How do we make a reality of ‘prevention is better than cure’?
The LGA has consistently argued that the current social care and health system is unsustainable. It will buckle under the weight of demand unless we re-engineer our planning and service provision to protect health, prevent sickness and intervene early to minimise the need for costly hospital treatment and care.
Focusing on treatment alone is not the answer.
We need preventative strategies that mitigate or defer the need for costly interventions and, at the same time, deliver better outcomes for individuals.
There is now a political consensus – including recent commentary from former government adviser and Chief Executive of the Royal Society of Arts Andy Haldane – that our worsening national health is holding the economy and our communities back, with long-term sickness now one of the most common reasons why people are economically inactive.
If we are to make a reality of ‘prevention is better than cure’, it will require significant progress across six key areas.
First, health is more than just health care.
Health is often thought of as more of a concern for the NHS than for local government. As the All-Party Parliamentary Group for Longevity has said: “We have been caught in a false view that our national health means the NHS.”
The role of councils in tackling the causes of poor health is crucial, particularly given the strong focus on place and cross-sectoral working.
Second, adult social care has a significant role to play.
Despite the importance of adult social care prevention, there is an inherent tension between its level of priority and investment.
The LGA has long argued for additional funding to allow for better investment in, for example, falls prevention services, maintenance and adaptations.
This would also enable more investment into the voluntary, community and social enterprise (VCSE) sector, which provides important services such as befriending and post-discharge support.
Third, the Government should introduce a community transformation fund.
We recognise that providing additional financial support is challenging, especially given the current financial pressures. However, without some double-running of additional resources specifically for prevention, we won’t see the radical step change required to reduce impacts on the NHS and adult social care.
Fourth, we need to adopt a system-wide approach.
It is difficult for councils to build a business case to invest their scarce resources in initiatives where the financial benefits accrue to other agencies such as the NHS or the benefits system.
This can only be tackled by adopting a system-wide approach, rather than separate budgets for treatment and prevention operating in silos.
Fifth, we must address perverse incentives.
The healthcare system rewards hospitals for dealing with the very complications we are trying to avoid by increasing budgets or offering performance payments for treatment services at the expense of investing in prevention and early intervention.
Finally, we need greater understanding of what we spend on prevention.
We need a clear idea of current prevention spend across the system, and an aspiration about what the percentage of total government spend needs to be to improve health and care.
Unless we make the difficult choices now, the risk is that the healthcare system continues with business as usual, and any new resources are devoted to dealing with acute sector pressures – with no real change to the pattern of investment.
Future generations count, and we can, and should, make their lives better.
- The National Children and Adult Services Conference and Exhibition 2023 takes place in Bournemouth from 29 November to 1 December.