By 2040, the number of people in England living with major illness is projected to rise by 39%, three and a half times faster than the growth of the working-age population. This is not only a challenge for the NHS; poor health lowers labour market participation, reduces tax revenues, increases welfare costs and raises pension liabilities. The Office for Budget Responsibility identified population health as one of the greatest risks to the UK’s fiscal outlook.
Without change, public services risk being trapped in a cycle of crisis response that threatens their long-term sustainability. In this context, CIPFA, with support from the Health Foundation, set out to define, map and measure current levels of preventative investment. The aim is to build consensus around what counts as prevention and to test whether it can be tracked consistently across public sector organisations.
Public service reform across the UK
Shifting the system from treatment to prevention is essential. Reform must focus on building resilience in individuals and communities, addressing the root causes of poor health and wellbeing, and reducing the likelihood of future demand for reactive services.
In England, the 2025 Spending Review identified prevention, integration and devolution as three organising principles of reform. A £3.25bn fund has been committed to modernising services, but much of the emphasis still falls on efficiency and digital upgrades rather than redirecting resources upstream. The NHS 10 Year Health Plan also promises to move the service from sickness to health, but its approach to prevention remains largely clinical, with heavy emphasis on screening, genomics and digital monitoring. Wider determinants such as housing, transport and employment receive far less attention.
Scotland and Wales have made more progress. Scotland’s Public Service Reform Strategy recognises that reactive spending will become unsustainable as pressures grow. It commits to preventative budgeting, redesigning accountability around shared outcomes and embedding prevention into how resources are allocated. The Scottish Population Health Framework goes further by setting out a 10-year plan that adopts a ‘health in all policies’ approach across areas like housing, planning and transport.
In 2015, Wales embedded prevention in law through the Well-being of Future Generations Act, requiring public bodies to consider prevention and long-term thinking in every decision. A decade on, the Future Generations Commissioner warned that failure to move resources upstream amounts to collective self-sabotage, urging the government to create ring-fenced and growing prevention budgets backed by transparent reporting.
From rhetoric to reality
The case for prevention is not new. Governments have long promised to shift the system upstream, yet these ambitions have rarely been supported with the financial frameworks needed to make change happen. Activity follows money. If budgets remain tied up in reactive services, prevention will always remain a secondary priority.
That is why establishing a clear picture of current preventative investment is so important. Without understanding where money flows today, it is impossible to know the scale of the shift required or to chart credible pathways for reform. For finance professionals, this is not simply about measurement. It is about enabling better decision making, reducing future demand for reactive services and helping public bodies deliver better outcomes for communities.
The full report on preventative investment was published on 30 October
