The National Audit Office have been looking at what they call early action and their report across quite a broad landscape is a positive endorsement for trying to intervene earlier in the course of preventable social and health problems.
Their definition of early action is I think quite helpful to our field, drawing together as it does prevention, early intervention and early treatment.
They reiterate that early action has been a theme of the government’s strategies across a number of departments but argue that there has not been a shift of central government resources to match the rhetoric, and that increasingly the decisions in this area have been devolved to local policy makers.
This localisation is seen as both a threat and opportunity with many local policy makers looking to protect reactive services and a significant minority expressing an interest in early interventions. I’d note that this reflects the findings from the UK Drug Policy Commission’s report on drug services for young people and the New Local Government Network’s review of preparations for the transfer of public health to local government.
For the NAO one of the reasons for the lack of clarity around whether early action will receive support is the relative lack of evidence around cost effectiveness. They point out:
Strong evidence of early action’s impact and cost-effectiveness is thin on the ground. The Allen review found 19 of the hundreds of early action schemes it scrutinised met the very highest evidence standards, and of those only eight were available in the UK. The best examples suggest that, over the long term, returns on investment of up to 4 to 1 can be reasonably expected.
For the NAO there are four key challenges largely aimed at central policy makers:
- Generating and disseminating evidence for what works.
- Incentivising a longer term outlook on achieving outcomes for society.
- Aligning departmental working – and interestingly they identify drug prevention as an area where they think this is happening – towards achieving the same outcomes.
- Increasing the capacity of departments to ‘innovate and take bold long-term decisions’.
The report concludes with a set of recommendations for government including calling on the Treasury to undertake or commission a study into the potential of early action to reduce public spending, increase economic growth and achieve better outcomes for individuals and society. It asks the Cabinet Office to coordinate the ‘what works’ centres and to drive the social investment market through providing advice on delivering cost-effective services and cashable savings. And it asks spending departments to review the current spending on early action in a ‘rigorous and consistent way’.