How can the UK make preventative policy work – and last?

No policymaker or public sector leader consciously chooses a reactionary response over the anticipatory. And as much as the word is overused, no one actively seeks to exist in ‘perma-crisis’. Across policy areas such as health, justice, defence, and beyond, the case for preventing harms, rather than treating consequences, is both intuitive and repeatedly proven – at both an economic level, and in terms of wider social value.

Vanishingly few people would contend with the idea that installing 100 fire alarms is cheaper than putting out one fire. Yet for policy-makers and decision-makers across the public sector, the challenge isn’t making the case for prevention. It’s how to install fire alarms whilst being engulfed in the flames.

This isn’t hyperbole. The crises we routinely see play out across the UK – be it critical shortages of prison spaces or hospital beds – have a strange double effect. They both make the case for upstream, long-term prevention, whilst orienting the focus towards short-term survival.

What’s preventing prevention?

It’s not only that acute needs distract and divert resources from tackling root causes. It’s also that those root causes are frequently complex, involving multiple interrelated factors, and that the impact of interventions has historically been hard to measure.

Consequently, the evidence base is often hazy. Even when a policy succeeds, and where this success can be measured, it can take so long that its impact is significantly discounted. On other occasions, prevention policies are impeded by institutional inertia. If free school meals or breakfast clubs have a role in preventing childhood diseases, whose responsibility is that?

Funding is another issue. Where the case for investment is made, preventative projects are either too small to make material impact, or the funding times out after one year. Most crucially, prevention-based investment is often directed to present-day need.

Predictive, preventative, progressive – a tipping point?

So, while there is unanimity on the benefits of prevention – there’s also dispiriting consensus on the difficulty of breaking the cycle. Yet this ‘doom loop’ needn’t be perpetual. With the right, and sometimes difficult, interventions, we can make data-driven prevention work. And at the outset of a decisive decade, the conditions are right for success:

• The political will and appetite for change is in place – with acute demand forcing the need for different thinking
• New technologies and techniques – such as apps, wearables, and medical robotics – offer new pathways to prevention
• These interventions can now be much more targeted – and analysed in ways that deliver insight and demonstrate impact
• Hard lessons from the past show us how to bring citizens and communities with us.

These conditions inform four actions to drive immediate progress – followed by a bigger, more difficult consideration that offers a tantalising glimpse of a fully preventative state.

1. Create intelligent investment cases

With the government calling for a ‘revolution in prevention’, the door has opened to more sophisticated discussions about investment. And where once prevention was abstract, foggy, and hard to quantify, digitally-enabled prevention is now crisp, concrete, and quantifiable – helping to create that compelling investment case.

In our work across government, we’ve seen the value of real-time analytics that collate a spectrum of quantitative and qualitative indicators. These include factors such as the number of people potentially affected by a risk, wellbeing indexes, and estimates for the overall value potentially at risk.

In a constrained cost environment, focus is often on the direct cost saving rather than the wider-system saving. Instantaneous, real-world data can provide the whole-life cost view – across the system – enabling better informed trade-offs. And with costs often in one place, but benefits spread disparately, this data can also aggregate a unified cost-benefit view.

Linking to the government’s missions is another way to reposition prevention. For example, preventing hospital IT outages and cyber-attacks links to the government’s mission to ‘build an NHS fit for the future’. Recording tangible impacts such as the number of GP appointments lost and operations cancelled brings potential risks to life.

Another way to outline the case to invest is to highlight the cost of inaction. ‘Doing nothing’ is less justifiable when the costs of failing to act are laid bare. This could include financial losses, reduced productivity, reputational costs and loss of public trust. The Home Office recently estimated that the average cost of a fire is £78,000. With an average of 93 house fires a day, that’s a cumulative cost of £26.5 billion over the next 10 years – which suddenly makes those fire alarms seem a much more worthwhile investment.

2. Empower citizens with new technologies

Digital advances allow public service providers to reach more people, more cost effectively than previously feasible.

In health, apps and wearables are supporting the monitoring and management of chronic health risks like obesity and diabetes; for example, nudging people away from fast food outlets to healthy, on-the-go alternatives. Gamified apps such as Couch to 5K use behavioural nudges to encourage progress and reward achievements – and similar techniques could be used to incentivise other preventative behaviours.

While likely to be private sector-led, governments have a key role to play in encouraging and supporting this. Japan has notably attempted to create a clear path for regulatory approval, publishing a document in 2023 to accelerate programmed medical devices, with extensive guidelines for developers. And the ban of smoking in public places, seatbelt laws, and food safety regulations all serve as reminders of the vital role of regulation.

Further support will come from preventative prescriptions – ensuring people are aware of what’s available. For instance, Essex County Council saw an upturn of 150 percent in care technology solutions such as personal alarms, fall detectors, hazard sensors, seizure mats, and robotic medication dispenser after a programme to increase referrals. Research has found that the NHS could save more than £1.2 billion through the use of non-intrusive lifestyle monitoring technology in social care alone – freeing up two million hospital bed days, and funding the equivalent of 10,000 additional full-time carers in the system by 2035.

In the justice system, the last few years has seen a marked emphasis towards alternative dispute resolution, particularly in the realm of small claims. And better routing of people towards mediation and arbitration before the cost, and potential delay and disruption of a court case, is good for litigants, for the efficiency of the justice system, for the wider economy. Our own research shows the wider cost of legal disputes could be around £3 billion annually.

3. Target interventions, maximise impact

Another major challenge of prevention has been around identifying who to target – and how to do so without stigmatising. Advanced analytics and sophisticated risk-reward thinking can show exactly where efforts are best directed, with pinpoint accuracy, for maximum impact.

During the COVID-19 pandemic, the UK government’s vaccination programme used risk stratification to categorise groups of individuals, select priority areas (e.g. the elderly and vulnerable), and to intervene at the right time – with 76.5 million invitations and reminders. The same principles could extend to the idea for citizens to have a Personal Health Profile. This would not only collate care data but would ultimately create a platform for further combined data to be aggregated – think of wearables, medical devices, and at-home testing kits.

While schemes such as the vaccination programme created national-level population health management, cohorting, notification, and booking systems – they now offer the opportunity for more localised prevention work. And this type of local, place-based empowerment will be key for Integrated Care Systems to more accurately prioritise relevant, high-priority preventative needs.

‘Nudging’, where behavioural science is used to increase compliance at relatively low cost, often works best in digital environments – and when you meet people where they are. Simple A/B testing has suggested that flu vaccines were more effective when framed as reminders for already-booked appointments rather than encouragements to make a booking; and the success of the COVID-19 vaccination programme was dependent on the data-driven way we knew people wanted to be contacted – by text.

This experimentation can be taken further to personalise messaging, with Bayesian networks – an advanced computational technique. This allows researchers to determine not just which people respond differently to different messages, but why – enabling tailored, population-level personalised messaging.

These advanced computational techniques can also help unpick the relationship between complex phenomena, such as the links between adverse childhood experiences and later-life offending. With a transparent process of discovery, these tools hold greater potential to win public trust than a ‘black box’ algorithm. This remains an active area of research, with models exploring the interconnectedness of economic policy with housing and health inequalities.

Feeding into these models are greater data inputs than ever before. The Internet of Things creates data where there was previously a blind spot: innovations like lower cost air quality monitors and improved satellite sensors allow a more granular understanding of where air quality poses a risk to health, which could lead to local changes in traffic management. Our Patient Catalyst innovation uses AI to aggregate data on waiting list, surgeries, and consultant availability to increase the efficiency of getting patients through theatres by up to 20 percent. We use a similar technique to predict when a patient will be ready to leave hospital – calculated from the moment they arrive.

4. Apply a whole-systems approach

The most compelling business case, the perfect technological capabilities, and data-driven intelligent insight will all come to nought unless the public comes with you.

Successful prevention is dependent on the wider network of families, communities, doctors, and agencies such as the police – as well as the willingness of the individual to bear some of the responsibility. Yet even in healthcare, where it is clearly in people’s interests not to get sick, only around 40 percent of people take up their invite for a free over 40s NHS Health Check, for example. And the jury is still out on whether people want to be ‘activated’ as part of a shared solution.

High-profile moments from history have left work to do when it comes to community trust. For many years, police forces – particularly in the United States – have tried to use predictive algorithms to identify crime hotspots, to direct their resources more efficiently. Some high-profile cases, such as in Los Angeles, have seen criticism that prevention schemes embedded and reinforced racial stereotypes, and violated the presumption of innocence. 

To succeed, remember not to force digital solutions where they’re not best suited; for instance, in areas where there is less data, or where digital exclusion may be an issue – such as older people who are less likely to own a wearable device.

The good news is that the appetite for preventative approaches is there. Our research into the move from clinic and hospital-based care to home environments found that by 2030, 96 percent of global healthcare providers believe people will be so focused on preventative care that most hospital visits will be unnecessary.

5. Face the uncomfortable truth

With the above, we’re confident that progress can be made towards a proactive, preventative state. Yet to truly unlock the power of prevention, difficult choices must be made. Current systems are in crisis because they operate in the conditions for crisis.

Market distortions, such as the way locum GPs are incentivised, or the extent to which the NHS relies on bank and agency staff, absorb money that could be invested in long-term prevention initiatives. And there are similarly knotty legacy issues across other areas of government where adjustments could be made.

Ultimately, there needs to be debate and agreement on how much we prioritise prevention – across departmental silos and – ideally – spanning electoral cycles. That, in turn, requires more than just political will. It requires political consensus across parties that prevention generally, and in specific cases, is worth investing in for the long term. Here, DEMOS have suggested the creation of a Preventative Investment Unit (PIU) within HM Treasury, and the passage of a Public Investment Act to create a target for preventative expenditure. Devolution will also have a key role – with big picture thinking translating into local priorities from one prevention-focused budget pool.

Finally, one of the surest routes to political consensus and reform is to continue strengthening the evidence base. By rigorously and judiciously using the testing, measuring, modelling, and analysis capabilities that technology is making available, the public sector could run better preventative experiments and gather better return on investment data to justify future prevention policies. And as discomforting as this final step may be, it would ultimately create a virtuous circle of benefits and efficiencies; where digitally-led prevention sees us start to overcome long-term challenges, reduces the pressure on the UK’s justice and health systems, and turbocharges the economy with a healthier, happier, and more productive workforce.