On (dis)investing in prevention

The recent review into Sure Start children’s centres offers a window into a complex system: early years services. They were designed to bring a range of such service sunder one roof and improve access, often in the more disadvantages communities in the UK. Indeed, in my local government role I sat on a board for a local sure start centre, so experienced first hand the impact they could have.

The IFS report estimates that increasing children’s access to Sure Start “reduces hospitalisations at age 11 by 18 per cent of their pre-Sure Start level. That’s equivalent to preventing around 5,500 hospitalisations of 11-year-olds annually”. Yet despite their positive impact many have closed. Clearly austerity and the need to make budget savings is one reason for such closures. Yet why should this be the case?

The fate of SSCCs is illustrative of a number of challenges facing the prevention agenda as it relates to a complex social challenge: how to provide improve the life chances of young children aged between 0 and 5. These challenges illustrate why it is difficult to invest in initiatives that aim to prevent the worst effects of complex social challenges. Here are some of the more obvious barriers that prevent the investment in prevention:

Timescales the benefits to the child are only evidenced after a long time period so it’s difficult to evidence impact in the short term

Incentives the people making the decisions today are unlikely to be around in 20 years time when the generational impacts start to be realised so the incentives to invest in prevention are not salient 

Tyranny of proof there is no counterfactual with which to convince economists, public health experts of the efficacy of such a scheme – in other words, we don’t know what would have happened if the beneficiaries of the service hadn’t received it.

Funding lag the financial benefits of investing in preventative initiatives such as this are difficult to account for as they don’t pay back in the same year as the investment is made. Any benefits are likely to accrue in different parts of the system, to others’  budget lines – the product of being a complex social system. 

Budgetary pressures when local authorities are faced with cutting half of their budgets due to reduced funding from Whitehall, statutory functions such as education and social care had to be protected

Tougher eligibility criteria A lack of prevention means that not only are people’s needs continue to get worse but they have to be worse than ever before tough eligibility criteria are met. This is the only way service providers have been able to make budget cuts demanded by austerity

Complex systems don’t respect the neat service boundaries we set up to meet the needs of our bureaucracies, so one service’s  budget cut is another services budgetary pressure as demand goes up. 

Accountability clearly, the under 5s are a population segment that doesn’t have a direct voice for at least 13 years.  

Sometimes we focus intently on the need for new ideas, and yet if we dig back through the literature of the recent (and not so recent) past, we can excavate ideas and programmes which worked. Sure, they’ll need to be brought up-to-date for a changed context, but where the principles still hold, perhaps we shoudld look to the tried and tested as well as the new? 

The role of local authorities has been emasculated over the years, yet it remains a democratically-accountable body with a responsibility to local citizens for their local area. This responsibility used to range across the provision of services, the solving of local problems and shaping the future of their places, an emphasis that has shifted away from preventative services over time. In my mind, prevention and a long-term perspective should be the heart of our local public services. 

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