1. Rebecca Mason Knowsley Metropolitan Borough Council Simon Capewell University of Liverpool 8 th December 2015

2. Benjamin Franklin 1706-1790

3. Born out of the significant threats to public health funding: £200m cuts to public health grant to local authorities ACRA re-formulation of funding formula Concerns that reducing funding for prevention will have serious consequences for health and social care services in the future Attempts to quantify the opportunity cost of losing £200m in local authority public health funding

4. A tool that enables us to calculate what savings can be made relative to the original investment Closely related to benefit/cost ratio’s (BCR) Can be used to compare the financial efficiency of different interventions, and the return for different sectors

5. RoI easy to understand – for every £1 we spend on this, we expect to save £ X in 5, 10 years time RoI highlights savings across various sectors RoI provides a valuable tool for commissioners when attempting to engage partners in co-commissioning arrangements

6. Aim: to identify studies that calculated a return on investment or a benefit/cost ratio We identified 4985 potentially relevant titles Data extraction ongoing Aiming for January submission

7. Quality of analyses variable ROI values ranged widely Health protection interventions: median ROI of 10 (range 1 – 166) Health improvement interventions for children: ROI 38 (range 18-55) Health improvement interventions for adults: median ROI 6 (range 1-11) Wider determinants interventions: median ROI 8 (range 4-10)

8. Significant volume of evidence in relation to the ROI of vaccines: Single measles vaccine BCR of 167:1 MMR vaccine BCR 14:1 Flu vaccination of healthy workers (non health- care) 2:1 Systems to support reduction in HIV prevalence report a range of ROI values between 4-20

9. Significant volume of evidence, not all high quality Wide range of interventions focus on improving literacy, reducing obesity, health education, parenting programmes Very high quality evidence to suggest that the introduction of a tax on sugar sweetened beverages would give a return of 55:1 to health services alone

10. Programmes to reduce rates of coronary heart disease report ROI 10 Includes interventions to reduce prevalence of smoking, obesity, physical inactivity Tobacco control consistently reports an ROI of ~2 Ex-smokers tend to live longer than smokers, but with a higher prevalence of ill health requiring input from health and social care services

11. Emerging field of evidence Very wide ranging: 20mph zones, family interventions to reduce offending, literacy classes, road safety, urban planning Early results : ANY cross-sector investment in ‘public health interventions’ yields a positive ROI

12. Emerging evidence suggests that public health interventions offer substantial returns on investment, particularly universal interventions Interventions typically achieve an ROI of at least 6:1, and typically ROI 38:1 for interventions in children The proposed £200m cuts to public health budgets may cost the NHS over £1bn in the near future, with a further £1bn cost to wider services such as social care and criminal justice systems

13. Provide a supportive framework for public health teams when considering the impacts of funding cuts: Where can teams get the most bang for their ever diminishing buck Provides evidence towards increasing co- commissioning arrangements What returns can partners expect to see if they pick up some of the public health funding shortfall

14. ‘Health in all Policies’ within local authorities: Requires improved integration with wider local authority functions such as planning and children’s social care Public health as the leaders for system change and co-commissioning arrangements Devolution is a significant opportunity to look at public health and social care as a blank canvas: What joint investments can we make across our City Region’s to improve health and reduce demand?

15. Any Questions?

16. Thank you For more information, please email Rebecca.Mason@nhs.net