The preventative shift: how can we embed prevention and achieve long term missions

In the years since austerity and the ongoing crisis in many public services, preventative services have been drastically reduced to address the immediate problems.   

So, in the NHS, rising health care spend is focused on acute need and away from prevention such as primary care and public health. In children’s social care, early help has been cut, resulting in growing numbers of children going into care and rising the bill for residential support; and services aimed at cutting reoffending have been scaled back, leading to an expanding prison population. 

This creates a ‘doom loop’ in public services, growing ever more reactive to escalating demand. Over the longer term costs will only be reduced by focusing on preventative action that supports a thriving population and in turn will reduce demand on services.  

But a focus on near-term savings in the Spending Review is putting this approach at risk – ending the doom loop will require protection of upfront investment in prevention. The idea of shifting towards a preventive approach in public spending is gaining traction, with recognition at the Autumn Budget and the NHS incorporating prevention into its ten-year plan.  

To support this transformation, we have been working with Demos on a body of work exploring a fundamental shift away from firefighting in public services and towards preventing problems arriving.  

In 2024, we published a paper exploring the challenge of measurement and making a series of recommendations, including the passage of a 'Public Investment Act', to show how this could be appropriately achieved.  

The new briefing The Preventative Shift looks at how to shift the culture of public bodies to think ‘prevention first’ and target spending at activities which are value for money and improve outcomes.