Exploring preventative investment in local government

By Dr Eleanor Roy, CIPFA Health and Social Care Policy Advisor and David Finch, Assistant Director, Healthy Lives, Health Foundation.

Over the next two years CIPFA will be undertaking a project, supported by the Health Foundation, to explore the extent to which local authorities’ spending on preventative action can be quantified, with the aim of increasing the transparency on levels of preventative investment. 

When it comes to improving population health and reducing inequalities, prevention is indeed better than cure. Prevention is often thought of as a healthcare issue, but good health is not only dependent on the NHS. Our health is shaped by a range of factors including our early life, the work we do and the income we earn, the education we receive and the homes and places we live in. Our public services are interconnected and almost all have a role to play in investing in good health as an asset and in preventing ill health.

Councils play a vital role. As place-makers they provide a range of services which shape the building blocks of health – housing, education, public health, social care, transport to name a few. Many of these services can be preventative, both in keeping their population healthy and in averting the need for more complex and costly acute interventions, either by councils themselves, or wider public services. 

Few will argue against preventative action. But, in the current climate, there is a tendency towards more reactive, short-term responses, with resources being targeted towards immediate pressures. Unfortunately, long-term investment is often seen as an easy tap to turn off. While this may ease short-term pressures it fails to recognise the long-term consequences. A twin track approach is necessary to ensure services can deal with immediate pressures, as well as making the long-term investments that can ensure services are financially sustainable, provide value for public money and improve outcomes for population health and reducing health inequalities. So how can greater preventative action be supported? 

As highlighted in previous work on evaluating preventative investments, the key to putting a greater emphasis on prevention is understanding the current position and the future implications of not making such investments. 

Yet most councils, like other areas of the public sector, have no clear picture of how much they currently spend on preventative action. Having a local view of how much is currently invested in prevention would: 

  • support better evidence-based decision-making on use of resources,
  • increase transparency and accountability for how resources are invested,
  • improve incentives to invest in prevention relative to acute interventions, including where costs/benefits fall to different organisations,
  • improve communication and reporting to local citizens in a meaningful manner.

There are significant challenges in identifying such spend, including classifying what constitutes preventative action and the ability to capture spending under relevant categories. This project, supported by the Health Foundation will conduct exploratory work with partner councils and wider stakeholders, seeking to build consensus on a definition and scope for preventative action against which services/programmes could be mapped and then seeking to identify current levels of spending against those criteria. 

The aim is to increase transparency on levels of investment in prevention, add to the evidence base for decision-making on issues such as the balance of reactive versus preventative spend and to build the case for a greater emphasis on preventative action. On a wider scale, we hope that learning from this work will help to inform guidance and best practice for the wider public sector, to assist in conducting similar exercises and to contribute towards the ambition of building a complete picture of preventative investment across all levels of government.

The Health Foundation is an independent charity committed to bringing about better health and health care for people in the UK.

This article originally appeared in the October edition of PF Magazine.

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