When Benjamin Franklin said that an ounce of prevention is worth a pound of cure, he hadn’t bargained for the weird weights and measures of today’s care and health system. A heady mix of history, conflicting funding mechanisms and the grinding immediacy of rising demand ensures that it is easier to spend lots of money on illness and long-term care than on keeping people well and independent.
The NHS spends around £1,700 per person per year. By contrast, councils’ public health grant is £49 a head and their social care spend on prevention amounts to pennies per person. As the NHS and social care edge ever close to a financial precipice, the imperative to reduce the need for care has never been more urgent. What can be done?
First, we should not to hide behind “lack of evidence” as an excuse for inertia. Much of the £130bn combined spend on health and care in England rests on evidence that is thinner than many imagine. And we know enough about the preventive impact of some services, such as intermediate care and re-ablement, that they should be included in mainstream commissioning plans everywhere. Yet we have less than half the intermediate care that is needed.
Second, we need to get better at evaluating prevention and do more of it over the long term. There are no quick fixes. Too many evaluations have been driven by policies in search of evidence.
Local context is key – there is rarely a single, one-size-fits-all solution.
A third must-do is to take a long-term view: the really big prize lies much further upstream, where compelling evidence is emerging of return on investment from public health programmes and work in schools, communities and housing.
Finally, the benefits of prevention are not necessarily reaped by the organisation that funds it. To remove this disincentive, risk-sharing agreements between NHS and social care partners should recognise that the benefits – and the costs – of preventive spending should be shared too.
Richard Humphries is an assistant director of the King’s Fund
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