Christie Commission on the future delivery of public services

6. PRIORITISING PREVENTION, REDUCING INEQUALITIES AND PROMOTING EQUALITY

A third key objective of reform should be to ensure that public service organisations prioritise prevention, reduce inequalities and promote equality.

INTRODUCTION

6.1 In Chapter 2 we identified the growing demand for public services in Scotland. In part, at least, this demand can be said to stem from a focus on reactive spending as opposed to preventative spending, which seeks to prevent problems before they occur. The costs to Scotland and its public services of negative outcomes such as excessive alcohol consumption, drug addiction, violence and criminality are substantial. Addressing the 'failure demand' that results from focussing on consequences rather than causes, and approaches which alienate or disempower service users, has a high cost for society and high costs for public services. This will be increasingly difficult to sustain into the future.

6.2 Many of the submissions we received emphasise the extent to which public service delivery is absorbed with tackling the symptoms, as opposed to the causes, of inequality. As NSPCC Scotland (2011) observed, the consequences of late intervention have high human costs, including " educational failure, anti social behaviour, crime and violence." Moreover, "responding to these problems consumes increasing sums of public money and increases the risk of relentless intergenerational deprivation." It is also recognised that reactive approaches are heavily resource intensive and represent a lost opportunity to have a more transformative impact.

6.3 The reasons for the prevalence of reactive approaches to failure demand are complex, but include:

• resources are frequently occupied dealing with immediate problems, to the exclusion of longer-term initiatives;
• an understandable but unhelpful focus on short-term results, sometimes exacerbated by political demands; and
• organisations having an unduly narrow focus on specific outputs or outcomes - meaning that beneficial, preventative investment they could make is not seen as being central to the mission of that organisation.

THE CASE FOR PREVENTATIVE APPROACHES

6.4 A growing body of evidence demonstrates the improvement in outcomes that can be achieved by taking preventative approaches.

When preventative programmes are targeted at solving well-researched problems and are strategically led and delivered, they can have an enormous impact on service delivery, providing a cost-effective use of taxpayers' money.

NESTA

6.5 Similarly, the recent Scottish Parliament Finance Committee Report on Preventative Spending (2010) demonstrated the broad support for the concept of preventative spend. The evidence submitted to the Finance Committee demonstrated the impact that preventative spending could have in "major areas of policy such as the early years, climate change and health and social care, as well as more specific areas such as mediation, fire prevention and smoking." The Finance Committee noted that a striking feature of its inquiry was "that witnesses have unanimously supported the concept of preventative spending as perhaps the primary means by which some of these social problems could, at best, be eliminated or, more realistically, be ameliorated."

6.6 In the submissions we received, the benefits that can be derived from preventative approaches both in terms of improved outcomes for people and communities and reduced demands on public services emerged clearly. As just one example, Consumer Focus Scotland stated that "there is social benefit in reducing or avoiding harm as early as possible and supporting people so that vulnerabilities (in terms of age, education, geography, ethnicity, gender, disability or ill health) do not disadvantage them, in terms of access to resources, benefits and opportunities."

6.7 In the context of budgetary decline and increasing demand for services the adoption of preventative approaches may be more challenging but it is imperative. A preventative approach offers a key means of tackling 'failure demand'. In relation to local government spending, CIPFA (2011) identifies a "need to manage and reduce the demand on public services which means moving from a system that deals with negative outcomes once they have occurred to prevention, early intervention and promotion of positive outcomes first time round." The Finance Committee report on preventative spending cited evidence that an estimated 40 to 45 per cent of public spending in Scotland is focussed on meeting 'failure demand', that is short-term spending aimed at addressing social problems. It also identifies the high cost to the economy of violence and the high levels of spending in the health sector on obesity and smoking related diseases. In the first decade of devolution, the increasing costs of 'failure demand' could be met by budgetary growth, but this will not be sustainable in the future.

6.8 The adoption of preventative approaches, in particular approaches which build on the active participation of service users and communities, will contribute significantly to making the best possible use of money and other assets. They will help to eradicate duplication and waste and, critically, take demand out of the system over the longer term. As Professor Susan Deacon observed in her recent report on early years ¹⁷ , the energy and investment that has gone in to youth justice, antisocial behaviour and criminal justice would have been transformational if applied to early intervention. In a future of declining budgetary resources and increasing demand, the imperative of reducing demand makes that adoption of preventative approaches incontrovertible.

6.9 All that said, we recognise that one of the major barriers to the adoption of preventative action has been the extent to which resources are currently tied up in dealing with short-term problems, to the exclusion of efforts to improve outcomes in the long term.

6.10 We do not believe there is any magic solution to this problem. Our view, however, is that we all need to recognise that there is no alternative: if we do not manage to effect a shift to preventative action, increasing 'failure demand' will swamp our public services' capacity to achieve outcomes. In all aspects of our system of public services, therefore, from setting national policy to reforming the governance and organisation of public services, through to the design and delivery of integrated services, all parties must prioritise and build in action which has the effect of reducing demand for services in the longer run.

6.11 One key aspect of the need for a preventative approach lies in the persistence of significant inequalities in our country - the stubborn fact that a substantial proportion of the people of Scotland do not share fairly in the wealth and success of the country. People experiencing high levels of multiple deprivation experience a number of negative outcomes that are inextricably interlinked. They frequently live in families and communities where poor outcomes are mutually reinforcing, reflecting the significant spatial dimension to inequalities.

6.12 Living in an area with poor quality housing, low employment rates and high crime levels impacts on the health and wellbeing of all those that live there and perpetuates both the generational and geographical experience of poor outcomes. The most acute levels of deprivation tend therefore to be highly localised, with a spatial clustering of poor outcomes. Evidence indicates that tackling these multiple problems in isolation addresses neither the experience of negative outcomes through people's lives, nor their root causes.

6.13 This presents a glaring challenge to our aspiration that public services act as a force for social justice, as well as human rights. We believe that there has been a strong sense of social justice in Scotland historically and that this must continue to underpin the ethos and principles of public services in Scotland. We share the view that "no progress towards positive outcomes can or will be achieved without addressing the issue of inequality." ( EHRC, 2011) Furthermore, tackling inequalities not only promotes more positive outcomes for individuals but also has benefits for the 'common weal'. We are convinced that Scotland, as a more equal society, can deliver better social and health outcomes for its people. The Commission also concurs with the Scottish Human Rights Commission (2011) that "the core principles of a human rights based approach of participation, accountability, non-discrimination, empowerment and legality are embedded into the development, design and delivery of public service provision that dignity and fairness for all can be better achieved."

6.14 A clear conclusion that we draw is that, if public services are at once to promote social justice and human rights and to be sustainable into the future, it is imperative that public services adopt a much more preventative approach; and that, within that, they succeed in addressing the persistent problem of multiple negative outcomes and inequalities faced by too many of the people and communities of Scotland.

HOW REFORM CAN SUPPORT A PREVENTATIVE APPROACH AND TACKLE INEQUALITIES

6.15 The recommendations we have made in the preceding chapters of this report will help to support a preventative approach and tackle inequalities, in the following ways:

• pooling budgets in support of a longer-term, outcomes-based approach should allow preventative approaches to be prioritised. It should also contribute, over time, to a reduction in 'reactive' public expenditure by preventing duplication and reducing negative demand;
• extending and deepening a local partnership approach can involve a wide range of public service organisations in coordinated and preventative approaches;
• empowering front-line staff should promote greater initiative in identifying ways in which the causes of inequality can be tackled;
• empowering people and communities to engage in the initiation, design and delivery of public services should support the development of preventative approaches; and
• helping communities to achieve their own ambitions.

6.16 We believe that prevention is such a significant issue for the future delivery of public services that further, more specific steps should be taken. We have already, in Chapter 5, recommended that the statutory framework for public service organisations should be amended to introduce common powers and duties, focussed on the pursuit of outcomes.

6.17 We recommend that such powers and duties as are developed should include a specific presumption in favour of prioritising preventative action, and action to tackle inequalities.

Specific action on inequalities

6.18 Given our analysis above, action to prioritise prevention needs to be accompanied by specific action to tackle inequalities. This section considers two aspects of that question - the reform of service delivery relating to employability; and wider action on regeneration.

6.19 A recurring theme in the evidence presented to the Commission has been the importance in addressing inequalities of public service interventions that enhance the employability of individuals, and so improve their and their families' life chances. The Commission has received evidence from a range of stakeholders which demonstrates how, and by what mechanisms, assisting individuals to move into training and work delivers positive social and economic impacts and contributes significantly to ending cycles of inequality.

6.20 This is all the more important given the ways - already noted in this report - in which the current period of slow economic growth will adversely impact on families and communities, possibly for many years to come. Improving the delivery of those public services which interrupt this cycle of inequality must be a priority for action.

6.21 As has also been noted earlier in this report, a key issue in this area is the separation of responsibilities between the Scottish Government and the UK Government, and the resulting potential for differing policy approaches. In the course of our meetings across Scotland it has became clear that the interface between reserved and devolved policies on employability ( i.e. job search and support services) has compromised the achievement of positive outcomes. Particular concerns were expressed about a 'one-size fits all' approach on the part of the Department for Work and Pensions ( DWP) and Jobcentre Plus; about the ways in which programmes are contracted out from Whitehall; and about the extent to which DWP and Jobcentre Plus services are coordinated with devolved public services at the local level.

6.22 We are also aware of efforts which have been made to join up services across these potential divisions.

Box 6.1 - Glasgoworks Glasgoworks is an innovative programme focussed on finding local solutions for the vulnerable unemployed. It acts as a vehicle for partnership action, with an independent board that includes representatives from the Glasgow City Council, Jobcentre Plus, the health board, Skills Development Scotland and the local chamber of commerce. The team ensures that an inclusive range of services and supports are provided to unemployed people with multiple and complex needs, and delivered through concerted and effective partnerships with local organisations, to support their journey back to work. Since July 2008, Glasgoworks has secured 4,300 successful job outcomes. This work will continue through funding confirmed from the European Social Fund until 2013 that will enable them to offer support to 10,500 people to improve their employment chances; there is an expectation of a further 2,200 going into work. Engaging and supporting employers is critical to success, and this function is undertaken by a dedicated employer engagement team from within Glasgoworks. The team also manages the Commonwealth Jobs Fund which will support 1,000 jobs between November 2010 and July 2012 for young people aged 18 to 24 who have been out of work for six months of more.

6.23 The various issues considered and recommendations made in Chapter 5 about local partnership in support of integrated service provision apply in the case of services in reserved areas, as they do in devolved.

6.24 We recommend the full devolution of competence for job search and support to the Scottish Parliament to achieve the integration of service provision in the area of employability.

6.25 Employability is one aspect of the action required to tackle inequalities. As noted above, the spatial dimension to inequalities is also critical; and this has been recognised over many years in the implementation of successive policies on regeneration . Evidence received from the Improvement Service (2011), in the course of our work, provides further evidence of the clustering of negative outcomes at a small area (local neighbourhood) level, and argues for an integrated and highly localised approach to service delivery.

6.26 A recent Scottish Government discussion paper - Building a Sustainable Future ¹⁸ - addressed the future direction that local and community regeneration policy should take, stressing the importance of community empowerment in the economic and social regeneration process. In that paper the Government highlighted the organisational challenge of " how we make developing and supporting community-led solutions a part of mainstream business, rather than an occasional project, add-on or experimental programme."

6.27 It follows from our analysis throughout this report that action on community-led regeneration should be a priority for the Scottish Government, local government and their partners. This is also an acute example of the need for integrated service provision in that action must address the highly localised nature of multiple deprivation.

6.28 We call on the Scottish Government, local government and other partners to work together as a priority to develop specific public service approaches targeted on the needs of deprived communities. These approaches should:

• be based on highly localised and disaggregated data, capturing the specific circumstances and needs of deprived areas and populations;
• be based on clear understanding of the successes and failures of previous regeneration initiatives;
• bring together and deploy as flexibly as possible all resources devoted by partners to each area;
• maximise the contribution that community engagement can make in enabling communities to identify and achieve their own ambitions;
• allow for particularly innovative approaches to service delivery, for example through specialised not-for-profit providers; and
• provide clear accountability, to each other and to the public, on the part of all partners involved.

Promoting equality

6.29 We also recognise that among those that experience negative outcomes in Scotland, there are a disproportionate number of people who are vulnerable to discrimination as a result of their identity or status.

6.30 Since April 2011, when the general duty in the Equality Act 2010 came into force, Scottish public bodies have been subject to a new, single equality duty covering race, sex, disability, sexual orientation, religion and belief, age, gender reassignment and pregnancy and maternity. In accordance with this general duty, Scottish public bodies must have due regard to the elimination of discrimination, the advancement of equality of opportunity and the fostering of good relations. It is expected that specific duties to enable the better performance of the general duty will be reintroduced to the Scottish Parliament later in 2011.

6.31 We recommend that the Scottish Government, working with the Equality and Human Rights Commission and other stakeholders:

• identify the key equality gaps in Scotland, and address these gaps through further development of the outcomes and indicators contained within the National Performance Framework; and
• produce guidance on how the public sector equality duty can best be expressed in the context of partnership working.