An investment in prevention


By Dr Eleanor Roy, CIPFA Health and Social Care Policy Manager

As the peak of COVID-19 passes and lockdown begins to be lifted, albeit at different rates across the UK, many are reflecting on how well prepared we were and asking what more could have been done to prevent this?

The issue of prevention is something that we’ve been focused on for a while - and we will continue to shout about it from the rooftops! In order to ensure that those who need help receive it now and into the future, especially in the context of COVID-19, we must ensure that the ‘new normal’ has a much greater focus on preventative investment.

COVID-19 has highlighted the need for more investment and preparedness across the board – not just for health and public health, but also for all public services that play a crucial role in our communities. If we don’t make prevention a priority, we must at least consider the risks of not making such investments – perhaps problems with PPE supplies and underperforming track-and-trace systems?

If nothing else, COVID-19 has highlighted weaknesses in the resilience of public services – and exacerbated them to an, as yet, unquantifiable extent. That is not to say our public services have not made a heroic effort to meet the new expectations, but the support provided has not been in line with the challenges faced.

And we may not be out of the woods yet. Although we have passed the peak, we may yet have to face a second wave of COVID-19. This experience has brought home the stark reality that such outbreaks are not merely the problem of other nations – similar outbreaks are a very real possibility in the future – and we have learned that basing our preparedness planning on flu or flooding is not up to the task.

Internationally we have observed that countries that have encountered comparable SARS-like outbreaks in recent years have performed better, with preventative measures already firmly in place. With a change of mindset in how we view prevention – as a true investment rather than an easy tap to turn off - we can expect better outcomes in any future crisis. Even in the absence of a crisis situation, investment in preventative measures across all services can provide a reduction in future costs, a greater emphasis on good financial management and reduced demand.

The COVID experience has highlighted that prevention is not only about public health, it needs to be front and centre in other vital areas of public services. Adult social care has been severely impacted by the current crisis – but was already on the back foot, due to increasing demand, workforce shortages, a fragile provider market and significant levels of underfunding. Reform of social care funding has been a political ‘hot potato’ for decades – and is urgently required.

In approaching this, it must be recognised that this is an area where the right long-term preventative investments have not been made. While this was understandable in times of tightening budgets and intense pressure to meet immediate need, taking a more long-term preventative view and providing the financial headroom to do so, would go a long way to addressing increasing demand and workforce challenges, at least.

Homelessness and the lack of affordable housing is another area highlighted by the current crisis as suffering from a lack of preventative investment. In 2020, thousands of families are living in converted shipping containers, ex-office blocks or one-bedroom flats. CIPFA's Housing 360 suite of tools revealed that it will take 17 years to build enough properties to rehome the 1.2 million people currently on local authority housing waiting lists unless something changes.

Across all public services, when budgets are tight there is intense pressure to meet immediate need, but this approach squeezes out the preventative investment which would enable a more secure and sustainable footing to be reached. Rather it accelerates the next crisis, which in turn, requires another short-term fix.

We need to change the mindset around prevention – it’s not just a public health issue. It applies across the public sector and can improve outcomes as well as reducing demand for services and improving financial sustainability. We must look at investment beyond the political cycle, and look at the extent of preventative investment being made – and the future revenue obligations which will accumulate if it is not.

CIPFA and PHE have developed a framework with the goal of improving the evaluation of investment in prevention, which can be applied across all public services and allows for evaluation of the costs and benefits of preventative interventions in ‘place’ across organisational boundaries. Improving the evaluation of preventative measures on a consistent basis would lead to increased transparency and accountability and allow a clearer picture of the vital role of prevention in our public services.

Placing emphasis on prevention will help mitigate the heavy burden expected to fall on public services in the coming years, and safeguard them in the event that another crisis hits. As we begin leaving lockdown and entering into our new normal, prevention must always be at the forefront of our minds and our financial plans. COVID-19 has proven that it’s a tap we cannot afford to turn off any longer.

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  • CIPFA recently brought together its resources, insight and solutions regarding social care. These are easily accessible via the new Building Sustainable Social Care page. There you will find overall context, how CIPFA can help, and reports, publications and more to help you face the very considerable challenges, even pre-COVID-19, that professionals face. More information and support are still to come.

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