Is prevention common sense?

18.12.2012

A few months ago on this blog Nesta's Ruth Puttick tentatively challenged the received wisdom, embedded in many a hackneyed phrase, that Prevention is always better than cure. Does a stitch in time always save nine? Will Horwitz from Community Links provides a response in this guest blog.

Well let's ask a harried local authority commissioner, budget shrinking, demand rising, needing to balance the books this year. Does he cut the acute service, leave the most vulnerable struggling and risk the vicious backlash of a scandal like Baby Peter as services buckle under the pressure? Or does he cut the preventative service, valuable certainly but a burden on this year's budget and yielding nothing cashable anytime soon, if at all? For that commissioner, cure seems better than prevention, a stitch in time might save nine but the jumper still works for now and that nine will be someone else's problem next year.

Or ask the police chief, who knows that repeatedly sending officers to respond a few families' crises is a tragedy for the families and a real burden on the force. She'd like to get all the agencies together and put some money on the table to work on preventing the next 999 call, but is afraid the others will grab it and run, leaving her force worse off with nothing to show for it. Carry on with curing then, not even well.

For decision makers across the public sector, desperately balancing this year's budget and working in strict organisational silos, prevention rarely seems better than cure, a point well made in Nesta's recent report on prevention and in the Early Action Task Force's report The Deciding Timepublished last week. In it we suggest these are two of the biggest blocks to reorienting the public sector around prevention. We make a range of recommendations to extend the horizon for decision making and blur obstructive organisational boundaries, including treating early action spending as an investment and plotting the ten year costs of spending review policies, but more prosaically and as a first step we need to know what we spend already, and how much it costs.

Because to answer Ruth's question in detail we desperately need more information. The Social Justice Policy Group estimated in 2007 (albeit with plenty of caveats) that 'social breakdown' costs the economy £100 billion a year, equivalent to 14% of annual public sector spending, or 7% of GDP. Barclays Wealth and New Philanthropy Capital found figures of similar magnitude earlier this year when they looked in detail at just three areas, chaotic families (£12bn per year), children with conduct disorders (£51bn), and mental health problems which lead to employment difficulties (£45bn).

There is an insatiable media thirst for exposing 'public sector waste' - every £500 of spending is now open to scrutiny. And yet this £100bn waste - socially destructive as well as economically profligate - is largely ignored in favour of hunting down first-class flights or expensive biscuits. Perhaps it's too large to comprehend, or thought too complicated to grasp or maybe the figures just aren't robust enough to be credible (I suspect it's a combination of all three).

Yet if these figures are true, the (surely undisputed?) social benefits of acting earlier to prevent social problems from arising go hand in hand with economic necessity. If we could ever afford to wait so late and then spend so much, we certainly can't now. Either way we'd know, at least economically, whether prevention is better than cure.

We recommend the Office for Budget Responsibility begin providing authoritative estimates of the costs of acting too late, and of the assets that could be created through an early action programme. They are already required to produce an analysis of the sustainability of public finances once a year; the Fiscal Sustainability Report looks at the long-term impact of government policies on debt, taking into account trends in revenue. They should widen this out, gradually if necessary, to encompass health, the environment and social policy.

On top of that, we recommend the Office for National Statistics begin recording how much is spent on prevention across various sectors, since we currently have no idea (except in health, where the figure scrapes in under 4%).

I believe prevention is almost always better than cure, but Ruth is right to question how we know this in every instance, and why the incentives on decision makers so often suggest the opposite. It's only by tackling these big barriers to prevention, starting with a lack of information, that we can know whether it's worth it and if so how to do it.

Will Horwitz is policy & media coordinator at Community Links and supports the Early Action Task Force.