Prevention not cure?

How do we build a society that prevents problems from occurring rather than one that, as now, copes with the consequences?

It’s a tricky issue.

At the Big Lottery Fund we have been looking at where our Lottery funding has supported groups or projects addressing a long standing issue by taking an early action or preventative approach. We want to see what we can learn as well as find out if our funding is well spent supporting this, often innovative, work.

We know from conversations across the voluntary, community and statutory sectors there is a widespread desire to take action earlier. And we understand that it’s hard. Evidence shows few organisations and partnerships have managed to successfully refocus their activity to deliver preventative activity instead of (or even as well as) current services on a large scale.

urban-fox-5Some of the thorny issues are clear:

  • the need to continue current services can mean there is often not the time, money, or leadership to collaborate, to deliver a genuine shift towards using more public resources in early action.
  • many fantastic individual projects that are successful in taking a preventative approach for a set activity can struggle to be sustained or mainstreamed as their funding draws to a close.
  • proving that something did not happen is difficult (rather than there is a problem to solve) often requiring a long term analysis rather than instant results. This in turn causes issues when that organisation has to then compete for funding to continue existing work. There will always be a need to offer services that support people in times of crisis.

However here in Scotland we’d like consider how our Lottery support could encourage the redesign of services concentrating on taking early action, and therefore preventing negative consequences in the future. We are interested as we believe people will live better lives if they avoid the need for intensive support or crisis services at any point.

To do this we know that learning from those who’ve tried this to deliver early action or preventative activity is key to understanding what might work and where significant challenges lie. We would like to better understand ‘what works’  not just with regard to those who benefit in the long term but also what are the key elements that help organisations successfully re focus; moving to a preventative rather than responsive set of services.

In particular we’d like to talk to you if you’ve made this kind of fundamental change and the result has  led to improved joint working between agencies, it is has involved meaningful co-production with local communities and end users, or led to a shift in mainstream expenditure.

We’d like to hear about your experiences and see your comments below – so please get in touch.


  1. Hello

    Step It Up Highland, a project run by Partnerships for Wellbeing a voluntary sector organisation based in the Highlands, has been offering free health walks in communities across the Highland region (with the exception of the Cairngorm National Park) for the last 12 years.

    Our aim is to enable people to become and remain active by offering low impact, low cost, local walks. The impact of the walking groups on the people who walk with us can be significant for both physical and mental wellbeing and we have many examples of the positive outcomes that people experience by walking regularly as part of a supportive group. Our work is highly preventative, by encouraging more people to be active we are helping them to manage their health and wellbeing, preventing a range of conditions and illnesses associated with isolation and inactivity.

    However, we struggle to find funding and, like many in the sector, exist on a shoestring. We are looking for funding to help us keep doing what we already do, we work with a wide range of individuals and communities and to be fair what we do is not ‘sexy’ – it is not big impact stuff, for a number of our walkers the benefits of accessing Step It Up Highland may not become apparent for some years. Trying to re-frame what we do to fit into funders criteria can be exhausting.

    Given we exist to be preventative I would be very interested to hear how the Big Lottery feels it could support organisations like ours both in terms of sustaining current activity levels and also promoting the message that prevention really makes a difference. I would also be interested to hear how an organisation like ours could support the Lottery in its desire encourage a shift in attitudes and priorities to a longer term view.

  2. Midlothian Voluntary Action (MVA) is part of the Third Sector Interface in Midlothian. We recently undertook a research project aimed at establishing our part in the preventative spend agenda.

    We used a Cost Benefit Analysis to identify any savings arising from our activity, looking at potential benefits including reduced stress, improved confidence, increased capacity, time saved, reduced cost of processing failed applications, costs avoided through successful funding application.

    We also examined how our work might be more preventative in its approach.

    Both a full and summary report can be accessed here:

  3. The Nurture Group Network (NGN) has been piloting our National Nurturing Schools Programme in Aberdeen (as a cluster) and with individual schools across Scotland. Using the principles that have delivered successful Nurture Group provision for many years, the National Nurturing Schools Programme has developed methodology for taking the learnings from acute intervention and transposed them into a whole-school setting. The purpose is to prevent early indications of social, emotional, and mental health issues becoming more embedded, this can lead to behavioural problems, exclusions and more severe conditions.

    The Programme is based on using the Boxall Profile to assess each child, the outcomes provide an insight for teaching staff into the developmental and diagnostic profile of the child, highlighting areas of concern and suggesting targets and interventions.

    The National Nurturing Schools Programme is now ready to be extended into more schools although funding (it costs c£1,500 per school for training plus £150 per annum for Boxall Online) continues to be an issue. On December 7th, NGN will be launching our Nurture Portrait which will show the data we’ve collected from the 7,969 Boxalls that were carried out on 6,042 children between December 2015 and July 2017 across the UK.

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