The writer is chief executive of the think-tank Demos
The UK state is stuck in firefighting mode. Brexit, the pandemic, Russia’s invasion of Ukraine and the cost of living crisis have bent it into an entirely reactive mindset, responding frenziedly to whichever new disaster is tearing through the country. The state is now wired to service problems it can’t ignore, rather than to take preventive action and address the underlying causes of those issues.
But the repercussions of this reactive stance run deep. Budgets to support families have been cut and the cost of children going into care has risen. The prison population is creeping up again. Obesity rates have soared, fuelling cancer, heart disease and the rapidly escalating diabetes crisis.
Periodically, there are calls to address this. Earlier this month, an NHS review, led by the former health secretary Patricia Hewitt, called for a 1 per cent shift in health funding towards prevention. “There will never be a perfect time to shift the dial towards focusing more on preventive services,” she wrote. Hewitt pointed out that unless we act now, we will simply push an older and increasingly unhealthy population into hospitals which cannot cope.
Few would argue with that. But what if, instead of prevention being an afterthought, it was at the heart of public services? There is a case for three system-wide public services reforms to help focus on prevention.
The first should target the human and local. We need partnerships with communities to produce social capital as a powerful mitigating force. The Wigan Deal, in which the council and the community informally agreed to work together to create a better borough, is one example of this. As part of this social contract, formed in 2011, the council invested £13mn in local residents’ ideas such as community co-operatives, sports initiatives and start-up investment in schemes such as Wigan Men’s Sheds, a community business designed to teach new skills and reduce social isolation for men. Wigan subsequently added seven years to healthy life expectancy in its poorest neighbourhoods, while life expectancy stagnated in the rest of the UK.
The Community Wealth Fund is an attempt to scale this idea by investing cash in abandoned neighbourhoods. Formed out of a campaign involving over 600 civil society, public and private sector organisations, last month the government announced the fund will receive a share of dormant bank account assets.
The second reform considers how public services use data. A recent report by Tony Blair and William Hague makes the case for data-sharing across the state to improve outcomes. Of course, there are privacy risks to consider but we have to grasp this nettle — with the right safeguards. If we had joined up data across public services, authorities would be able to better identify where demand might grow, and target support earlier.
The third reform should tackle the spending question. Prevention needs a different funding stream so it isn’t competing with demand-led costs. Treasury orthodoxy prioritises known costs over the more risky long-term spending that prevention will require.
There are currently two categories of Treasury spending but we are developing the idea of a third funding stream: Prevention Investment Expenditure, allocated solely to long-term preventive measures such as investing in neighbourhood infrastructure to enable that protective social capital to flourish. A version of this has been piloted in the NHS, and local government has called for a fund along these lines. But to be truly transformative it needs to be baked into Treasury thinking.
Wigan’s success shows this is not the moment for defeatism. With a general election nearing, there is an opportunity for the parties to make prevention a unifying new model for reforming public services. We need a radical reset of the state to focus on stopping, rather than servicing, the suffering of an increasingly beleaguered population.
