Government spending on preventative policies from vaccines to family hubs should be significantly increased and the Treasury should create an accounting category to monitor it, according to a report by the thinktank Demos.
“What you measure really matters: that’s how things get prioritised,” said Anita Charlesworth, a co-author and the director of research at the Health Foundation, a thinktank.
Charlesworth said the Covid-19 pandemic had underlined the critical importance of prevention – yet the NHS does not report how much was being spent on preventative measures.
“Coming out of Covid, and coming through the transformation that vaccination made to our lives – if you need a textbook example of why prevention should be absolutely top of the list, both to improve our health and for economic benefit, you don’t need to look much further than that,” she said.
“Despite that, insofar as we can measure it, it looks as though we have been spending less over the past decade, and in fact we’re spending per person about a quarter less on some of the most cost effective things there are in healthcare – so things like helping people stop smoking.”
Demos is calling on the Treasury to publish how much each Whitehall department spends annually on preventative measures – citing examples such as the government’s family hubs, where parents can access help and advice, and anti-smoking or anti-obesity programmes.
That would mean creating a category of spending, supplementing the existing approach, which splits Whitehall budgets into long-term “capital” spending and day-to-day – or “resource” – spending. The existing approach was introduced by Gordon Brown as chancellor.
With preventative spending reported separately, Demos argues politicians could then pledge to increase it over the course of a parliament and beyond – with the aim of overriding the short-term thinking that frequently results in programmes like these being cut back.
The report said: “Spending on prevention is often the first to go when the UK faces challenging fiscal conditions.”
It cited the chancellor, Jeremy Hunt, lamenting as health secretary in 2018 that money earmarked for “transformation” often got sucked into acute care instead, so the NHS was not able to “focus on the really important prevention work” that could transform services in the long run.
The chief executive of Demos, Polly Curtis, said: “We are proposing a completely new way of prioritising preventative spending at the heart of the Treasury. The aim is to invest longer term to prevent problems before they arise rather than spending huge amounts of public money trying to fix things when it’s too late.”
Curtis gave the example of children’s social care, adding: “We now spend more money than ever, removing more children than ever into a care system that isn’t good enough. There’s good evidence that investing in families to stay together safely is cheaper but more importantly better for those families –and the right thing to do.”
The report suggested institutions would need to be set up to make the “preventative departmental expenditure limits” work, including a panel to examine the question of what spending should be counted as preventative.
