The shift to prevention is possible

After 15 years working across the NHS and local government, most recently as Corporate Director of Adults, Health and Communities at the London Borough of Newham, I’ve recently joined the Health Foundation. I loved working in local government; the energy, the workforce, the proximity to our residents, the ability to innovate and make change happen.

But I felt deep motivation to try and contribute to wider change, change which I think is urgent because of two stark realities we face.

The first is that we face significant health challenges in the UK. We are seeing levels of childhood vaccinations below a safe level and a growing burden of poor mental health among young people. Growing health-related unemployment, increasing homelessness, poor housing, and a substantial burden of preventable chronic conditions.

The second is that our public services are in a deeply troubling state. In local government, an ever-greater proportion of resources is spent on meeting crisis needs. The Local Government Association estimates that 1 in 4 councils will rely on exceptional financial support in 2026/27 – exceptional no longer feels exceptional. The consequences for council services, including the vital social infrastructure of place – from playgrounds and parks to libraries, community centres and the quality of the public realm – are significant.

Public confidence in the NHS is at a historic low of 21%. An overstretched system is buffeted by rising demand, workforce shortages, difficulty accessing primary care, corridor care, lengthy waiting lists and struggling community services – from mental health to community nursing and therapies.

Meanwhile, with the desperate state of our public finances and little prospect of a miracle turnaround, the prognosis looks bleak. If we continue as we always have, we will get what we’ve always got. Acute need will keep rising, the proportion of public spending going to crisis response will continue to grow, and we will increasingly be unable to meet people’s needs and aspirations. Ultimately the greatest risk is to the shared endeavour of public services altogether.

Something has to change. Urgently.

Some answers will come from technology. There are likely to be significant productivity gains, and in years to come, tech and AI will undoubtedly transform how public services are delivered. Some answers will come from rethinking the balance between taxation and the services the state can afford. The current balance is unsustainable.

But a third change must come in the nature of the UK’s overall operating model. How can we shift from a crisis-driven approach to one that supports people to stay healthy and well, to better manage life’s trials, and to recover more effectively when challenges arise?

In my local work I tried to embed a prevention ethos into everything we did. This meant many things, including:

• Primary prevention: From embedding health in the local plan to partnering with voluntary and community organisations to build support and connection in communities – helping people thrive and preventing problems before they occur. The incredible work done across the country during the COVID-19 pandemic should inspire us to see the potential of working with communities with common purpose.
• Secondary prevention: Delivering well-evidenced interventions in the community to address existing risks – from welfare rights advice to smoking cessation and falls prevention.
• Tertiary prevention: Scaling reablement in social care so that those who experience health shocks, such as a stroke, can return as close as possible to their baseline health.

The amazing thing about these approaches is not just that they work – we saw significant improved outcomes and flattened the demand curve for long-term support – there is plenty of evidence to show that. But these approaches are also support people to lead their best lives. 

To borrow from Confucius: ‘Every healthy person wants a thousand things; every unhealthy person just wants one.’

Despite at least 25 years of rhetoric about the merits of a prevention shift in public policy, action has rarely followed. The reasons are well-rehearsed:

• The acute tap of need continues to flow, and we lack the resources to shift upstream.
• The timelines for prevention impact are too long for budgetary or political cycles.
• The evidence base isn’t strong enough for many prevention approaches.
• Leaders don’t get credit for prevention – they only get in trouble for failing to manage crises.
• Funding flows don’t incentivise prevention across the system.

Some of these are myths.

For one, the huge overspends in our public system show that the funds exist; they’re just increasingly flowing into crisis response, paying for failure demand rather than investing for the future. There are already evidence-based approaches that could be confidently implemented and some prevention impacts can be seen even within a year.

Other challenges require more work – how do we activate the system effectively? How do we join up budgets across and within sectors to ensure our public system is as allocatively efficient as possible?

I passionately believe that a shift to prevention is best for our public services: for everyone who uses, works in them (often deflated by creaking systems that fail the people they want to serve), and for their future sustainability. I also believe this shift is possible.

The government has committed to supporting this shift, and there is much to be done centrally – particularly around the wider social and commercial determinants of health and ensuring sufficient funding is dedicated to prevention so it isn’t continually siphoned off to meet short-term crisis needs at long-term cost.

This agenda can be – and is being – championed across the country, at all levels: by committed politicians, professional leaders, practitioners and community activists, but there is so much more we need to do.

Please do get in touch if you’d like to work together to push this agenda forward in the years ahead.

This blog was originally published in the Local Government Chronicle on 31 October 2025.