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Pressure on our health and care services is building. More people are living with ill health, putting our frontline teams under immense strain and costing the economy billions. But without tackling the insidious causes of these rising levels, we will never improve the nation's health.At last month's National Institute for Health and Care Excellence (NICE) Conference, I took part in a panel exploring whether creating healthier communities can save the NHS.The answer is easy: Yes. It is obvious to me that the NHS will continue to struggle unless we invest more wisely across prevention and in an environment that supports healthy lives. As Sir Michael Marmot says: ‘What's the point of fixing people and sending them back to the things that made them sick in the first place?'The question for me though isn't whether healthier communities can save the NHS, but whether we are prepared to fundamentally redesign our communities, so people stay healthier for longer.For its part, the Government has committed to shifting from treatment to prevention and, last month, continued with the roll out of its 10 Year Health Plan by publishing new guidance on neighbourhood health. Local areas will spend the next year forming the foundations for their Neighbourhood Health Plans with the guidance setting out a path for Integrated Care Boards to work with local authorities and other partners to move health and care services away from hospitals into communities.As well as making it easier for people to access the NHS though, we must make sure that the Neighbourhood Health Plans consider the wider determinants of our health because only 20% of our health is shaped by medical care. The rest is shaped by the conditions in which we live, work, grow and play.By supporting people to find secure work, creating safer homes, making planning decisions that prioritise health or improving access to green spaces and affordable food, we are helping to protect our communities. These actions, together with fostering stronger social connections, are improving resilience and laying the groundwork for creating healthier environments for future generations to grow up in.Prevention initiatives cost far less than NHS interventions. Take obesity interventions for example. School programmes cost as little as £500 for each healthy year of life. In comparison, weight loss drugs can cost £20,000 or more for each healthy life year gained.Crucially, none of this can be done by one organisation alone – it can only be done through true collaboration and partnership working between local authorities, the NHS, the voluntary and community sector, local businesses and beyond.That's why across Cheshire and Merseyside, directors of public health and directors of population health have worked together to create our All Together Fairer Neighbourhoods Framework. Underpinned by six guiding principles, the framework is designed to bring together partners around a shared vision for local planning and health delivery. This includes working with communities to drive forward plans shaped around their needs and working together as one system to support shared ownership and responsibility for improving health outcomes. This approach complements improving access to healthcare with recognising that only by also supporting people to live healthier lives will the benefits to the NHS really be felt.While local action is paramount – and the Government's commitment to devolving power through local government reorganisation, devolution and the suite of NHS reforms is a welcome move towards achieving that – it needs to be backed by national resource.Prevention initiatives cost far less than NHS interventions. Take obesity interventions for example. School programmes cost as little as £500 for each healthy year of life. In comparison, weight loss drugs can cost £20,000 or more for each healthy life year gained.However, despite this clear cost benefit to investing in prevention, over the last decade, investment in public health, and in local government more broadly has decreased. And when there's not enough funding, it's no surprise that the services and functions we provide end up overstretched or overwhelmed. If we want to change that, we need to really think carefully about investing in our people and places.Ultimately, the NHS was never designed to create healthier communities. That is the job of local authorities and, if we want the NHS to be there when people need it most, we must work together to create the conditions that help people stay well for longer. Only then can the NHS be freed up to do what it does best.Professor Matthew Ashton is director of public health for Liverpool and board member of the Association of Directors of Public Health

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Putting prevention first

By Matthew Ashton | 09 April 2026

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