of the skills of nurses, allied health professionals and community care staff.

Staff wanted support, sufficient funding and patience while the workforce undergoes the changes required for the shift to prevention. There was a sense that most do not currently have the bandwidth to undertake this alongside existing responsibilities. They wanted the magnitude of the changes required to be recognised and for staff to receive the time, space and formal support they need.

Staff empowered to drive change and develop so they stay and want to do the best job.

(Staff deliberative event participant, South West)

Integrate, streamline and standardise systems and processes

At the deliberative and online events, staff consistently emphasised the importance of breaking down silos between healthcare, public health, social care and community services (including education) to make the shift to prevention a success. They felt that care needs to be integrated, with better collaboration between providers.

Health system leaders were particularly likely to recommend collaboration across silos within the healthcare system and partnerships between other sectors, such as education, to make the shift a success. They said that NHS leaders need to align funding and priorities so that preventative care is incentivised from the top down.

Staff also said that systems and processes needed to be streamlined and standardised. They felt this would have the added benefit of reducing the administrative burden and freeing up time for patients. In practice, they thought this could entail more information-sharing across silos. This would require better data collection and sharing between systems and would need improved technology and IT infrastructure to deliver it.

A systems approach to improve effective, simple, person-centred pathways.

(Staff deliberative event participant, North East and Yorkshire)

Adequate and sustainable funding

Funding was seen as key to the success of the preventative shift. Staff wanted dedicated funding to help make the shift happen. They felt that without adequate resource, the shift to prevention will not be successful, particularly in the context of staff already feeling that NHS budgets are stretched.

They emphasised that funding needs to be sustainable: a multi-year and long-term, ring-fenced investment in prevention.

Long-term funding needed to sustain not just implement [the shift].

(Staff deliberative event participant, South West)

Community-based services

Staff at deliberative and online events felt that easily accessible community-based services should be prioritised to make the shift a success. Overall, staff described effective prevention as moving beyond top-down, one-size-fits-all approaches to healthcare, and towards services that are tailored to different communities’ specific needs, challenges and cultural contexts.

They said that prevention would require moving beyond traditional healthcare settings to deliver services in places that are familiar, trusted and convenient for different populations. They felt that services should be physically, financially and culturally accessible to diverse communities.

Health system leaders described effective community-based services as requiring tailored approaches for each local area as well as specific communities. They said this requires NHS leaders to be flexible and proactively communicate to the public that the shift is being made and explain what it means for them.

Making it relevant to local communities where health and needs are different.

(Staff deliberative event participant, Midlands)

Prioritise education of children and adults

As outlined in figure 20 above, education was a top-of-mind recommendation for many staff participants at deliberative and online events. However, over the course of discussion and deliberation, the focus on education diminished and staff focused increasingly on other recommendations.

By the end of the deliberative process, staff saw education as one way among many in which the shift could be delivered. In particular, they emphasised early years and family support through services like children’s centres and school-based health programmes. Education of children was more front-of-mind than adult education, but staff also saw health coaching and public health campaigns targeted at adults as well as children as part of the picture.

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