The worrying privatisation of prevention

Walk into any Waitrose café, and you'll see them: thirty-somethings sipping lattes while scrolling private health apps. MyOnlineTherapy at £49 per session, Juniper for GLP-1s from £150 per month, and Regenerus for DNA screening from £249. Young people, disillusioned by 8.00am phone scrambles for GP appointments and worried about their physical and mental health, are fleeing from the NHS to a new generation of "PreventTech". Private video consultations, once a pandemic novelty, have become routine for under-35s, with apps like Fettle for sexual health checks from £29 per test and Push Doctor offering instant GP access for £50 a pop. These are the new badges of middle-class prudence. No wonder there's a 10,000-waiting list for trendy Neko.

Meanwhile, the NHS is backing off from prevention. Cervical screening coverage has plummeted to 68.8%, the lowest in a decade. Bowel cancer participation lingers at 67.6%. Childhood MMR rates are at 83.9%, threatening UK herd immunity. Smoking cessation services are mostly defunded. The NHS, once a global leader in vaccination, is struggling to vaccinate its own staff (with just 37.5% of frontline healthcare workers in NHS trusts) and is increasingly outsourcing herd immunity to Boots and Superdrug. Our COVID infrastructure, such as wastewater monitoring and Lighthouse labs, is closed down, so we are undoubtedly less prepared for the next pandemic than before. For most under-75s, COVID boosters now require a credit card. GPs, once community health sentinels, are reduced to referral clerks, their contracts incentivising throughput, not prevention. Only 52.6% of eligible adults completed an NHS Health Check between 2012 and 2017, with uptake 30% lower in deprived postcode areas.

For those who can afford it, prevention is an aspirational consumer choice. As Forbes Magazine put it, "longevity is the new luxury". For everyone else, it's a postcode lottery. 1.5m Brits are paying for their GLP-1 drugs while just 25,000 of the most extreme cases qualify for the NHS Tier-3 scheme. That's the most graphic illustration of the new two-tier prevention economy in action.

The private sector is still a long way from overtaking the NHS in terms of activity volume, but the point of singularity is drawing closer. The irony is as thick as a Greggs sausage roll. In upside-down Britain, we socialise the costs of disease and privatise the tools to avoid it.

Prevention, which benefits everyone through herd immunity, cleaner air, and healthier populations, is being stripped of its collective purpose. Heartbreakingly, this is just the time when "PreventTech" science, such as obesity drugs, brain health treatments and early diagnosis, is taking off.

Meanwhile, the treatment of disease, which could harness private sector efficiency for hip replacements or cataract surgeries, remains stubbornly socialised. Hospitals swallow 90% of NHS budgets, and preventable conditions like type 2 diabetes drain £14 billion yearly.

Nowhere is this perverse inversion clearer than in our food environment. Five companies control 80% of pre-9.00pm snack ads and fast-food outlets near schools have exploded by 59% since 2014, clustering in deprived areas like moths to a deep-fat fryer. Ultra-processed foods make up 57% of the UK diet. These booming junk food businesses are shielded by a Food Standards Agency that prioritises salmonella over sugar or salt, and a Competition and Markets Authority that shrugs off concerns about food deserts.

The "Prevention Divide" is accelerating health inequalities. For the wealthy, health is a proactive investment. Private screenings, GLP-1 weight-loss drugs, and fast-track appointments with Zoom GPs translate into longer, healthier lives. Boys born in the richest areas can expect to outlive those in the poorest by 8.4 years, a gap that has widened since 2001. Their children, too, benefit. The income-health gradient emerges by age two and persists through adolescence, with wealthier families reporting fewer and less severe chronic conditions.

Contrast this with the prospects for poorer Britons, who cannot afford private prevention in today's new health economy and often face hidden costs, longer waits, and more barriers even in the supposedly universal NHS. They are more likely to develop long-term conditions. 35% of men born in 1968-70 in the poorest households report a limiting illness, compared to just 11% in the richest. It's no surprise that there are 2.8 million people on the sick list.

The ten-year NHS plan is a chance to reset this madness. The 2025/26 planning guidance prioritised elective recovery (65% within 18 weeks) and A&E waits (78% within 4 hours), with no targets for vaccinations or dementia care. This is a chance for a reset. To do so, we must take four essential steps. Firstly, renegotiate GP contracts to reward population health outcomes, not just patient throughput. Let doctors lead community prevention, not shuffle paperwork. Secondly, flip the incentives to fund preventive services based on diseases prevented, not treatments delivered. Thirdly, stop demonising obesity. It's not a moral failure, it's a policy failure. Scrap "nanny state" finger-wagging and regulate the junk food flooding schools and high streets. Lastly, we must democratise innovation. For instance, we need a NICE for prevention, an A&E for mental health and a GLP-1 Access Fund to expand eligibility to 500,000 high-risk patients by 2026. If 1.5 million Brits can pay privately to avoid diabetes, the NHS can too.

This isn't idealism, this is pragmatism, and it mirrors the rhetoric of Wes Streeting before the election. The alternative is a future where your credit score determines your health, and the NHS exists to mop up the fallout. The ten-year plan must choose: keep playing firefighter, or start building firebreaks.

That's why I will be writing this week about the rise of PreventTech, great PreventTech companies and the "movement" to fight disease. I hope these can make a difference to government thinking. The alternative is stark. MUKHA, the British MAHA movement, will see the NHS social contract health blown up forever.

References

1. NHS Digital, Screening Coverage Statistics (2024) [https://digital.nhs.uk]
2. UK Health Security Agency, MMR Vaccine Coverage (2024) [https://www.gov.uk/ukhsa]
3. Diabetes UK, Cost Analysis (2024) [https://www.diabetes.org.uk]
4. Lancet Public Health, Fast-Food Outlet Growth (2024) [https://www.thelancet.com]
5. Food Foundation, Ultra-Processed Diets (2024) [https://www.foodfoundation.org.uk]
6. The King's Fund, NHS Health Check Uptake (2023) [https://www.kingsfund.org.uk]
7. Health Foundation, Smoking Cessation ROI (2023) [https://www.health.org.uk]
8. NHS England, GLP-1 Prescribing Data (2025) [https://www.england.nhs.uk]