Prevention and Early Intervention: the last great untapped opportunity?

Advising my clients in local government at the moment can sometimes resemble therapy rather than professional management consultancy. They are facing the toughest budget setting round they will have likely experienced in their lives. Already having saved 30% over the past 3 years, they are now facing at least another 30%, and often more. Staying positive in these circumstances is a tough ask for both members and officers. Tensions run high; relationships are strained and staff jobs are at risk in the run up to Christmas. Being creative and bold is difficult; yet it is likely to be the only way that a sustainable future can even be imagined, let alone delivered.

One major opportunity area which I think has been neglected is in prevention and early intervention. This may seem a surprising claim – after all reablement in adult social care has been a real success; and troubled families in children’s services has also had good press.  What more can be done?

Actually there are still three huge opportunities, and we are helping our clients with each of these.

Firstly, there are still too many children being taken into care, and too many older people and vulnerable adults requiring support. We have shown that this demand is not inevitable. Our clients’ reviews of their own cases show that around 30% of the children being taken into care could have been avoided with better prevention; and a similar proportion of adults and older people. These budgets between them account for around 70% of local authority spending; a 30% reduction here is huge.

Second, prevention spending itself is hugely inefficient. Our analysis shows that it tends to be fragmented and not coordinated; often duplicative with many small interventions on the same individual or family; poorly measured and managed; targeting the wrong issues, and with a lack of accountability for improved outcomes. One example is in children’s services; the vast majority of family breakdown is caused by parental behaviour; but just a tiny fraction of the work done on ‘prevention and early intervention’ is aimed at actually getting these parents to change their behaviour.  Savings can be made here too; but more importantly reorganisation is required to ensure that it delivers. Our recently released map (for our INSIGHT mail subscribers) shows how this might be done.

Finally, poor interfaces with internal services and external agencies means that there is a lot of make-work, and wasted effort. One of my clients worked out that £1m of social work time was taken up assessing children where ‘no further action’ was taken. Similarly, our work has shown that staff in external (referring) agencies for vulnerable children think that, as a default, the right place to send a child if they have even mild concerns, is social care. Getting these behaviours right so that children and adults are helped in the right place at the right time would save another significant amount of money.

Overall, delivering these changes requires system leadership, a willingness to challenge traditional custom and practice, and confidence to believe that not only is demand not inevitable, but that public agencies can do something to prevent the needs arising in the first place.