The NHS is poised for a transformative shift with the launch of Change.NHS. By prioritising the needs of vulnerable individuals and leveraging existing assets, we can move towards a future where prevention is the norm, not the exception
This week, the new Labour Government launched Change.NHS, a consultation aiming to reshape the future of health and care. One of the core areas for reform aims to shift the NHS from a reactive sick care system to a proactive health and wellbeing service that prevents deteriorating health conditions from the outset.
In his Health in an Ageing Society report, Chief Medical Officer Professor Chris Witty also stresses the importance of prioritising secondary prevention and screening services to support this long-term vision for care. He advocates for improving the quality of life in adults’ later years by reducing disability and ill health and enabling people to live as independently and enjoyably as possible. Telecare and tech-enabled care can be critical in realising this preventive care vision.
But as a nation, one thing is clear. We spend a lot of time and energy talking about integrated care, prevention, and data-driven population health management, but we are not yet working consistently in this way. What is preventing us from really progressing towards prevention?
Moving from a reactive to a predictive model
Preventative care is not a new medical concept. Health and care professionals worldwide have been planning ways to implement this model to enhance the delivery of care to citizens for some time.
In 2012, I moved from the United States to the UK; one of the motivations for my move across an ocean was that I firmly believed that a public system—one that takes care of its citizens across their entire lifespan—could focus more on prevention. From a policy perspective, I’ve seen prevention woven into the fabric of many NHS plans over the years. I’ve had the privilege of working closely with NHS England to help design and deliver a programme designed to support population health management as a data-driven proactive service to enable integrated, citizen-centric care.
However, progress in making prevention and real preventative care a true reality remains slow.
So, what needs to change in preventative care?
To make progress, we must put the vulnerable people who often receive disjointed, reactive care at the centre of our strategy and design services and solutions that work for them. I joined Tunstall just over a year ago, and I moved from a more ‘health-orientated organisation to a ‘care-orientated one because I believe that to truly transform, we must put the person at the centre. That means not just at the centre of our design but also at the centre of our budgeting methods.
In population health management, a familiar benchmark is that 5% of the population generates 50% of the costs. At Tunstall, we support vulnerable people living independently to receive emergency support—often in crisis, such as when they have fallen. Our model in the UK is today very reactive. Tunstall Healthcare operates over 16 response centres worldwide, including those in the UK. We also support other local call centres by offering our dedicated software and associated technology.
In our UK response centres, we directly support almost 100,000 citizens across England. We receive over 1 million calls into that call centre annually and make over 30k calls to emergency services on behalf of those citizens in distress. Some simple modelling based on these numbers suggests that the cost to the NHS for those calls—including ambulance services, A&E visits, admissions, etc.- could be upwards of £100m GBP.
The transformation will require us to start from the citizen and then understand the assets in place across the wider health and care system—both public and private—that can enable a more person-centred and seamless approach to care. We must design services around the person and find ways to enable budgets and funding to reward those preventive efforts that impact downstream costs across the person’s entire care journey.
Leveraging existing assets
When we think about prevention, we don’t need to reinvent the wheel, as much of the necessary infrastructure is already in place to make this happen. By understanding the total available infrastructure across health, care, the third sector, and private organisations and building ways to connect them, we can make the entire ecosystem greater than the sum of its parts.
Response centres are major assets that allow us to collaborate with local authorities and integrated care systems (ICSs) and will undoubtedly play a leading role in enabling prevention at scale.
What success looks across Europe
Whilst our service today in the UK is mainly reactive—it does not need to be that way. For example, in Spain, our call centres offer a proactive service—with 80% of calls being outbound vs inbound. Our care professionals assess the individuals’ risk and work with the local Council to determine an appropriate pathway of proactive calls. This proactive contact contributes to reducing incidents, but we are working towards data-driven prevention by integrating sensors and personalised data to identify potential risks, such as falls, before they occur.
This is where the innovation takes shape. This data on specific users is fed back into the data platform to create a real-time risk stratification engine. So, rather than simply completing an initial consult to decide on an individual’s level of risk, we can access a data-informed and relevant ongoing assessment. The service can be dialled up or down depending on the level of care required at the time it’s required.
Spain proves that this ambition of delivering genuine predictive and preventative care is possible. While it’s early days, we believe that together, we can better leverage technology to enable proactive care models. Together, we can share best practices on care and funding models and collectively learn how to best support people living independently for longer. Our ambition is to support person-centred prevention at scale.
