Prevention is better than cure

Working together to prevent social harm is a good thing but it's more difficult to justify spending in areas where policy evidence is weak
Hurdler fall trail
Better to prevent than to cure

An inspirational project aimed at stripping away the bureaucracy preventing collaboration between public bodies and designed to prevent social harm rather than dealing with its aftermath was outlined in a speech given by Jason Lowther, director of policy and delivery at Birmingham city council, to the Society of Information Technology Management's annual conference in Edinburgh.

Like most other areas, Birmingham has had a Local Strategic Partnership (LSP) for some time, Lowther said, but also like most areas, "it used to be talking shop, which existed because it had to, to access Neighbourhood Renewal funding."

Accordingly, the policy behind the LSP had been all but meaningless. "With our first LSP strategy, a consultant wrote it, so it was a lovely strategy, but it just sat on a shelf. The next time we thought: let's take it more seriously, draw up a local area agreement and consult people on what we are aiming for together as partners in Birmingham."

What emerged was a strong commitment to collaboration among all local partners, who finally saw the value of working together, including working towards joint commissioning of services and joint appointments, Lowther said. "We were late to it, but we are catching up."

Together the partners sketched out a series of principles "to get more for less", which included 'co-production' – helping communities to help themselves; personalisation of services, as far as possible; and prevention – "shifting the model away from where most money is spend on problems once they have happened to solving problems, thus preventing much larger expenditure in months to come."

The initiative has led to Birmingham being selected for the new 'Total Place' experiment which is piloting both a collaborative and preventative approach between public agencies in 13 locations in England.

In Birmingham, project themes include early intervention for children with behavioural difficulties; learning disabilities; mental health; reducing impact of drug and alcohol misuse; and combating gangs.

For each theme, the team will visit sites that are known to be innovating by collaborative working across agencies. They will also look at savings, since the project as a whole is "unashamedly about saving money, as well as improving services."

The key will be to put the citizen at the centre, Lowther said. "At the moment, if you are vulnerable young person, you will have masses of reviews by housing, social services, mental health etc, none of them talking to each other."

He illustrated the human failings of such a system with the poignant tale of a young man known to his family, 'Matt' (not his real name), who after a traumatic childhood had been adopted and had had behavioural problems at home and at school which had led to his exclusion; return to foster care; and drift into petty crime.

A huge amount of money had been spend by many public agencies on Matt, said Lowther, but at no time had any of them spoken to each other and worked out how to prevent further harm together, saving a fortune in the process.

"It doesn't have to be like that – we could do common reviews."

As part of Total Place, Birmingham had carried out an exercise mapping total public expenditure on the area, he said, and where it was spent, and it had come out as £7.2 billion a year, excluding pensions. "My first thought was, Gosh, that's a lot of money," Lowther said. "My second was, are we confident that this is being spent in the best possible way? I am pretty sure it is not."

Very little of that money is currently spent on prevention, for example, he said. "In the health service, less than 2% is spent on preventing ill-health. And far more is spent on employment benefits than on regeneration and job creation."

There may be some good reasons for this, Lowther admitted. Often, there was a lack of evidence as to which preventative measures actually work, for example: "policy evidence is strong in health, but weak in social care."

There are also problems with a mismatch of where savings accrue, he said. "For example, parenting classes have been shown to work, and for every £1 spent by council, £4 comes back to public sector. But only £1 of this comes back to the council itself, so we spend £1 to save £1 – that's OK, but not exciting. And the other partners get £3 back, for no action. So we are starting to have conversations about how we can get more payback."

Furthermore some major barriers to progress can only be addressed nationally, by ministers, Lowther said. One big stumbling block is the existence of short-term financial horizons, which make expenditure now impossible if savings are only accrued in several years' time. "So we need to talk to the Treasury about looking longer – can we look over a 3 or 5 year period, or 10 or 15 year periods?"

Conflicting performance management and regulatory or audit expectations on different public sector partners was another barrier at national level, he said. "Unless we have a single performance management structure for public services, it will not work: we will not be thinking about collaboration, we will be thinking about whether we will be sacked or not."

This is an edited version of a speech by Jason Lowther given at the Society of Information Technology Management's annual conference in Edinburgh. Dan Jellinek is editor of e-government bulletin

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