Superbug risks fail to dent attitudes to antibiotics

Antimicrobial-resistant infections could be killing more than 33,000 people a year in Europe.

Warnings about drug-resistant superbugs aren’t enough to change most people’s behavior on using antibiotics, according to a Europe-wide poll out Thursday.

The Eurobarometer survey reported seven in 10 people who received information telling them not to take antibiotics unnecessarily said it didn’t change their views on using them.

Excess use of the drugs is contributing to a growing threat of antimicrobial resistance and related infections. As germs multiple they can develop the ability to defeat the medicines designed to kill them — and those infections could be killing more than 33,000 people a year in Europe, according to recent estimates.

“It is ridiculous,” European Health Commissioner Vytenis Andriukaitis said in response to the fact that people aren’t responding to warnings, at an event in Brussels Thursday. “We have science on one hand and lack of trust on the other.”

“Unless we act decisively, immediately and together, we could face a public health and financial disaster,” he added.

The EU is failing to gain traction with its effort to get member countries to combat the rise of resistance.

The Eurobarometer survey showed the number of people who had taken antibiotics in the last 12 months fell from 40 percent in 2009 to 32 percent in 2017. But less than half of people said they were aware that antibiotics don’t work to treat viruses, and 20 percent said they take antibiotics to treat flu or colds.

Seven percent of people said they took antibiotics without having seen a doctor or getting a prescription.

Andriukaitis said the survey, which polled around 27,400 people in 28 countries, shows Europeans “are still not sufficiently aware of the dangers of AMR.”

A report from the European Centre for Disease Prevention and Control (ECDC) on Thursday raised particular concern about the rise of superbugs in hospitals and care centers — estimating there are around 8.9 million cases of health care-associated infections in European facilities each year, many of them caused by multidrug-resistant bacteria.

Brussels is largely forced to take a backseat to national capitals | George Frey/Getty Images

The ECDC said these infections are being fueled in part by overprescribing of so-called broad-spectrum antibiotics, which wipe out multiple forms of bacteria and are stronger than traditional, more targeted antibiotics such as penicillin. Prophylactic antibiotics, meaning those prescribed before a surgery in anticipation of potential infection, are also being prescribed for too many days, it said.

Meanwhile the EU is failing to gain traction with its effort to get member countries to combat the rise of resistance.

The Commission released a One Health Action Plan in 2017 that included guidelines on how to ensure prudent use of antimicrobials in people, and promised to promote global standards in areas such as trade. It also set aside funding for research to monitor and control potentially fatal infections, and develop new antibiotics or vaccines to combat transmission.

But the EU’s limited competence in health means Brussels is largely forced to take a backseat to national capitals. While governments such as the U.K., Sweden and Finland have made fighting antimicrobial resistance a priority, Andriukaitis said Thursday he’s frustrated the EU can’t be more effective.

“Our main goal is to show that the EU is a best practice region fighting against AMR. But it will be empty words if you do not have concrete instruments at member states level,” he said.

Last line of defense

One area the Commission has been able to push new rules in on the use of antimicrobials in farm animals.

Andriukaitis said he is expecting a “major breakthrough in a few days” when the Council of the European Union will greenlight new rules on veterinary medicines and medicated feeds. These are designed to phase out the prophylactic use of antimicrobials as well as preventing their use to promote growth in cattle.

The EU will also under the new rules ringfence a protected list of antibiotics for human-use only — part of an attempt to keep drugs that still work in humans from becoming obsolete.

Malta and Croatia were named for their poor performances | Joe Raedle/Getty Images

The proposed list, a joint effort between the ECDC, the European Medicines Agency and the European Food Safety Authority, is expected to be put out for consultation next month, according to the ECDC.

ECDC Director Andrea Ammon said at the event Thursday that getting patients, health care providers and national governments to cut down on unnecessary prescribing will take time but there is still a chance to limit the threat from AMR.

The ECDC’s efforts to monitor antimicrobial resistance country-by-country in Europe have been “quite powerful because no one wants to be at the bottom” of the list, Ammon said. The agency also visits European countries at their request to assess their national antimicrobial resistance plans and recommend improvements.

Eight European countries saw a statistically significant drop in public consumption of antibiotics between 2013 and 2017, according to ECDC data released Thursday: Finland, Germany, Italy, Luxembourg, the Netherlands, Norway, Sweden and the U.K.

One area the Commission has been able to push new rules in on the use of antimicrobials in farm animals | AFP via Getty Images

Malta and Croatia were named for their poor performances, recording increases in antimicrobial consumption in hospitals.

A report on antibiotic use in humans by the World Health Organization published Monday concluded Greeks consume the most antibiotics on average in Europe, with Italy, France and Belgium also named as having high use.

Improvements are “not something that will happen very quickly because this epidemic has built up over years and it will take some years until it goes down. It needs sustained efforts,” Ammon said.

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David Simmonds: The case for more investment in early intervention

The long-term dividends for individuals, local services, employers, and the Exchequer can far outweigh initial costs.

David Simmonds is a Conservative councillor in Hillingdon and trustee at the Early Intervention Foundation.

As we learn more about the long-term benefits of early intervention, the case for long-term investment becomes clearer.

The basic principle of early intervention is as straightforward as it is familiar: it’s better to step in early, when a problem first starts to appear, than to wait and deal with the consequences later.

When it comes to children’s development, from their earliest years through to their transition into adulthood, the long-term consequences of failing to act early can include an increased risk of mental health problems, poorer academic achievement, reduced employment chances, increased antisocial behaviour, risk of offending, and reduced adult relationship quality – which, alongside other factors, can simply serve to perpetuate the cycle from one generation to the next.

In short, too many children are facing challenges or disadvantages that can threaten their future life chances, health, and happiness.

While early intervention cannot solve every problem, it can substantially improve children’s lives, if it is delivered to a high standard to the children or families who need it most. It is vital now, today, to ask whether this is being done, or whether some fundamental changes are required so that effective, early support can be provided to all those who stand to benefit.

First, however, we need to come to terms with the wider benefits that effective forms of early intervention can achieve. Leaving problems unresolved in childhood doesn’t only impact on the lives of individuals and families – it also impacts on society and our economy, by undermining the wellbeing of communities and reducing people’s opportunities to live positive, productive, successful lives.

Intervening early is crucial. There are good grounds to believe that investing early rather than later will lead to cumulative benefits – that the skills children acquire when they are young will lead to greater additional gains as they get older. And these benefits are widely shared, accruing to the whole of society and the wider economy, not just to public services and government bodies.

This ‘pay-off’ may be particularly large where early intervention leads to labour market gains. For example, the Department for Education has estimated that individuals who achieve five or more good GCSEs have additional productivity gains (counting benefits to the individual, Exchequer, and future employers) of around £100,000 over their lifetime, compared with those with qualifications below this level.

The flipside to this potential benefit is the potential extra costs associated with dealing with the long-term impacts of problems rooted early in life. The Early Intervention Foundation (EIF) has estimated that the cost of ‘late intervention’ – covering expensive, acute services such as mental health support, youth justice, and tackling school absenteeism or domestic violence – is nearly £17 billion a year across England and Wales. Though clearly these costs cannot be reduced to zero, this does outline the quantum of resources that are wasted in tackling issues that could have been dealt with sooner, and where the long-term outcomes for society could have been improved.

In short, we know that the costs of intervening early are likely to pay off to society in the long run. The sums can be difficult to do with great accuracy, given the complexity and assumptions involved, but there is a wide body of research which suggests that the value of these benefits to society is often far higher than the costs of intervening.

Now, those of us who advocate for early intervention – among which I count myself, as a trustee of the EIF and long-time champion of local early help services – are sometimes tempted to raise expectations just one peg too high, to alight on early intervention as a means of saving money in local services this year or next.

Early intervention can achieve such ‘cashable’ savings, but that’s when commissioners are able to turn around and decommission services or settings that are no longer required. If early intervention succeeds in reducing demand on a local service, but this additional capacity is immediately soaked up in dealing with other demands – perhaps issues or cases that have simply been on the waiting list – then what looks like a gain may not appear on the bottom line.

Of course, this is still a gain, if front-line services can address a wider range of problems or focus more time on the most urgent cases, but that’s not the same as saving money. As my colleagues at the EIF say, early intervention is not a financial coping strategy for local or central government, and arguments that rest on the potential for short-term cashable savings miss the bigger picture – and risk undermining the good case altogether.

Is enough being done to capitalise on the potential of early intervention? We know that there are some longstanding, oft-cited barriers within the system – from familiar challenges around funding and political short-termism, to less familiar issues, like just how much of what local services provide remains untested, and thus has not been shown to be working, with empirical evidence.

In their new report ‘Realising the Potential of Early Intervention’ the EIF has made a bold case for change, including some fundamental changes to happen at the national and local levels. As they argue, there are resources in the system, but more needs to be done to understand what impact it is having, and what scope there is to redirect funding to things which are more likely to be effective.

In early intervention. as in all areas, public money must be spent in ways that are more likely to improve people’s lives and which build our understanding of ‘what works’ to better inform future decisions.

Andy Reid: The true test of any Minister for Sport is how they influence other departments

Davies faces an overflowing in-tray, but DCMS does not have the power to address many of the biggest challenges facing the sector.

Andy Reid was the Labour MP for Loughborough until 2010 and is director of the Sports Think Tank.

The arrival of a new minister is always a threat to continuation of a policy agenda – or an opportunity to rip up a failing agenda  and delivery, depending on your position. So this week the sports sector is coming to terms with its next ministerial appointment.

Tracey Crouch was well respected – the sector likes somebody who understands and has a passion for sport. She leaves with her integrity intact.

Sport has generally been an area of policy in Parliament with a large degree of cross-party consensus in my 21 years’ experience, so the there is good will ready to welcome a new minister.

However, there were signs that momentum was slipping and the delivery of a shiny new strategy #SportingFutures was stalling. It is always harder to implement a strategy than the preparation and launch. There had been moments when the sector felt Crouch could have done or said more when other departments made cuts – over the Healthy Schools Capital programme for example.

Over the years the most effective sports ministers have been those who know how to make the Whitehall machinery work for the sector – not those who ‘know and love sport’. You could sense the frustration from Crouch in her interviews that she wasn’t able to influence policy enough, even as the Minister responsible.

So, Mims Davies has a hard act at a personal level. But what will be in her in-tray?

The #SportingFutures strategy signalled a big shift away from sport for its own sake, and called for the sector to take on a much broader role in the eider physical activity agenda. Whilst this was largely welcomed, there has been a feeling amongst many that this may have tipped too far away from supporting the grassroots of sport – the 150,000 amateur sports clubs that make up the backbone of the sports infrastructure.

At the elite end of sport, the 2012 Olympics and cross-party support for Team GB funding has given us unparalleled medal success, which every government enjoys. But it has come at a cost, with mental health and bullying allegations now putting greater emphasis on athlete welfare. The drive to medal success has also meant many team sports have missed out on funding to get to the Olympics (and many non-Olympic sports not being funded at all).

One of Crouch’s last acts was to set up a £3 million Aspiration Fund to allow many sports that missed out an opportunity to compete again. It was a slight opening of the door for a more fundamental look at why we fund elite sport at Olympic level. We hope at the Sports Think Tank that the door is opened even more in the future. It will take political courage to accept we might dip in the medal table, but more sports with a broader impact should be competing at future Olympics

The issue of Safe Standing at sports grounds will continue to rumble this year. There is growing grassroots support amongst fans and the English Football League, and Crouch was softening the policy tone from the Department.

She also led the way on governance and duty of care. The new Governance Code for sports has had a big impact already, and Duty of Care has been embedded across the sector culturally, but still many of the recommendations of the Tanni Grey Thompson report have to yet to be implemented

The growing levels of obesity and lack of physical activity amongst children is probably the biggest issue facing the minister. According the ‘Designed to Move’ campaign, the next generation of children could be the first to see a decline in life expectancy by as much as up to 5 years. The new strategy has extended the remit of Sport England to children from age five and upwards (it was previously 16+) – but only outside of school.

The measure of the strategy is how ‘joined-up’ government is or isn’t working. The current funding methodology of giving primary schools around £16,000 each is largely felt to be ineffective. The investment is at about the right level – it’s the way it gets spent we would like to see changed. Whilst it’s another department’s responsibility, the true test for a minister is how they can affect cross-government working and spending.

Finally, the question of resources won’t go away. Austerity has had a big impact on local government spend on leisure – we estimate spending has fallen from a peak of about a £1.5 billion a year to just under £1 billlion last year. On top of this the squeeze on public health budgets at local level has taken out the ability to fund the physical activity commissioning. The Health Foundation and UKActive claim the Budget last week will take another £1 billion from the public health budget at a time we want to grow the preventive health agenda.

The loss of green spaces and the general public realm also impacts on activity and wellbeing, and the single biggest determinant of activity levels for individuals is their income status. So how a sports minister is able to direct the vast spending of other departments is their biggest test. The DCMS budget still remains tiny in comparison, even for sport.

Sports ministers are buffeted around by events like anybody else, anything from doping allegations and safe standing to the sale or non-sale of Wembley, whether or not these things are actually their direct responsibility. But the sport and physical activity agenda is no longer a nice to do around the edges. Our lifestyles are killing us, and the task of a sports minister, working with colleagues across government to get us all moving again, has never been more important.

Health groups warn Brexit drugs supply risk at code ‘red’

NHS providers, companies and patient groups warn of ‘widespread shortages’ if there’s no Brexit deal.

The U.K. government’s preparations for maintaining drug supplies in the event of a no-deal Brexit are so lacking that the warning level should be raised to “red,” a group of health organizations has said.

National Health Service providers, pharmaceutical companies and patient groups wrote to the government to warn that Britain is seriously unprepared to maintain access to medicines if there are border delays after Brexit.

In the letter to Health and Social Care Secretary Matt Hancock obtained by POLITICO, eight organizations say industry has done all it can in preparing for a cliff-edge Brexit — and that the government needs to take action to prevent widespread drug shortages.

“If this is the reality of U.K. government preparation for No Deal we do not believe that the current medicine supply plans will suffice, and we will have widespread shortages if we do not respond urgently,” the letter dated October 31 says.

Expressing support for Hancock’s “efforts to raise the warning level in Government,” the organizations say: “Only when we start to work through options will we all know where we are, but on medicines supply, on what we know and can glean from public information, we think we are at ‘red’.”

The groups calls on the government to be more transparent “and reveal what cover we have by therapy area and where there are gaps,” so that the signatories can “find further creative solutions to shortages, but we need the data to engage.”

They also request an urgent meeting in the form of a roundtable between ministers and industry.

A spokesperson for the Department of Health and Social Care said in a statement: “The Government is confident of reaching a deal with the EU that benefits patients and the NHS. However, as a responsible Government we are also preparing for a range of potential outcomes in the unlikely event of a no deal.

“As part of our contingency planning, we continue to work closely with pharmaceutical companies and storage providers to ensure the continued supply of critical drug and medicine supplies,” the spokesperson said.

The letter to Hancock is backed by, among others, the Association of the British Pharmaceutical Industry (ABPI), the Association of British HealthTech Industries (ABHI), the BioIndustry Association and the Brexit Health Alliance — a conglomerate of NHS, medical research, industry, patients and public health groups.

“When an incredibly broad group of medical organizations and bodies are telling the government we are at warning level ‘red,’ it shows the preparations government has made are both shockingly inadequate and woefully behind,” said Liberal Democrat Brexit spokesperson Tom Brake.

The government in August asked drugmakers to stockpile an extra six weeks-worth of drug supplies in preparation for delays in importing medicines, but companies have since warned storage will be a major hurdle.

Speaking Wednesday evening on ITV’s Peston show, Hancock said that in the event of six weeks of extra supplies not being enough, “then we will have to do things differently,” because “you can’t have stockpiles for enormous lengths of delays.”

“All of this is doable. It is difficult. There’s a lot of work going on already to make it happen,” he said, adding that the government is “building refrigerator capacity right now.”

Companies advising the government on how to maintain supplies after a no-deal Brexit have signed strict non-disclosure agreements (NDAs) barring them from revealing information.

Outlining the extent of potential disruptions at Britain’s borders, the letter cites reports that U.K. minister David Lidington told the Cabinet the Dover-Calais trade route could be limited to 12 percent of normal capacity for six months after Brexit.

The letter points to a recent report from the National Audit Office that concluded 11 out of 12 critical upgrades to IT systems at the border are at risk of not being delivered on time, and that there is a high risk of failure in the government departments’ border programs for “day one of no deal” due to their scale, complexity and urgency.

With much of the necessary infrastructure unable to be built before March, the timescale is too tight for companies to make the necessary changes, it adds.

This article has been updated to add Health Secretary Matt Hancock’s interview with ITV.

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“We need a radical shift in the NHS, from a hospital service for the ill, to a service to keep us healthy.” – Hancock’s speech, full text

“Over just the last year, emergency admissions at A&E have increased by 6.6 per cent. This rate of growth of demand is simply unsustainable.”

Matt Hancock, Health and Social Care Secretary, delivered the following speech today to the International Association of National Public Health Institutes.

We’re here to talk prevention. And if there’s one thing that everybody knows it’s: ‘prevention is better than cure’.

When I was thinking about prevention I looked into where this comes from. I’m told it was Erasmus, the 16th century Dutch philosopher, who coined the insight.

The irony was that Erasmus died suddenly from an attack of dysentery, which we now know is a wholly preventable condition.

The other person who can lay claim was Benjamin Franklin, who said: ‘an ounce of prevention is better than a pound of cure’.

And Franklin founded the first fire brigade in Philadelphia and made it one of the safest cities for fires in the world.

So prevention works. As the founding fathers knew.

Prevention saves lives and saves money.

Two of the biggest health successes of the 20th century had prevention at their core: vaccination and cutting smoking.

In the UK, both were achieved by careful and considered government intervention.

We didn’t outlaw cigarettes because blanket bans curtail personal freedoms and often have the opposite effect.

We encouraged better behaviour through informing the public and by stopping smoking in public places where it could affect the health of others.

We didn’t compel people to vaccinate against their will. We helped them see it was in their interests and everybody else’s too.

Ultimately, at the heart of our public provision for healthcare there’s a social contract. A social contract at the heart of our NHS.

We, the citizens, have a right to the healthcare we need, when we need it, free at the point of use.

But, we have a responsibility to pay our taxes to fund it, and to use the health service carefully, with consideration for others, and to comply with medical advice to look after ourselves.

Because the NHS is not just a service – it’s a shared stake in society.

Too much of the health debate in England has been about our rights: what we deserve, and what the NHS can deliver. And, of course, those rights are important.

But, I think we need to pay more attention to our responsibilities, as well as our rights.

Today, I want to talk about those responsibilities, and our task for the National Health Service to help empower people to take more care of their own health.

I want to talk about how we need to focus more on prevention to transform our health and social care system, save money, eliminate waste and make the extra £20.5 billion we’re putting in go as far as it can.

Because only with better prevention can our NHS be sustainable in the long term.

Over just the last year, emergency admissions at A&E have increased by 6.6 per cent. This rate of growth of demand is simply unsustainable.

But, of course, it’s not just about the finances. I want to talk about how preventing ill health can transform lives, and transform society for the better too.

That might sound radical. It is intended to.

The government-wide plan we are publishing today sets out how we need a radical shift in how the NHS sees itself, from a hospital service for the ill, to a nationwide service to keep us healthy.

Where those who work on the front line of the NHS including the GPs, who are its bedrock, feel confident to remind people of their responsibilities too.

So first, let’s talk about those responsibilities.

At the core of my political philosophy is a belief that the state has a duty to protect the most vulnerable in society, and an equally firm belief that we must empower people to fulfil their potential to be the best they possibly can be. From the education they receive in school, to the freedom they have to achieve in work.

And nowhere is this more true than with health.

Given this duty, our starting point is to ask: what contributes to living longer in good health?

The Prime Minister has set this question as part of the Ageing Grand Challenge – to seek five years’ longer healthy life expectancy by 2035.

The best evidence points to a 4-factor breakdown.

Around a quarter of what leads to longer healthier life is acute care – or what goes on in hospitals. The second factor is genetics. The third factor is environmental – things like air quality that an individual can’t control.

And the final factor is what people do – the choices they make, the lifestyle they choose.

Different people put different proportions on these four factors: but suffice to say they’re all important.

Yet currently, we spend the overwhelming majority of the £115 billion NHS budget on acute care.

Last year, we spent just £11 billion on primary care where the bulk of prevention happens.

Yet the combination of prevention and predictive medicine have more than twice the impact on length of healthy life.

That isn’t just the difference between life and death, it’s the difference between spending the last 20 years of your life fit and active, or in a chronic condition.

So our focus must shift from treating single acute illnesses to promoting the health of the whole individual. And from prevention across the population as a whole to targeted, predictive prevention.

So as the government is spending £20.5 billion more of taxpayers’ hard-earned cash over the next 5 years – the single, largest cash injection to the NHS ever – we must see the proportion of funding on primary and community care in the NHS rise. And that is exactly what will happen in the long-term plan.

But it isn’t just about the quantum of money. It’s also about reform.

I want to see people taking greater personal responsibility for managing their own health. For looking after themselves better, so staying active and stopping smoking.

Now, I want to address head on how we can do this without undermining people’s liberty.

Take alcohol. Like many people, I enjoy the odd glass of wine.

I support the budget in which we froze duty on scotch and beer. I don’t believe in punishing the masses to target those who need help.

Yet alcohol abuse puts a huge burden on the NHS. High-risk drinkers make up less than five per cent of the population, but consume over a third of all alcohol.

They’re more likely to end up in A&E. And drunk people are more likely to be responsible for abuse and violent attacks on NHS staff. I’ve seen it for myself. So we need action on alcohol that targets those who most need our support, without punishing those who don’t.

Likewise, we know that smoking contributes to 4% of all hospital admissions in England each year. And smoking costs the NHS around £2.5 billion each year. And this is despite the massive reduction in smoking over the past 30 years.

For smoking, the next step towards a zero-smoking society is highly targeted anti-smoking interventions, especially in hospitals.

If someone is admitted as a heart patient, and we know that stopping smoking could save their life, then we will do everything we can to help them quit, as they do in Ottawa.

This is a Canadian model I like the look of. I want to see bedside interventions in our hospitals so smokers who are patients are offered medication, behavioural support and follow-up checks when they go home.

And we need to fulfil our commitments to the obesity strategy, and set ambitious targets also on salt.

Salt intake has fallen by 11 per cent in under a decade, but if salt intake fell by a third it would prevent 8,000 premature deaths and save the NHS over £500 million annually. So we are working on new solutions to tackle salt and will set out more details by Easter.

Because focusing on the responsibilities of patients shouldn’t be about penalising people but about helping people to make better choices.

How do we do that? How can we empower people to take more care of their own health?

By giving people the knowledge, skills and confidence to take responsibility for their own health.

By using new digital technologies, to help people make informed decisions, with more access to primary and community care, and with more social prescribing, all aimed at stopping people from becoming patients in the first place.

So the second thing I want to talk about is how we must focus more on prevention to transform our health and social care system to save money, eliminate waste and get the best return on our extra £20.5 billion.

This isn’t just about empowering people to take more personal responsibility. It’s about reforming the system and harnessing new opportunities.

There are two new technologies in particular with the potential to change everything: the combination of artificial intelligence and genomics.

They promise the potential to unlock our genetic codes; and allow us to apply those codes to how we live our lives. To predict which of us are susceptible to which illnesses, to diagnose those already ill, faster, and to develop new tailor-made treatments to bring people back to health.

Together, they will transform medicine. We are finally now able to crack that genetic factor of our health.

We can intervene earlier. Save money on unnecessary and invasive tests. Eliminate waste by prescribing the right medication or the right treatment the first time round. And save NHS resources for people who really need it.

And this isn’t something that’s far off in the future. It’s already happening.

The new NHS Genomic Medicine Service is expanding.

In Cambridge, we’re at the cusp of sequencing the 100,000th genome, and are now aiming to sequence 5 million so we can diagnose rare diseases, more quickly and with fewer painful tests for patients.

The world-leading Moorfields Eye Hospital is working with the world-leading AI company Deepmind. Their AI system has made the correct diagnosis on over 50 different eye diseases with 94% accuracy – at least matching the best human experts. And that figure is only going to improve.

These technologies, and other new digital services giving targeted health advice, are starting to transform global medicine.

As it has been with every wave of technology for the last 70 years, the NHS must be at the forefront, embracing these new technologies and shaping them as they evolve and improve.

The NHS must go from being the world’s biggest buyer of fax machines to the tech pioneers of the future. And I know we can do it. Because we’ve done it before.

From 1796 when Edward Jenner developed the first smallpox vaccine, to 1928 when Alexander Fleming discovered penicillin, to 1950 when Richard Doll proved the link between smoking and cancer.

The next frontier of prevention is using the data at our disposal to predict who will be ill with what, and to get in there early.

The Prime Minister has spoken with great eloquence about the power of artificial intelligence to save lives by spotting cancer earlier – and we must do that.

But predictive prevention has a far broader application.

From diagnosing a susceptibility to dementia due to a vitamin deficiency, to motivating activity to tackle obesity, we can have better, more targeted interventions than ever before. Again, giving better results, and helping the NHS eliminate waste and save money.

Our aim is to prevent people becoming patients through personalised advice and intervention. Public Health England are leading the way on predictive prevention. They are bringing together a range of experts so we can scale up this pioneering work to a national level.

Now, I’ve talked about acute care, genetics, and choices. So let’s turn to the final factor in determining a healthy lifespan: the environment.

And this is linked to my third and final point: how getting prevention right will transform society for the better. Right now, we tend to think of things in isolation.

Pollution is seen as an environmental problem. Employment is something for the Treasury to worry about. And housing is either a public good or a private investment.

But health can’t work in isolation. Our health is affected by each and every one of those.

So a true focus on prevention means tackling the environmental factors that affect a person’s health too. It means a new drive for clean air, building on the successes of recent years in cutting emissions. Secure employment, building on the record number of jobs available now. Higher quality housing.

And it also means our GP surgeries, our hospitals, our care homes, our entire health and care system working more closely with local authorities, schools, businesses, charities and all the other parts that make up our communities.

It means employers playing a bigger role in helping their staff stay healthy and to return to health after illness. And we can learn from the excellent work of our military here.

Soldiers have an 85 per cent return-to-work rate after a serious injury, and they obviously have some very serious injuries. The equivalent rate for civilians is only 35 per cent. The reason why the military is better at getting people back to work is because they are more engaged in their workers’ recovery at every stage of the process.

Civilian employers must do the same. Employers have a responsibility to help improve the health of their staff and the nation. Each of us has a stake in our health and care system so each of us has a responsibility to work together to build a sustainable system. So, I want us to be open to new ideas and learn from other countries.

Like the Netherlands, for example. Where companies must demonstrate due diligence in their approach to the rehabilitation of sick staff and helping employees return to work.

To achieve this we need to strengthen the links between employers, their unwell staff, and the NHS.

That way, the challenge – for I never think of people as problems – doesn’t present itself at 3am at A&E.

Good health starts with the right pre-natal care, immunisation, nutritional support, fitness advice, minimising social media and mental health harms, secure employment, financial independence, safe housing, help with bad habits, friends and family to fight loneliness, careful and considered interventions at every stage of life into old age.

From cradle to grave, not just for the NHS, but for the whole of society.

Giving people responsibility for their own health. Empowering them to make the right decisions.

The best help when they need help. That is what getting prevention right means. That is the potential of prevention. That is the promise that it offers: a healthier, happier future for us all.