HealthSpan: moving towards a sustainable NHS
On 21st May 2018, Theresa May gave a speech on science and modern industrial strategy, and for the Healthy Ageing grand challenge she says “we will ensure that people can enjoy five extra healthy, independent years of life by 2035”. Ultimately, this will improve people’s lives. In achieving this, lifetime healthcare costs will be reduced for those additional five years that people are live in good health.
How will we know if we have reached that aim? Until now, there has been no current systematic measure of years of healthy life. Existing measures such as healthy life expectancy, QALYs (quality adjusted life years) and others are usually based on survey data for a sample of population who rate their own health. If we are to make strides in improvement, what is needed is an objective and data-driven measure of a population’s healthy lifespan.
There is no doubt that people living in good health for longer is a good thing. Dr Alexander Finlayson, GP and Nye Health Founder, described this life-course trajectory as a “square-wave”. Rather than seeing an inevitable down-hill trajectory in our health status and spending many years in poor health, our ambitions as a health system should be to keep people well for as long as possible. This is not a new concept. ‘The compression of morbidity’, introduced to us by Sir Muir Gray, has been described by Professor James Fries. Fries’ hypothesis is that ‘the burden of lifetime illness may be compressed into a shorter period before the time of death, if the age of onset of the first chronic infirmity can be postponed’. Extending lifespan, without extending our “healthspans”, will also only lead to a health system we can’t financially sustain.
There are early indications and reports that populations are acquiring illness earlier in their lives:
- A recent Public Health England report found that strokes are occuring at a younger age;
- Blood Pressure UK reported that more people are being diagnosed with hypertension in their 30s, 40s and 50s;
- Type 2 diabetes is reported to be continuing to rise in children and young people in the UK (Candler, TP. et al. Diabetes. Med).
- Cancer Research UK analysis shows that age-standardised incidence rates for cancers in young people increased by 33 per cent in the UK between 1993-1995 and 2013-2015.
In addition, last week The Times published an article showing as many as a fifth of people may suffer from poor health before the age of 30. A shocking headline. The less shocking but equally important headline is that nearly a fifth of people are living to well over 70 in good health. This early analysis also shows that prolonging healthspan nationally by a year could give 1.3 million people an extra year of good health, saving £3.4 billion a year. Extending it by five years could gain 6.8 million extra healthy years and save up to £17.1 billion.
Population segmentation approaches that are starting to be implemented across the country are looking at the ‘healthy’ population as a distinct group. The National Association of Primary Care (NAPC) has developed a population health management approach, which includes people who are ‘generally well’, as part of its Primary Care Home programme – a new care model that has over 200 sites across England. Identifying this population cohort is the first step to improving HealthSpan.
In a Royal College of Physicians Future of Healthcare paper by Ooutcomes Based Healthcare CEO, Dr Rupert Dunbar-Rees, he describes that “commissioning and payment mechanisms that underpin moves to sustainable care are essential enablers to get right”. Measures such as HealthSpan that often require years to be impacted can be further supported through long-term funding and reimbursement – enabling a ‘true’ currency for prevention.
Monitoring and analysing HealthSpan will now allow health systems to derive insights to understand their healthy populations, and ages at which conditions are first being diagnosed. Further stratification can identify those most at risk of deteriorating health, and the contributing features. Measuring HealthSpan supports more personalised and innovative approaches to reducing the incidence of disease before it occurs, keeping people healthy longer and reducing the overall burden of illness and lifetime cost of healthcare. Just one great example of how digital behaviour interventions are being used to prevent type 2 diabetes is the pilot programme of the NHS Diabetes Prevention Programme. Proactively focussing on the currently healthy population paves the way for a systematic shift to primary prevention, a more proactive health and care system, and one which gives us a chance of a more sustainable health and care system.