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Calls for 'shift in thinking' on public health investment evaluation

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A culture change in the way organisations evaluate long-term investment in prevention is key to maximising the benefits of the shift to integrated care systems in the NHS Long Term Plan, a report has found.

The joint study published today by Public Health England and the Chartered Institute of Public Finance & Accountancy highlights the difficulty of forming a coherent system-wide view of prevention investment when costs and benefits are spread across a series of organisations.

The findings of the report Evaluating Preventative Investments in Public Health in England, based on views which emerged from roundtables involving health and local government experts, also said there is a perception that a higher bar is set for prevention investment than spending on treatment.

But the report adds the status of public health approaches could be improved through a common approach to evaluation.

It also says an accurate estimate of overall spend on prevention and how it relates to healthcare spending is key to making the case for appropriate investment.

New PHE analysis in the report estimates that in 2014 – chosen as it represents the first full calendar year that councils had responsibility for public health commissioning – 4.7% of healthcare spending in England was invested in prevention, amounting to £5.2bn in real terms.

The report adds an improved evaluation framework for prevention investment should highlight financial and economic costs and benefits, as well as taking a “whole-system place-based view, unrestricted by organisational focus”.

The report puts forward a number of approaches that could achieve this. These include a focus on cost benefits analysis which is widely used across the public sector as it is able to take account of wider social and economic costs and benefits but is not widely used in health.

It says a common adherence to this approach would enable analysis across multiple organisations so they can “facilitate decisions on a place-based basis”.

PHE’s finance and commercial director Michael Brodie said; “We want to champion a common approach which views investment through the lens of the ‘public pound in a place or locality’ rather than the ‘local government pound’ or the ‘NHS pound’.

“We hope this report will provide a valuable contribution to the debate in what will be a crucial year for public health with the implementation of the NHS Long Term Plan alongside an expected green paper on prevention and a spending review.”

Cipfa chief executive Rob Whiteman said: “This report starts a conversation about how we achieve transparency and consistency in our approach to evaluating preventative investments. We hope it will prompt a shift in thinking and be a catalyst for change in the near future.”

The NHS Long Term Plan announced that the government would consider a “stronger role for the NHS” in commissioning public health services currently the responsibility of councils, such as sexual health, health visitors and school nurses. This led some senior public health figures to accuse NHS England of a ‘land-grab’.

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