The Week 18 October 2024

As we end what feels like the 700th week of budget speculation, the ever-evolving world of NHS policy continues to provoke public debate. This week we saw the resignation of NHS England’s Chair, while Wes Streeting suggested giving Ozempic to the unemployed.

One thing is for certain: from banning smoking in pub gardens to embracing weight-loss jab Ozempic, this Government wants to signal a focus on public health.

While there is clearly a role for Ozempic in public health long term, its current position is ambiguous. Indeed, as our blog highlighted this week, pharmaceutical prevention can lead to?impressive results, but it is expensive. Nesta calculates that to halve obesity by 2030 with these drugs would cost around ￡16.5 billion a?year?– almost the entire NHS budget for prescriptions, and 4.5 times the public health grant (￡3.6 billion) for local authorities.

What’s more, early evidence shows the weight loss doesn’t always last – because people regain their appetite without a commensurate change in behaviour – further undermining the return on investment. Its cost is also why it’s mainly used by the wealthy who can afford it to pay for it?privately, rather than those who need it and cannot.

Nevertheless, the cost of the drugs will reduce over time, while the cost of (obesity induced) long term conditions will rise. But it’s worth saying that prevention in general is highly cost effective. Local authority public health?interventions?provide excellent value for money – for every ￡1 spent, they save the public sector ￡14 in?cash, costing significantly less than Ozempic at ￡3.6 billion a year. So while Ozempic may ultimately be good value, the question is: might other public health interventions be?more?good value?

Onto the read of the week..

To further avoid overwhelming readers with more budget anticipation – this week I am recommending something slightly different on the prisons crisis. Overflowing prisons in the UK have? illuminated a deep (and necessary) debate about how we deal with criminal reoffending, and the role this plays in our criminal justice system. Do we lock too many people up? Or do we lock the right people up and not do it properly?

Chris Atkins?– a documentary maker – went to prison in 2016 for tax fraud and wrote a compelling account of his time in?A Bit of a Stretch, which you must read if you haven’t. But his most recent book,?Time after Time, explores repeat offending through inside stories from people he met himself in prison. It is a unique insight into the complicated underworld of re-offending, presented in a funny, readable manner. It’s a must-read for anyone interested in an alternative perspective on the current prisons crisis.