Organisation objective
- NHS Mandate from government
Working with people and communities
What approaches have been used to ensure people and communities have informed this programme of work?
- N/A
Action required
The Board is asked to discuss and provide feedback on the progress presented in the report.
Issue and context
1. A decline in working-age health has had a significant impact on the labour market. A record 4 million people are not participating in the labour market due to a work-limiting health condition, with 2.8 million citing long-term sickness or disability as their main reason for being out of the workforce. Alongside this rise in people out of work due to ill health, there has been a 64% increase in the last decade in the number of 16-64 year olds with ill health who are in work and a huge growth in health and disability related welfare spending. The Office for Budget Responsibility (OBR) now forecasts health and disability related benefits will grow from £64.7 billion in 2023/24 to £100.7 billion by 2029/30.
2. There is a multi-billion pound economic and fiscal opportunity to the Exchequer in tackling ill health and helping keep people with health conditions in work or bringing them back into work if they left employment due to ill health from higher tax revenue and lower welfare spending. Doing so will also help to tackle health inequalities and should improve the performance of NHS services over time too.
3. There is now a broad consensus that economic and health outcomes are strongly related and that national health and healthcare systems are critical to economic growth, given that health affects both workforce activity and workforce productivity. There is growing evidence that health interventions can deliver both better health outcomes and economic outcomes. This can be done without deviating from our core principle of prioritising based on clinical need.
4. The Long Term Plan represented a step change in NHS approach to preventing ill health. Key successes since then include avoiding thousands of cardiovascular disease events since 2019 and being on track to exceed the Long Term Plan ambition by preventing 175,000 events by 2028/29. In addition, 1.6 million patients have been referred to the Diabetes Prevention Programme. Independent analyses undertaken by the University of Manchester (DIPLOMA Research Programme) published in 2023 shows that referral to the programme was associated with a 20% reduction in risk of developing type 2 diabetes.
5. NHS England has worked with the government to establish health and growth accelerators across 3 integrated care systems (ICSs). These have been selected to demonstrate how to operationalise the shift to prevention and neighbourhood health approaches, tackle the health conditions most associated with economic inactivity and improve the join up of services, workforce and data. Evaluation and learning from these accelerator sites will develop the evidence base for how to reduce health-driven economic inactivity at scale.
Health and growth accelerators
6. NHS England worked with government on new analysis demonstrating the economic and fiscal impact of ill health on the economy and on the design of a new delivery architecture through health and growth accelerators. As a result, in the Autumn Budget 2024, the Chancellor awarded £45 million total funding to launch the first wave of health and growth accelerators in at least 3 ICSs. These local areas will bring together and streamline work, health and skills support to disabled people and those who are long-term sick. This funding will be used to set up and deliver services in the 3 chosen systems, including through a national delivery offer to support systems and facilitate learning and knowledge sharing.
7. Wave one of the health and growth accelerators will be the first ICSs to test a new delivery model that could ultimately be expanded across all systems, building a more personalised, pro-active, digitally enabled model of prevention. As exemplar sites, this first wave must effectively demonstrate that reducing health-related labour market inactivity can be done, while also testing the feasibility of broader implementation in the future.
8. The first 3 health and growth accelerators will be located in South Yorkshire, North East and North Cumbria and West Yorkshire.
9. NHS England has been working closely with ICSs on this plan and the 3 chosen accelerator sites for the first wave will all:
a. build the evidence that we can reduce health-driven economic inactivity at scale within the agreed timeline generating a fiscal return
b. enhance integrated working at system level and support the development of the Neighbourhood Health Service
c. improve the productivity of current NHS services
d. help to reduce health inequalities
10. Building on novel research partnerships with University College London (UCL) (using longitudinal survey data) and Office for National Statistics (ONS) (using linked administrative data on health, earnings and employment) the biggest drivers of economic inactivity have been identified and quantified: cardiometabolic, mental health and musculoskeletal (MSK) conditions. For example, 53% of people out of work due to ill health report mental health as the reason. Moreover, 80% of people with severe mental illness want to work but 6-8% are in paid employment. Preventing and proactively addressing these conditions, including the known issue of multimorbidity, have been selected as the target areas for health and growth accelerators.
11. Further NHS England work with UCL and ONS will build our evidence base on the multimorbidity combinations with the highest impact on economic outcomes and will incorporate deep dives into further areas. This will allow us to better target ill health related economic inactivity including in specific population sub-groups. Further modelling work is ongoing to better understand the impact of health conditions on pay and on benefit spending.
12. We are working with the ONS to assess the economic benefits of a variety of health interventions such as Talking Therapies, bariatric surgery, treatment for endometriosis, the diabetes prevention programme as well as the impact of elective waiting times on employment and earnings. This will support work with government and the OBR assessing the labour market effects of investment in health interventions.
Plan for the next few months
13. Programme delivery is underway and running at pace with a ‘go-live’ planned for April 2025. The selected systems have been engaged, working groups set up and detailed co-design of future services is taking place. Each system has a labour market outcomes target for 2025/26. Governance is currently being set up and funding flows and processes being agreed.
14. Health and growth accelerators will seek to transform service delivery, moving from treating illness to preventing it; from hospital to community-based care and from analogue to digital. As such, NHS England is working in close partnership with ICBs to deliver on core enablers including making better use of data and population health management to build more personalised approaches.
15. Accelerators present the opportunity to pursue a more radical digitalisation of service delivery for MSK and mental health. For MSK, local teams will be supported to identify and implement suitable digital MSK therapeutics, while the digitalisation of Talking Therapies will see national team members working with ICSs to identify suitable digital tools and/or therapeutics to implement. Some of these therapeutics can be targeted at specific mental health conditions, such as social anxiety disorder, PTSD, or depression.
16. The NHS England Workforce, Training and Education team is also closely involved in the design process, to ensure that workforce considerations and impact are considered throughout service design and implementation. These considerations will include the role of NHS England as a significant employer developing services that best support staff with health conditions to remain in employment and providing a supportive employment environment.
Looking to the future and aligning with other programmes of work
17. A key ambition for the health and growth accelerators evaluation is to help build a world-first evidence base on the impact of health interventions on labour market outcomes. The National Institute for Health and Care Research is leading on the evaluation of each service and on the data requirements for evaluation.
18. Through partnerships within communities, NHS neighbourhood health services will be driving towards a shift where organisations work together at a neighbourhood level to prevent ill health and provide easier access to healthcare. Accelerators will enhance the proactive preventative aspect of neighbourhood health services – again building up from locally determined initiatives, with national support. The outputs and learning from the Accelerator Programme will be used to inform how successful proactive initiatives can subsequently be incorporated into every ICS’s neighbourhood health model. As such, this programme is a key component of Neighbourhood Health’s proactive care agenda.
19. There is a clear relationship between mental ill-health and worse economic outcomes, as the Darzi review highlighted. Talking Therapies for anxiety and depression and individual placement and support were the first health programmes to successfully demonstrate to the OBR that they reduce economic inactivity. The accelerators create a good opportunity to align to these services and expand their impact, for example by investing in digital interventions that complement treatments or to aligning to at-risk groups such as those aged 18-25. Capitalising on the wider health and work agenda from here is also important to act on other drivers and opportunities, for example by using the NHS’s role as an anchor institution.
20. The key principles and learnings from the health and growth accelerators will be valuable in the development of the 10 Year Plan – in particular, how to operationalise the shift to prevention.
Publication reference: Public Board paper (BM/23/04(Pu)