A stitch in time as the saying goes!
Obesity, unemployment, social isolation and violent crime – nobody wants to have these problems, yet they keep occurring and demand for services dealing with these issues keeps rising.
Most local councillors, medics, police and public service commissioners see themselves as problem solvers: they use their skills to identify and cope with people’s needs. An overweight child, a jobless young man, a woman with a violent husband and an isolated older woman need health services, job centres, appropriate policing, day centres or residential homes. But suppose the child does not become overweight in the first place, the man is able to find work, the husband is not violent and the older women is close to family and friends? They’d all be happier and less likely to need expensive services. Multiply this effect and the strain on public funds could be greatly reduced. Obesity alone costs the NHS more than £5bn a year. Preventive services should be a much higher priority. And that’s the focus of a unique venture by two south London boroughs that published their report on Monday: Local Early Action: how to make it happen.
The idea behind the Southwark and Lambeth Early Action Commission is to find ways to prevent these problems that ruin people’s lives and trigger demand for costly services. Leaving it too late and then coping with the consequences is bad for people’s wellbeing and a shocking waste of public funds.
The Commission consists of six prominent experts in the field of early action, and is chaired by Margaret Hodge, who championed preventive services when she was chair of the Commons public accounts committee. There have been plenty of initiatives aimed at preventing harm in various ways – Sure Start and the 5-a-day fruit and veg campaign, to name just two. But this is the first attempt to make early action a strategic priority for local councils and their partners in healthcare, policing and the voluntary sector, so that it shapes everything they do and how they spend their money.
The chancellor’s axe will fall heavily on local government again next week. Lambeth and Southwark expect their core funding to be whittled down by more than half and between them are facing a budget gap of more than £150m.
The effects of the cuts are paradoxical. Service leaders will be driven to pare down their activities to the bare bones, so that they only manage acute crises for the neediest and most vulnerable – the very opposite of early action. Yet they are increasingly aware that a preventive approach is the only viable response to the massive cuts that confront them.
The commission finds that most local problems that raise demand for services share the same underlying social and economic causes. Problems are best prevented not by launching new initiatives or by “nudging”, but by changing systems: institutional arrangements and what are thought to be “normal” ways of working.
While some of the underlying causes, such as poverty and inequality, need to be tackled at national level, there is plenty of scope for local early action. Councils must find out how much they spend on activities to prevent problems and how much on coping services and then commit to shifting a sizeable chunk of spending towards prevention each year.
The report cites more than 30 practical examples of early action in both boroughs and beyond. In Southwark, there’s a scheme to keep fast food and betting shops off the high streets using planning and licensing laws. In Lambeth, there’s a large lottery-funded partnership that aims to give a better start in life to 10,000 babies born in the borough over a 10-year period. Across both boroughs, new local care networks are working to join up local voluntary groups and public sector professionals so that everyone who comes into contact with older people can pick up problems at an early stage and offer help to prevent them from getting worse. These examples show what’s possible, but they are still the exception, not the rule.The report says early action must become the standard way of getting things done. Most councils are desperate to find ways of improving residents’ lives and saving money at the same time. A wholesale shift to early action is the only way of hitting both targets.
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