We know it makes sense, but we still struggle to shift resources into early intervention and prevention. Whilst we know from evidence that early intervention works - saving the state millions and improving the lives of children and families - we continue to invest too much in acute and crisis care rather than in spotting and resolving problems when they first arise. We set out similar arguments for Action for Children a few years back.
Recently, as part of a project to help a city in the North of England to integrate health and care, I was pulling together some data on how well the area as a whole was performing - what we call key performance indicators.
What hit me immediately is that the current approach to delivering public services for this area is not sustainable. Not only are some of the outcomes for young people lower than they should be, but the system is fast running out of money to pay for rising demands for care. And yet - and this is typical of many local areas -proportionally very little of the total funds available is being spent on prevention and early intervention.
Early intervention - that is the approach to public service delivery which is about taking action as soon as possible to tackle problems before they become more difficult to reverse - has been a mainstay in public policy for at least 20 years. There's agreement across the political divide that intervention has to happen. The quantum leap needed, however, changing the way services are funded and delivered, has not taken place. So why not?
Firstly, people often lack the evidence to support earlier interventions. In tough financial times, some find that funding projects without having the confidence that they will work is a risk too far. Secondly, short-term projects continue to be funded, in an attempt to fix immediate problems, when in reality early intervention programmes can take years to deliver better outcomes. And thirdly, of course, there is the critical issue how you shift the money into early intervention. How do you continue to support the care of those with critical or acute needs, whist finding the money for new early intervention services? You can't just drop those most in need, and direct the money elsewhere.
But given the darkening financial picture, continuing to fund services in the way we do is no longer viable. We need to shift resources from crisis care to early intervention now. That is not to say there isn't progress being made. In North Yorkshire, for example, the number of children on child protection plans is falling - bucking the national trend - due to a range of innovative initiatives. This includes an initiative called No Wrong Door, which is a multi-agency early intervention scheme that supports children most at-risk and helps them avoid a damaging lifetime of fragmented care and low outcomes. In Sheffield the introduction of new multi-agency weekly meetings to identify and support those at risk from needing increased social care support have led to a reduction in more severe cases.
But too often innovation is taking place within a single project or a single part of the system, when much wider strategic change is called for. This is why initiatives like the Southwark and Lambeth Early Action Commission is so welcome. Produced with the help of Nef, the Commission has set out ambitious plans for transforming funding so that more is spent on tackling the causes of poor health and social problems, and less on treating and managing the symptoms. And places like Hampshire and the Isle of Wight and York are set to follow - believing that only investment in early intervention and prevention will result in better outcomes and manageable finances.
It's a very challenging problem we face: how do we significantly reduce our spending on crisis care and acute treatment and start investing in tackling the problems that emerge early in children's lives. It will take brave decisions by leaders and commissioners to move in this direction. But we have to start doing it so that children and young people start experiencing the quality outcomes that we as a society should be able to provide for them.