Case studies: prevention and early intervention to address austerity and inequality #POLU9SP

This is the first of three posts which use case studies of cross-cutting and specific policy areas to add more depth to our discussion of Scottish politics and policymaking.

We begin with a broad focus on ‘prevention’ policy for 4 reasons:

  1. It is a major Scottish Government priority, to use ‘prevention’ and ‘early intervention’ to reduce socioeconomic inequalities and/ or public service costs.
  2. It is an integral part of the ‘Scottish approach to policymaking’, with a strong emphasis on the changes to joined-up national government and partnerships in local government.
  3. It highlights multi-level policymaking and key overlaps in Scottish and UK Government responsibilities.
  4. We can compare the Scottish Government’s initial statement – committing itself to a ‘decisive shit to prevention’ – to actual outcomes.

But what is prevention policy?

Broadly, prevention and ‘preventative spending’ describe a range of policies designed to intervene as early as possible in people’s lives to improve their wellbeing and reduce demand for acute or reactive public services. The argument is that too much government spending is devoted to services to address severe social problems at a late stage. The aim is for governments to address a wide range of longstanding problems – including crime and anti-social behaviour, ill health and unhealthy behaviour, low educational attainment, and unemployment – by addressing them at source, before they become too severe and relatively expensive.

Prevention policy is described periodically as the solution to three major crises in politics.

  1. If we don’t make fundamental changes to the way we fund and deliver services they will go bust.

Prevention symbolises the desire to shift from expensive demand-led reactive services – such as acute care hospitals, jails, and police and social work interventions for ‘troubled families’ – towards intervening as early as possible in people’s lives to improve their life chances and reduce their reliance on the state. The classic intervention may be a public health policy to encourage healthy behaviour, or an early intervention programme to improve the life chances of teenage mothers and their children, but prevention is broad enough to include a campaign to reduce falls among older people, aimed at keeping people out of NHS beds.

  1. Prevention policies can reduce major inequalities within society.

The broad aim is to address the ‘root causes’ of social problems – such as poverty, social exclusion, and poor accommodation – while specific projects focus on early interventions, such as pre-school provision and parenting programmes, to address major gaps in key indicators, such as education attainment, that can be identified from a young age.

  1. Prevention is a solution to modern crises of government.

A prevention philosophy goes hand in hand with a governance philosophy which identifies the failures of top-down centralist government. The general rhetoric is about policy failure when governments try to do things to you, in favour of making policy with you. It comes with a commitment to: ‘holistic’ government in which we foster cooperation between, and secure a common aim for, departments, public bodies and stakeholders; ‘localism’, or fostering the capacity of local communities to tailor national policies to their areas;  tailoring public services to their users, encouraging a focus on the ‘assets’ of individuals, and inviting users to participate and ‘co-produce’ their services; a shift from simplistic short term targets and performance management towards meaningful long term outcomes-based measures of policy success and population wellbeing; as well as some reliance on ‘evidence based policy making’ to identify which interventions produce the most benefit and deserve investment.

How does prevention relate to the ‘Scottish approach’?

In other words, prevention policies generally combine specific ‘interventions’ with the broad governance principles, including ‘localism’ and the inclusion of users in the design of public services, that we discussed in relation to the ‘Scottish approach’ (but which is also pursued, in different ways, by the UK government). For example, the Scottish Government pursues prevention policies primarily via Community Planning Partnerships and the Single Outcome Agreements produced largely by local authorities.

Have a look again at the descriptions of the Scottish approach by Elvidge and Housden (including Elvidge’s belief that ‘traditional policy and operational solutions’ based on a ‘target driven approach’ would not produce the major changes in policy and policymaking required to address major problems such as inequalities).

What aspects of ‘prevention’ does the Scottish Government control?

The UK government controls monetary and fiscal policies, largely determining the budget used by the Scottish Government to spend and invest, and limiting its ability to redistribute income to address economic inequalities. It controls most aspects of social security, including the ability to address inequalities through direct payments, and determine the rules relating to benefits and unemployment.

Therefore, although the Scottish Government has primary responsibility for most areas of delivery relevant to prevention – such as health, education, housing, local government, and criminal justice – as well as some aspects of economic regeneration and employability, it does not have the responsibility to ‘join up’ taxation, social security, and the delivery of public services. For example, its ability to address health and education inequalities by using taxation policies to address income inequalities is very limited (even after proposed changes in the Scotland Acts of 2012 and 2016). It could not reform the benefits system to supplement its powers to influence ‘employability’ policy, or emulate the UK Government’s attempts to pass on social security savings to the local authorities implementing its ‘troubled families’ programme.

How does it fit in with the bigger picture of policy change since devolution?

Although the Scottish Government referred rarely to ‘prevention’ before 2010, it identified several ways to address inequalities. From 1999, it began to address ‘social inclusion’, which ‘become a shorthand label to refer to individuals alienated from economic, political, and social processes due to circumstances such as unemployment, poor skills, low incomes, poor neighbourhoods, bad health and lack of access to childcare’ (McGarvey and Cairney, 2008: 211). The most direct responses, to encourage employability or provide social security benefits, were UK responsibilities, and the Scottish Government relied on UK Government’s policies such as ‘welfare to work, the minimum wage and the Working Families Tax Credit’ (2008: 211).

The Scottish Government’s main response was to address disadvantages by focusing on economic regeneration in specific geographical areas, and reducing ‘unequal access to services such as education, health and housing’ (2008: 210). Its approach to governance reflected a developing ‘Scottish approach’, with an emphasis on social inclusion as a cross-departmental theme and the development of ‘Social Inclusion Partnerships’ (SIPs) which resembled CPPs (2008: 211).

Yet, overall, Scottish social inclusion policy did not differ markedly from the UK Government’s ‘social exclusion’ initiatives, and both governments have continued to promote concepts such as community and individual resilience rather than push for redistributive policies to address exclusion.

Further, the Scottish Government shared with the UK Government a tendency to focus on high profile issues or policies designed to improve outcomes overall without necessarily reducing inequalities of outcome (see the next two lectures/ posts on health and education).

Is there an implementation gap? Or, how do outcomes relate to initial expectations?

Until policymakers make sense of prevention, and turn it into a series of specific policies, it remains little more than an idiom – ‘prevention is better than cure’ – with little effect on government policy.

Although it is probably too early to detect an implementation gap associated with the ‘decisive shift’ in 2011, we can identify the great potential for unfulfilled expectations  based on the lack of progress associated with previous efforts. For example, the Christie Commission, which set the Scottish Government’s new prevention agenda in 2011, stated that:

on most key measures social and economic inequalities have remained unchanged or become more pronounced … This country is a paradoxical tapestry of rich resources, inventive humanity, gross inequalities, and persistent levels of poor health and deprivation … In education, the gap between the bottom 20 per cent and the average in learning outcomes has not changed at all since devolution. At the same time, the gap in healthy life expectancy between the 20 per cent most deprived and the 20 per cent least deprived areas has increased from 8 to 13.5 years and the percentage of life lived with poor health has increased from 12 to 15 per cent since devolution. The link between deprivation and the likelihood of being a victim of crime has also become stronger.

However, note the ‘bottom up’ element to this new agenda: does it make sense to identify the top-down idea of an implementation gap, when the Scottish Government is so keen to set a broad strategy and delegate policymaking responsibility? For me, this is a fascinating dilemma for governments: how to they ‘let go’ of policymaking and make sure that their broad aims are met in a meaningful way?

We can explore these issues in more depth in the next two posts which focus on two of the most devolved policy areas: health and education.

See also: Can the Scottish Government pursue ‘prevention policy’ without independence?


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