– in the Scottish Parliament on 9th March 2011.
The next item of business is a debate on motion S3M-7994, in the name of Andrew Welsh, on the Finance Committee’s “Report on preventative spending”. I call Andrew Welsh to speak to and move the motion on behalf of the Finance Committee.
This will be one of the last speeches that I will make as an MSP, and it is my final scheduled contribution as convener of the Parliament’s Finance Committee. Therefore, I welcome the fact that I will address a topic—preventative spending—that has the potential to deliver long-lasting social and financial change, and to transform the way in which our public services are delivered.
I believe that our report, which was agreed on a unanimous cross-party basis, leaves a powerful legacy not just for our successor Finance Committee, but for the Parliament as a whole. The inquiry sparked discussions that were often very powerful and passionate. I would not use the word “debates” simply because there was such strong consensus that preventative spending is the correct approach and that it must be adopted more widely.
I want to make it clear that the preventative spending message is extremely simple: public money would be more wisely spent on preventing social problems from occurring than on dealing with problems once they have occurred. That message is by no means novel, of course. Members will be familiar with, for example, the mass vaccination programmes against polio and tuberculosis. Those are well-known and highly successful examples of investments that have delivered considerable long-term benefits.
As the committee’s report makes clear, Scotland faces some appalling social problems. Debates in the chamber have shown that members are acutely aware of those problems—whether they are to do with alcohol, ill health, poverty or violence—but it is important that we constantly remind ourselves of the damage that such problems inflict on our society so that we never cease to search for effective solutions. To be optimistic, the clear message that we received throughout our inquiry was that preventative spending is one of the best means of providing such solutions. However, if we are serious about helping to engineer real, long-term social change, it is no use for the committee simply to publish such a report and then to move on to the next new thing. Rather, we need to build momentum for change and convince other people to join us.
With that in mind, we have already had a discussion on the report in the chamber of the Scottish Parliament. Last Friday, 90 senior delegates from across the public sector came together to discuss it, the Scottish Government’s response to it, and how the barriers to preventative spending can be overcome. I intend to highlight the main points from our report and some of the contributions that were made at that event.
One reason why the Finance Committee is so positive about the benefits of a preventative approach is that our current approach to dealing with social problems is simply unsustainable. For example, it is estimated that violence, smoking and obesity cost the Scottish economy more than £3.5 billion a year. At United Kingdom level, one report has claimed that the economic cost of continuing to address current levels of social problems will amount to almost £4 trillion over a 20-year period. We received evidence that claimed that around 40 to 45 per cent of public spending that is aimed at addressing social problems is negative—that is, it is short-term spending. To its credit, the Scottish Government has acknowledged that the current balance of spending is skewed too much towards reactive spending.
We could have looked at how a preventative approach would work across virtually the entirety of Scottish public spending, but we had to direct our efforts realistically. The report therefore focuses on the early years and health and social care. The early years issue in particular is currently one of the most topical issues around. In addition to our inquiry, former MSP Susan Deacon, Frank Field MP and Graham Allen MP have all recently reported in the area. The fact that they were asked to do so by Governments of different political persuasions demonstrates the consensual and non-partisan nature of the debate.
In the simplest terms, early interventions aim to provide support for children—including support through their families—at as early a stage in their lives as possible. Such interventions include better child care, better support for mothers before, during and after pregnancy and more targeted support for children with particularly complex needs.
I know that the debate is supposed to be consensual, but will Andrew Welsh comment on the abolition of the health in pregnancy grant?
Such questions are better posed elsewhere. I am relaying to Parliament a positive report, rather than the usual negativity that is produced in debates. I say to Elaine Smith that early interventions can significantly help to prevent or reduce the likelihood that children will develop social problems that might necessitate a future intervention by the state. Such an approach could save sizeable sums of money, as the number of interventions that public bodies must provide would be significantly reduced. That approach is of obvious and considerable appeal to the Finance Committee.
It would be a dereliction of duty if I did not echo the many voices who made it clear that early intervention is also the right thing to do from a moral and societal perspective. I mentioned that powerful and passionate views were expressed throughout our inquiry, so I will share some of them with the Parliament. As Dr Suzanne Zeedyk, a senior lecturer at the University of Dundee, put it:
“Children’s brains develop more quickly between birth ... and the age of three than they ever will again. So we need to get the money into services and get support to families because, after that age, those brains are in place. If we delay, all that happens is we continue to spend our money in ways that are, frankly, dumb.”—[Official Report, Finance Committee, 2 November 2010; c 2614.]
One charity, the WAVE Trust, pointed out that
“Study after study ... demonstrates that to invest money in prevention is simply the best economics and the best investment for national and local government.”—[Official Report, Finance Committee, 9 November 2010; c 2655.]
The committee acknowledged the work of the Scottish Government and the Convention of Scottish Local Authorities in establishing and driving their long-term early years framework. However, some disquiet was expressed during our inquiry and at our chamber event that the framework is built on a relationship between central and local government that may place too much emphasis on local delivery. For example, although the Scottish Government claimed that
“the key to success ... is what happens at local level”,—[Official Report, Finance Committee, 30 November 2010; c 2832.]
we heard several voices calling for more concerted central direction if early years provision is to flourish and if outcomes are to improve.
We also asked the Scottish Government to consider whether its framework should be more focused on the zero-to-three age group, given the stark evidence that we heard about the importance of investing in the very earliest years.
The second area on which our report focused was preventative spending from a health and social care perspective. In simple terms, the debate is about the extent to which people can be supported in their own homes rather than in far more expensive institutional settings, such as care homes or hospitals. Much enthusiasm was expressed for such a switch, but witnesses were very honest about its challenges, including making the shift to investing in cheaper social care services by disinvesting in more expensive health services when there is no sign that demand for such services is abating.
COSLA discussed the need for a new approach that would involve disinvestment and reinvestment in individual public sector organisations, between public sector organisations and at Government level. Such a move might well require far better partnership working than we have sometimes witnessed in the public sector.
Our inquiry heard particularly blunt views about the likelihood of some organisations working together to realise the benefits of preventative spending. For example, Detective Chief Superintendent John Carnochan of the violence reduction unit considered that
“There is still a deal of territorialism between agencies, including the voluntary agencies, that is more corrosive and pernicious than that between the gangs in the east end of Glasgow”.—[Official Report, Finance Committee, 26 October 2010; c 2561-2.]
Aside from partnership working, we are well aware of other potential barriers to preventative spending; for example—and inevitably—the impact of budget cuts. If we politicians are honest, we must acknowledge that our focus is too often on the short or even immediate term. As we all know, that is especially the case at election time. Realising the full benefits of preventative spending will require concerted planning over a much longer timeframe. Otherwise, we run the risk of paying only lip service to it.
For the first time since devolution, a parliamentary committee has examined preventative spending in depth and across different spending areas. We heard remarkably strong evidence about the benefits of that approach. We must face up to that, so I call on everyone involved to work together and to acknowledge that preventative spending is not top of the political agenda. We must make the preventative approach irresistible to politicians at local and national levels.
The Finance Committee considers that the Parliament’s committees are ideally suited to driving that agenda forward on a continuing cross-party basis. The committee’s legacy paper recommends that scrutiny of preventative spending should be integral to the annual budget process and that appropriate guidance should be issued to subject committees to help them to scrutinise the Scottish Government’s progress. I hope and trust that the new committees that will be established after the forthcoming election will meet that challenge and ensure that real progress is made.
I thank my colleagues on the Finance Committee and I thank the clerks for their expertise and contributions. I hope that action will follow and that Parliament will let this unanimous report be a positive start to solving some deep-seated problems.
That the Parliament notes the conclusions and recommendations contained in the Finance Committee’s 1st Report, 2011 (Session 3): Report on preventative spending (SP Paper 555).
Mr Welsh said that this was his last scheduled appearance in a parliamentary debate as convener of the Finance Committee. As finance secretary, I am always a bit nervous when there is speculation about an unscheduled appearance by the Finance Committee convener in the remaining days of the parliamentary session. However, as a longstanding colleague and neighbouring constituency member of the Scottish Parliament to Mr Welsh, I place on record my appreciation for his contribution to parliamentary life, in the House of Commons, where I had the privilege to serve with him, and here in the Scottish Parliament, where he has made a distinguished contribution to public life—no more so than in his final speech this afternoon on such an important subject.
I welcome the debate on preventative spending. I welcome, too, the Finance Committee’s inquiry report, which has brought together a wealth of evidence and understanding. It has demonstrated that there is substantial agreement about the importance of undertaking preventative spending. I hope that we can take the opportunity to build on that in the course of the debate.
I will set out a number of areas of activity that the current Administration has taken forward on preventative spending. I am struck by the fact that many of those interventions were priorities that were taken forward by our predecessor Administrations. There is wide acceptance across the political spectrum that many of the deep-seated problems to which Mr Welsh referred, which were discussed at length in the participative session in Parliament last Friday, at which the Minister for Children and Early Years represented the Government, will not be readily solved in a parliamentary session. However, they require sustained and continuous commitment regardless of the political colour of the Administration. This Administration has willingly accepted the need to build on many of the programmes and initiatives that were established by our predecessors.
The Government has provided a written response to the inquiry report, exploring the issues that were raised by the Finance Committee. I want to set out some of the areas of activity in which preventative action is significantly entrenched in policy making in Scotland. The Government has presided over the introduction of the early years framework, which is aimed at pre-natal to eight years of age, with the overarching intention of ensuring that each child has the best start in life, regardless of his or her circumstances.
We have put in place the equally well framework, which sets out the need to address the underlying causes of future ill health and other negative social outcomes. We have also put in place “Achieving Our Potential: A Framework to tackle poverty and income inequality in Scotland”, which is designed to encourage the public, private and third sectors to work together to tackle poverty and income inequality. The three frameworks have been important building blocks of the Government’s policy response on many aspects of these areas of activity.
That response translates into a range of other programmes. The Government, in partnership with our local authority partners, the third sector, health boards and other organisations, will allocate resources to tackle some of the major issues with which all members of the Parliament are familiar. I refer to our work on smoking cessation, on shifting emphasis on to anticipatory care, on tackling alcohol abuse, on screening, on crime and offending, on tackling the corrosive impact of domestic violence on households, and on putting in place state support for older people at the stage in life at which they require it. The Government and its social partners are involved in delivering active intervention in many areas. That work will continue.
The process was reinforced yesterday, when the Minister for Children and Early Years launched the £6.8 million early years early action fund, which will enable national voluntary sector organisations to work with Inspiring Scotland and local projects to help local people and local communities to create better lives for themselves and their children. That is just one practical example of how we intend to deploy our resources to support early intervention.
The committee noted that the earlier in the life of a child an intervention is made, the greater the return on the investment. The Government accepts that. The committee went on to question whether the early years framework should be more focused on the birth to three years old age group. Members will see from our written response that we recognise the importance of that period, which is at the core of the early years framework and underpins our approach to maternal services. Nevertheless, we think that the zero-to-eight age group coverage of the framework is right. It was well supported by the experts who were involved in gathering evidence on the issue and reflects an appropriate time span in a child’s development.
The frameworks that the Government has introduced have been developed in a way that is intended to draw together the work of all public agencies: Government, local authorities, other agencies, health boards, the third sector and the private sector. The frameworks have helped to give structure and focus to many aspects of the work that the Government wishes to undertake, which is broadly supported by all parties that are represented in the chamber.
In the past four years, we have shifted fundamentally the focus of policy making away from monitoring processes and inputs to agreeing outcomes with local partners. One clarion call that has been made around many aspects of this area of public spending concerns the necessity of focusing on outcomes, to guarantee that all of us are able to see that the impact of public expenditure and public policy has been to make a difference to the quality of life of individuals in our society and to deliver better outcomes in all circumstances. The performance framework that the Government has put in place enables its activities and those of the public sector in general to be monitored against the achievement of those outcomes.
I heartily endorse the cabinet secretary’s comments, but does he recognise that the committee found it difficult to establish what baseline information on outcomes was available and to judge whether we were meeting those outcomes? That shapes the budgets that follow.
Mr Purvis goes on to fascinating and complex ground in all of these areas. With Scotland performs, we have tried to identify a set of indicators that will provide us with an indication of a baseline against which performance can be judged. I freely accept that there has been a choice—a selection—of criteria, and that other criteria could be selected. However, I hope that members will look at Scotland performs as a genuine attempt to put in place a dispassionate set of measures to determine whether progress is being made. When it comes to assessing the performance of individual planning partnerships, we have an opportunity to review progress and to determine whether outcomes are being achieved, because outcomes are the focus of all the single outcome agreements that are in place at local level.
One of the major areas in which we recognise that there must be further activity in preventative action is adult social care. The £70 million change fund, which the Deputy First Minister and I announced in the course of the budget process, is designed to encourage partnership working between local authorities and the health service, so as to improve the models for health and social care delivery at local level, building on the work of the integrated resource framework. I hope that that is welcomed across the Parliament.
The Finance Committee convener quite properly indicated that such decisions and discussions take place at a very difficult time for the public finances. The decisions that I took for the budget were designed, in essence, to protect the major areas of preventative spend in the health service and in early intervention. Those are difficult choices, but they are the right choices for ensuring that every one of our citizens has the best start in life and that, when our citizens require intervention, the public sector and public policy are able, at the earliest possible moment, to deliver the interventions that people require.
I am pleased to speak for Labour in support of the Finance Committee’s report. I associate myself with the remarks of the cabinet secretary on our convener, Mr Welsh. I fear that I might have tested his patience somewhat on occasion, but he always dealt with it with good humour, for which I thank him. I also associate myself with Mr Welsh’s remarks, thanking our clerks for their hard work not just on the report that is before us, but during the two years for which I have been a member of the committee.
It is not just we on the Labour benches who believe that Scotland should be one of the best places in the world to bring up children. As Mr Welsh commented, the committee’s report was unanimous. Anything that puts me, Joe FitzPatrick and Derek Brownlee on the same page in agreement must be an achievement. Throughout the Finance Committee’s evidence sessions, that view was echoed by nearly every contributor to our discussions.
All parties believe that Scotland’s public services must focus more on preventing social problems from arising, rather than reacting to problems once they have occurred. I believe that the negative aspects of Scotland, including our higher rates of drinking and substance abuse compared with the rest of the UK and other countries, our relatively high prison population as a proportion of the total population, and our lower life expectancy compared with the rest of the UK, particularly in some parts of Glasgow, remain a major concern for us all.
The scale of the challenge that faces Scotland’s public sector in dealing with child wellbeing and social problems such as violence and ill health is huge, but it is not insurmountable. A lot of interesting and successful work is being done in that regard.
Is it not common sense to recognise that good habits that are picked up early in life can have an impact on reducing the future cost of ill health to the NHS; that they can help to boost economic output; that they will reduce the risks of vulnerable individuals getting involved in crime and potentially going to prison—with all the costs that are associated with that; and that they can impact on the quality of learning and the skills that are held by individuals, with productivity implications for society as a result? All our expert witnesses suggested that a preventative approach is one of the best means of tackling those problems, and that it can deliver significant financial savings in the process.
Mr Welsh has already quoted Detective Chief Superintendent Carnochan of the Strathclyde Police violence reduction unit, and I would like to do so, too. He said that
“the future of Scotland’s children” was
“at a crossroads”.
He commented that, if he was offered the choice between 1,000 new police officers and 1,000 health visitors, he would be minded to opt for the health visitors.
Mr Carnochan said:
“We are presented with the opportunity to make Scotland the best place in the world to bring up our children and to change their destiny and improve their outcomes. That is within our grasp ... their future is our future. Our economy, our culture and our country depend on them.”
He went on to say:
“Plans and interventions that tinker around the edges and halfway measures are no longer acceptable ... Doing nothing is not an option ... we need to make investments in the early years so that our kids are not left behind before they even get to school.”
The committee’s report shows the consensus across the board that more focus must be placed on preventing social problems from arising, rather than on reacting to them once they have occurred. With common sense, we can see that there is no shortage of evidence and experience firmly pointing towards the placing of greater emphasis on prevention and early intervention, rather than on crisis intervention. The overwhelming consensus during the Finance Committee’s inquiry shows that greater recognition is required for that crucial early stage.
Children 1st put it in black and white in its submission: it wants less talk and more action. The charity is concerned that shifting the balance towards prevention should not remain merely theory and rhetoric but should become the reality on the ground.
For example, we spend more than £1 billion on funding higher education. That is more than three times more than we spend on pre-school education. One of our witnesses, Professor Edward Melhuish, of the University of London, suggested that the emphasis in investment should be the other way round.
Children 1st used the example of police funding. Police forces spent £320 million on community safety in 2009-10. Much of the money is spent on diversionary activities for young people to prevent offending, on antisocial behaviour teams and on closed-circuit television operations. There is no doubt that some community safety activity prevents problems from escalating, but it would be far better to prevent the problems from even beginning.
Some preventative work is going on. Dundee has one of the highest teenage pregnancy rates in the UK and NHS Tayside is one of the pilot areas for the family-nurse partnership programme, which supports vulnerable pregnant teenagers. Another scheme is running in NHS Lothian. We heard it argued that such a service should be universal in Scotland, as is the case in the Netherlands. Many respondents argued for universal services for all families, on the grounds that such services are non-stigmatising, ensure that people who need intensive help can be more easily plugged into support and, most important, enable every family to put in place the parenting approaches, attitudes and supports that ensure parent-child attachment and a positive home environment.
As we found, and as Mr Welsh and the cabinet secretary said, in the short-term cycles in which political debates take place it can be difficult to shift spending priorities towards the longer term, given that the benefits of doing so might not appear until years or generations later. Let us try to move those concerns aside. Labour certainly does not think that the issue should be the subject of a political spat.
Much of the literature that I have read on prevention focuses on early years intervention, which can contribute to beneficial outcomes across a range of policy areas—from health to justice to economic development. One of the best examples of such an approach comes from the Netherlands. The most recent United Nations Children’s Fund study of child wellbeing in Organisation for Economic Co-operation and Development countries ranks the Netherlands as top, with the UK at the bottom of the table. How does the Netherlands do it? It has an overall national policy, which is pushed through by the minister for children.
James Heckman, the Nobel prize-winning economist, has argued that returns from investments in early years greatly outweigh the returns from investments in any stage of education—school or tertiary—and that an optimal investment strategy is to invest less in the old and more in the young. The committee’s report points in that direction and I commend it to the Parliament.
I thank the committee clerks, and the witnesses who gave evidence to the inquiry. I also thank Andrew Welsh for his time as convener of the Finance Committee. The inquiry on preventative spending was perhaps one of his easier tasks and I know that he feels strongly that it is an important legacy not just of his work, but of the work of the Parliament as a whole.
The Finance Committee does not divide on issues as frequently as people think we do, but even for us there was a striking degree of consensus among the parties that are represented on the committee on the need for greater focus on preventative spending. That is important, particularly because of the point that Andrew Welsh and David Whitton made about the difference between the political timeframe and the timeframe in which preventative spending has an impact. It is not surprising that politicians focus on a timeframe that is based on the electoral cycle. It is therefore necessary that there is a degree of consensus among political parties, so that valuable programmes are preserved when there is a change in political leadership. The proof of that will be found in what happens when Governments change.
It is interesting to note how rapidly the debate on the issue is growing. Susan Deacon’s report was useful and added to the weight of evidence that the Finance Committee received. The Northern Ireland Assembly has taken on board some of the evidence that we received and its implications for policy, so I hope that work that we did in Scotland can have a positive benefit, not just in Scotland but elsewhere.
The key point about preventative spending is that, for it to be effective, it must be genuinely outcomes based. We talk often about moving to an outcomes-based policy framework, although I am not sure that we get there as often as we hope to.
One of the biggest challenges with preventative spending is simply how we measure it over the long term. To put it simply, no one would ever expect preventative spending to be 100 per cent successful, and a significant proportion of public spending will always be reactive. People could not foresee some of the social issues to which we have to react and would not foresee them in the timeframe that allows preventative action to take place. However, we need to be able to assess the effectiveness of not only reactive measures but preventative measures.
If we are talking about the success of early intervention in affecting people’s life outcomes once they leave school, we are looking at a timeframe of at least 16 or 17 years. The key difficulty is not only whether we have the determination to track people through and assess their outcomes over that period, but how we can be sure over that timeframe that the projects that we hope have a positive impact are working. Some of them may not bear fruit until late in the day and some will show impact earlier on.
The challenge in shifting spending, which other members mentioned, is that there is always a vested interest in defending existing spending. To be frank, disadvantaged three-year-olds and, perhaps, their parents will not understand the interaction between the quality of nursery provision and their life chances later on but, if we were to take away spending in another area to pay for that provision, people who were affected by that spending reduction would certainly lobby against it.
One minor way in which we might get round that is the concept of social impact bonds, which are being tried in England. They attempt to align benefits to Government with benefits to philanthropists. However, that is a relatively small example and how we shift on a broader scale is one of the fundamental problems in the debate.
A wealth of evidence was given about the relative benefit of preventative spending and the benefits that it could provide. One of the commonly quoted statistics relates to drug and alcohol abuse: for every £1 that is spent on preventing people from entering into drug and alcohol abuse, we save something like £9 in the longer term.
Another interesting point is that it is possible to link pupils’ attainment levels when they start school—that is, before they have even started their formal education—to later life experience. I think that that information came from a report by the National Endowment for Science, Technology and the Arts. There was also a study that showed that the difference between attainment levels in England—I do not think that it was done for Scotland—and in other nations that started formal education later could be explained almost entirely by the quality of pre-school education. In the UK as a whole, pre-school education has not had the focus that it has had in other places.
In the health service, some good examples were given of preventative spending around pregnancy, such as the importance of preventing foetal alcohol syndrome by ensuring that women who may get pregnant understood the risks, and the importance of taking folic acid. There is also a good example in relation to hip fractures in NHS Ayrshire, where a pioneering clinic is identifying people who are at risk and treating them before they get to the point at which they need major operations.
There are little pockets of good examples within Scotland already. One of the best is in education. The improvements in literacy rates in West Dunbartonshire will probably have more of an impact on the life chances of the people who have gone through the pioneering literacy programme that was done there than most of the other interventions that have been tried, however well meaning. That is a major impact on people’s later life chances.
Parenting skills was one of the key issues that came through in the evidence. I was particularly struck by the evidence that Phil Wilson gave about health visiting and the move from a universal approach to a risk-based one. I think that the statistics were that 8 per cent of the lowest-risk group of parents were identified as having evidence of depression and were being missed by the system. Also, at 30 months, something like 10 per cent of children had evidence of language delay, which can have a correlation to problems later on. However, about half of that 10 per cent was in the lowest-risk group.
That demonstrates that there is evidence about how we can change things. We need to do better, but the changes will inevitably be longer-term interventions that will require a degree of consensus across the parties.
This is an important debate, which is why I am particularly sorry that I will have to leave before the end of it, as I have a meeting regarding my constituency with the Minister for Enterprise, Energy and Tourism. I apologise to you and other members, Presiding Officer.
First and foremost, I agree that any report that brings together Mr Whitton, Mr FitzPatrick and Mr Brownlee must be an impressive piece of work. The fact that I was excluded from that list shows that there is a recognition among all members that I am automatically consensual. It is useful to have that in the Official Report. As the Cabinet Secretary for Finance and Sustainable Growth rightly says from a sedentary position, that is undisputed.
To maintain the consensual tone, I agree with others’ comments about our convener, Andrew Welsh. I used to work for David Steel. When he stood down from elected office, in his final remarks he said that politics was the highest calling of all. It has been a pleasure for me to have known Andrew Welsh—although I have not known him for as long as other members have. When in this chamber the words “intelligence”, “integrity”, “courteousness” and “considerateness” are mentioned, perhaps we will automatically think of Andrew Welsh. I wish him good fortune, as I am sure that he will continue to support his local community, which he is passionate about. As Derek Brownlee said, this was an appropriate report for him to leave as a legacy for incoming MSPs from all parties.
I will focus on whether the issues that we discussed are deep seated or intractable; whether we have the right aims going forward; whether we have the right mechanisms to deliver on those aims; and, to touch on the issues that Derek Brownlee raised, the need for new ways of thinking.
By the time that we had completed our work, it had become abundantly clear from the evidence that children from the poorest backgrounds who are brighter than those from the richest backgrounds will start to fall behind in schooling and attainment by the age of seven. That is now demonstrable.
In Scotland today there are 600,000 children under the age of 10. If we make no changes but draw a straight line to the outcomes that we expect over the coming decade, we know what social outcomes there will be. We know that of those 600,000, 120,000 will not be in employment and will not be economically active at the age of 19 or 20. They will not have the skills that they need, or which we need as a country and as a society. We also know the number who will be in the criminal justice system and the number who will be starting to have a family, which itself will not have the social outcomes that we want. The problems are deep seated, but we must never say that they are intractable.
This is not a debate about minimum pricing for alcohol, but one of the answers to a parliamentary question that has stuck with me was one that Joe FitzPatrick asked about the average level of morbidity for alcohol-related problems for every constituency in Scotland. My constituency had the lowest level at 30 per cent of the UK average. In fact, it must be one of the lowest levels in the UK. Glasgow Shettleston’s figure was 564 per cent of the UK average. The fact that there is nearly a 600 per cent difference on that one indicator alone shows that there are considerable, deep-seated problems. Given that at a micro level within Glasgow life expectancy varies by 10 years within a radius of 10 miles, we know that there are considerable challenges for Scotland.
I asked the head of social work and the head of education at Glasgow City Council what their 10-year ambition was for reducing the number of children who are currently in vulnerable families, but they did not have one. They simply said that they were striving to meet the Government’s laudable aim of providing children with the best start in life. It struck me that there was a lack of clear, baselined aims for our largest city, which we know faces considerable problems. It is not a case of going back to a target culture; it is a case of looking at what 10-year ambitions it would be right for us to have for Scotland.
That is why our party has indicated that, if we are to radically improve our education and health outcomes and reduce inequalities, it is important that we set a number of 10-year ambitions for where Scotland should be at the end of this decade. If nothing else, that will set the framework for those 600,000 children, while recognising that many of the difficulties that they will face are already starting to be ingrained.
The committee highlighted a number of areas that are challenging not just for the present Government but for all future Governments. In paragraphs 151, 152, 154 and 155 of its report, the committee looked at the way in which the Scottish budget is put together. That is not the fault of the present Government; it is a situation that has evolved since devolution. The committee indicated that we must pause to consider how budgets could be put together differently. In paragraph 151, the committee said:
“there is no indication within the draft budget as to the extent to which spending proposals are preventative.”
In paragraph 152, it said that there was
“a risk that all public spending could potentially be defined as being in some way preventative.”
Social impact bonds are an example of the new ways of thinking. Liberal Democrats are exploring with the voluntary sector what we term outcome-dependent funding, which involves balancing risk and looking at moving away from what we currently do, which is to budget failure, towards identifying how much can be gained for the public purse by meeting those outcomes.
The report is highly significant, and it falls full square in the committee’s legacy paper to our successor committee. I hope that it serves as a legacy to every committee in the Parliament, not just the Finance Committee’s successor after the election in May.
As a member of the Finance Committee, I, too, was very pleased to take evidence in the inquiry into preventative spend and to help to compile the report.
There were two additional aspects of the inquiry that were extremely important. One was the involvement of Scotland’s Futures Forum. The committee’s clerks and its convener and deputy convener are to be commended for taking such a forward-thinking approach and for adopting such an innovative way of looking at things. The other important factor was our report on the reform of public services, because I do not believe that it is possible to look truly at a preventative spend model without looking at how we reform public services. That is a big issue in this country.
Much of the report focused on the early years. That is as it should be, because there is nothing more important to any society than its children. However, achieving a significant turnaround of society as far as our children are concerned involves taking a long-term view and I am concerned that, because of that, it is far too easy not to even start. People think, “That’s away off in the future. We’ll get round to doing that.” When it comes to prevention, there is a mindset in our society that has to change. It needs to be realised in the health service that it is better to prevent than it is to treat and in the criminal justice system that it is better to prevent than it is to punish, for example.
Among the six points that emerged from the committee’s event on Friday, which was excellent, was that the debate on preventative spending needs to go much wider than just the early years and health and social care, and I think that that is very true. It is often the case that we deal with issues in crisis situations. That came out in some of the evidence that we took during the inquiry. Alan Sinclair, who helped us a great deal with his evidence, said:
“The overwhelming mindset that lurks behind how our public services are delivered is that we should invest at point of impact when things have gone wrong ... instead of going back and putting something in systemically.”—[Official Report, Finance Committee, 21 September 2010; c 2496.]
NESTA took a similar view when it wrote that
“The prevalent approach to tackling these challenges is to deal with the symptoms rather than striving to prevent their development.”
Sometimes simple and effective solutions can be put into place when we look at the short and medium term. Members will have their own examples, but one that comes immediately to my mind is the service gap facing those people in our prisons, hospitals and communities who have chronic mental health problems. This morning, I heard about the gap facing people who have to move from child to adult psychiatric services. Surely, if we intervene early enough and use prevention, that will be better than what we will end up with in the future. This morning, I also visited the Up-2-Us project, which is an early intervention to help young people to avoid ending up as pawns in the criminal justice system. These are fairly simple and straightforward potential solutions, so what stops us from putting such ideas into practice?
When taking evidence, the committee was frustrated to pick up on bureaucratic barriers, budget defensiveness, issues of ring-fencing and people saying, “That’s our budget.” A lot of work has to be done to change that mindset, which appears in all sectors. We do it in this Parliament. Local authorities, health boards and the voluntary sector do it. Everyone is looking after their own budget and closing their minds to the idea of being a bit more innovative in looking for solutions that can prevent social problems and save a lot more money down the line.
It does not always have to be about extra money. I was struck by a tiny bit of evidence that we heard. Somewhere in the south of England—I cannot remember where—a local health board paid to have roads gritted in an area in which there are a lot of elderly people. The result was that the health board had to treat fewer casualties and fractures over the winter, which meant a net saving to the public purse. We do not see much evidence of that sort of thing happening in our country because everyone is looking after their own budget. Perhaps Mr Swinney’s change fund will help to alleviate some of the pressures that mean that people think that they have to protect their own professions, services and organisations.
Such an idea must start from the top. We must all show a commitment to working together. There must be a recognition that we can do things differently and better. There is a responsibility on us all to stop making some of the populist sound bites that we are all guilty of and to work together.
The committee convener has already commended the report to the Finance Committee’s successor committee, with a view to it taking the recommendations on board. The committee’s legacy paper will also reflect that view. I can end only with the committee’s words about
“the need for a consensual approach in moving towards a more preventative approach to public spending”.
That will require leadership across all political parties and locally in communities. As the parliamentary session comes to an end and a new one approaches, I hope that we can commend that approach and make a difference to Scotland.
I start by paying tribute to Andrew Welsh for chairing the Finance Committee in a model, non-partisan way for the past four years, and for the contribution that he has made to his constituents and in public life more generally for four decades.
This is an important report from the Finance Committee, and a significant development of our work. The Parliament knows a great deal about what we spend—in fact, we on the Finance Committee know everything about what we spend—but we know very little about what we save. We need to become very good very quickly at the science of preventative economics and I hope that the Finance Committee report makes a small contribution to that.
Preventative spending goes much wider than the early years and health and social care, but there are good reasons for concentrating on them in the report. Briefly, in relation to health and social care, we have talked about the issues with a growing elderly population for many years, and we have also talked about shifting the balance of care and, in particular, trying to cut escalating emergency admissions to hospital through preventative and continuous care in the community. Indeed, that was the central theme of the David Kerr report. However, the fact is that, despite great progress in health over the past decade, we have not got anywhere with that agenda.
It is important to flag up both that point and the various issues that are connected with it in the report. It is a big challenge for the next parliamentary session. I believe—if I can be slightly partisan for five seconds—that Labour’s proposal for a national care service will help on that agenda, but the issue is wider. We will need more than that to shift the balance of care and balance of spending.
The most important evidence and recommendations in the report are on the early years. That theme was repeated in a conference in this chamber on Friday morning. I recommend in particular the words and wisdom of Dr Suzanne Zeedyk and Detective Chief Superintendent John Carnochan. Their evidence was given on 26 October and 2 November 2010, and members can also read their speeches in the transcript of last Friday’s conference.
I will start with a brief quotation from John Carnochan to the committee:
“the most important four years of a child’s life are those up to age three.”—[Official Report, Finance Committee, 26 October 2010; c 2555.]
I wish that that was written up on the Canongate wall. We know that it is not just somebody’s opinion. Other members have quoted some of Dr Zeedyk’s evidence, and she explained the neuroscience behind the truth that we all know that
“Children’s brains develop more quickly between birth—really conception—and the age of three than they ever will again.”—[Official Report, Finance Committee, 2 November 2010; c 2614.]
The brains are in place at age three, which is why we need to refocus on the years nought to three—or, we should rather say, conception to three. We were told that the quality of early interactions is particularly crucial.
People say that if we concentrate on the early years agenda we will get results only in the long term. We will get results in the long term—we know that investing in the early years, particularly nought to three, will have implications in improved mental health, reduced crime and so on—but we should also point out that there would be benefits in the short term, too. Suzanne Zeedyk was particularly strong on that point. I do not have time to read out the quotation that I planned to read from column 2614 of the Official Report of the meeting on 2 November, but she made that point. That is important for politicians. It is difficult for us to invest now for benefits in 20 years’ time but, as she points out, we will have benefits within a very short timeframe—within one year—if we invest in the agenda.
Another theme was the tension between universal and targeted services. Derek Brownlee mentioned that with reference to health visiting, but—to mention a third witness—I was struck by the evidence from Dr Philip Wilson, who answered the conundrum by saying that we need universal services for screening and identifying the families and children who have problems, whom we then target. That is the key insight into the tension between targeted and universal services.
Let us refocus on nought to three. Let us build consensus around that, starting with the committees of the Parliament. I want also to say—this is a bit more controversial—that we need concerted central direction. As has been said, a lot of the evidence pointed in that direction. Again, I was going to read a quotation from Detective Chief Superintendent Carnochan at column 2574 of the Official Report of the Finance Committee meeting on 26 October, but I am in my last minute so I had better not. He said, controversially, that we may have to reconsider ring fencing money for the early years and ensuring that all local authorities prioritise that work. I realise that that suggestion is controversial and anathema to many people in the chamber.
What is not controversial is the fact that we need to lead on preventative spending. Whichever way we think that leadership should be given, the Parliament has to lead on the agenda. Recognising the strength of the evidence that we receive, we must shift investment as far as we can to nought to three. I say “as far as we can” as I recognise the financial difficulties of the time that we live in, but if we shift investment to the early years we will save in the short term as well as in the long term. If the next Government—whoever it is—will not lead on the agenda, I hope that the Finance Committee and the Parliament as a whole will do so.
I associate myself with the words of tribute for our convener, Andrew Welsh. As Malcolm Chisholm said, Andrew has always convened the finance committee in an entirely non-partisan manner. As a new MSP, I sometimes found that quite frustrating, but Andrew Welsh’s years of experience show that that is the correct way for a convener of a parliamentary committee to conduct his business. It has allowed us to make far more progress than we would have done if we put party before the Parliament at all times. I therefore associate myself with the words of members who have already spoken.
I am pleased to be able to take part in the debate, which follows one of the most important inquiries that the Finance Committee has conducted in my four years as a member. At the start of the inquiry, we were unanimous in thinking that the subject was important, and the inquiry has only made that clearer. It has also made it clear that not only will the current financial pressures make it more challenging for us to achieve a shift of funding into preventative projects, but it is becoming increasingly important that we face up to that challenge and overcome the barriers that Andrew Welsh mentioned in his opening remarks.
Preventative spending is not new. We recognise that a lot of progress has been made by the Scottish Government, building on the progress that was made by previous Administrations. Nevertheless, we must step up a gear in the next session. Although we heard of some proposals that could produce rapid results in as little as a year, most preventative spending will not see readily measurable outcomes for many years, often spanning several parliamentary sessions, as Derek Brownlee said. That is why it is vital that we approach the issue in as consensual a manner as possible, ensuring that all parties and civic Scotland as a whole buy into what we are doing to make that long-term progress. We achieved consensus on the committee and took the correct approach. We are now entering the heat of an election campaign, but I hope that we can quickly resume that consensual approach in the next session.
I will spend some time in outlining examples of preventative spending projects in Dundee, the first of which is the family-nurse partnership, which Mr Whitton mentioned. Earlier this year, Dundee and its surrounding towns and villages were chosen as the second pilot site for that specialist programme, which gives first-time teenage mums extra support. The project was piloted previously in NHS Lothian, where it supported 145 young families. It is based on a model that we have seen in progress for a number of years in America. The NHS Tayside pilot was launched in January by Nicola Sturgeon, the Deputy First Minister and Cabinet Secretary for Health and Wellbeing, at the St Andrew’s family support project in Dundee, where she met young mums with their babies and some of the staff who were leading the local pilot. Evidence from programmes that are already up and running in America and the Lothians show that the initiative is improving prenatal health, increasing employment among young mums, cutting the number of unintended pregnancies and helping to reduce child neglect.
Family nurses visit first-time mothers under the age of 19 every one to two weeks during their pregnancy and throughout the first two years of their baby’s life. The nurses offer guidance on child development, preventative health measures, parenting skills, breastfeeding and better diet as well as advice for mothers on education and employment. The project is a fantastic example of how dedicated support in the earliest stages not only supports parents, but helps to improve children’s health and long-term opportunities. It will make a real difference to the lives of almost 300 families throughout Tayside.
Another example of preventative spending is the keep well programme, which has been operating for a number of years, including in Dundee, and provides health checks in areas in which there is a high level of deprivation. The success of the keep well programme has been recognised and its funding has been extended by £11 million to enable it to cover all of Scotland’s poorest communities by 2012, tackling some of the deprivation issues that Jeremy Purvis mentioned. The keep well programme has already helped thousands of people, and the additional funding will enable it to help a further 30,000 Scots a year to get the assistance and treatment that they need.
The recently announced life begins at 40 package of services, backed by nearly £15 million, will help people approaching that landmark birthday—which I passed some years ago—to consider their lifestyle and take the opportunity to access health checks. Further, at the start of the year, the Scottish Government announced a four-year pilot project to explore the feasibility of introducing universal face-to-face heart MOTs for those who are aged over 40. That pilot should help 20,000 people, who will receive a check-up.
Those are only some of the most recent interventions. As I said, they build on the work of the present Scottish Government and its partners and on the work of the previous Scottish Executive. However, we must do much more in health, early years, social services and elsewhere. It will not be easy, but the tone of this debate gives us hope that, as a Parliament, we will be successful.
I trust that I will not change the tone of the debate too much.
I am grateful to have the opportunity to contribute to the debate. As the first person to speak who is not part of the Finance Committee company—the pointy heads, as I like to call them—I, too, offer my best wishes to Mr Welsh. The respect for his work is shared by those outwith the Finance Committee. In a job that can be a bit like herding cats, he has managed to work with a great deal of authority.
There is a danger that debates about budget processes and so on can be either very technical or very consensual in a merely cosy way. That has not been the case in today’s debate. It would be fair to say, however, that anyone who is thinking about preventative spending will have some anxieties about some of the choices that are being made at a UK level, which place disproportionate burdens on women and, for example, make it less likely that they will be able to work and support their families, which is something that, in the long term, will have consequences for their children. That is something that people need to be aware of. We know that budgets reflect people’s political priorities and, to some extent, the challenge is to ensure that they do that. Some of the debate about preventative spending involves people who say that they support families, but are not spending money at the right stage in order to do so.
It is absolutely critical that we embrace the rationale behind a shift to preventative spending, make rational decisions about our priorities and have a greater awareness of what makes a difference. For example, a lunch club for elderly people stops bed blocking two or three years down the road, as it addresses issues of isolation and enables people to identify deterioration at an early stage. Similarly, a little bit of support for carers—enabling them to take a half-day away from their loved ones, for example—means that we can sustain the cared-for in a way that is real to their family. It is important, therefore, that in interrogating spending decisions, we have an understanding of what is effective. The issues that the committee has reflected on with regard to the early years can be applied to a range of important social policy areas.
I do not pretend to be as close to the issues as the committee members are, but I would like to highlight a few points that I hope members will find useful.
Malcolm Chisholm flagged up the connection between strategy and delivery. A key criticism that is being made is that there is insufficient connection between the framework, the strategy at a national level and what is happening on the ground. The Scottish Government has said that it does not want a top-down, prescriptive approach. Nobody would want that—that is a pejorative way of describing an anxiety that people have. However, we want there to be a connection. We want to know that strategies that are developed are delivered on the ground. There will be tough decisions about how that can be ensured and about how we can make strategies focused and consistent across the country as opposed to simply being a good read.
The Scottish Government highlights the importance of an outcomes-based approach and John Swinney reiterated that in his speech, commending the concordat and the community planning partnerships in that regard. However, the key issue is not to outline an outcomes-based approach, but to ensure that it is happening on the ground. The reality is that, in the past four years, we have had one brief overview of how single outcome agreements are progressing and we are still waiting for any detailed analysis of their progress.
We are aware of the frustration of voluntary organisations in particular, which say that they have to pick their way through single outcome agreements to identify the spend. The minister knows of my on-going concern that there is no equality impact assessment of single outcome agreements, which means that they do not reflect the rigour that we require. It is not sufficient to assert that something is working if there is no evidence in that regard, and I hope that the minister will take that on board.
In recognising the importance of preventative spending, I have a concern that the policy is not being applied in the Scottish Government. One example of that, although it is not in the Finance Committee’s reflections, is the decision to cut the housing association grant by at least a third. That will possibly stall developments and prevent future developments, but critically—and most worryingly—it reveals a lack of understanding about the central effectiveness of the community-controlled housing and co-operative movement. Providing sufficient funding to build, maintain and repair good houses is part of a wider action that allows those communities to be sustained. That has worked, and short-termism in the funding of housing will have longer-term consequences for the very families that we want to help.
There is also the key issue of making the transition in approach from reactive to preventative spending. I am concerned that people sell the idea of doing things differently because it is cheaper. They say, “You can spend a little early, and save money later”, and then force change by quantifying possible savings and applying that as a cut. We know that that is a worry in some places with regard to social care spending.
I think that we all agree on the importance of evidence-based spending and we must be alive to early spend-to-save. That is reflected in the argument about targeted versus universal spending, and I agree with the Scottish Government’s response on that. For example, Home-Start runs an early intervention programme for vulnerable mothers in my constituency that helps them to keep their children and prevents those children from being taken into care. It is not necessary for most mums, for whom health visitor support would be sufficient, so it is a good example of targeted spending working well.
Equally, the provision of nurture classes in our schools by definition recognises that some children are vulnerable and at a disadvantage. We ought to consider the built-in advantage that some families have, which must be addressed by providing support to those children. It would be nonsense to provide such support for all children, but it is critical in closing the gap in advantage that is experienced by some children.
We need to reflect on how those choices are now being made. We know about the key role of the voluntary sector in understanding preventative activity and we know what we can do early to stop crisis later on. However, we also know that in tough times the danger is that those who make the choices see that little bit of spending as a luxury.
I commend the report and I hope that my comments add to it. In terms of preventative spending, the key issue will be how we shift from the reactive to the preventative without leaving a gap in provision.
As a non-member of the Finance Committee, I thank Andrew Welsh for his contribution to the Parliament, and the committee for its very useful report.
The committee’s strong support for preventative spending is welcome. As the report states, such spending
“has the potential to deliver great social and financial benefits to Scotland.”
The early years sphere is one in which the potential benefits of preventative spending are perhaps unrivalled. That is certainly reflected in the number of reports that have come out on the subject recently. The support from those who gave evidence to the committee for an emphasis on early years support was overwhelming.
We know that a child’s experience in the very early years has profound consequences for later life and that intervention and support measures can stop negative social outcomes. We know the groups of children who are most at risk; in fact, common sense tells us which groups often face the biggest challenges. They include children with parents who struggle with drug or alcohol addictions; children who are in care, or on the edge of being taken into care; children who grow up in poverty or in families with a history of violence, and so on.
The submission by Aberlour Child Care Trust highlighted the especially poor outcomes for Scottish children who have been in care during their childhood. More than a quarter of those in Scotland’s prisons have been in care; more than 20 per cent of our 20,000 16-to-19 year olds who are not in education or employment are recent care leavers; and only 3 per cent of care leavers go on to gain a higher education qualification. We know about the particularly poor chances that those youngsters face, so we must begin to use the resources at our disposal more wisely to give them the very best chance of a happy and successful future as early as possible.
We must also realise that this is not just a matter of the allocation of resources. Barnardo’s pointed out that the failure to eradicate Scotland’s social problems is much more complicated. It said:
“we have doubled the amount of money that we spend on welfare in the past 10 years—yet we still have the same reoffending rate among young people who come out of prison, little movement on child poverty, the same level of educational attainment for care leavers and increased problems with alcohol and substance misuse. We have doubled the amount of money that we spend, but we have barely put a dent in the problems.”—[Official Report, Finance Committee, 2 November 2010; c 2625.]
Johann Lamont is absolutely right to focus on the importance of evidence-based decisions that are based on outcomes, and also to flag up the possibility of the problems that are involved in shifts from reactive to preventative services.
Now more than ever we need to reconsider our approach to social problems and see that simply throwing money at problems does not always solve them. We need to get much better at evaluating what does and does not work, and we need to target resources in specific programmes and base those programmes on the needs of the users. That is crucial. Services work best when they are well received by those at whom they are aimed, so we need to listen carefully to the needs of those whom we know are most likely to face negative life outcomes and involve them in the process of service reform and future service provision.
We should not underestimate the challenges that local authorities and health boards face in service redesign. In one example in my constituency, the City of Edinburgh Council quite successfully introduced a re-enablement service that has made a big and positive difference to elderly people in Edinburgh, but the initial response from many people was negative—they were a little bit wary of what the service would actually mean. That is a big part of the problem, so I agree with Linda Fabiani about the importance of getting public service reform right and taking service users with us.
Detective Chief Superintendent John Carnochan of Strathclyde Police has been quoted many times today. I bet he wishes he was getting an amount of money every time his name was mentioned. He has been quoted as saying that investing in 1,000 more health visitors would be more effective in terms of violence reduction than tackling community safety in the longer term through 1,000 more police officers. However, it would be a brave politician who would pull the money out of the latter to pay for the former. That is why political consensus on the approach is so important if we are to tackle some of the things that I have mentioned.
The Joseph Rowntree Foundation argues that interventions that are based on family, parenting and parent-child interactions are the most effective forms of prevention and that they have the longest-lasting impacts. That is why the family-nurse partnership work that has been going on in Lothian and is now being rolled out to Tayside is fundamentally important. We will benefit from early intervention measures if we can build a consensus that introducing such measures is what we ought to be doing and if we take it from the rhetoric into action.
We have supported early intervention measures throughout the current parliamentary session because we recognise that they are often the most effective means of working and they often deliver the best results. We acknowledge the work that has been done in many fields by the current Government and, indeed, by ourselves in previous Administrations. I note the comment in the Finance Committee’s report that
“early intervention should not be viewed simply as a means of saving money. It should also be seen as an approach that will deliver wider benefits to children, their families and society as a whole.”
If I can make a more general point on the financial situation that we find ourselves in at present, the only positive thing that I can see in it from the many meetings and conversations that I have with people in schools, colleges, universities and across the education sector is that people are actually starting to look at the best use of the public pound and they are probably a little bit more focused in that work than they have ever been before. If we show that same focus in seeing that we need to shift from reactive to preventative spending, we will be doing ourselves a service in not only the short term, but the long term.
I congratulate the committee on its work on this report. I am not on the committee and have not been intimately involved in the process, but even a rudimentary read will show that it is an important report that deals with important issues and has important lessons for Scotland. That is particularly true given the current circumstances, and it is important that we consider preventative spending in the light of spending constraints from elsewhere.
First of all, though, I echo others’ comments about the work of Andrew Welsh. I wish him very well in his well-earned retirement. He has represented his party—my party—and his area with very great distinction for many years since he was first elected in 1974. I have not seen him in action at the Finance Committee at first hand, but his colleagues’ comments this afternoon speak volumes about his work and this is the culmination of many years of dedicated public service and his astute chairmanship of the Finance Committee. I wish him well for the future.
As I have said, the report is important. However, a useful starting point might be to ask the question, “What is preventative spending?” After all, we have been using the term without assessing what it means. The committee report says:
“there is not an established definition in use by relevant bodies that would capture all the examples that were provided to the Committee”.
Essentially, however, what it means is spending that helps to prevent negative social outcomes, as becomes clearer in the context of the three specific policy areas that the committee examined. Those areas are the early years framework—I should declare an interest as the father of a one-year-old at home—health and social care, and collaborative working. Before I look at each of them, I should mention in passing the benefits of the committee focusing on and looking at such areas in very close detail.
Considerable research has shown the benefits of early and effective intervention in the early years. Indeed, I am talking not just about policy-based evidence; the Scottish Government’s response to the report highlights the work of Professor James Heckman of the University of Chicago, whose studies of the neuroscience of brain receptivity from pre-birth to age three show that intervening in the very earliest years is likely to achieve better results than later intervention. As a result, the committee was right to focus on the early years framework. Evidence also shows that the benefits of such intervention apply at any stage of a child or young person’s life, indeed even after they have been defined as a young person. The early years are our first chance to get it right for every child.
The report highlights examples from the Netherlands and Scandinavia, including universal child care provision from birth. I am sympathetic to such policies—I should perhaps redeclare my interest—but I think that, in its response to the Finance Committee about implementing such policies in Scotland, the Scottish Government was probably right to caution against cherry picking policies from different contexts and taking them in isolation. I do not want to strike a discordant note, but the committee might like to reflect, as I am sure some members have, on the fact that the context for the Scandinavian countries and the Netherlands is very different from that of a devolved Scotland. For a start, those countries are independent.
The report also examines specific preventative spending issues in health and social care. I was very interested to hear of the life begins at 40 project that Mr FitzPatrick mentioned although, unlike him, it will be many years before I will have to avail myself of it.
It seems plenty to me. I also gently point out that Mr Welsh had represented Angus for five years before I was born, although I am not sure whether he will thank me for saying so.
The report asks whether greater investment is needed in health professionals such as health visitors in supporting early years programmes. I note from its response that the Scottish Government agrees that those professionals play an important role in providing care, advice and support but that it is for health boards to determine appropriate provision in their areas. I suppose that that reflects the fact that we need a collaborative approach to this type of preventative spending.
That brings me to the third area that was considered. Collaborative working is crucial to ensuring the effective use of resources, particularly in times of squeezed budgets. The report recognises the role of community planning partnerships in taking forward collaborative working that involves agencies, local government and health boards. I know that the Government encourages partnerships to go beyond traditional policy boundaries and spending territories to make the best use of resources, which is particularly important in the current context.
In conclusion, it is clear from the committee’s report and the Scottish Government’s response to it that the committee and the Government agree that the report will help to inform the commission on the future delivery of public services, which is chaired by Campbell Christie and is due to report later this year. The report is useful in that regard. It is playing its part, and I hope that it will leave a legacy beyond its mere publication. It seems that committee reports are too often published and then forgotten about, but that should not happen with this one.
I welcome the debate, which has been fairly consensual, and the general thrust of the report. I wish Andrew Welsh the very best for the future.
I do not often get excited by the work of the Finance Committee, important though it is. However, its report on preventative spending is excellent, and I commend the committee for its vision in undertaking the work that it has done. Like other members, I, too, wish the convener of the committee all the best for the future.
The report highlights the gains from preventative spending not only for individuals and their families but for society as a whole. I, too, commend in particular the evidence on universal benefits, which is extremely interesting.
Jamie Hepburn made a point that I agree with. It seems reasonable to at least start with the committee’s recommendation that
“a robust and measurable definition of ‘preventative spending’ that could be used across the public sector” should be provided. That would allow for increased spending in areas that might have lacked resources in the past but which are vital to the preventative approach. We have heard a number of examples of those areas, but I want to highlight one in particular: support for and promotion of breastfeeding.
Sadly, breastfeeding services have been treated as something of a Cinderella service, and hard-gained local provision is suffering from the current cuts agenda, which is unfortunate. There has been much mention today of giving children the best start in life, and breastfeeding does that. It has not been mentioned much in the debate, although Joe FitzPatrick did. As the children who were involved in the Dundee longitudinal infant study are now around 20, it would be interesting to look at that study for examples of where preventative spending has achieved results.
During a debate on early intervention last month, Richard Simpson told members about the fantastic work that was undertaken by breastfeeding support nurses in Wishaw general hospital in assisting his daughter-in-law. Unfortunately, the 22 breastfeeding support nurses in Lanarkshire are facing redundancy by the end of March, as the funding from the Scottish Government’s CEL 36—chief executive’s letter 36 of 2008—programme is coming to an end. Sadly, public bodies and organisations see such services as an easy option to save money, which is unfortunate because their impacts are measurable. The community mothers project in Lanarkshire was also under threat due to the local authority withdrawing its funding, but it has been given a temporary reprieve, as the health board has picked up the costs. Going back to what Malcolm Chisholm said earlier, I think that that might be an argument for a degree of ring fencing. Such funding is exactly the sort of funding that needs to be continued and prioritised as preventative spending.
As we know, spending on breastfeeding projects results in significant cost savings in both the short term and the long term because of the obvious and undisputed health benefits that are associated with it for mothers and children and because it lowers the risk of certain illnesses. UNICEF pointed out an example of that some years ago. It is not a Scottish example, but it nonetheless gives an indication of the cost savings. UNICEF pointed out that the NHS spent £35 million a year in England and Wales on treating gastroenteritis in formula-fed infants, and that, for every 1 per cent increase in breastfeeding at 13 weeks, £500,000 would be saved on the treatment of gastroenteritis. We should be investing heavily in such services because they deliver long-term health benefits, particularly in areas that suffer from a legacy of poverty and ill health.
Sadly, a negative attitude towards breastfeeding remains that continues to hinder its rates, so preventative spending must also cover education and training across a range of public bodies and awareness raising. It is important to give an example of why that is needed. I have dealt with a case involving a new mother—Sacha Moonsammy, who is a paediatrician—who was subjected to verbal abuse. She was told by a senior member of staff in TK Maxx in Sauchiehall Street to stop breastfeeding, was ranted at by a customer and had to leave in a distressed state with a very hungry baby. Strathclyde Police charged two individuals with contravening the Breastfeeding etc (Scotland) Act 2005, but the procurator fiscal issued only a warning letter—a slap on the wrist—to the company, although that was a traumatic situation that no woman or child in Scotland should face. The Procurator Fiscal Service should treat such incidents more seriously, given their propensity to put women off breastfeeding, which will have an impact in future. It is a strange world in which we are—rightly—willing to prosecute football supporters for shouting across stadiums but a woman who is forced to suffer horrific verbal abuse and is told to stop breastfeeding is not afforded justice.
Spending on education is essential to eradicate negative attitudes and to encourage positive approaches, which contribute to prevention. In 2004, pupils from Rosehall high school in Coatbridge undertook a series of awareness sessions. A subsequent report demonstrated that such spending on education produced improvements in young people’s attitudes. Following the sessions, positive attitudes to breastfeeding improved from 10 per cent to 48 per cent in secondary 1 and from 13 per cent to 58 per cent in S4. It is a bit worrying that the figures were so low to start with but, given those positive outcomes, such schemes could be integrated into curriculums. The outlays would be well worth it in comparison with the longer-term benefits and savings.
Susan Deacon’s report criticised the amount of money that is spent on new strategies and initiatives when front-line services are being cut. She said:
“Bluntly, if the choice is between a policy analyst or a play worker—I know which I would choose.”
I would do the same as her—I would choose the community mothers programme and breastfeeding support nurses over another infant feeding strategist.
I will finish with a good quotation from Children 1st’s briefing for the debate. It said:
“We also urge Members to commit to creating a child-friendly Scotland in which every child is valued, respected and protected in our society and where they grow up in families and communities which are confident about nurturing them.”
That ties in well with the preventative spending agenda and with breastfeeding. I hope that the committee’s legacy paper will receive the support that it deserves.
The debate has been interesting and, by and large, consensual. Like several members who have spoken, but not the majority, I do not serve on the Finance Committee, so I read the report with much interest but without having had the close involvement of the members who participated in its formulation.
I associate myself with the many kind and absolutely deserved remarks that have been made to the committee’s convener, Andrew Welsh. It has been a pleasure for all of us—and certainly for me in the past 12 years—to be in the Parliament with him.
An interesting feature that emerged from the report was the overwhelming evidence that was presented to the committee. The case for preventative spending on the basis of that information was undoubtedly compelling. I asked myself from time to time why, if the case was so compelling, we had not undertaken preventative spending uniformly before. There are several good reasons for that.
In reading the report, I found myself agreeing that the examples that it gave were compelling—there was no question about that. However, I wondered how groups or witnesses could assemble such information when those of us who have served on committees of the Parliament or who have been ministers, as I was in the previous Government, have often struggled to have such information to hand when we have tried to take the right decisions.
Many members have mentioned that preventative spending is not new, and indeed it is not. In my early days, I attended an economics class in which we discussed at length and in a rather obtuse way the concept of opportunity cost. When it is translated into modern language, the opportunity cost of doing or not doing something involves to an extent considering preventative spending. It is certainly not new, but it has not dominated the way in which we in the public service and in Parliament consider our spending choices.
A number of interesting points have been made in the debate. I accept the overwhelming evidence that my colleague Jeremy Purvis associated with the report but, more than that, the report begs questions about what we do in a policy framework and in a monitoring, recording and budgetary framework to try to ensure that preventative spending and its benefits are more regularly and systematically brought before Parliament in future.
Derek Brownlee made several interesting observations. We have all now got our heads round the critical issue of switching from an input to an outcome basis although, in the early days of the Parliament, we had not. However, although the majority of those of us in the Parliament now subscribe to that view, it remains a fact that far too many propositions are still posited on an input basis. We have not quite got the cultural break that would make us almost automatically deal with issues on an outcome basis.
There is a burden on all of us to ensure that that happens in our parties. A remarkable consensus has broken out, which has all sorts of people on the same page, although Jeremy Purvis, who has left to meet someone, was rather hurt that he was excluded from David Whitton’s opening remarks. I tried to console him, but I failed—he was unmoveable. That consensus has to last if we are serious about moving towards preventative spending.
Johann Lamont was right that there will constantly be choices in which our philosophical differences will emerge. Although such differences are healthy, if we want to make choices on an informed basis, we need consensus in order to consider how to present policies on a basis that is genuinely outcome driven.
That brings us back to the issue of what we do every year when we get the budget. I have never seen an outcome-driven budget. That is not a criticism of the current Government; it is down to the way in which we produce the information, which does not facilitate the kind of choices that all members have welcomed this afternoon. We need to be able to say to those who prepare such information, in a consensual way, that we need their help. Indeed, it may be constructive for Mr Brownlee and I, as members of the accounting profession, to say that if, as a matter of public policy, we can see positive benefits of preventative spending accrue in a range of areas, and if such benefits are going to be measured and be part of the budgetary process, we need assistance. I do not know whether the institute of which Mr Brownlee and I are members might wish to give some assistance, but it seems to me that the more people who are engaged in the process, the better.
Members mentioned various aspects of preventative spending that are working. However, my concern is not about the report or the consensus that has emerged on the need for preventative spending. My concern is that if preventative spending is to become part and parcel of the process of Scottish government, it needs an equal consensus to address the problems of control and monitoring, and the output measurement that is so critical to the future of such a project.
Ross Finnie raised an important point about the outcome basis. Although there has been a shift in rhetoric in Parliament about moving towards an outcome basis, that has not been matched by a shift in everyone’s point of view on how we deal with it. Too often, we still equate spending more with getting more. In fact, as Margaret Smith pointed out, it is not always the case that if we spend more, we get more.
Ross Finnie’s observation about the budget process is possibly the key point. If we do not want the report simply to gather dust on a shelf somewhere, we have to ensure that it is implemented. All the budget processes that I have observed, under the current Government and its predecessor, have been largely focused on incremental change. That is not surprising and is not confined to politics—it happens in most areas of budget setting. Often, it is the simplest way of doing things, as there is a certain clarity to it, but sometimes it prevents the more fundamental questions from being asked, such as whether we are using resources most effectively and are focusing on the outcomes that we want to achieve, rather than simply on what was done previously. As we get beyond the election and head into a spending review by whoever forms the Scottish Government, we will have the ideal opportunity to take a more strategic perspective for the rest of the spending review period and to think about whether we need to move away from a more incremental approach to one that is more outcome based.
I do not wish to add more items to the list of requirements for budget documents, which is easy to do. However, when Parliament gets a draft budget, it is given a draft set of spending plans and an indication of what those will deliver. The Government of the day will always put the best spin on that, which is entirely understandable, but the process falls down when it comes to giving members a depth of understanding about how money could be shifted around and the impacts, both positive and negative, that that could have. It is a difficult challenge to deliver that degree of context to the budget process without burdening everyone with screeds of information and giving the civil service a lot of extra work to do. However, if we do not somehow get there, it is difficult to see how we will get beyond more debates in which everyone is consensual and agrees that it is the right place in which to end up, but we do not make progress towards it. The single biggest question that I have about the report is how we turn its aims, on which there seems to be a significant degree of consensus, into practice.
Some members have raised the issue of how evidence based policy is. It is probably fair to say that, although we would like all policy decisions to be evidence based, that is simply not the case. That is true of all Governments.
Linda Fabiani said that one of the biggest risks was that we simply would not start, because the timeframe is so long. To some extent, I agree with her on that. Ross Finnie’s remarks demonstrated the same point.
I am tempted to say that this is one of the rare occasions on which I agree with Elaine Smith—on two issues. Often I, too, do not find the work of the Finance Committee exciting; she can join my club in relation to that. The second, more substantive issue that she raised was breastfeeding, a cause that she has championed for some time. As someone who is in the same position as Jamie Hepburn—although I will not cast aspersions on his colleagues for their age, as he did—and as a relatively new father, I find it confusing that there are many issues that simply do not cross someone’s mind until they become a parent. I do not know whether that is a particularly male perspective. The quality of education and the factors that affect the cultural decisions that impact on the uptake of breastfeeding are not well considered, certainly not among males. The issue would never have been discussed during my time in schooling. We need to cross some cultural barriers if we are to change practice. Some of the interventions that Elaine Smith described will be effective, but there is also a cultural barrier. Often, cultural barriers are the most difficult ones to overturn.
The difficulties in service redesign on which Margaret Smith touched are also real. There is a lot of pressure on spending. Every part of the public sector is under pressure, and it is always easier to make savings in the short term than in the longer term. It takes courage to take difficult political decisions that will not yield benefits in the short term—indeed, which will often be criticised in the short term—but which will bear fruit in the long term. Perhaps the real test of political leadership is the ability of politicians to put aside short-term political interest and do that. It may be asking too much to call for that credibly at this stage in the political cycle, so close to an election. However, I hope that whoever is part of the Parliament after May—Ross Finnie gave me some interesting ideas as to what I might do, in relation to the accountancy profession, if I am not—will give serious consideration, as part of the spending review and beyond, to how issues of preventative spending can be mainstreamed more into debate and scrutiny in all committees, for all policy initiatives, so that we can get away from well-meaning debates and into policies changing and action being delivered. If that comes out of today’s debate, it will have been well worth it.
I place on record my thanks to Andrew Welsh for his contribution to the Parliament and its workings. I also thank the Finance Committee for its report.
Having listened to this afternoon’s debate, I think that we should reflect on some measures that we have taken. We should not beat ourselves up too much about issues to do with preventative interventions. Malcolm Chisholm mentioned the David Kerr report—the national framework for service change in the NHS. The smoking ban was supported by many members of the Parliament. The vaccination programme for the human papilloma virus—HPV—to prevent cervical cancer was advocated by many members, too. I can also mention antenatal care interventions, fruit in schools, school meals projects, the sexual health strategy, the breastfeeding legislation that was championed by Elaine Smith and the Scottish bowel screening programme. We have taken many measures that have gone beyond the political cycle, and we have reached levels of debate and discussion to which we should continue to aspire. However, we should not be complacent.
There are barriers, and I believe that we politicians are one of the significant barriers in the way of progress in this regard—with a lack of ambition, perhaps, or a lack of courage, and with our innate ability to cut to the political chase and try to score points. Those are sadnesses, and I do not exclude any political party or individual from that. We should frequently look at ourselves in the mirror to try and visualise whether we are enacting the principles that have been set out in the Finance Committee’s report—and also set out by others in the past.
We should not forget, either, the empires that are built by officials in the public sector across the country and the protectionism that leads to an inability to instigate change or reform in the way that we should be doing.
We should not forget the professional vested interest that exists in relation to some of the substantial changes and challenges that we face on issues such as preventative interventions, as was covered in the committee’s report.
I think that it was Andrew Welsh who spoke about the moral perspective. I hope that we can continue throughout the election period and beyond with the debate and discussion on the morality of our decision making and our ability to reach the higher ground and a higher plane of decision making.
We are always deficient as far as information is concerned, but we have good resources when it comes to knowing where ill health occurs, where there is a lack of educational opportunity and where we need to make interventions. I recall from when I was Minister for Health and Community Care that the chief medical officer could almost tell me, by postcode, how many heart attacks would take place in certain parts of Glasgow. That drove the statins programme, through which we sought to address that challenge in a preventative manner.
The example of North Karelia has been mentioned. A different approach was taken there, but if one charts the reduction in the rate of heart attacks over the years there, one sees that Scotland figures pretty well in comparison. We took a medicine-based approach, using statins and other interventions. Although I would advocate that the approach that was taken in North Karelia was a better one, we have also taken some preventative measures that are of value to our communities here in Scotland.
Going back to the principles around our commonality of interest, I think that it is indeed about spending to save—money is important, and prevention is better than cure. Actually, it is also better for people. It is better for families, for children and for communities if we carry out preventative interventions in the manner that is described in the committee’s report. Ross Finnie reminded us of economics lectures about the opportunity costs of taking actions or not taking them.
Various members have raised the bar in the debate. Margaret Smith spoke about the need for consensus. A range of Tory speakers made contributions about calibration and how we use information. Elaine Smith spoke about the breastfeeding legislation. I am glad that she was excited about a Finance Committee report. I, too, have a degree of excitement about the report, which has brought a lot to the Parliament’s discussions.
Joe FitzPatrick mentioned the idea that we need to shift the balance of resources even harder. That has been a personal ambition of mine, and an ambition of my party, for a number of years, and we need to put all our shoulders behind that effort. He spoke in noble terms about what we need to do in that regard, and I want all of us not to forget those noble sentiments as we go through the battle of elections and whatever comes out the other end. We have a collective responsibility in the Parliament to try to address the worthwhile issues that have been raised in the report.
Johann Lamont talked about the challenge of the shift to preventative spending and Linda Fabiani rightly talked about the good work of Scotland’s Futures Forum, which we should not forget. Malcolm Chisholm, who made the pretty bold statement that he knew everything about what we spend, reminded us that we might know the price of everything but the value of nothing. We need to bear that in mind as we go about our efforts and consider the causes and effects of our interventions.
Statistics can act in strange ways. A civil servant once told me excitedly that the health inequality gap had closed, because middle-class women were drinking more. The gap between the working class and the middle class had closed, but for all the wrong reasons.
We have a good report on our hands. One of the witnesses in the inquiry—I do not know who—said that a leap of faith is required. I hope that the Parliament will be up to making that leap of faith in future. That is my appeal to the Parliament.
It is not often that I can follow Mr Kerr in a debate and agree heartily with many of the sentiments that he has expressed. I particularly agree with his starting point. Although we all agree, I think, that there will always be a demand for us to undertake more preventative spending, it is important that we recognise what we are currently doing and what has been done in the past.
That is why, in my opening speech, I acknowledged that this Administration has built on what we inherited from the two previous Administrations and, I dare say, from the Scottish Office in the old days—surely some good things must have come out of the Scottish Office. We have done that in recognition of the need to tackle the issues. In a sense, the argument that we are at a point when we must, for the first time, change how we allocate spending misses the point; over different periods of the political cycle there has been a genuine effort to tackle some of the long-term problems in Scottish society. I am confident that the approach will be sustained, whatever the composition of the Parliament after the election.
There have been a number of thoughtful and substantial contributions to the debate. I will concentrate on three areas that relate to how we take the agenda forward. The first is leadership and how that is expressed in this context. During the lifetime of the Parliament there has been a debate about that, in which Johann Lamont has actively participated. Is it about ring fencing, which was much utilised by previous Administrations, or is it about trying to create willing agreement, which has been very much the hallmark of the current Administration?
I think that members well know my feelings about ring fencing. However, we must be able to answer confidently the question that Johann Lamont put to us about how we establish a meaningful connection between framework and strategy and delivery. We must be able to demonstrate that the approaches that we take in the context of delivery and leadership address that point.
The second area is evaluation. Margaret Smith said that we must be much more assiduous in evaluating what works. The corollary of that must be that if something is not working we must stop funding it and change our priorities. That is not easy to do—we all know how difficult it is. However, if there can be acknowledgement that we should stop funding things that do not deliver the results that we think they should deliver and fund new priorities, we can have a model that will serve the Parliament well in the years to come, particularly given the financial times that we are entering.
The third area is how everything that I have talked about translates into the budget process. I appreciated, as I always do, the way in which Mr Finnie expressed himself in that regard, and I appreciated his beautiful explanation of opportunity costs, which brought back happy memories. He and Mr Brownlee asked, “How does all this appear in the budget process?” Having presided over four budgets that, by the nature of the process, have had to acquire support from other political parties, I can see how Parliament could be presented not only with the draft allocations that I present to it habitually in September but, earlier in the year, with some choices for different ways in which we could tackle particular problems.
Mr Brownlee said that that would add to civil servants’ workload. Well, they have the summer months and they must be kept busy during that period—they have certainly kept me busy in the summer months over the past four years. There are ways in which we could formulate propositions about choices and different ways of attaching greater or lesser significance to particular questions, which would come to Parliament for consideration, perhaps in the fashion that we are considering the report now. The point that Margaret Smith raised about being prepared to confront whether measures are working or not could manifest itself in such a process.
The measures that we have introduced, such as the early years fund that Mr Ingram announced yesterday or the change fund that the Deputy First Minister announced, are the latest efforts to change the focus within the balance of preventative spending to try to deliver better outcomes. Obviously, we will report to Parliament on those outcomes.
I will deal with another couple of specific points from the debate. Elaine Smith intervened on Mr Welsh about the health in pregnancy grant. I point out—I know that she knows this—that its abolition is one of the changes that the United Kingdom Government is making. Obviously, supporting mothers-to-be is a very important part of the support that we can put in place for the benefit and wellbeing of young people.
In her speech, Elaine Smith went on to make powerful points about breastfeeding, as she has done throughout her service in Parliament. I observe that the Government has concentrated on breastfeeding in some of its social marketing activity. Communication costs have been allocated to launching and running a TV and radio campaign to support the greater uptake of breastfeeding.
That is an example of how public information promoted by Government can have a pretty good and desirable impact. We get criticised, of course, for spending money on advertising and all that goes with it, but I hope that Parliament acknowledges that, sometimes, choices are made for the right reasons—namely, to try to structure different outcomes.
I hope that I have signalled the Government’s willingness to take a continuous approach to preventative spending. The report will certainly give the incoming Administration food for thought and I hope that I am part of that to take forward a positive response to the Finance Committee’s work.
I will make an observation on Johann Lamont’s point about some of the simple examples of preventative expenditure. She mentioned a lunch club for elderly people that might just keep them connected and out of hospital. I visited a lunch club in the village of Inchture the other day. It has nothing to with the public sector and everything to do with about three local people who make it their business to gather together 60 or so senior members of the community once a fortnight for a good meal and a good blether. The social interaction and benefit of that was obvious when I walked in the room. Even the smallest interventions of that type can have the most significant impact in our communities.
As others have done, I acknowledge Andrew Welsh’s service. I will not repeat all the plaudits. I simply say to him that he should be proud of his public service over a long number of years and of the way in which he chaired the Finance Committee and steered the report to its final conclusions. I wish him well in whatever he chooses to do when he leaves this place.
Every committee wants its work to count and to make a difference. At the risk of being accused of special pleading, I must say that the report, which is focused on preventative spending in the early years, can make the kind of difference that we all came into politics to make in the first place.
So much of the discourse in this place is bluster and hyperbole, but the truth is that between the parties of any size in this chamber there is always more that unites us than divides us. Here is a policy direction that can and should unite all sections of the chamber. Here is a policy to inspire and revolutionise our society.
Mr Swinney was right when he made the point a few moments ago that it is far harder to stop a policy than it is to start one. If we are serious about finding the means and resources for preventative spending in the early years, we need to be serious about facing up to very hard decisions over policies that were started with the very best of intentions but for which the evidence base of outcomes having been produced simply does not exist. When we can do that, we will make shifting from current expenditure to a new form of expenditure easier, if not easy.
This is not untried or untested territory. If the report did anything, it demonstrated the wealth of evidence from around the world that has emerged over a long period of time. Nordic countries and the United States have seen a real difference with sizeable reductions in contacts with the justice system, sizeable improvements in educational attainment and marked improvements in health outcomes over a long period of time.
Investment in the early years is an investment in the nourishment of our society. It is the reintroduction of human beings with empathy.
One of the things that we learned—I am sure that many members knew this already—was that by the age of three, a child’s brain has almost fully developed and what has been lost can never be regained. The best illustration that we saw of that was two images of two different children’s brains. One child was three years of age and their brain filled the entire skull. That child came from a background of nourishment, love and encouragement. The other child came from what we would describe as a chaotic background, for want of a better expression. Their brain was markedly smaller. That child’s capacity and life chances were set in stone at the age of three, because the support, nourishment and empathy simply had not been there, because of the circumstances that they were born into.
That, in essence, is what preventative spending is about. It is about taking the huge decision to channel resources towards those who are more challenged and towards providing that nourishment and support in order to ensure that by the age of three every child has the best chance of having developed the mental capacity that will sustain them through the rest of their life.
By the time a child is five, neuroscientists and a range of other specialists can predict their life journey in terms of educational attainment, health outcomes and contact with the justice system—the impact that that child will have in our society. I have heard primary school teachers say that when they receive children at the age of five, they can often tell the children who will flourish and those who will be challenged.
That is not just anecdotal evidence. This report demonstrates that that is proven, not just in this country but in countries around the world. By the age of five, if a child is lost, regaining them and giving them the life opportunities that we would expect them to have is a gargantuan task.
We have a stark choice: embrace the incontrovertible evidence and knowledge, or continue to promote the intergenerational failure that increasingly curses our communities.
As many have said, we need a political consensus. We need brave politicians who can see beyond the electoral cycle. I know that some have said that the returns will be in the long term. We received a piece of evidence from a pilot that showed that, with the appropriate support, parents under 21 who would normally attend only about 30 per cent of their doctor’s appointments can reach a level of 90 per cent attendance. That is an immediate win, not only for public expenditure, but for the development of the children of those young parents and for the parents’ understanding of what is required to help their children to develop.
If we pay nothing more than lip service to a comprehensive restructuring of our early years intervention, we will diminish individual opportunity and will continue to perpetuate an unsustainable system. In the face of the incontrovertible evidence, we need to learn what others have learned and put that learning into practice so that we can say that, on our watch, we put in place the building blocks of a more cohesive society.
As others have said, we need to face up to the challenges of making that fundamental shift. We need to face up to the protectionism and the professional demarcation that will stand in its way. It is in the interests of our children and those in society who face substantial challenges in preventing intergenerational failure that we do so.
With the committee’s report, we have a massive opportunity to demonstrate how politics can revolutionise our society. Given that faith in politics and politicians is hardly at a high, surely now is the time for all those members across the chamber who came into politics for the right reasons to take the right decisions to reinstitute that faith in the systems that we have to guide our society.