Prevention is better than cure. It's an old adage but one that few would disagree with, particularly when talking about health and social problems. Done well, it can also save money. So why then does the vast majority of state funding still go to dealing with people in severe, immediate and acute need? And why does so little go to intervening earlier to prevent people from reaching that expensive crisis point? On schemes like investment in early years, or with NEETS, offenders or people with mental health problems? Why, for example, does 80% of NHS spending on treating diabetes - a disease which costs the UK £23bn per year - go on treating complications which could have been prevented?
On 28 November, the Early Action Task Force, of which I am a member, published its latest report, The Deciding Time. The report seeks to answer some of these questions as well as putting forward some proposals about how to bring about change.
There are many reasons for the failure to invest in early intervention and no one solution to this complicated problem. One of the big issues is the way in which government tends to think about early action. It fails to distinguish between money that is spent on preventative care - an investment that pays off - and that which is spent on acute need, which, however desirable, does not reduce future expenditure let alone avoid unnecessary suffering. The Task Force report proposes some radical but sensible changes, for example, to technical issues such as the way in which spending of different types is defined and monitored.
A further problem is the fact that the financial benefits of early intervention are rarely reaped by the part of government that pays for it. When social services invest time and money to reduce the number of children in care, the long term savings are made by the health service and the criminal justice system, resulting in a constant tendency to under-invest in early action. The deciding time recommends ways to break down these silos and encourage joint working.
There is also this conundrum: if we give a homeless person a room for the night, we can see it, count it and know it happened. When we try to intervene earlier in that person's life with the aim of reducing their chances of ending up homeless, we cannot be certain that they will avoid homelessness. Given that uncertainty, the bias will always be towards the certain output (helping a homeless person by providing a bed for the night) and away from the early preventative action.
These problems are not new, nor will they go away any time soon. There is an inherent uncertainty about preventative early action that will never be true in addressing acute needs. As the report says, it is harder to judge an action that aims to stop something happening than one that just does things. But we can certainly do more these days to understand which early interventions work, how effective they are and how much they can save us in both cash and societal terms. Many organisations, including the one that I run, NPC, can help assess this sort of thing. The report suggests a variety of ways to strengthen this evidence base.
A major challenge is how to switch resources from acute to early action. If preventative services work then we won't need the same levels of acute care - but we can't stop paying for these services as they will always be needed to an extent. The net result is the need to pay for both at once - not a tempting prospect in current financial times. This is, I think, the most thorny issue. It would be unrealistic to believe that we can move quickly to a better balance; there needs to be some kind of long term commitment to move a proportion - say 2 or 3% - of spend in this way each year. Over time that would lead to a very powerful change.
It is estimated that 80% of reduction in public expenditure has yet to hit the front line, and in the current economic climate spending will remain rationed for a long time to come. This means that making the right choices about investment is more important than ever. The message from the Early Action Task Force is loud and clear: to really make expenditure sustainable, as well as create a better society, switching more spend to early action is key.