Roundtable briefing: A preventative approach to public services

Executive Summary

• Excellent local practice exists, with local government, NHS and VCFSE organisations working in partnership to impact individual and community outcomes in new ways, and prioritising tailored preventative support. The challenge is now to systematise these examples.
• The complexity and breadth of delivery in a preventative context can make it difficult to know where to start. Data, case management and other systems and national guidelines must be tailored to local contexts. This allows intelligent decision-making linked to individual outcomes, rather than just outputs.
• Prioritising and directing effort at neighbourhood level is currently limited by the availability of data and mapping of need and outcomes. Early work between the ONS and local practitioners shows potential to understand local needs by linking large datasets and exploring trends at the LSOA level.
• Central government, through the Test, Learn and Grow programme, is considering what system conditions are needed to enable local flexibility - including risk-taking, which was identified as essential to testing and development. Creating “experimental risk spaces” and environments for change is a priority.
• A new type of actionable evidence base is also needed - more than single case studies but less time-consuming than long-term studies - so that places can demonstrate impact and make the case for further reform.
• There is a call for purposeful experimentation, as many places undertake PSR-informed pilots. Devolution, welfare reform and the ten-year health plan all create opportunities for this, brought together through integrated settlements.

Greater Manchester’s Mission

Greater Manchester’s has a leading track record of near 3% economic growth over the past decade, and part of the Combined Authority's mission to ensure every resident can access opportunity and quality services as part of that growth. Public service reform is central to this mission. Through the Live Well movement, GM aims to deliver services at hyper-local level, ensuring residents can access a set of public services that suit their needs. 

The next step for Greater Manchester, building on over a decade of local collaboration - and for the national approach - is to systematise and grow a preventative approach, replicating excellent practice across communities. Greater Manchester is working with the Treasury to develop the prevention demonstrator for health, to shape what an “everything on” approach could look like and to show that transformational change is achievable.

The prevention demonstrator will focus on:

• Individuals with multiple disadvantages
• Early years
• Young people who are NEET
• Economic inactivity
• Health

The moment is now to address these themes and to help central government understand what is needed to deliver preventative, place-based approaches.

Key Themes
Theme 1: Implementation and Data Sharing

Attendees reflected on the challenge of where to begin: should reform “start somewhere and go everywhere” or attempt “everything, everywhere all at once”? Trust in local communities, and investment in the infrastructure of the VCFSE sector are essential starting points.

Bravery is also needed in funding and delivery. Attendees warned against reverting to commissioning models, instead calling for deeper collaboration across sectors. VCFSE colleagues highlighted their expertise in linking outcomes-focused data, but raised concerns that prescriptive national approaches often undermine local innovation, where flexible, tailored approaches are limited.

Theme 2: Test, Learn and Grow

Prevention requires cultural and institutional change. Test, Learn and Grow avoids the language of “scale,” focusing instead on adapting provision to context. The challenge is to create the systemic conditions - set nationally but delivered locally - that enable reform.

Attendees also noted the importance of combining ‘hard’ data with soft intelligence from communities. Service users must be part of shaping change, ensuring that prevention is compassionate and not technocratic or paternalistic. The discussion also called for a place-level consideration with a focus on outcome delivery, as well as the need for an actionable evidence base strengthened by devolution.

Theme 3: Deepening Collaboration

A key theme of the discussion was placing people at the heart of reform. Purposeful experimentation was championed: pilots should be coherent, intentional and designed across neighbourhood, city-region and national levels. Practical models already exist, such as housing projects in Salford and approaches preventing health inequalities in Greater Manchester, which demonstrate what prevention looks like in practice.