The barriers to change
The National Audit Office’s Early Action Landscape Review identified four key challenges the addressing of which could help in the design and implementation of early action programmes: namely, more consistent and robust gathering of evidence of what works; overcoming short-term thinking and other practical barriers; effective cross-government coordination of early action; and strengthening departments’ capacity to innovate and take bold long-term decisions. It also said that determined leadership is necessary to divert resources away from pressing and highly visible current needs, in line with public expectations, towards long-term early action programmes, particularly at times of fiscal austerity.
The Early Action Task Force explores these barriers further in the Triple Dividend and Toward Effective Prevention highlighting that action is needed to address all three of these areas: leadership, culture and systems. As well as short-termism and silo working, it identifies lack of information - about how much is currently begin spent on early action compared to acute interventions and about the costs and benefits of inaction versus early action - and the extra costs of "dual running" of early action alongside acute interventions as problems. Lack of clear, shared early action goals and performance and contractual systems that are aligned are also identified as issues by the Task Force.
These barriers require concerted action. As Sir Derek Wanless in his second health review, in 2004, Securing Good Health for the Whole Population, wrote:
“What is striking is that there has been so much written often covering similar ground and apparently sound, setting out the well-known major determinants of health, but rigorous implementation of identified solutions has often been sadly lacking. If we are going to capitalise on the growing cross-party support for early action, we must recognise and tackle the barriers, align the incentives and, first and foremost, we must win hearts and minds throughout Whitehall, local government, public services and wider civil society.”