'A Better Start' – How will it pay?

The ‘Preventonomics’ Unit Cost Calculator (PUCC)


In our first Preventonomics blog we commented that there is a general agreement in both policy and research spheres that we should ‘invest’ more in prevention and early intervention services. By increasing the amount of money spent, outcomes for children will improve and so there will be a ‘pay-off’ in terms of reduced use of expensive services in later years, and potential for societal saving though better attainment at school and at work.

However, it is important to know how much you are spending today to generate those downstream savings, particularly in these times of budgetary constraint. In this blog post, we introduce the Preventonomics Unit Cost Calculator – or PUCC. This simple, free-to-download Access database can help you estimate costs.

The PUCC was originally developed to support the A Better Start initiative, funded by the Big Lottery Fund, to understand the costs of the interventions the five participating sites are putting in place.  The PUCC can help users, researchers and providers alike, to estimate the costs of their new – and existing –health and social care services. Of course, a blog is not the place to provide detailed user instructions but full Guidance, with screenshots to illustrate the PUCC, is included in the PUCC download.

The PUCC can help you to estimate the cost of a single professional, but the exciting feature (exciting for us anyway!) is that you can build up the cost for a more complex intervention.  Perhaps where two professionals deliver two-hour weekly sessions to a group of families over a ten-week period; or where nurses, social workers and occupational therapists deliver an integrated package of treatment and care for someone who has just left hospital. Or PUCC can be used to estimate the impact on the cost of a course of cognitive behaviour therapy should different professionals deliver it. This screenshot of the PUCC welcome page shows the PUCCs facilities.

Each large button takes the user to a different PUCC function.

Clicking Enter new unit cost allows you to estimate details for single professionals. The data entry form asks a series of questions about the profession type and grade, salary, and the organisations’ overheads, as well as hours worked.

The underlying method builds on the approach used in the Unit Costs of Health and Social Care volumes to help ensure the unit costs are calculated in a robust and systematic manner.  The programme has some default values already entered, however, we advise using your own local data so that the resulting unit costs better reflect your local circumstances. The unit cost can be viewed by clicking the button labelled Open unit cost report. Importantly, the information entered here is stored in your database so you don’t have to enter this information again.

Key to the PUCC is its capacity to generate more complex costs. Enter new intervention cost allows you enter information about how your intervention or service will be developed and delivered: staffing requirements, number of sessions or users, etc. You can draw in information on the cost of the professionals involved from the database. Again, all this information is summarised for you and can be viewed by clicking the Open Intervention cost report button, and is stored in the database.

The buttons labelled Export unit cost data to Excel and Export intervention cost data to Excel do just what it says on the tin – or rather, the button. They enable you to easily export your data into a spreadsheet format. This is especially useful for intervention cost data, which can be further analysed using pivot tables and graphs.

It would be great to find a connection between our PUCC and Shakespeare’s Puck, thus coming up with an amusing end to this blog post. Perhaps there is a tentative link between “… yonder shines Aurora’s harbinger…” and “bringing in a new dawn of unit cost calculations”? To be honest, even to us this seems over the top, not to say convoluted.  However, we believe that PUCC is a useful addition to the existing toolkit for developing and understanding unit costs data; we hope that users will agree.



Download the PUCC here: https://www.pssru.ac.uk/project-pages/unit-costs/pucc/



We would like to thank everyone who has supported the development of the PUCC and the guidance. PUCC is only one part of the Preventonomics Toolkit that supports the five A Better Start sites. Our aim has been to develop evidence-based tools to support the five A Better Start areas to:

  • understand the unit costs of the interventions they are putting in place
  • help track their area-level finance and outcomes data, and
  • provide an early estimate of the cost savings that could be made from their prevention interventions five and 35 years down the line.

Our thanks are extended to the Big Lottery Fund (BLF) who commissioned this work as part of their A Better Start initiative and we would like to thank the A Better Start team at BLF for their support. We would also like to thank the A Better Start site personnel who contributed their expertise and PSSRU colleagues who helped us with this work, particularly Lesley Curtis, Cate Henderson and Valentina Iemmi who ‘road-tested’ earlier versions, and the members of the PSSRU cost-effectiveness cluster who provided feedback and advice.

‘Preventonomics’ – a focus on outcomes


The evidence base for prevention and early intervention in the early years is growing, but there are still some significant gaps when it comes to costs and cost savings.

For ‘Preventonomics’, we are putting together estimates of the costs of not intervening early. We will, for example, look at the costs to society caused by child maltreatment. Child abuse and neglect have a profound impact on children, and recent research has linked it to not only mental health and behaviour problems, but also a higher risk of developing chronic health conditions in later life.

But for a lot of things that can impact children’s lives negatively, there is no good source of cost data. How can we address this problem?

The ‘Preventonomics’ model will use an outcome-focussed approach to estimate the costs of childhood problems. This way, we can make use of the available data, while acknowledging the complex relationships between childhood risk factors and outcomes.

Let’s go back to the example of child maltreatment. There are few studies examining the costs associated with it, be it directly or indirectly. We know a little bit about the costs of taking children into care, but that is only a small part of the story. What we do know, however, is that child maltreatment is closely associated with children developing behaviour problems. And this is an area where there a decent evidence base already exists. We can therefore take what we know about the consequences child maltreatment and the costs of behaviour problems, and put this information together to estimate the costs of child maltreatment.

For the ‘Preventonomics’ model, we have identified several key problems emerging in childhood that are linked to the three ‘A Better Start’ areas of intervention: Social-emotional development, speech and language development and nutrition. These childhood problems are in turn linked to longer-term outcomes, for example lower academic achievement and a resulting lower income later in life. This means we will have a common framework for assessing the impact of ‘A Better Start’ on a range of childhood problems and their economic consequences.

An outline of the model framework can be downloaded here. It reflects our current thinking and is by no means meant to be a complete picture of the final model. The arrow at the top signifies different stages in a child’s life and the passing of time. The first two sections, “pregnancy and birth” and “home environment / parenting” are where interventions as part of ‘A Better Start’ will happen. “Child outcomes” are the types of childhood problems that ‘A Better Start’ is looking to prevent. The vertical, double-ended arrows indicate that the problems noted in each section are interlinked. And “economic end points” represent the longer-term consequences of childhood problems that can be quantified in terms of money.

The focus on outcomes is useful for developing the ‘Preventonomics’ framework because it helps us work around a shortage of cost data, but it has another advantage: It allows us to focus on what really matters for children and their families. The model will estimate savings in terms of ‘bad’ outcomes averted, and through this will reflect the focus of ‘A Better Start’ – improving the lives of children through prevention and early intervention.

In our next post, we’ll talk about some of the advantages and limitations of economic models more generally, and what this means for ‘Preventonomics’. Until then, follow us on Twitter (@preventonomics, @BigFirstYears) and join the conversation by using the hashtag #ABetterStart.

60,000 vulnerable babies to have a better start in life


Today, the Big Lottery Fund announces five areas in England sharing £215 million to help parents of 0-3-year-olds.

There is strong evidence to show that what happens in the womb and through the first three years of life can profoundly affect a child’s future.

Tens of thousands of vulnerable babies who may be at risk of a future of long-lasting health issues, unemployment or even criminal activity will now have a better start in life following a £215 million Big Lottery Fund investment to five areas in England.

There is a wealth of research that demonstrates the importance of a good start in life. Recent research has shown*:
• 35 per cent of toddlers from impoverished inner-city areas are anaemic (1)
• more than half of nursery-age children living in disadvantaged areas have a communication disorder, with as many as 7 per cent in some cities (2)
• 10 per cent of children entering school are obese (3)

Meanwhile research also shows:
• For every £1 spent on early years education, £7 has to be spent to have the same impact in adolescence (4)

The areas announced today have been awarded up to £50 million each – Lambeth, Southend, Nottingham, Blackpool and Bradford – in a ground-breaking ten year test and learn initiative to see what methods are the best for laying the foundations for 0-3-year-olds to improve their future health, social and educational outcomes. The investment aims to improve the life chances of more than 60,000 babies and children.

A cross-sector partnership of local health, statutory and voluntary sector organisations will work alongside local parents in each area to redesign local services and test how well they can improve social and emotional development, nutrition, and language and communication development in young children to prevent costly problems in later life.

Southend and Blackpool plan to create internationally recognised and renowned centres of excellence and sources of expertise, bringing together practitioners, researchers and parents to lead the change in delivery of services.

Across Nottingham activities will tackle the stress caused by family conflict and domestic abuse, parental substance misuse, and parental health problems. Midwives caseloads will be reduced from 100 to 40 in Bradford to enable a more personalised care, providing more home visits and establishing links with children’s centres.

In Lambeth more than 50 new community champions will be recruited in the first year and trained to promote crucial advice.

Evidence will be produced over the ten years to show which approaches work best to demonstrate the social and economic benefits of investing to prevent harm, in order to influence early years funding across the country.

Dharmendra Kanani, Big Lottery Fund England Director, said: “Parents want the best for their children and as a society we know that what happens in the first three years of life profoundly affects a child’s future life chances. A poor start in life can affect your health, wellbeing, outlook on life and how you form relationships. Prevention matters more in the early years as we have a much greater understanding of what can and might improve the life chances of a future generation, that is why this investment is focusing on the three key areas of social and emotional development, nutrition, and language and communication development.”

The Southend partnership, which receives £40 million will be led by the Pre-school Learning Alliance which aims to transform maternity care, parental support with activities delivered from key sites including a network of children’s centres with a wide range of local, voluntary, statutory and health organisations involved. Midwifery and health visiting services will be increased and there will be improved access to high quality resources to maximise maternal health during pregnancy. The Centre of Excellence, Innovation and Best Practice will bring together practitioners, researchers and parents to lead the development and delivery of services and systems change. Workshops to improve ‘school readiness’, speech and language, and address obesity will be introduced alongside breastfeeding support workers. The partnership expects to improve the lives of 13,000 children in its target areas.

The NSPCC have been awarded £45 million to lead the partnership in Blackpool which is the sixth most deprived local authority in the country. Thirty per cent of babies experience poverty and the town has the highest levels of looked after children in the country. Work will address low breastfeeding rates, limited prenatal care, family conflict and domestic abuse, maternal obesity, child poverty, substance misuse, poor social cohesion and lack of exercise. Young children will be encouraged to eat more fruit and vegetables, health professionals will support pregnant women understand the risks of being overweight and midwives will be trained in newborn social and communications skills. Community environmental projects will include creating more open spaces for families to promote the benefits of being active, while education campaigns will focus on alcohol abuse, domestic abuse and mental ill health. The establishment of a Centre for Early Child Development will play a crucial role, aiming to become an internationally recognised and renowned source of expertise and innovation in services and systems from pregnancy to the age of three.

Across Nottingham as a whole, 39 percent of children are classed as living in poverty and one in four adults in the city have no formal qualifications. There are high numbers of children with early onset behavioural problems, chronic health conditions, unhealthy gestation and birth, and poor school readiness. The Nottingham CityCare Partnership receives £45 million and the project includes activities and interventions that will tackle the ‘toxic stress’ caused by family conflict and domestic abuse, parental substance misuse, and parental health problems. Projects will be delivered within pram pushing or toddler tolerance distance of all family homes, utilising 16 local delivery centres across the communities. This will include opening up community buildings in the evenings and weekend. All staff and volunteers in direct contact with children and families will receive accredited training in communication and engagement, family dynamics and child development, safeguarding and welfare. A new workforce of paid family mentors will be recruited and trained work alongside professionals.

Bradford Trident will lead the partnership in the town which receives £49 million to engage with around 20,000 babies and children over the ten years. According to Bradford Trident the district as a whole has significant deprivation and within the three target wards (Bowling & Barkerend, Bradford Moor and Little Horton) there are high rates of infant mortality, child poverty, poor oral health, high child obesity rates, low numbers of school readiness and high rates of domestic violence and child protection orders. Research shows that one in five children in the three wards have poor communications skills at the school readiness stage and one in three children have poor social and emotional development when starting school. Midwives caseloads will be reduced to enable a more personalised care, providing more home visits and establishing links with children’s centres. A befriender scheme will be introduced for all expectant and new mothers affected by or at risk of postnatal depression, while a targeted service working with parents will increase their understanding of infant brain development. There will also be home-based language development programmes, outdoor play, story-telling, exercise activities and nutrition programmes.

In Lambeth, the National Children’s Bureau, which receives £36 million, will improve breastfeeding rates, reduce childhood and maternal obesity, reduce domestic violence, improve social, emotional, communication and language development. The projects will be delivered at 26 sites, 13 of which will be enhanced and outdoor plays areas created. The new spaces will allow all those working with families to use the same base, share information and work with parents so that health professionals such as health visitors and midwives will work much more closely with the council’s family support workers, social workers and ‘community champions’ to support families in a more coordinated way. More than 50 new community champions will be recruited in the first year and trained to promote key advice and build connections in the community to reduce the social isolation of some new parents. A further ten breastfeeding supporters will be added to the existing team.

Big Lottery Fund Press Office: 020 7211 1888
Out of hours media contact: 07867 500572
Website: www.biglotteryfund.org.uk
Twitter: @biglotteryfund #biglf #ABetterStart
Facebook: www.facebook.com/BigLotteryFund

*Annual Report of the Chief Medical Officer 2012, Our Children Deserve Better: Prevention Pays:

(1) Gregory JR. National Diet and Nutrition Survey: Children
aged 1.5 – 4.5 years. 1995; London: UK, HMSO

(2) www.stokespeaksout.co.uk

(3) Ridler C, Dinsdale H, Rutter H. National Child
Measurement Programme: Changes in children’s body
mass index between 2006/07 and 2011/12. Oxford:
National Obesity Observatory, February 2013

(4) DCSF. The Impact of Parental Involvement on Children’s
Education. London: DCSF; 2008.

• The Warwick Consortium, led by the University of Warwick, will measure the impact of this funding and share learning. The Warwick Consortium includes key figures in early years research from Oxford University, Ipsos Mori and Bryson Purdon Social Research.

• The London School of Economics will establish a robust cost-benefit framework that will measure the cashable savings to society and the public purse through A Better Start interventions.

• The Social Research Unit at Dartington supported the partnerships throughout the process by providing them with local data, helping them to identify the best evidence and facilitating community engagement.