Good morning and welcome to the 20th meeting of the Finance Committee in 2010. I ask everyone to turn off their mobile phones and pagers.
Health England provides a good definition. It defines preventative spending as
Would anyone else like to talk about the definition of preventative spending? Have we an accurate definition?
The Nordic countries define it best, and implement it best as well, because preventative spending is woven right through the system. I dug out the objectives of the Finnish Ministry of Social Affairs and Health, and its first objective—I stress that it is their first—is problem prevention and the provision of support through sufficiently early action by primary services. That is quite different from what we are used to here, and is also a good definition of preventative spending.
Quite a wide range of considerations potentially needs to be borne in mind. Legislators can make rules on a series of services that have the same impact on human beings as, say, the education and health systems. However, there are other aspects of Government action, particularly in economic and housing policy, that impinge on the outcomes in which you are interested but which we do not normally think of as being directly related to the incidence of crime, poor school outcomes and so on. Economic and housing policy influence the infrastructure within which parents function, and parents are the primary preventative mechanism for altering the developmental course of children as they become adults. In seeking to alter children’s developmental trajectories for the good, the committee should focus on those that directly impinge on the child and the family.
Many submissions that you have received show that there is a huge amount of evidence in many areas and that, when they are designed appropriately and intervene at the right stages, those interventions are, in the main, cost saving. There is a fundamental difference between interventions that are taken much later and the kind of preventative interventions that we are discussing.
Now that we have set the broad parameters, can the panel say how far existing Government spending can be termed preventative?
One clear-cut example is the entitlement to free pre-school education for every three and four-year-old in the country, which was introduced in 2004. It boosts the likely educational attainment of the children who receive it and changes their behavioural profile in a way that is likely to have outcomes other than educational ones by, for example, increasing the likelihood of employment, reducing the likelihood of criminality and so on.
Does anyone else wish to comment on existing practice?
In preparing the Royal Society of Edinburgh’s submission, we found that in England preventative expenditure in health amounted to 4 per cent of the total health budget. Of course, that does not include housing, social justice and whatever but, relatively, the amount is very much smaller than the amount that is spent on responding to the acute problems that my colleagues have outlined.
We do not do much at the margins on spending to prevent. However, if we look at the issue historically, I believe that big leaps were taken when the problem of cleaning up water and sewage, which is almost a metaphor for where we are now, was addressed in Victorian times. Although the expenditure was very large, it left an enormous legacy in many areas of our life. We are advocating something similar when we say that we need to get our act together on early years.
The current reshaping care for older people programme, which is looking at care and support for an older population, has found that each year in Scotland £1.4 billion is spent on emergency admissions of older people. Of course, with regard to the definitions that are emerging, we would not necessarily call that kind of spending preventative. It is a huge cost that could partly be avoided through more preventative interventions, particularly at the local community level. Given the broader financial context and challenge that Scotland and the rest of the United Kingdom face, it could be seen as a target for reducing spending and shifting provision into other areas where money could be saved and from which the population could benefit.
The committee might be interested to hear that Government spending on early years services is around 1 per cent of gross domestic product in the UK but 2.4 per cent in the Scandinavian countries. As a result, there is great disparity between the current situation in the UK and what is happening in countries that are recognised as having the best models of early years provision.
Between 2000 and 2005, one of the issues that I was addressing in NHS Greater Glasgow and Clyde, which covers about a third of the population of Scotland, was the impact of certain very important and useful Government measures such as the provision of fruit in schools, healthy eating initiatives, the emphasis on teeth brushing and so on. However, such measures tended to be relatively small experimental pilot schemes that were very difficult to evaluate and from which it was hard to take any lasting conclusions or evidence. I hope that in future there will be an emphasis on hard evaluation of the beneficial effects of such measures. We are in the foothills of such activity in this country and have an opportunity over the next 10, 20 or 30 years to build up a very comprehensive evidence base. I certainly think that this is a good time to carry out such work. In any case, an evidence base is important because we cannot keep putting money into something that we think will do a good job; we have to prove that it does a good job.
We have talked in generalities—I think that we now need to focus on specifics.
Can you expand on your comment that Scotland is lagging behind?
In comparing school achievement by children in Scotland, Ireland, Wales and England, an academic from the University of Durham, Peter Tymms, has found that pre-school education affects educational attainment in England, Wales and Northern Ireland. However, he did not find the same relationship in Scotland. That suggests to me that something different might be happening in Scotland. Not knowing the intimacies of the Scottish situation I cannot comment, but I urge the committee to look at such services as a key preventative measure. One needs high-quality pre-school services.
I appreciate the broad picture that has been painted. Does anyone else wish to finish this line of questioning?
I have loads of questions. If I ask a couple now, will you let me back in later on?
You never know.
Dr Harris touched on some of this, but it seems to me that most of the evidence on preventative spend focuses on the early years and children, which is perfectly understandable. However, that is very much a long-term gain and benefit for society. Can any medium-term and even short-term measures also be taken in relation to preventative spend for an overall benefit?
We seem to characterise early years benefits as being long term and intergenerational, and the evidence tells us that the long term is where you get the biggest bang for your buck. However, that does not mean that we do not see benefits much earlier.
If you look at the submissions, you can see quick returns from programmes that are well designed and evidenced. There are those that focus on more intensive support for families, particularly families in difficult circumstances, such as those struggling with drug and alcohol issues, and those that focus on offender management and which are well rooted in the community and supported and led by voluntary and community groups. I agree with what Alan Sinclair said. There is a danger in characterising prevention as something that pays back only after 20 or 30 years, because there can be quick returns from some programmes that accumulate into much greater returns when we get into longer timeframes.
Can you supply us with any examples of such programmes so that we can see how what you have just described happens in practice? If you cannot do so now, you can write to us after the meeting.
Absolutely. I praise the committee for beginning this inquiry because you have a wealth of evidence. There are resources that cover many different fields of public services and social problems, and point to both long-term and short-term evidence.
Linda Fabiani asked a very important question. When providers such as local authorities and health boards are thinking about that question, they have to ask, “If we make that investment in the first three years, when is it going to pay off?” I accept that there will be spin-off benefits, but there are acute problems of drug addiction and the quite disturbing figures for alcohol-induced disease in Scotland that we need to look at.
What was the acceleration in the rate of alcohol-influenced illness in the 1980s down to? Why did the rate accelerate in the 1980s?
I do not think that anyone has the answer to that.
Convener, do you know that I am not finished yet?
Carry on.
From what has been said, it seems that we cannot take just one approach. There is no catch-all answer, so we require to take what is called these days an holistic approach. During the past years and decades, we have seen all sorts of different approaches, such as the multi-agency approach or community planning partnership approach—approaches that were supposed to make agencies work together. However, we know that, for example, health boards and local authority social care providers do not work particularly well together—the services are not joined up. Do bureaucracy and organisations’ self-interest create barriers? If so, what do we have to do to get over them? Can we fix what we have, or do we really have radically to rethink how to provide services in a way that makes proper use of preventative spending?
I could speak for a long time about that subject. There is no doubt that, even if there were no financial crisis, the problem of how to crack that issue is really acute, given the times that we are in. There are various complex reasons why interagency working is not as beneficial, or as efficient in meeting the public’s needs, as it should be. I will not go into all those reasons, but now that we are under particular financial pressure, I consider that it is absolutely essential to take steps to improve the interface. Whether it is between police forces and local authorities, local authorities and health boards, the fire service and the police force, or early responding organisations and health organisations, we have all seen examples where interagency working has let us down.
On early years services, the evidence in England shows that the sure start programmes function a lot better where there is good co-operation between health services and the local authority-provided education and social services. A mechanism that has been useful in producing greater integration is integrated children’s centres that act as one-stop shops for services that are relevant to young children, such as health services, education-related services, social services and so on. That approach requires that health visitors, in particular, integrate with the work of the local authority staff in the children’s centres. In that example, new structures are needed to integrate the work of health board staff and that of local authority staff. That is a potential way forward that Scotland might investigate.
There are already some children’s and family centres, such as the Jeely Piece Club in Castlemilk, the Girvan family centre, and others in Fife and Lanarkshire. They have all been getting a bit of a squeeze lately, but they reach out and bring together a lot of services, so we have some of the footprints of what we need on a bigger scale in the future.
Alongside that, central Government has an important role to play in understanding and shifting the regulations and systems that inhibit that more integrated working on the ground and those more creative, integrated services. It is important to look at the funding streams, the auditing, the national indicators and the accounting rules—all the mechanisms that, without a fundamental shift, will not create the incentives for health boards to work more effectively with social care and local authorities, for example.
I have a few questions, convener, the first of which is for Sir John Arbuthnott.
That is a core question. I have said that health improvement is a thin layer, and I have found information to confirm that—as far as preventative spending is concerned—at least in some areas. That is perhaps not so much the case when it comes to education, but it is in health.
Such things cannot be done in isolation—we cannot consider separately where the existing costs are, think about where efficiencies can be made and make greater investment in more preventative approaches. That needs to be part of a programmed transition over quite a number of years, and we need to start as soon as we can. The financial challenges that we now face, however difficult they are, could be used as a major impetus to begin some aspects of the process.
The policy that my colleague has just outlined is currently being explored with regard to early years services in Birmingham, where the projected savings for other services are being considered. Those savings could be used to estimate what investment should be put into early years services. The Birmingham case might offer a source of further evidence for the committee.
It is a case of a static use of finance being changed into a dynamic one.
In private companies as well as in public jobs that I have had, I have needed to take large sums of money out of the system. The most important principle that I have followed—there are parallels with the public position—is to take money out in such a way that there is still a forward march, while knowing what we are trying to create beyond simply taking the money out. That approach helps significantly to inform decisions. We should be asking questions about what type of society we want to create in this period, and we should let the answers inform what we do.
Professor Melhuish gave the example of sure start south of the border, and spoke about how funds had been earmarked. I absolutely understand the point that you are making. It would be fair to say that, here in Scotland, the direction of travel is the opposite. I am not making a political point here, as the next Administration might do the same, but the current Administration decided not to ring fence certain funds for local government. I repeat that that is not a political point—it might be flavour of the month politically to do that, and another Administration might do the very same thing.
Yes. If we are dealing with an established service system, with a highly professionalised workforce who are experts in their jobs, following many generations of practice, then leaving them in total control of what they do is probably a good thing. If we are setting up new services, in which professionals are still finding their feet, where the training systems are not in place and where there are not necessarily established models for practice, then leaving it to the people on the ground is probably a bad thing.
If we had a time machine, we would go back more than 10 years to have this debate in 1999, at the start of the Scottish Parliament, and would, I would have hoped, now be reaping the benefits of preventative spending. Unfortunately, however, we cannot do that. I guess it is just the way of things; it is when money is tight that such decisions are made, and that is when it is most difficult.
I think that we need to challenge the construction of that dilemma a little bit. If you take an approach that says that we know that we need to disinvest from certain services now for whatever reasons—whether it is to invest more in preventative approaches or just to save money—you are already taking some actions.
If we do not do that, what will happen is exactly what was suggested, which is that the magnitude of the savings will be what is in front of the eyes of the manager and the executive team. They will not be thinking about doing anything new, because they have enough of a challenge in providing the services with a diminishing resource. Essentially—to follow up Michael Harris’s point—at a very early stage we have to decide not to leave it to salami slicing but to give some guidance as to what we seek to achieve. Things will be particularly acute as a whole range of services, not only local authorities and health boards but the police force and all the other public services, adjust to the situation and adjust to big staffing changes. As early as possible, a body such as the Finance Committee—I suggest that this is an appropriate body, for the reasons that I outlined previously—should give a clear sign that we are looking at assessing our priorities for the future and that we are saying from the very beginning that things are not going to be the same as they have always been.
Over the past 10 years we have gone through a process of change in early years preventative services from almost zero state investment in the 1990s through to substantial investment today. We have crept up to about 1 per cent of GDP. If we fall below 1 per cent of GDP, we will start to go backwards in a serious way, which will have long-term implications for the services. Given that it is inevitable that one has to focus one’s expenditure in straitened times, I suggest that one needs to focus the high-quality early years services, to the fullest extent, in the 30 per cent most deprived areas in the country, where 70 per cent of poor children live, because that is where you will get the biggest bang for your buck. I suggest that in the remaining 70 per cent of areas, where 30 per cent of poor people live, the voluntary and private sectors should be involved by subcontracting from them provision of services for poor children in the more affluent areas.
In 10 years of devolution, the world labour market doubled in size. That process will continue, so it is not as though, in 10 years when the cuts are over, we will just go back to where we were. We are beginning to reach into a new period in our economic and political development. For that reason, the early years are important.
That handily takes me on to my question. Mr Sinclair said that nursery teachers can tell at the age of three the children for whom it is too late. I assume from what you have said that those for whom it is too late at the age of three are the children of the teenage mothers in deprived areas that you talked about.
They are largely, but not exclusively, such children. There is a large middle-class phenomenon in Scotland of subcontracting your children out and not caring a damn.
Given what you have just said about having children and family centres in the most deprived areas, how would you reach the children in the middle-class areas?
The problem that we have in Scotland is not simply with the feckless—it is bigger than that. We have a middle-class problem, a working-class problem and a sub-working-class problem. It is hard to change attitudes and culture, but we can change public policy. If we were to change public policy progressively, there is a reasonable chance that that would have an effect on culture.
Earlier today, when you spoke to Scotland’s futures forum, you mentioned nurse-family partnerships. I assume that such partnerships would care for all mothers, regardless of their background, so that such partnerships would pick up what you are talking about.
They would pick it up, but it is almost self-defining that teenagers who become pregnant are the children of poor and dysfunctional backgrounds, although not exclusively. I would apply the provision universally to teenage mothers—and fathers, if they are there, as we should try to ensure they are—and support them intensively for a two-year period. They were the children—they are still often not far from being children—who were not well parented. That approach would be an attempt to break that intergenerational cycle.
My next question is for Professor Melhuish. Do the people who are involved in early years education—the nursery teachers, for want of a better description—have the right training and are they valued enough?
In short, no. The current training needs to be upgraded substantially. There have been many improvements in the past 10 years, but we still have a long way to go before we have a well-trained nursery workforce. It is still a low-paid profession and many people go into it for the wrong reasons. We need to aim for a workforce who see the job as a career to go into for the long term. We need reasonably able people to work in the area. I suggest that we aim for a workforce of one third graduates and two thirds non-graduates, with that two thirds probably having done a two-year training course of some kind to work with the graduates—
I am sorry to interrupt. Would you therefore advocate shifting resource from tertiary education into nursery education?
Yes. I would advocate the shifting of resources from tertiary education to the early years, generally.
Dr Harris, the submission from NESTA speaks about a scheme called age unlimited, which is described as being “socially motivated”. Could you give me a better explanation of what the scheme is?
Age unlimited is an experimental programme that is taking place in Scotland and in other sites across the United Kingdom. The particular focus in Scotland is on how community groups and voluntary organisations that are formed by older people can play an important role in reducing the social isolation of older people in the community. The idea is, essentially, a preventative one. That relatively low-level form of social support—someone popping round to help with minor repairs and so on—can be incredibly important in terms of someone’s social wellbeing because it can prevent them from feeling isolated, from suffering from depression or from ending up in hospital because, for example, they have tried to fix something that is beyond their physical capabilities.
When will the results of those pilots be available?
We hope to have some initial findings about what those communities and older people have focused on; we have supported them to choose their own areas of focus. The programme will run for a couple of years and we will be evaluating and disseminating the results as we go. We also hope to do some longitudinal work after the end of the programme, which is obviously going to be helpful to policy makers.
Are there indications that there would need to be a shift of resource from the local authority to some of those organisations, if they prove to be as successful as you hope?
We feel that the third sector and community-led groups can play an incredibly important role in providing that kind of support and in being the first point of contact for those who need help. That is generally because they know the conditions on the ground and are aware of the particular issues in a community. They can be more approachable than publicly provided services, and they can also be more efficient and imaginative in terms of how they respond to the issues, including through preventative approaches.
Your submission said that Nottingham was an “Early Intervention City”. Could you explain a bit about that? What is involved in being an early intervention city?
I can submit more information in writing but, essentially, Nottingham has taken an holistic approach and has focused on a number of its communities. It has said, “Here are the problems and here is where our spending is going. We will set a number of indicators and targets to improve the wellbeing of people in those communities and then we’ll gather our public service organisations around the question of how we can achieve those better outcomes.” There is an effort to create a much more integrated and holistic approach, which is, in part, inspired by the experiments in the total place initiative in England, which started with an accounting approach to discovering where money was being spent and where there was an overlap of spending.
You have given evidence to the committee previously on total place. Does the approach that you are discussing today move forward from that?
Yes. You might not be surprised to learn that an enormous amount is spent in certain communities and on certain families that are struggling and which have various state agencies responding to them in narrow ways. The approach that I am discussing is an attempt to make our interventions much more co-ordinated and cost effective.
I know the Nottingham example. The approach in Nottingham came about largely through the determination of the local Labour MP, Graham Allen, who also happened to be chair of the urban development corporation—which is very unusual. In the past five years, he has collaborated extensively with Iain Duncan Smith. They produced a book together on the early years and what we should be doing about them. That level of cross-party collaboration is extremely unusual. Their book is really worth reading.
I point out that we have invited Nottingham City Council to give evidence to the committee, which should be helpful.
I have a final point to put to Sir John Arbuthnott. You said that during your time as chair of Greater Glasgow NHS Board, you tried to introduce some early preventative measures. What held you back? I know that you introduced a number of them, but you indicated that you were not as successful as you had hoped to be.
When I arrived at the health board, we were at the beginning of a transition towards taking health improvement much more seriously, so there was a climate for asking how we should go about that. The executive and the non-executive members of the health board, who were responsible for about £3 billion of spend and were therefore very hard nosed, had to be convinced that spend on such a process was not spend that was not particularly well founded. My reaction to that was to ask how we could find out much more about how the population of Glasgow, greater Glasgow and the west of Scotland respond to interventions. If we were to measure or to assess the efficiency and effectiveness of such processes, what should we do?
I think that we are all persuaded and will be increasingly persuaded about the importance of the agenda that we are discussing, and I hope that we will all become champions of it. I hope that we can communicate that and that the agenda will start to inform all of our budget and policy processes.
I think that Alan Sinclair’s views and my views are very close, although we have said things that might seem to show that there are discrepancies between them. I have talked about three and four-year-olds because my top priority is to maintain spending on them and spare them from cuts. It would be a disaster if spending on them was cut. That is not to say that spending on the zero to three-year-old group is not important—it is important, particularly for the most deprived groups. However, I want to qualify one thing that Alan Sinclair said. It can be recognised that a three-year-old will have a very bad outcome, but it is not as if that outcome cannot be changed. It is still not too late to intervene for three-year-olds, but it is too late to intervene by the time those children are five.
We would do very well in a three-legged race on almost every issue, and we meet only so many times a year.
According to Professor Melhuish’s research, the evidence on child care for children from nought to three is mixed. Is that to do with the quality of the child care?
Yes. Basically, high-quality child care in the early years fosters good language development and subsequently better social development, for example, whereas poor-quality child care can inhibit language development and other aspects of development. To some extent, the findings relating to early child care are similar to those for parenting. Unresponsive parenting and unresponsive child care will lead to poor outcomes.
Your comments are helpful. We want to sell this approach because it is the right thing to do, but we also want to sell it on the financial arguments. Sir John, in your submission you caution against
It is based partly on the work that I have done for the health service and partly on the work that I have done in the past year or more in local authorities, which has enabled me to see where the junctions and needs are.
Although evidence and evaluation—especially around the design of particular interventions, which can be incredibly important to their impact—are vital, the bigger issue that we face is not cuts but increasing demand. There have been historical episodes in which we have managed to cut public services—that can be done, however difficult it is—but we have not yet succeeded in managing and reducing increasing demand on our public services, which we will need to do.
All of us can see the logic of what is being argued for. Some of the specific cases that have been mentioned sound persuasive; it is intuitive, to a degree, that dealing with issues early will lead to savings elsewhere. However—to pick up a point that Sir John made—there is a danger that, if it becomes the vogue for us to switch spending towards preventative spending, every public sector budget holder will pop up and say that their budget is preventative spending. That will become the defensive tactic.
If you go in to any large company in a country, you will find that it has a research and development division, which constantly monitors the company’s products and the efficiency and effectiveness of production, and alters the company’s strategy year by year.
It might be useful to tell you that we are alert to that issue; there is a financial scrutiny unit in the Parliament.
I want to pick up on some of the stuff that I have heard since I asked my previous questions. I am keen that we examine what is already being spent in this country and termed as preventative spending; some may have an opinion on whether it is or not. One could say, for example, that free personal care is preventative spending, because it prevents the backlog of hospital beds in geriatric units and therefore makes savings.
If we return to the Health England definition that I quoted at the start, I think that the answer is yes. The definition refers to
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—indeed, when things have gone seriously wrong—instead of going back and putting something in systemically. We are far away from that latter approach. In the set of papers that I prepared either for this meeting or for my previous appearance before the committee, I included the Organisation for Economic Co-operation and Development’s league table of children’s wellbeing, which shows the UK to be very near the bottom next to some ex-Soviet countries. Although that is sad, it also presents something of an opportunity. After all, if you are really bad at something, there is usually more of an opportunity to get better by getting a few things right, whereas if you are already doing exceptionally well, it is hard to shave off another tenth of a second. There is more scope than we might realise to get ourselves moving, and once you get a sense of movement, things grow on top of that.
I asked earlier about multi-agency approaches and the bureaucratic barriers that build up when you try to take an holistic approach. I believe that Professor Melhuish said that there needed to be very strong central guidance, although the general view seems to be that it is probably best to have local service provision. In that respect, is there any scope for extending local authorities’ existing single outcome agreements to cover an issue base and thereby ensure that public service agencies in a given area address certain issues?
Two kinds of output measurement apply here: first, you can measure the amount of services that are provided; secondly, you can measure the change in a certain social problem, such as the change in special needs or the change in children with language difficulties. Measuring those outputs involves very different exercises. Measuring the output of services is fairly straightforward, and indeed fits in with existing procedures. However, it is much more difficult to measure outcomes with actual people. It requires another level of measurement over and above what we currently do and would add to the cost of evaluation. I am not saying that we should not do it; I am simply pointing out that it would lead to an extra layer of cost.
Earlier, we talked about setting the bar for where we want to be in certain geographical areas. I suggest that for certain issues we set the bar that we expect all those who are publicly funded and working in the field to achieve, perhaps with the central pledge that all help will be given to break down some of the practical and legislative barriers that exist.
The idea is very interesting, but my only concern is that if we define the issue too narrowly, it might become the target, which will lead to a silo approach and replicating another set of indicators and another narrow set of behaviours. If the issue were broadly enough defined to allow local public services, voluntary organisations and so on to come up with creative approaches, it might be very useful.
Dr Harris makes an important point. This has to be a two-way process. In other words, we need to keep refining and improving what we want to do. We are not absolutely content with what we are doing, because of the many barriers that we have to deal with. The process then becomes an interaction with the professionals whom we expect to provide that service but who might say all the things that I have heard before, such as, “We can’t do that, because these people have to be trained in a specific way.” It is quite possible to say, “No, we’ve got to think differently and do that plus. Tell us how you’re going to do that. What do we have to change?” If we just accept the existing barriers and differences, we will never make that jump.
My final question relates to Sir John’s earlier comments on the potential role for a committee such as this one in looking at the bigger picture and plotting the way forward. Does anyone on the panel know of legislators elsewhere in Europe or more widely who have decided at some point in their country’s history that there is a bigger picture and that certain things have to be achieved following an election, regardless of political persuasion—things that are sacrosanct to all and will be worked towards?
I suppose the most obvious examples are the Scandinavian countries, which have said that certain early years services—such as universal child care from birth onwards as well as high-quality pre-school provision and family support—will be provided for the population. They regard those things as essential to a civilised society, in the same way that we view sending all our children to school. That is the clearest example that I can think of. The approach that those countries have chosen is based on some evidence, but to a large extent they have accepted that those things are inherently good and they believe that they are justified by the inherent social worth of the exercise as much as by the long-term economic benefit.
I am still trying to understand how Holland, Finland, Norway and Sweden got themselves into a position where they are doing those things, and doing them so well. We were discussing that at lunch time. Many factors came together. Some of the reasons are economic, as there were shocks to some of those economies at different times, but some of them relate to the roots of the culture. A colleague who comes from Holland says, “In Scotland, it seems to me that you just tolerate children. In Holland, we love children.” That has an effect. Some of the reasons came from the greater participation of women in work in the 1960s and 1970s, the women’s movement and the notion that, if women were going to participate in work, the children had to be properly looked after rather than just pushed out. Somehow, that translated itself into public agitation in the 1960s and 1970s across a range of countries, but we were not one of them. It looks as if that public agitation led to the approach becoming strongly entrenched in systems and budgets. That is as close as I can get to an answer.
The final question comes from Tom McCabe.
It is really for Mr Sinclair and Professor Melhuish. I entirely agree with all that you said about early interventions and some of the things that you have suggested, but my experience suggests to me that we have what I have sometimes described as a growing underclass or a number of people who are ill equipped to deal with the problems that they face in society or in bringing up children, and those people are also cursed by having a poorly equipped peer group and even poorly equipped parents.
I agree that we need to go with quality interventions with the right duration and dosage. Some of the problems that you know of in your constituency are deep inter-family problems. However, the good thing about a number of the studies that have gone on for decades is that we can see that parents and children have benefited significantly from different measures, so we know that benefits have flowed from single interventions.
At the beginning of the meeting, I said that many of the things that we need to consider go beyond the services that are directly provided for children and families. I mentioned economic and housing policies, and they are directly relevant to the points that you have just made, Mr McCabe.
In today’s meeting, we have touched on some deep and fundamental aspects of our society and its possible future. There being no final questions or comments, I thank our witnesses for an informative session that was based on theoretical and practical knowledge and experience, which will be very useful to the committee in its further deliberations.