I recently blogged about the potential benefits of preventative policy-making – an approach that aims to prevent or reduce the risk of social and economic problems. But if prevention really is better than cure, why isn’t prevention universally accepted and implemented? What are the challenges, barriers and limits to preventative policy?
- Funding and budgets are usually short-term while preventative policy requires long-term commitment. It may take decades for a preventative approach to deliver outcomes, yet require significant up-front spending. When faced with shrinking budgets, it may seem expedient to cut preventative spending rather than services that more immediately benefit local communities.
- Changing priorities can undermine preventative approaches. Much political attention is currently focused towards economic development, and it has become harder for many public bodies to maintain spending on activities that don’t explicitly target economic growth, even if they would save money in the long-term. Public opinion fluctuates, and often focuses on local solutions rather than high-level holistic approaches. Yet preventative policy often depends on long-term commitment.
- Preventative intervention is difficult to evaluate – partly because of the long time-scale, sometimes compounded by a lack of obvious measures of success, but also because the problems such interventions try to address usually cut across policy domains, making it difficult to determine the net impact of any individual initiative among an ever-changing set of interrelated interventions. To put it another way, preventative policy faces problems of both measurement and attribution. This puts it at a disadvantage when there is an expectation to demonstrate measurable progress.
- There is limited evidence about ‘what works’ in preventative policy. The policy-making cycle operates at a different timescale to that needed to create a robust evidence base. The Big Lottery suggests longitudinal studies of at least five years to support research into prevention. People often quip that politicians want quick answers… the other side of the argument is that researchers only want to give comprehensive answers!
- Public sector budgeting isn’t well suited to those ‘wicked’ issues that cut across departmental and service lines. Preventative spend in one area may save money in another by reducing demand for services.
Long timescales, interdependent issues, and limited evidence, all mean that preventative intervention carries a high level of uncertainty, and can be seen as risky.
There are also some general tensions within policymaking that are exacerbated when taking a preventative approach.
- Participatory policymaking – communities may prioritise locally identifiable outcomes rather than long-term, holistic interventions. Issues that are important at a local level (e.g. noise pollution, traffic congestion, litter) are not always the same as those policymakers seek to address, particularly using a preventative approach.
- Centralised processes to establish good practice and monitor progress versus greater autonomy for localised decision-making and freedom from central interference.
- Using evidence to follow established practice balanced against policy and research innovation to try and to evaluate new approaches. The relative paucity of evidence about some areas of prevention and early intervention mean that policy risks need to be taken, and policymakers have to accept uncertain returns and some risk to reputation.
- Activities that have a predictable return or accepted value versus those that have potential for greater positive impact but less certainty.
Despite these challenges, prevention is a policy imperative throughout the UK, if for no other reason than its potential to reduce future public spending. However, it’s particularly notable in Scottish policymaking.
The Scottish Government designated prevention as one of its priorities for reform in its response to the Christie Commission on the Future Delivery of Public Services. The influence of the preventative principle can be seen in the Single Outcome Agreements (SOAs) produced by local authorities and their respective Community Planning Partnership. The guidance to CPPs issued by Scottish Government in 2012 explicitly stated that SOAs “should promote early intervention and preventative approaches”.
Prevention aligns with some of the other principles behind the CPP process in Scotland and public service reform elsewhere – the idea of co-operation between levels of government, pooling resources and sharing benefits. It may be risky, but it’s an imperative that all organisations involved in funding, designing and delivering public services ought to embrace.
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