Prioritising national interventions to improve population health - how we did it in the Middle East
09 October 2019
As part of the Long Term Plan (LTP), the NHS is committed to ambitious, quantitative health gains in the population. This includes preventing 150,000 heart attacks, strokes and dementia cases, saving 50,000 additional lives a year through early cancer diagnosis as well as reducing stillbirths and mother and child deaths during birth by 50%.
Delivering on these national commitments requires health leaders to list and prioritise the most strategically relevant interventions, both nationally and locally. This raises some key challenges. How are the LTP commitments translated into national and local interventions with quantifiable health gains year on year? How is the NHS prioritising these interventions to optimise health improvements and affordability over time?
Given the historical pressure to manage rising costs in healthcare, leaders have typically felt pressured to prioritise interventions that can demonstrate reduced costs, particularly in the short-term. However, a focus on reducing costs as early as possible may not be helpful for delivering on the LTP commitments such as preventing heart attacks. Instead interventions should not only measure and demonstrate cost savings, but also health gains. In the case of heart attacks for instance, a measure may well be the number of Healthy Life Years (HLYs) gained. HLYs take into account both the length and quality of life added and provide a single easily communicated measure of health improvement which can be compared across any sort of intervention (similar to ‘Quality Adjusted Life Years’, or avoided ‘Disability Adjusted Life Years’).
The benefits of prioritising interventions based on costs per health gain, as opposed to cost savings alone, are twofold:
- Costs per health gain would allow health leaders to optimise health returns per pound spent.
When health leaders are selecting and prioritising a list of interventions, it may be the case that all interventions are considered ‘cost effective’ relative to an agreed benchmark (e.g. National Institute for Clinical Excellence (NICE) guidelines). However, the prioritised interventions may not be delivering maximum potential health gains. Our analysis indicates that for the same cost, re-prioritising interventions, taking HLYs into account, can more than double the number of HLYs gained. Similar benefits can be evidenced using other health gain metrics.
- Health leaders could make better decisions by prioritising interventions which may be costly in the short-term, but present significant cost and health benefits in the long-term.
We have successfully developed this with health leaders in the Middle East. We worked with the Vision Realisation Office (VRO) in the Kingdom of Saudi Arabia (KSA) in 2019 to develop national strategies to improve cardiac and organ transplant services. We were able to demonstrate substantial savings by 2030 as well as how to deliver 570,000 additional HLYs for cardiac services, and 27,500 additional HLYs for organ transplant services. For each strategic intervention, estimated costs and effects took into account implementation timelines. We have subsequently developed a 2030 roadmap to support our strategic interventions.
Prioritising interventions using costs per HLYs gained could support national and local health leaders to deliver on NHS commitments outlined in the LTP. Historical cost pressures in the healthcare system, and a natural human preference for immediate rewards, have led to prioritising interventions that can evidence short-term cost savings. However, working towards 50,000 additional lives and 50% reductions in deaths would require health leaders to steer away from a ‘cost saving’ mindset towards one of generating optimal ‘health return’ over time, per pound spent.