Domain 1: Preventing people from dying prematurely

NHS Commissioning Assembly logoThe content on this page has been co-designed and developed by NHS England’s Clinical leaders and local commissioners, who are members of the Quality Working Group and tasked with leading the development of the Quality agenda for the NHS Commissioning Assembly.

Key issue

Currently, England’s rates of premature death are worse than those in many other European countries for big killers like cancer, heart and liver disease.  There are also significant inequalities between different communities and groups within England for both overall life expectancy as well as the quality of health people can expect to enjoy towards the end of their life

The NHS should be preventing people from dying prematurely by promoting good health and discouraging decisions and behaviours that put your health at risk, but where people do develop a condition, diagnosing this early and managing it in the community so that it does not deteriorate

Areas of Action

We have identified a set of key areas for action.  These are actions which will need to be taken forward in partnership between NHS England, Clinical Commissioning Groups across the whole commissioning system, and other partners such as Public Health England

Local case studies

Please click on the links below to access examples of good practice that area teams and local CCGs have supplied. Note:  we will be continually updating and building this list of case studies with examples of good practice supplied by local CCGs.

  1. Nottingham City: Prostate specific Antigen service
  2. Erewash: Atrial Fibrillation Detection Programme
  3. Thurrock: Introduction of Telehealth
  4. South London: Screening Programmes/development
  5. Leicestershire & Lincolnshire: Adoption of jointly Created Decision Architecture
  6. Leicestershire & Lincolnshire: Collaborative Commissioning with CCG’s
  7. Hertfordshire & South Midlands: MMR Catch up campaign
  8. Norwich: Healthy Norwich
  9. Birmingham South & Central: BSC Community Gynaecology & Direct Access Ultrasound
  10. Coventry: Improving COPD Care
  11. NHS England: Specialised Services

Key resources to support local plans

  • NHS Indicator portal – access CCG outcome indicators data here, for each domain
  • CCG outcomes tool and explorer – The CCG outcomes tool allows users to view maps, charts and tables of individual outcome indicators across CCGs, and to view a spine chart of all the outcomes for one or more CCGs. The CCG outcomes explorer allows the user to explore the relationships between two outcomes or between demographic information and outcome

Further resources are currently in development and will be coming on-line here from mid-October

Maximising the contribution that the NHS can make to preventing disease

The NHS has a major role to play in the prevention of early death, alongside Public Health England, local authorities and others.  The NHS for example provides Health Checks, which aim to help prevent heart disease, stroke, diabetes, kidney disease and certain types of dementia by spotting the early signs and preventing deterioration.    NHS services must also take the opportunity of every contact with patients and service users to support people to live healthier lives, pointing them towards stop smoking services, advising on alcohol consumption and promoting physical activity.  It also employs 1.3million staff and has a responsibility as an employer to support staff to keep healthy.

Finding the ‘missing millions’ and diagnosing earlier and more accurately

It is estimated that millions of people in England are living with undiagnosed diseases.  There is a huge opportunity for the NHS to prevent people from dying too soon by diagnosing conditions as early as possible and getting them the treatment they need before the condition worsens.  Cutting edge scientific and technological advances are improving diagnosis and treatment, and the NHS, particularly general practice, needs to proactively seek out those people who are living with unidentified illnesses which could be treated.

Treating people in an appropriate and timely way

Once someone is diagnosed early and accurately they need to be managed and treated appropriately to prevent early death.  Establishing how far advanced the disease is at the point of diagnosis (risk stratification) helps to tailor treatments to the individual.   NHS providers should be implementing best-practice guidance (such as NICE guidance). Rehabilitation after episodes of ill-health or deterioration of symptoms is important in seeking to reduce the number of people who die from their conditions.  More radical change in terms of how care is delivered can have a significant impact on outcomes.  For example, stroke services in London have been reconfigured to improve management of specialist stroke services and provide 24 hour access every day of the week to medical specialists.  Similar service redesign in other services will be essential over coming years.

Addressing unwarranted variation in mortality and survival rates

There are significant inequalities across the country in life expectancy and people dying too soon. For example, more than twice as many people from the poorest backgrounds die of circulatory disease than those from the most affluent backgrounds.  There are also inequalities associated with ethnic background and gender.  By targeting and tackling these inequalities, the NHS has a real opportunity to lower the rates of early death in England.

Reducing deaths in babies and young children

Infant mortality makes up 60% of deaths in childhood.  To reduce such deaths, our goal must be to prevent extreme prematurity and improving perinatal care. Understanding the range of clinical, social, economic and environmental factors contributing to premature birth will be important, as will early diagnosis of congenital abnormalities, through the 20 week anti-natal scan and understanding maternal history.  To reduce neonatal mortality and stillbirths we need to identify risk factors in mothers, and at a population level, understand more about the causes of such deaths.  In older children, aged 1-14, cancer is the biggest killer. To reduce deaths, which are slightly high in England compared to the rest of Europe, the NHS must ensure prompt and accurate diagnosis, referral to specialist teams, and that patients get the right treatment.