Investing in prevention being spent on preventing or coping with problems ‘makes it possible to plan and scrutinise the Both the FOI responses and joint health and transition to early action and to understand the wellbeing strategies indicate recognition that trade-offs between prevention and downstream 53 resources need to be shifted from reactive services.’ The triple definition of prevention can be to preventative spend. However, there is a useful tool in doing this. demonstrated uncertainty about how to go Local Government Information Unit (LGiU) recognised about doing this. that one of the biggest barriers to prevention is indeed ‘a lack of clarity around what constitutes Pleasingly, Staffordshire’s joint health and wellbeing preventative activity, how this links to outcomes and 54 strategy devotes a whole section to ‘shifting how much money councils spend on it overall.’ In resources’. While acknowledging that spending partnership with the British Red Cross and Mears, ‘more on prevention and early help means spending they therefore piloted an approach to mapping less on reactive intensive support’, it also recognises preventative spend against one of Camden Council’s the cost benefits of doing this: ‘This should quickly key outcomes. At the end of the pilot, LGiU published a 55 become a virtuous circle, where increased focus on toolkit for other local authorities to do the same. prevention and early help reduces the need for later intensive intervention, releasing further resources for Recommendations: 50 prevention and early help.’ > Local authorities should commit to shifting Staffordshire’s strategy also recognises that such a percentage of their resources towards a shift in spend would have to be accompanied by prevention. In doing so, they may find the significant changes to how this intensive support recommendations set out in the Southwark is delivered. The cited options include: reducing and Lambeth Early Action Commission’s the number of hospital beds used by emergency report, ‘Local early action: how to make it patients, reconsidering the number of hospitals happen’, useful. within the county or ‘reducing expenditure on > Local authorities (and Health and Wellbeing residential care, through helping many people to Boards) can use LGiU’s toolkit to track and 51 better understand their preventative spend. remain independent and living in their own homes.’ Several FOI responses mentioned the creation 41. Earl Howe, The Parliamentary Under-Secretary of State at the Department of Health (3 July of whole new prevention-focussed funds 2013): publications.parliament.uk/pa/ld201314/ldhansrd/text/130703-0003.htm or budgets. Others intend to gradually shift 42. Care Act first-phase reforms and local government new burdens: oral evidence, October 2015: data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/public-accounts- resources from reactive to preventative committee/care-act-firstphase-reforms-and-local-government-new-burdens/oral/22864.html 43. The Local Government Association, Association of Directors of Adult Social Services and the spend. A tangible commitment has been made Department of Health are working in partnership to support local areas in implementation of the by Nottingham: ‘Nottingham City’s Procurement care and support reforms. 44. Local Government Association, Care Act Stocktake: local.gov.uk/care-support-reform/-/ Strategy states as an aim that the Council should journal_content/56/10180/6341378/ARTICLE “Increase % spend on early intervention and 45. Local Government Association, Association of Directors of Adult Social Services and the Department of Health ,Care Act Implementation : Results of Local Authority Stocktake local.gov. preventative approaches by 1% each year across uk/documents/10180/6869714/2015-08-11+Stocktake+4+report+%28Final%29.pdf/c1db7184- 5ea6-4a11-8d8d-07691a36e902 support services for adults and children.”’ 46. Phil Hope with Sally-Marie Bamford, Stephen Beales, Kieran Brett, Dr Dylan Kneale, Michael Macdonnell and Andy McKeon (Report of the Ageing Societies Working Group 2012), Creating Sustainable Health and Care Systems in Ageing Societies, Case Study 10 47. Malaria Journal (October 2012), Toward malaria elimination in Botswana: a pilot study The Southwark and Lambeth Early Action to improve malaria diagnosis and surveillance using mobile technology: malariajournal.com/ Commission (set up to find local ways of taking early content/11/S1/P96 48.Earl Howe, The Parliamentary Under-Secretary of State at the Department of Health (3 July action and preventing problems) noted in its final 2013): publications.parliament.uk/pa/ld201314/ldhansrd/text/130703-0003.htm Department of Health (October 2015), Care and Support Statutory Guidance, Chapter 2 (2.42) report: ‘The only way to ensure a significant move 49. Staffordshire Health and Wellbeing Board (2013), Living well in Staffordshire: Keeping you well towards early action is to commit to an incremental Making life better: staffordshirepartnership.org.uk/Health-and-Wellbeing-Board/Health-Wellbeing- Strategy-Staffordshire-2013.pdf 52 50. Staffordshire Health and Wellbeing Board (2013), Living well in Staffordshire: Keeping you well funding shift.’ Making life better: staffordshirepartnership.org.uk/Health-and-Wellbeing-Board/Health-Wellbeing- Strategy-Staffordshire-2013.pdf 51. Staffordshire Health and Wellbeing Board (2013), Living well in Staffordshire: Keeping you well As a precursor to doing this, it recommends Making life better: staffordshirepartnership.org.uk/Health-and-Wellbeing-Board/Health-Wellbeing- ‘classifying spending’ to distinguish reactive from Strategy-Staffordshire-2013.pdf preventative spend. Knowing whether money is 52. NEF, Southwark & Lambeth Early Action Commission (November 2015) Local early action: how to make it happen: b.3cdn.net/nefoundation/a5845188d1801a18bc_3nm6bkn3b.pdf British Red Cross Prevention in action [email protected] l l 19