The Community Links led Early Action Task Force has recently published a new book One Hundred Days for Early Action: Time for Government to put prevention first: A collection of essays by a respected group of leading experts and thinkers with decades of experience of Government – as, civil servants, senior advisers or respected commentators.
Thwo authors share the billing in this post serialising the essays between now and the General Election: Carey Oppenheim – CEO of the Early Intervention Foundation and former Special Advisor to Tony Blair in the Number 10 Policy Unit; and Haroon Chowdry – Evidence Analyst for the Early Intervention Foundation. Their article outlines what an incoming administration should prioritise to an ensure early action approach at the heart of government.
Download the book.
After 7th May, the new Government will wake up to the big challenge of how to meet growing needs and demand with sustained reductions in public services spending at national and local levels.
The less money is available, the more important it becomes to offer timely support to people in a way which reduces future demands on public services and the taxpayer. Our recent report shows that the state spends £46 million every day on “late intervention”: the acute services and other support required when children and young people experience significant difficulties in life. In order to reduce this cost – not to mention the far more substantial suffering and wasted potential that it represents – Early Intervention is more crucial than ever.
What do we mean by “early intervention”? It is about supporting children, young people and families early on when issues arise, and there is still the opportunity to prevent lasting consequences. A growing body of evidence from psychology, social science and neuroscience shows that the right interventions or support can significantly improve children’s lives and future prospects.
Politically, there is a strong consensus for the principle of Early Intervention – the case made by Graham Allen MP in his reports to Government was accepted across the political spectrum. Our own organisation, the Early Intervention Foundation, was set-up to promote greater use of evidence-based early intervention that improves the lives of children, prevents future social problems and reduces the costs of such problems. Prevention and early intervention is a now common refrain – all aspire to getting to the root causes of social issues, whether it is ill-health, or youth crime, or unemployment – rather than dealing with the symptoms.
In terms of action, there have been noteworthy initiatives: investment in evidence-based parenting programmes including Family Nurse Partnerships; the Department of Communities and Local Government’s Transformation Challenge Award scheme, which has supported some areas with innovative redesign in the delivery of early intervention; the Big Lottery Fund “Better Start” programme, focusing on evidenced-based approaches for families with the children aged up to three; and the growth of social finance to support Early Intervention approaches. These are helpful steps forward, but they are piecemeal and not yet near the scale of what is required to meet the challenge ahead.
So what should a new Government do to fast track Early Intervention in its first 100 days?
1.Prioritise early intervention during austerity
Rising demands on services coupled with tighter budgets have made early intervention more difficult to prioritise for departments and councils alike. The available estimates, crude though they are, suggest that only £1 in every £20 spent in health and social policy is preventative. In local government, unprecedented demand for social care on one hand combined with reduced funding from central Government on the other means that, as statutory services are protected, Early Intervention services bear the brunt of cuts. This trend creates the risk of mounting social and health problems later on. Currently youth crime and unemployment both cost over £1 billion a year,12while the long-run cost of childhood obesity has been estimated in the region of £600 million. If these and other costs continue to rise, then dealing with the “costs of failure” will swallow an increasing share of increasingly scare public resources.
To get on top of this, the next Government must accurately measure what is currently spent on early intervention and prevention by national Government, local government and other bodies. It must also ensure that resources are available to prevent it sliding down further.
After a baseline for early intervention spending has been established, the next Government should set a national target for a concerted shift in spending towards Early Intervention by 2020 (followed by further targets for future years). Alongside this, the Government should track child and family well-being using a basket of indicators relevant to Early Intervention. This is important because it will ensure that the focus is on outcomes and therefore on the quality of spending, not simply the quantity.
A new Government should also create an Early Intervention “Invest to Save” Fund, focused on increasing the quality and quantity of early intervention. This would follow the examples set by Northern Ireland, Wales and Scotland, where large-scale funds for early intervention have been created as part of an agenda led by National Government. Like the much larger Obama investments in testing what works in Early Intervention, these approaches allow for localism without sacrificing good measurement and evaluation.
The Fund could draw in public, private and social finance, and invite bids from all sectors to trial evidenced based approaches to Early Intervention. Importantly, the public element would not have to be additional spending; it could be redirected from existing budgets by identifying duplication, inefficiency and money that is currently not well spent. Bids would have to meet minimum quality criteria including good use of evidence, robust implementation plans, and detailed plans for evaluation and cost-benefit analysis. Funds could be offered in a number of forms – low interest loans or an offer to match contributions raised by local partnerships. Importantly, there should be a minimum of five years to trial and evaluate the initiatives funded.
2.Incentivise local public services to work together better
It is also clear, however, that existing resources for early intervention must be used better, rather than layering on new services to an already complex system. Ensuring that public agencies pool budgets, jointly commission and deliver services, and share information about the communities they serve is crucial, both to protect early intervention but also to make it more effective. We need to move beyond the traditional silos that still characterise too much of our public service delivery, and develop flexible services that can respond to the totality of people’s lives and problems.
In many cases organisations that fund early intervention are not the major beneficiaries of the improved outcomes which result. For example, a local authority programme might generate benefits for schools, the NHS, police and youth justice services, and the Treasury. If only a small part of the programme benefits accrue to the local authority itself, then the programme – through no fault of its own – might not be deemed viable.
Some local areas are already working flexibly across local authority and other boundaries to invest together in shared services (for example, Camden and Islington have developed joint approaches with their Clinical Commissioning Groups). The approach of the Public Sector Transformation Network is also promising. Reforms which enable commissioners to secure contributions from other agencies and levels of Government (and indeed from the private sector) will help catalyse early intervention on the ground; the funding measures above can be structured to promote this.
Successful Early Intervention is not just about sharing budgets, but also about how services interact with each other and with the people they serve. Health and Wellbeing Boards in each area provide an important focus for working across local Government and health functions; early intervention for children and families should thus feature more centrally in their role. They could be charged with producing and implementing a clear strategy for early intervention in their area. The aim of this would be to ensure that adult and children’s services inside and beyond the local authority share data and work together to better assess local needs, prioritise target groups for support, and jointly agree strategies for commissioning services. These boards could also be required to report on progress on shifting to prevention at local level in an effective way. Finally, even the best early intervention services can fail to reach those who most need them. Public service reform needs to put this centre-stage, ensuring that data and whole-family approaches reach the most vulnerable, and learning from the most effective methods (trusted lead workers or intermediaries, multi-agency working, use of new technologies such as apps). It is also important to ensure that the key workforces are able to identify families and explicitly focused on engaging those who are least likely to access services. For example, agencies which have policies of striking families who fail to attend appointments off their lists are often storing up problems for later.
3.Put the early intervention agenda at the core of its vision
Perhaps the most important step, as well as a precursor to the steps outlined above, is to ensure that early intervention and prevention are at the heart of Government activity. This could be achieved through create a central Government unit responsible for it, or by building on the What Works Network.
Alternatively, there may be a role for a new Early Intervention and Prevention Commission. The current coalition’s programme for Government had fairness and social mobility as its core theme, which became the litmus test for many of its policies. The Social Mobility and Child Poverty Commission was also created to monitor trends, report on the state of the nation, make recommendations and ultimately hold Government to account.
Early intervention could be the theme of the next Government, with an Early Intervention and Prevention Commission performing a similar role. This would be an arms-length standing body but located at the heart of Westminster, supported by the Treasury but with an independent chair. Its initial tasks would be establish a baseline measure of early intervention spending, and then use that to inform a Spending Review to come in the autumn. The Commission would also have an important role in shaping the public debate and helping to forge consensus about the importance of Early Intervention. Establishing prevention and early intervention as the approach to public services is unlikely to grab front page headlines. It may not lure people to the ballot box or provide convenient sound bites for a leaders’ debate. But it is the smart and realistic choice for using ever scarcer public money. Broad acceptance of the principle of early intervention must be matched by the political will to back it for the country’s long-term interest. If we are committed not to leave future generations with a mounting fiscal deficit, we should also apply such foresight to the social problems they will have to deal with. Our report shows that these aims can be achieved together.
This is the prize to be won if the next Government can put Early Intervention at its heart.