Investing in prevention

As the world’s only accountancy and standard-setting body dedicated to public services and public financial management, CIPFA is in a unique position to support and empower public sector organisations towards closer collaboration, with an emphasis on prevention to improve population health and wellbeing, as well as ensuring our public services, and the public finances, are resilient and sustainable now and for future generations.

The sustainability of public services requires a change in mindset

The case for change is undeniable, as demonstrated in Performance Tracker 2023, which found: “Public services that have for years been creaking are now crumbling. The public is experiencing first-hand the consequences of successive governments short-term policy making.” Such short-termism can clearly be seen in the imbalance of acute versus preventative action in recent years.

As highlighted in CIPFA’s work on Integrating care: policy, principles and practices for places, continuing on this path will necessitate the need for short-term fixes in the future if we do not transform services and invest in our health as an asset and to relieve future pressures. A twin track approach is required to ensure that places are adequately funded to deal with the existing pressures they face, as well as making such investments to ensure public services are cost effective, achieving best value and are financially sustainable to meet future needs.

However, in the face of immediate pressures, such long-term investment in prevention can often viewed as being an easy tap to turn off. In Evaluating preventative investments, in addition to providing a framework for evaluation, we called for a change in the mindset around prevention, to consider it as a true investment – in our health as an asset, and the future of public services.

There are an increasing number of voices calling for a re-think on how we shift the emphasis towards prevention. It will demand innovative solutions to consider how we can allocate existing resources more effectively to prevent ill-health. Not only is this good for the health of the population, but also for the stability of the economy, sustainability of our public services and the resilience of our communities.

Exploring preventative investment in local government

If we want to build a healthy society, we need to prioritise the conditions and resources that support good health and enable us to thrive. These factors are known as the building blocks of health. They include clean air and safe surroundings, stable and affordable housing, and adequate money and resources among others. Ensuring these building blocks are in place is a key part of taking a more ‘upstream’ preventative approach for growth and development for all.

Local government play a vital role, providing a range of services which influence these building blocks. Many of these services are 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.

Good financial management requires making evidence-based decisions on the allocation of public money. However, there is one vital piece of evidence missing for prevention. Most councils, like other areas of the public sector, have no clear understanding of how much they currently spend on preventative action.

Following previous work on evaluating preventative investments, CIPFA is working with the Health Foundation to explore the extent to which council spending on prevention could be quantified. Working with partner councils and wider stakeholders, this work will seek to build consensus on a definition and scope for preventative action against which services and programmes could be mapped, and current levels of spending identified. The aim is to increase transparency on levels of investment in prevention and 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 for preventative action.