Dr Connie Junghans-Minton
NAPC Faculty Member, Co-Lead CHWW National Programme
For years, people have framed prevention as a long game; morally right and socially desirable, but fiscally inconvenient or simply unfeasible while acute care struggles. Picking between saving someone from having a heart attack and doing more cholesterol checks earlier in the community is often the false binary choice that this kind of rhetoric invokes.
Many believe investing in prevention will improve lives, but they expect the financial return decades later – too late to ease today’s overstretched services. This assumption isn’t just outdated; it’s actively harming us.
In reality, well designed prevention, especially through Community Health and Wellbeing Workers (CHWWs), delivers rapid, measurable cost savings across health, social care and wider public services. The impact is not theoretical or generational; it materialises now.
The idea that prevention takes decades to pay off comes from a narrow definition. It focuses on deep-rooted risks like smoking, obesity, or heart disease, and long-term measures like vaccines and cancer screening. People often treat shortfalls as an information gap, fixing them with advice, signposting, campaigns, or screening drives. But the problem is rarely knowledge – it’s trust, priorities, or logistics. Screening and vaccination initiatives mostly target conditions that services care about, not broader needs.
Community Health and Wellbeing Workers© (CHWW) come from the communities they serve, working across health, social care, and voluntary sectors. They proactively support households to improve health and wellbeing. The role is comprehensive, working with the whole household and anything that may affect wellbeing; hyperlocal, focused on a defined geography of around 120–150 households; universal, with every household seen regularly regardless of need or characteristics, with support proportionate to need; and integrated, operating as part of the medical team integrated with local GP practices, wider primary care and community system rather than as a standalone service. This model began in Westminster and now operates in over 28 UK sites.
Vaccination and screening related prevention absolutely matters (and CHWWs do demonstrate significant increases on those quickly in communities traditionally badged as ‘hard to reach’) but is only one part of the prevention picture. What this framing misses is secondary and tertiary prevention; spotting deterioration early, stabilising people before they reach crisis, and intervening quickly when things begin to unravel. These are not slow burn investments. They change demand patterns within weeks or months as we are already seeing in the 4 years that CHWWs have been deployed in the UK. CHWWs operate precisely in this space: upstream of crisis, but close enough to risk that action has immediate consequences.
Take, for example, the lady who was suicidal caring for her housebound husband, socially very isolated with poor nutrition due to financial hardship and logistical issues. Within months, the tailored support and CHWWs building a team around a household, led to this lady cooking healthy food for herself and her husband, as well as volunteering in the community, taking up swimming and having a small local network of informal support, feeling very much happier. New diabetes averted? A nursing home placement? A suicide even?
Consider the young drug user who often visited A&E, lived in squalor, and got into trouble. The CHWW registered him with a GP, improved housing, and connected him to a local community group. He joined the Men’s Shed and started vocational training. Over time, his drug use and A&E visits faded.
CHWWs also find 12-year-olds managing hospital appointments, translations, bills, and family care. They neglect homework and play, unaware of the mental burden – and so does the family. When CHWWs bring help, everyone benefits, especially the child. That support can change their life: more peer time, better grades, and depression or anxiety prevented decades later.
Clear signals often precede the system’s most expensive demand. A person stops routine appointments, a carer becomes overwhelmed, or mental health declines with debt or housing stress. Medication adherence drops, or social isolation deepens after a major life event.
These signals are rarely visible unless we are present. It takes trusted professionals embedded in communities who have the time, relationships, and local knowledge to notice change early.
When deterioration is detected at this stage, the cost curve looks very different; A conversation instead of an A&E attendance, a rapid chat with the community matron instead of an emergency admission, a joint visit to the Primary Care Mental Health team, practical support instead of safeguarding escalation. Every avoided crisis represents immediate savings, not hypothetical future ones. CHWWs relieve pressure across the whole system. They do not simply shift cost from one part of the system to another. They reduce demand across multiple services simultaneously.
In Primary Care, we’ve seen fewer emergency appointments. In Westminster, A&E admissions dropped 7% within a year. That was with only 25% population reach, similar to Cornwall. Unscheduled GP visits fell, driven by unmet social or emotional needs. Care plan adherence improved, with fewer crisis-driven ED visits and shorter hospital stays. Readmissions dropped thanks to better discharge support and community connections. Mental health services saw increased uptake of talking therapy among groups who rarely used it before. Early support prevented escalation to secondary care; crises became shorter and less severe. Adult social care saw delayed or avoided care packages and reduced carer burnout. Wider services reported fewer police and court interactions. The list goes on.
One timely intervention can prevent multiple downstream costs across budgets. Health and social conditions often intersect, compounding deprivation. Prevention works fast during crises. When someone faces mental health, domestic stress, housing instability, or financial shock, effective support does more than resolve today’s issue. It prevents the next crisis. Stabilising today reduces tomorrow’s demand. Community-based responses deliver rapid returns: avoiding a crisis this month prevents another next month and reduces long-term dependency.
Return on investment is often underestimated. Traditional evaluations miss the true value of community health roles. Savings spread across organisations, benefits appear as avoided events, and outcomes include resilience, confidence, and capability – not just service use.
In Integrated Care Systems and new neighbourhood working, this becomes a strategic opportunity rather than a problem. CHWWs are one of the few interventions that naturally align incentives across health, social care, and the voluntary sector bottom up.
We need to start thinking differently about prevention. It is not just about changing lifestyles over decades. It is about shortening the distance between risk and response, acting before problems become pathologies and supporting people where they live, not just where services are delivered. CHWWs make the system more anticipatory, more humane, and more financially sustainable now, not in a generation.
Think of prevention as a pressure release valve. In the current climate, the question is not whether we can afford to invest in CHWWs. It is whether we can afford not to. They are not a future aspiration. They are a practical, evidence based response to today’s pressures: reducing avoidable demand, preventing crisis and delivering immediate value across the system. Prevention does not only pay off in the long term. When done well, it pays off right away. We owe it to ourselves and future generations to turn the National Health Service, currently struggling with an ever-increasing sharp end, into a Neighbourhood Health Service that focusses on health creation, wellbeing and offers the right support at the right time all the time.
