It is worth noting that not all preventative strategies needto entail public spending.Indeed measures which canwork without significant public spending ought to beof particular interest at this time. These includeregulatory options,as with the smoking ban;financialsticks and carrots e.g.the proposals for a minimum priceof alcohol;and public information.
In any case,shifting to a focus on preventative initiativesshould not be limited to saving money.The real questionto ask ourselves is what kind of society do we want tolive in? Scotland has serious problems in areas such ashealth,alcohol misuse,drugs,knife crime,inequality andpoverty that the Scottish Government must address.If we rely on crisis management rather than preventativeintervention there is significant risk that things will gowrong,for example with our young people or for theelderly,before any action is taken to rectify the situation.
Commitments and prioritiesfor preventative spending
In any budget decision,money can be used mostbeneficially when prioritising initiatives and actionsthat are proven to be most effective.The difficultywhen evaluating preventative spending options is thatin many areas there is as yet little evidence on theeffectiveness of certain interventions.The ScottishGovernment must ensure that all existing evidenceon particular interventions is mined and understood,and that it is easily available to those who makeservice-related decisions,particularly local authorities.It must also prioritise the gathering of further evidence,with all initiatives designed and funded in such a waythat the delivery agency can monitor their impact fromthe outset.This is particularly important for initiativesthat are implemented on theory and principle,for which there is little or no existing evidence.Theevidence base should include internationalcomparators.
However,the lack of available evidence is also a resultof the complexity of the preventative spending arenaand the multitude of factors that can influenceoutcomes.It is crucially important that we do not takea narrow view of preventative spending and evidenceof its outcomes,but instead take account of the wider impact of initiatives on society and a range of keyfactors that determine wellbeing,such as equality andsustainability.Indeed,it may often be more tractable toestablish positive outcomes than to demonstrate theabsence of a negative one.
Early years intervention is often highlighted as apriority area for preventative spending,and the RSEagrees that this should be the case.There is evidenceavailable that strongly supports a range of early yearsinterventions,with the Netherlands and Scandinavialeading much of the work in this area because of their constitutional obligations to provide certain levels of early years support.But it is important too that early years support does not become synonymous withpreventative spending.Scotland faces significantchallenges in a number of other areas,including in careof the elderly,young people in care,alcohol misuse andlevels of heart disease,which must be addressed.Whereevidence shows that preventative interventions willhelp to tackle these challenges and have a positiveimpact on the wellbeing of society,such actions shouldbe prioritised.
While bearing in mind the need to assess the impactof preventative activity,and indeed all policies,in lightof their impact on a broad spectrum of factors thatdetermine wellbeing,a starting point for thedevelopment of appropriate preventative interventionsis to have a clear vision of the negative social outcomeswe want to avoid.For example,evidence shows thatisolation has a significant negative impact on the healthof elderly people,so preventative interventions wouldinclude ensuring that there are sufficient day centresand good community transport.
There is very clear evidence of marked geographicalinequalities in Scotland,with significant inequalities inhealth,educational attainment,and economicparticipation.This is shown very starkly in male lifeexpectancy which in Calton is only 54,compared to 82in Lenzie,seven miles away
.This too is recognised inthe Christie Commission Report.Communities whichexhibit multiple deprivation are likely to be highlydependent on public spending (both for the Scottishand UK Governments) and reductions which affectthem may exacerbate these inequalities.
Outcomes,indicators and baseline measuresfor preventative spending
The“Scotland Performs”framework currently in placesets out the five Strategic Objectives and 15 NationalOutcomes that form the Scottish Government’s visionfor the country.But it is not clear how these very highlevel aims will be able to drive decision making andassist with difficult choices at a time of spendingreduction.
Below the National Outcomes is a raft of indicatorsdemonstrating progress towards achieving the ScottishGovernment’s vision.Indicators can,of course,beinvaluable in forming a proper understanding of progress and the effectiveness of actions.However,numerical indicators are inevitably proxies for progressand a narrative is needed to interpret the indicators andto link them with the theory and principles thatunderlie an intervention,and to give a true picture of its impacts in the widest sense.Are we confident thatdetailed performance indicators are feeding through toaction for improvement?
World Health Organisation Commission on Social Determinants of Health,2008,http://www.who.int/social_determinants/thecommission/finalreport/en/index.html