Finance Committee

Meeting date: Tuesday, November 30, 2010

Official Report 525KB pdf

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Preventative Spending Inquiry

Item 2 is the final evidence-taking session in our inquiry into preventative spending. Unfortunately, the Minister for Children and Early Years, Adam Ingram, has sent his apologies due to the bad weather. I welcome John Swinney, the Cabinet Secretary for Finance and Sustainable Growth, and his officials: Kay Barton from the Government’s health improvement and health inequalities policy branch and Jim Stephen from its early education and childcare branch. Thank you for coming. I invite the cabinet secretary to make a brief opening statement.

Thank you, convener. My sympathies go to Mr Chisholm on the indignity of having to go through the process that he has just had to go through.

I welcome the opportunity to contribute to this inquiry into the important area of preventative expenditure. Preventative action is central to our approach to government. It goes beyond some of the more obvious areas of activity. One example of such action is protecting against the social and economic costs of unemployment through our economic recovery plan. At this time of financial constraint, it is important that we aim to avoid unnecessary costs in all areas through timely intervention. The committee has rightly focused its attention on areas such as health, early years, housing and justice. In the absence of my colleague, Adam Ingram, who concentrates on many aspects of the early years, I will do my level best to address the committee’s considerations. Jim Stephen will provide me with assistance in that respect.

In our submission to the inquiry, the Scottish Government gave examples of a number of different policy areas where the Government has developed the evidence and analytical base that are used to underpin our actions. I will not cover all of them in my remarks; instead, I will focus on what I believe to be the main issue.

The need for early intervention has been recognised for some time as a critical factor. The committee has heard about the evidence that shows that the early years are crucial in shaping a child’s development and life chances. That research underpinned the development of the early years framework and other, interconnected, frameworks that are aimed at tackling health inequalities and poverty.

Many of the people who have provided evidence to the committee were involved in the development of a new and dynamic approach to collaborative policy making that has been led by the Scottish Government and the Convention of Scottish Local Authorities. There are many examples of achievements at national level, such as the single outcome agreements, the family-nurse partnership and the getting it right for every child programme, but the key to success on our early years and early intervention priorities is what happens at local level. Adam Ingram has been tireless in his efforts to lead the agenda by spreading the message and pressing for progress at all levels of local governance in Scotland, particularly councils and community planning partnerships.

We will continue to give priority to early years and early intervention. We propose to introduce a new early years and early intervention fund, which will be aimed at the voluntary sector, with initial start-up funding of £5 million.

Action on early years is crucial but it is not the whole story; we are not just waiting for the next generation to solve our problems. We have in place a range of preventative spend measures, which were protected in the budget settlement as far as we were able to protect them. The committee has heard evidence on the cost of treating illnesses that are associated with drug or alcohol misuse, smoking and obesity. The issue is linked to action to reduce Scotland’s long-standing health inequalities—Kay Barton will assist me on some of those areas.

Such preventative measures will benefit Scotland and its economy in many ways, through improved productivity and reduced welfare and treatment costs. We also need to focus on preventative services that offer the opportunity for intervention at different life stages, such as parenting support, education and learning support, employability services, drug and alcohol services and community policing.

I have talked about areas in which there is preventative effort. It is clear that such areas do not work in isolation. We and our partners need to work together to take a more holistic approach. We know that the savings from prevention do not always arise in the area in which the preventative action was taken. That must not act as a barrier to preventative action. The Government wants to ensure that we overcome such perceived barriers. An example in that regard is our approach to the establishment of a change fund, which totals £70 million. The fund will be held by the health service, but it will be designed to support the redesign of services to help shift the balance of care away from the acute sector and towards primary and community care.

Some people argue that the only way to ensure that there is preventative spend is to ring fence funds for that purpose, but I argue that that is not the way to get the best decisions and produce the best results for the people of Scotland. Decision makers need to recognise the value of preventative spend and give it appropriate priority. Even when the full benefits of spend are not realised for many years, more immediate benefits and impacts can often be recognised, which indicate that preventative spend is on track to deliver.

In all areas in which we undertake preventative spending, we must ensure that we are prepared to challenge the effectiveness of spending. If we determine that spending is not effective, we must redeploy resources.

There are many challenges in the agenda, but the whole concept of preventative intervention lies at the heart of the Government’s policy interventions and will be central to the work that is undertaken by the commission on public services, which Campbell Christie will lead, on designing the model for excellent sustainable services for our communities in a challenging financial environment. The shifting of effort to preventative services is a key part of the commission’s remit, which acknowledges the need to address the causes as well as the symptoms of social problems.

Thank you, cabinet secretary.

I will focus on the early years, which it is fair to say have been the most prominent area of preventative spend in our inquiry. Many witnesses, including Detective Chief Superintendent Carnochan, emphasised the importance of political consensus around the early years. I think that there is a basis for such consensus; I certainly acknowledge the work that has been done and the continuity with what went on in the past.

I think that the strongest evidence the committee has heard was on the importance of the first three years—that applies to the health area that Kay Barton deals with as well as to the broader early years agenda, which Jim Stephen deals with. The early years framework covers a longer period. At a time when finances are under pressure, should we focus in particular on the first three years?

Many of our approaches to preventative spending build on foundations that we inherited from our predecessors. The agenda that the Government is pursuing did not start in 2007; much of the thinking about and formulation of the rationale on a number of questions is part of an evidence base that has been built up over some time. We now have a clear picture of the scale and detail of the major social and economic problems that would benefit from early intervention—not just in relation to the zero-to-three age group but across the age spectrum. It is now important that we ensure that all the design of interventions is appropriate and effective to deliver against those problems.

It is important that within the early years framework—especially for the zero-to-three age group—we design interventions that will have the maximum impact on the individuals concerned. The process is helped by the type of evidence base that has already been constructed within Government—the understanding that some interventions in relation to parenting support and the health care support that is given to expectant mothers and to women shortly after birth are aspects of a procedural approach to the care environment that provides the youngest of our citizens with a degree of confidence. Over a number of years, it has become clear to us that we need to have the sharpest possible policy focus in that area and to ensure that services meet the needs and expectations of everyone concerned.

The fact that we are operating within a performance framework that focuses all public bodies on the achievement of a certain range of outcomes will help us through the challenging financial times that we face. It is crucial that we achieve those outcomes, which give all players in the public sector clarity about what the Government is trying to achieve as a consequence of the way in which public expenditure is being deployed. That should provide adequate focus to enable us to design the particular interventions that will support the group to which you referred in your question.

When it comes to the allocation of resources, do you see the nought-to-three age group in the same way as the three-to-eight age group, which accounts for the rest of the years in the framework? Have you repositioned or could you reposition the framework slightly so that it is more skewed resource-wise towards the first three years? Do you see a case for doing so? I suggest that, on the basis of the evidence, there may be an argument for that.

I do not have in front of me the spending balance between the zero-to-three age group and the three-to-eight age group. I imagine that it would be difficult to put together those data.

The most important consideration is to focus on outcomes. That strikes me as the way in which to navigate our way through the many choices that exist around how programmes could be designed or how services could be delivered. The focus on outcomes should guide us in all our decisions. The data that we have and monitor should give us the confidence that we are making an impact on achieving those outcomes. If they do not, we should look to other data that do. The approach that I have outlined addresses the issue that you have raised and gets to the heart of whether we make a difference to individuals’ lives by the way in which we spend public money or whether public money could be spent more effectively than is currently the case.

14:15

My other question is to get your reaction to the report from Scotland’s Commissioner for Children and Young People. His main point is that he feels that there should perhaps be more national direction or leadership. When I read the report, it seemed to me that that was an inevitable result of the relationship that exists between central Government and local government—you do not really have a directive relationship. That may be partly what he is referring to. If there is to be a national priority and a national focus on the early years, which may even intensify in the next three years, to what extent can that be delivered through the existing relationship with local government? Is that a problem that the children’s commissioner has highlighted, or do you just reject the thrust of his report?

There is a very real question to be addressed. Mr Chisholm is absolutely right that we do not have a directive relationship with local government. The contrast is with the health service, with which Mr Chisholm will be very familiar, in which there is a very directive approach based on national policy running a national organisation. Local authorities and national health service boards have a fundamentally different character; local authorities are elected bodies that have their own mandate and governance arrangements.

A fairly substantial question lies at the heart of the point that has been raised. We have tried to address the situation by seeking agreement with local government about the focus of our respective work. I am confident that, as a consequence of the arrangements that we have arrived at since 2007, local authorities have been co-authors of many of the interventions that we have made. It would be inconceivable for us to develop a social policy framework that would affect children from birth to three without the full participation of our local authority colleagues. Indeed, the Government’s three major social policy frameworks have all been formulated through that joint working with local government. The purpose of all that is to get us all on the same wavelength so that Government can pursue much of its agenda in willing partnership with local authorities. Local authorities have agreed to the performance framework that lies at the heart of the Government’s interventions—the national priorities and the national outcomes—and that focus is replicated at the local level to support those national outcomes.

So, in answer to the children’s commissioner’s point that there is a vulnerability, although we do not have that directive relationship—I cannot sit here and say that the Government has directed 32 local authorities to do this and it will happen—we have made strenuous efforts, through the creation of a policy framework, to get local authorities and national Government working collaboratively and co-operatively in the same direction.

I am interested in what you say about the outcomes. The overwhelming evidence that we have received shows that it is outcomes that are important—in fact, some of the witnesses have been almost evangelical about the outcomes that there could be. There is recognition that there is a long-term strategy in early years intervention, but some of the witnesses have made it clear that there could be some fairly short-term outcomes that would be measurable. Does the Government have an idea of when some of those outcomes could be produced and looked at to see the effects?

It is absolutely clear that the Government considers the focus on outcomes to be essential in policy terms. Three and a half years into the current Administration, I am more confident that that message has percolated throughout the public sector. I see much more evidence of it in some of the decision making by public bodies—not just bodies that ministers direct, but local authorities—and a focus on the achievement of outcomes. As Mr Chisholm said, the same approach is pretty broadly shared across the political spectrum.

The second point is about when we see the fruits of our work. The answer really depends on the area that we are talking about. In some of the early years work, the fruits will take perhaps five years to come to the surface in the achievement of some of the more significant outcomes. In some of the health areas, however, the outcomes can be pretty swift. If people change their alcohol consumption or smoking intake—I do not know whether people take up smoking cessation or they just cease smoking—or if they follow some of the work that has been done on exercise and weight loss, the fruits appear immediately. There will be long-term benefits too, but outcomes can clearly be achieved in the short term. However, the outcomes from early years work will be slightly longer term.

As this inquiry has gone on, we have heard some pretty robust evidence that there needs to be a radical shift towards preventative spending, and I guess that we have wished that we had held the inquiry a few years ago so that we were not coming up with evidence just as there is an unprecedented spending squeeze. That said, the evidence has existed for some years and some progress has been made in the past. How can we ensure that we get a radical shift this time? How can we ensure that our report does not just gather dust but we get the change that the evidence suggests needs to be made?

I think that, ironically, the financial context provides some of the impetus. Let us look at some of the long-term questions of demography. If we assume that nothing will change, that the pattern of demography will continue and that people will live longer but conditions will become more demanding to manage and the pressures on the acute sector will increase, we conclude that the financial pressures on public services will become significant—more significant even than they are today. The impetus to say to public sector organisations that they have to recast the way in which they deliver services and deploy interventions will become ever more essential. In that context, the difficult financial situation can help to focus minds on reshaping services to meet the challenges.

The second part of the answer is about using outcomes to navigate our way through the questions. In a sense, what matters is what we achieve and what is delivered. If we deliver better outcomes as a consequence of the way in which spending is deployed, we can obviously remove some of the pressure on public services over time.

There is a good opportunity in the current environment to use the financial constraints to press for change in the way in which we deliver public services, and the way to do that is by encouraging organisations not to protect the way in which public services are delivered but to protect, and then improve, the outcomes that can be achieved—we clearly need to improve the outcomes. That is the focus that the Government will give to public services in this period.

I want to take the point about outcomes a stage further. Some of the evidence that we have received suggests that preventative spend in one area will sometimes have a positive outcome in a different area. How do we ensure that people do not protect their own little empires and that we get the gain in other areas?

Part of what the Government has tried to do is intensify the activity at community planning partnership level. There are 32 community planning partnerships in Scotland, to reflect local authority boundaries, and a variety of players will sit around that table, but they will predominantly be the local authority, the health service, the police, the fire and rescue service, the enterprise agencies and various others. The focus of community planning partnerships is on the formulation of single outcome agreements, so a focus on outcomes and what they can contribute towards the achievement of the Government’s national outcomes runs through all their discussions. We therefore hope that that creates a climate that addresses Mr FitzPatrick’s point about money being spent by one budget holder in one area perhaps having a benefit to another budget holder. Does that incentivise spend or put off spend? We would like to think that the community planning partnerships are essentially a model whereby we can build up collaborative activity at local level, because it is not just about how one budget holder spends their budget. For example, on an issue such as alcohol abuse, how the health service spends its money is one thing, how a local authority spends its money on the issue is another thing and how the police deploys its resources on the issue is another. If those organisations’ approaches are aligned, we have a much better chance of reducing the alcohol harm caused to the individuals who consume the alcohol and to those do not consume it but may be the inadvertent victims of its consumption.

The community planning partnerships essentially encourage the process of reflecting on the best ways to deploy resources and spending. For example, some research that has been undertaken has led the Cabinet Secretary for Education and Lifelong Learning to write to the chief executives, the directors of children’s services, the directors of education, the directors of social work and chief executives of NHS boards about the financial impact of early years interventions, essentially to promote that body of thinking and to encourage all the players to look at the research base, because there is strong evidence for the beneficial effects of early intervention, and to encourage financial choices to be exercised in that fashion.

Good afternoon, cabinet secretary. I will ask questions along the lines of those asked by Joe FitzPatrick on the collaborative working side. The committee has received quite a bit of evidence about that and I hear your comments. Detective Chief Superintendent Carnochan told us 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 2561-62.]

He is approaching the matter, if I may say so, from a perspective that is slightly different from your generous view. Is he right?

I certainly think that there is still work to be done on the issue.

With regard to that work, when representatives from Glasgow City Council were in front of the committee I asked the head of education and the head of social work what the long-term outcomes are for the vulnerable children in that city, but they could not tell me. On that basis, I understood that they do not have long-term outcomes that they are aiming for with regard to reducing the number of vulnerable children. Does the Government have a view on what the long-term outcomes should be for reducing the number of vulnerable children in Scotland?

I am surprised by the comments by the representatives you heard from, because I would have thought that the objectives and the desired outcomes were crystal clear from the Government’s national performance framework and the national outcomes, which focus on ensuring that every child has the best start in life. I could perhaps understand it being remarked that we do not have a numeric target for the vulnerable children we might have in one, two or five years’ time, but I would have thought that the policy framework and the policy intention, supporting outcomes that are clearly expressed in the national performance framework, of trying to secure the best start in life for every child would have given all the clarity that any public servant would require.

14:30

Is there a case for having a numeric target for that? Very interesting research was published a fortnight ago that certainly gives a lot of helpful numbers on the cost benefit of tackling the issue. For example, £131 million a year in the medium term, if we allow for the additional cost of severe cases, is a significant figure. Should the Government have a target for reducing the number of children in that category by, say, the end of this decade?

There may well be a place for that.

In your budget choices for the coming year, was there any resource transfer to the area of early intervention?

That is a rather difficult question to answer in the context of an approach to a local government settlement that has essentially been around the achievement of the national outcomes, which are implicit within the arrangements that we have in place between the Government and local authorities for joint working. The concept of resource transfer suggests that we take one block of money from here and give it to there, whereas our approach to local government funding is essentially to create as much flexibility as possible within the total sum of money available to local government to ensure that it can contribute as much as possible towards the achievement of the national outcomes, which are clearly expressed within the Government’s policy framework. That is the approach that is taken most directly to deliver that.

The reason why I ask is that you went beyond that in your budget statement and established a number of areas where you made a conditional offer to local authorities such that you would hold back a percentage of funding if local authorities did not accept your conditions, which included maintaining police numbers at their current level. The Government created a new mechanism this year in which I am interested. How did the Government determine the areas to which the new structure would apply? Were any early intervention measures considered as part of that determination?

First, the Government did not create a new mechanism in this budget settlement; the Government simply continued a mechanism under which it proposed to retain a certain proportion of the local government total settlement to afford certain priorities, which was a hallmark of the last spending review settlement on the council tax freeze. That has simply been extended this time round, so no new mechanism has been created. Secondly, Mr Purvis is correct that a number of specific policy interventions were set out in relation to one part of the agreement with local government. However, in addition to that, there is an acceptance—this is a key point in this whole explanation—in the local government settlement that the Scottish Government and COSLA, or COSLA’s political leaders, agree that local government will continue to support the three social policy frameworks, of which the early years framework is one.

There are a number of specific asks on police numbers, the council tax freeze and a variety of other matters, but there are also some generic propositions that structure local authorities’ approach to deploying public expenditure. That is channelled through the three principal policy frameworks of early years, equally well and achieving our potential. The local authorities are asked to provide their consent to all those arrangements, which includes those three major policy frameworks.

What is the mechanism for determining whether local authorities are delivering on the early years framework commitments, or do they simply have to say that they are doing it?

That is done through the way in which we monitor the national outcomes and it is a central feature of the single outcome agreements that are formulated locally.

It is also crucial that we do not simply compartmentalise the early years framework as being about local authorities. There are substantial issues in early years intervention that relate to the health service and the criminal justice service’s support for vulnerable families. It is not only an issue for local authorities.

The budget has been offered. What happens if, when officials in the Government examine a single outcome agreement retrospectively as part of the review at the end of the year, they find that the local authority has not achieved the early years component? Does the Government claw some money back?

I remind the committee that we have an evidence-taking session on the budget on Monday at our meeting in Angus. That seemed to be more a general question on the budget than one that was relevant to early years.

I am happy to answer it. The key point that I will make on single outcome agreements is that they are not retrospective but prospective; they are about things that local authorities have agreed to do in the future, although of course their performance will be assessed. The leadership on formulating the agreements tends to rest with local authorities because they are the lead organisations in community planning partnerships, but they bring together the input of a range of other organisations. The prospective single outcome agreement sets out the priorities.

I will address Mr Purvis’s question about what happens if the outcomes do not materialise with the answer that I gave Malcolm Chisholm earlier. Local authorities are independent, self-governing bodies that are elected by their local communities. In all that it does, the Government tries to encourage the greatest amount of joint policy making and aligned activity between public sector organisations. We put a lot of effort into that. Adam Ingram spends a huge amount of his time visiting community planning partnerships and local authorities and evangelising on exactly the point that Malcolm Chisholm and Jeremy Purvis raised with me to encourage the strongest possible participation on early years.

If it does not all materialise, a question arises as a consequence for all of us as policy makers about the best way of delivering policy. The Government takes the view that local authorities are democratically elected organisations and we should respect their right and ability to implement the priorities.

The Government’s official submission alludes to the fact that there is a balance between reactive spending and spending that is more focused on prevention. We will never get to a situation in which all spending is focused on prevention, nor have we had a situation in which all spending has been reactive. Is the current balance at a high level—a strategic level—right, or is there still scope to skew it more towards preventative spending?

The balance is inappropriate. It is skewed too much towards reactive rather than preventative spending.

Within the Government’s submission, there is a view that tends to move that analysis down to a local level, which is consistent with some aspects of the way in which the Government is structured. However, you have said that the balance is not what you would like it to be, and I do not think that anyone would argue that we should be spending more on reacting to problems than on trying to solve them. How can the Government take an informed view of whether it has made a meaningful impact on that balance, either in the time you have been in office so far or in future, if you go on longer? What mechanisms enable the Government to take a strategic view on where the balance of spending is and where the opportunity is to go further?

For me, the whole issue turns on the national performance framework, which we set out in 2007. At that stage, we decided to create a policy framework that looked to the longer term and accepted that there was no way that we could solve some of Scotland’s deep social ills within a four-year term of office. Issues such as smoking and alcohol abuse have been kicking around for many years. I contend that the intensity of activity on tackling those questions and shifting the balance has moved more swiftly in the past 10 years than it did in the previous 10 years. There is no doubt about that, and the public’s mood and attitude, along with our policy focus, are helping us with that.

The national outcomes are the way of judging whether we are making sufficient progress. As I say, some of the challenges that we face will not be addressed within a four-year parliamentary session or term of office.

That is a plausible explanation for breaking through the short-termism of the political cycle and taking the longer-term approach that is necessary. Surely, however, if we go by the national outcomes—assuming that they are retained in the long term—the focus will be on attaining those outcomes and, unless they are preventative by nature, how we get there does not really matter, does it?

We have talked extensively today about young people. One of our national outcomes is to make sure that we deliver the best start in life for every child. Pretty compelling evidence is available that that is not being achieved. Of course, we have many social problems and we all know about them through the communities that we represent. The challenge is to intervene to change the focus, so that we achieve better outcomes and, as a consequence, create better conditions and opportunities for the young people in our society.

That presupposes that the main or only way to achieve those outcomes is to make greater use of preventative spending, which seems to be a bit counterintuitive.

It will require us to make greater use of preventative spending, but not exclusive use. That is the distinction that I would make.

That takes me on to another issue, which is a difficult problem to confront. Because of the long-term nature of the timeframes in which initiatives will succeed, fail or deliver the same as previous ones, it is difficult to draw together the evidence and the policy in the timeframes in which politics usually work. In the timeframe of your Government, have there been examples of policies that were previously thought to be helpful in shifting towards preventative spending but which it became evident were not achieving the likely success rates, leading to corrective action being taken?

14:45

There is not a policy area that immediately strikes me. Well, perhaps drugs might be the one example on which we have taken a different course and focused much more on addressing the circumstances of drug users. Rather than supporting the management of a drugs crisis, it is about tackling its root causes. That is one area that I would highlight.

One of the dangers in policy making is that we are tempted by short-term initiatives to try to sort a problem. A lot of the analysis of policy over the past 20 years suggests that that does not work. A collection of pilot initiatives does not equal the pursuance of long-term outcomes-driven policy making that is determined to tackle our social ills. All the policy evidence analysis supports that procedural way of tackling issues, rather than just trying to put together different new ideas to tackle particular circumstances.

I can see where the logic of that takes us. Part of my reason for raising the issue is that, although there has been a significant consensus on some of the issues during the inquiry and there is no doubting the good intentions, separating good policies from the good intentions is a trickier prospect. One newspaper today reported that an initiative by a UK Cabinet sub-committee to try to frame longer-term savings rather than short-term budget savings is running into trouble. The article states:

“Although the Treasury is officially open-minded, there is a degree of scepticism about what one senior figure calls ‘spending departments bringing us spend-to-save measures as an excuse to get more money’”.

Is the Scottish Government as sceptical as the Treasury is, or does it take a different view?

Probably the less I say about Her Majesty’s Treasury, the better. If Mr Brownlee is asking whether I believe that there are justifiable spend-to-save measures, the answer is yes, of course I do. There might not be agreement among politicians in Parliament on all essential characteristics of alcohol policy, but there is certainly enough agreement that we have to do something about Scotland’s alcohol situation. Why? If any of you has the misfortune to have to go to an accident and emergency unit on a Friday night because of a circumstance that has nothing to do with drink, it is guaranteed that you will collide with the after-effects of drink there, even if you had nothing to do with it all evening. That says to me that if we take interventions that reduce the number of cases that populate our hospitals and A and E units with alcohol-related conditions on a Friday or Saturday night, or any other night of the week, that would be a good thing, and that would be a spend-to-save measure.

The general principle is that it is easy to come up with initiatives and make the plausible case that they will save money in the longer term. However, even if you were to take a very optimistic view of your electoral prospects, some of these proposals will not bear fruit until you are long out of office. You must be somewhat sceptical about being presented with such proposals. Surely a higher standard of proof is required when someone presents a spend-to-save initiative than when someone simply comes forward and says, “Well, we got this budget last year. This is a worthwhile programme and we would like to maintain it.”

In a sense, the judgment that I apply is to look at some of the wider considerations that I cannot avoid. I refer to questions such as demography and the challenges of longer life expectancy including the increased requirement for health care support that that longevity places on our public services. I am not familiar with the news article to which you refer, Mr Brownlee, but, if a Cabinet sub-committee was looking at a long-term measure to try to tackle some of these questions, I am sure that it would be seized with exactly the same data as I am. Unless we interrupt some of the ways in which we make demands on public expenditure, we will end up having to take some very difficult decisions in future years, particularly if we do not make the interventions at this stage to try to change our direction of travel.

I am interested in your views on the 1,000 extra police as part of your deal with COSLA in return for the council tax freeze. When Detective Chief Superintendent John Carnochan gave evidence to the committee, he was given the choice between 1,000 extra health visitors or 1,000 extra policemen. He chose 1,000 extra health visitors, because he said that that would give long-term benefit in terms of preventative spend. Do you have any thoughts on that—particularly given your recent experience of health visitors?

I have certainly seen enough of them.

I totally understand Mr Carnochan’s point. Essentially, it sounds like a trade-off between early intervention and policing, but my view is that having 1,000 extra police officers is early intervention, too. I would like to believe that a more visible police presence would lead to people thinking twice about whether to behave in a fashion that causes distress. I know that Mr Whitton has wrestled with some of these questions in his constituency.

I understand Mr Carnochan’s point and I am sympathetic to the idea. In looking through material before I came to the meeting, I was struck by the point—it is attributed to Iain Duncan Smith, I think—that a young person’s educational attainment is founded by the age of eight. I understand and accept the logic, but I am not sure that Mr Carnochan is comparing apples with apples.

I take your point; it can be argued that both are preventative spend. I think that Mr Carnochan’s argument was that, if we had the 1,000 extra health visitors, we might not need so many police officers in 15 years’ time. Mr Brownlee referred to that.

That may well be the case. As I tried to say to Mr Brownlee, taking steps now means that we will not be treating the same problems in 15 years’ time.

Some of the symptoms that we are treating today are the same as those our predecessors were treating 10, 20 or 30 years ago. However, some of the symptoms are not quite the same, and I would like to think that some of the decisions that we take in the current context will lead to fewer symptoms in 10, 20 or 30 years’ time. The purpose of the outcomes framework is surely to try to achieve that.

You said that you are not entirely convinced that a collection of pilot studies is the right way to go forward, yet the Government has introduced a number of integrated resource initiatives across Scotland. The directors of social work and the Royal College of Nursing say that progress is slow on those. Will you give us an update on whether you agree with that and say whether you might change your mind about pilot studies if you do not think that we should have as many of them?

I was not giving an edict against all pilot initiatives. I was just cautioning about where we should use them.

I do not agree with the RCN on work on the integrated resource framework, which I think is actually making more progress. It is a technical area of health board and local authority interaction that has to be undertaken. It is what the Government’s change fund in the budget proposals is all about; it is designed to try to put real muscle behind shifting the balance of care, and to—

Is it to speed it up?

It is not necessarily to speed it up. It is to give it greater potential and put greater practical resource behind it.

Mr Whitton will recall the budget session that we had in Kirkintilloch in his constituency. A gentleman from the elderly forum went through a number of statistics about how much it costs to keep an elderly person in an acute hospital, a local hospital and a care home, and in their own home. The numbers are dramatically different. To me, that was a powerful illustration from a member of the public of why what we are doing with the change fund is so important. The more people are supported in their home rather than in an acute hospital, the more it helps us with the long-term management of public resources.

The work on the integrated resource framework is going well, but it is something that needs to be constantly reinforced, which is what the change fund will help to do.

Strathkelvin and Bearsden are always glad to welcome the cabinet secretary to offer him policy direction. You are right—it was a good session.

I will touch on something else that will, no doubt, come up a lot during our budget discussions in the coming weeks. It concerns universal provision, particularly in relation to the early years. We have had a lot of evidence from other countries on the issue, and the explanation that we have had is that there are better outcomes in the Nordic countries and the Netherlands, where there is universal provision, than in the UK and America, where provision tends to be targeted. Does the Government have a view on whether it will roll out more early years provision on a more universal basis rather than on a targeted basis?

Are there particular elements that Mr Whitton has in mind?

Not especially. I guess that one would be family-nurse partnerships. There have been pilot studies of that approach. Are we going to roll it out? I suppose the other one that I was quite taken with is also a family-nurse partnership, but it specifically targets teenage mothers. The girl is allocated a health visitor, who has only a small number to deal with, rather than a huge number, as soon as she is discovered to be pregnant—you do not wait until the child is born; you do it before that. It struck me that those things in particular are quite effective.

15:00

There is a question about whether such provision needs to be universal or more extensively available. I can clearly see the merits of its being more extensively available.

The question of universality is obviously substantial. In some areas of provision, services are provided on a universal basis because the cost of disentangling who should be entitled to them from who should not can almost be greater than the cost of the provision itself. There is a fine line to be trod.

For example, I would describe free eye tests as an early intervention measure, and I think that they were probably described as such by the previous Administration when they were introduced. The cost of an eye test in an optician’s will be significantly lower than the cost of an eye test appointment with a clinician in an acute hospital. By getting people to go for a regular eye test every few years to check up on the condition of their eyes, it is likely that problems are spotted that avoid the health service incurring the significant costs that would be incurred were those problems not spotted for four, six or eight years.

At our recent party conference, I had a five-minute session with some people from Optometry Scotland, during which my pupils were examined using a piece of equipment. Just by looking at the detail of that image, they were able to go through four or five processes that enabled them to tell me right away whether my eyes needed further examination for condition A, B, C, D or E—forgive me for not having the detail to hand. That struck me as an excellent, easily accessible example of preventive intervention. That process could have taken place at a stall in a shopping centre. A five-minute examination is enough to give people a diagnosis and to allow them to find out whether they have any latent problems that they might not otherwise detect for some time. That example shows how we need to be more creative when we look at how we deliver public service.

I have a final question, which I would have asked Mr Ingram. As he is not here, Mr Stephen might be able to help Mr Swinney with the answer.

For a couple of years, I have pursued a campaign for free nursery education to be available to three-year-olds one month after their third birthday. I understand that that has been rolled out across Scotland and that all 32 local authorities have been told that they can make such provision if they want to. What progress has there been with that? I am not sure whether that is widely done.

You are right. Free at three was part of the framework for education deal with COSLA. We took it up with COSLA and the Association of Directors of Education in Scotland, but it is fair to say that progress has not been as rapid or as complete as we would have wished. I think that about eight or nine councils offer free provision or variations of it. Some councils offer free nursery education if it is provided in a local authority setting, but not if it is provided in a third sector or a private sector setting. It is a bit of a mixed bag all round. We need to reflect on where that stands, given the new budget offer that is with councils.

We reckon that such provision is available in about eight or nine council areas. At any one time, there are about 2,500 under-threes in the pre-school sector in Scotland, many of whom will be from vulnerable households. That is the best account that I can give you at the moment.

I have a couple of quick questions, which I suppose are to do with the £70 million change fund and what has been said about the institutional barriers to the public sector working cross-sectorally. Can the change fund be used by all the public bodies as a model for the way forward on preventative spending?

The whole purpose of the change fund is to realise some of the ambition that has come out of the joint work that the health service and local government have undertaken, in which there is a recognition that there is a saving to be made from preventive activity—to put it crudely, such activity reduces acute demands and strengthens community provision. The change fund is designed to support that journey, and the model might well apply to other policies. To me and to the Government, health and social care interaction is a key area in which an opportunity exists to make more progress by working in that fashion.

My final point is that many witnesses for this inquiry and the inquiry into the Public Services Reform (Scotland) Bill expressed the strong view that some important, big issues could not be tackled in one, two or even three four-year terms of a Government of a particular hue, as has been said. What is the cabinet secretary’s view on the idea that some matters are so important to our society—whether they are preventative spending in the early years or other activities—that they should go beyond political divides and proceed by consensus until certain outcomes are achieved?

Compelling evidence of that exists. The Administration has continued our predecessors’ direction of travel in several areas. We did not come into office and say, “That was what they did on smoking, but we’ll do something else—we’ll do the opposite,” because tackling some issues is too important for that.

When formulating the national performance framework and the national outcomes, we thought about how to put in place arrangements that would allow long-term policy making to be undertaken not just by this Administration in building on our predecessors’ work, but by the Administration that takes office in 2011, which can build on the work that the current group of ministers has undertaken.

No one else has questions. Does the cabinet secretary wish to make closing remarks? No—I think that he is perfectly happy with what has been achieved. We look forward to seeing him on Monday.

There will be a short suspension to allow the next panel of witnesses—two of whom have managed to arrive just in time—to take their seats.

15:07 Meeting suspended.

15:10 On resuming—