Scottish Parliament inquiry into preventative spending

The following is the transcript of the  Submission from Susan Deacon to the Finance Committee Inquiry into Preventative Spending.

Susan is a national champion for the early years in Scotland and an advisor to the Support from the Start Planning Board

I am grateful for the opportunity to submit evidence to the Finance Committee and welcome the Committee’s current inquiry into preventative spending.

Since the inception of the Scottish Parliament successive Ministers and Governments have recognised the importance of working to tackle the root causes of social problems and, in particular, the importance of taking action to give children the best possible start in life. While there have been  differences in emphasis and a variety of approaches to policy delivery and implementation along the way, there has been a consistent direction of travel which has commanded a high level of commitment and support across the political spectrum.

So too is there a vast body of research and evidence – much of which has been presented to the Committee during the course of this Inquiry  – which makes a compelling case for early intervention and preventative spend.

This begs the questions as to why we, and by that I mean Scotland, have not yet embedded in our public consciousness and culture, political debate, investment priorities, service design and professional practice a truly preventative approach and, in particular, have not been more successful in delivering a step change in how we support children and families to ensure that the lives of our youngest citizens are built on strong foundations.

Having spent more than 25 years involved in both the study and practice of politics, social policy, management and change, I have grappled with these questions from many angles. Since standing down as a member of the Scottish Parliament in 2007 and, most recently, taking on the role of Early Years’ champion with the Scottish Government, I have focussed much of my energy and efforts in examining the question of how we can get better at making such change happen.

In this submission I therefore offer a distillation of a few of my overriding observations and conclusions on some of the barriers to change and how we might overcome them. The focus of my submission is on children’s early years, but it will be clear that many of my comments have a wider resonance. The opinions offered are my own but are informed by formal study and, critically, by extensive dialogue with a very wide range of individuals and organisations. I am immensely grateful to those who have taken time to share their knowledge, opinions and insights with me. My work on early years is ongoing, and I will be reporting early in the new year, however I hope it is helpful for now to share these thoughts to aid the Committee’s deliberations.

 Raising awareness and public ‘buy in’ on the importance of Early Years

The problem is not lack of policy and research – in fact it is arguable that the proliferation of both has created a fog which needs to be cleared. Rather there is a need to build a shared popular understanding of why children’s early years’ experiences are so important and how big a part they plays both in individual life outcomes as well as the future social and economic success of Scotland.

This is important for two reasons. First, we need to create a climate and a context which is conducive to decision makers taking spending decisions which support early years investment – perhaps at the expense of more ‘acute’ or ‘crisis’ interventions. It is therefore important that the public does not see investment in, for example, parenting support, community groups or antenatal education as a ‘soft option’.

The second reason why public awareness and buy in is so important is because, as the current Early Years Framework acknowledges, there is a need for transformational change in how we parent our children and in what we do in the family and in the home. It is therefore not enough to simply limit the discussion to what professionals and public services can do, in fact it is arguable that we have to date got this balance quite wrong.

Such a public discussion needs to be plain speaking and accessible. Too much of our current debate in the policy and political worlds is locked up in ‘techno speak’ and jargon or is over laden with references to the latest policy document, research, tool or process. This needs to change. There can and must be a much more straightforward, ‘human’ discussion about what is going on in our families and our relationships, how that is affecting children and what we can do about it.

Some of the fundamental things which matter to children – love, cuddles, play, bedtime stories, routine etc – cost little but matter a great deal and we should not be afraid to say this.

 Developing a shared responsibility for supporting the Early Years

We can observe a pattern which goes something like this. We identify a problem (e.g. childhood obesity, youth disorder, poor literacy) and look to Government to fix it. Typically, Government accepts that challenge; puts in place a process; delivers a strategy; translates that into policy and an (often over-engineered) implementation process and, two or three years on, the problem (not surprisingly) isn’t ‘fixed’. This then becomes portrayed as a failure of the political leadership of the day so, we change Ministers or Government and start the same process all over again.

If ever there was a time to break this cycle, then surely it is now – and where better than in relation to children’s early years?

Government – and other public bodies – have a key role to lead, support and invest but they can only do so much. In allowing too much responsibility to transfer to professionals, and to government and its agencies we have, inadvertently, disempowered people themselves and this has militated against the very behaviours – in the home, the family and in our communities – which are widely understood to be a vital part of our social and economic well being.

I am under no illusions about the scale of the challenge to bring such a shift about and realise that it does not sit comfortably with our prevailing political culture, media debate or simply the way we think as a society. But I would argue that there is a big prize in working to foster this shared responsibility, to do so in a spirit of learning rather than blame and to get beyond the short-termism which bedevils us and stands in the way of sustained and sustainable change.

 Getting out of our boxes

For a small country, Scotland has developed a remarkable propensity to subdivide into a multiplicity of ‘boxes’. This is partly reflected in a cluttered public policy and public service landscape and in the propensity of Government, both national and local, to develop multiple parallel strands of policy, activity and investment – but the pattern runs deeper than that. Professional silos and demarcations and organisational and sectoral ‘agendas’ abound – and we can see this running right across sectors and activities.

All the evidence and experience tells us that the kind of support and services which really make a difference to children and families – especially the most vulnerable – need to be flexible, responsive and holistic. We need a really concerted effort to create the structures, systems and practices to bring that about.

There have been many years of ‘clunky’ and costly initiatives to foster better joint working, multi-disciplinary approaches, shared services, integrated plans etc etc, but I think we have to be willing to hold up a mirror and be honest that the impact of this effort and activity has not been on the scale that we might have hoped.

In the medium term – as is now widely acknowledged – there needs to be some rationalisation or consolidation of structures – if for no other reason than ongoing cost and efficiency. But structural change at agency level takes time and is costly and disruptive. In the short term therefore, I would suggest that there is a great deal more that can and must be done to foster the culture and behaviours which enable and support people to work together better across boundaries on the ground. This requires leadership at many levels both to drive such a change – but also to ‘let go’ and to release the potential and the creativity which exists both among our professional workforce and in communities themselves.

Alongside this there requires to be a much stronger and explicit recognition of the transformational impact which a preventative approach – often through small scale, locally developed projects  – can have.

 Focus on people not process

At the end of the day, it is people that make a difference. Across Scotland we have a wealth of knowledge, commitment and experience of people who at their own hand are leading change and delivering programmes, projects and activities which are having a real and positive impact. With just a little bit more support – or even simply ‘permission’ – they could do so much more.

I am encouraged that both at a national and local level there are a growing number of examples of where a more people-focussed, ‘lighter touch’ approach to change is being developed. e.g. bringing smaller groups of people around the table to drive practical action and change; supporting the development of creative partnerships across sectors and professionals; investing in and placing greater value in individuals who can broker and ‘oil the wheels’ of collaboration across professional and organisational boundaries and with families and communities. But we need to scale this up, and part of that is recognising that ‘no one size fits all’ and that people need to be allowed to get on with leading and driving change.

In short, we need to create a ‘bias for action’ and there is a real urgency to do this. The time, energy and money which is locked up in process is unsustainable and unhelpful. There is, for example, much more that could be done to consolidate and rationalise funding streams and simplify application processes – both nationally and locally – and so reduce the number of hoops and hurdles which professionals and voluntary organisations alike need to jump through – often to access very small amounts of money or support.

Our performance measurement culture also has become too much of an end in itself rather than an aid to performance improvement. There are still too many targets – often competing and conflicting within and across agencies – which get in the way. So too has our desire to develop approaches which are informed by evidence, led to an over dependence on research and analysis at the expense of action. How many research reports and conferences do we need to tell us that play is important to children’s development?

And while I would be the first to say that we should, where possible, measure and evaluate the impact of public investment, I say with feeling that I believe this is one area where we have ‘lost the plot’. Do we really need, and can we really afford – either in terms of direct cost or time delay – to construct a business case, do yet another pilot or carry out a formal evaluation on each and every project and activity before deciding whether to roll out the approach or to just get on with a project?

We know a great deal about what works and does not work, we just have to get on and apply that knowledge. Similarly we need to allow people to get on and do and test localised approaches in real time.

The fact is that it is difficult – in some cases nigh on impossible – to quantify the impact of preventative spend. It is hard to prove that if we had not acted or intervened there would have been a poorer outcome or to demonstrate short term improvements where change may be generational. But existing evidence, not to mention professional judgement, human intuition and experience  – and sheer common sense – can take us a very long way.

I acknowledge that there are tools, such as SROI (Social Return on Investment) which can help in this area, but I personally conclude that we should spend less time searching for measurement tools and more time getting on and doing what we know needs done.

I note also that when it comes to societal well being, many of the behaviours and relationships which matter and which do so much to contribute to our human and social capital – simply do not lend themselves to hard edged short term quantification. e.g. The grandad taking his grandchild for a walk in the park; the neighbour offering help and support to the young parents next door; the dads who take wee boys out to play football every week or the new mums who get together over a coffee to just meet and talk together with their babies. Maybe it is time to stop searching for proxies to count and measure all these things and accept that we know what matters to us as human beings.

 In conclusion, Einstein famously said that the definition of insanity is ‘doing the same thing over and over again and expecting different results’.

I genuinely believe that much of what we need to do to give children a better start in life is not rocket science but bringing about change will require us to think and work differently in the future.

 Susan Deacon is Honorary Professor with the School of Social and Political Science at Edinburgh University and was previously Professor of Social Change at Queen Margaret University. She was an MSP from 1999-2007 and is a former Scottish Health Minister. She is currently Early Years’ Champion for the Scottish Government.

Conversations with Susan

Susan Deacon, local parent, former MSP and health minister, is an advisor to the Support from the Start planning board, but also has a national role advising the Minister for education and lifelong learning about how Scotland can move closer to the vision of every child having the best possible start.

I was able to  spend a good part of the day on Thursday accompanying Susan to a series of sessions with parents who use early years voluntary sector services in Mid & East Lothian. The aim of the sessions was for Susan to have conversations with parents of early years children about what they find useful as support, and what they see as issues. They weren’t ‘consultation’ sessions or  ‘focus groups’, and were by no means scientific – they were simply conversations. Parents had the opportunity to tell their stories to a woman with considerable experience of how government and public service works, and a voice loud enough to be heard on a national stage. Susan had the opportunity to listen to, and ask questions of, people who had current first hand experience of being parents who were coping with difficult circumstances.

It was fascinating – belated apologies to the Woodburn Neighbourhood Planning Group, but I couldn’t pull myself away when the conversations over ran the allotted time.

These are my impressions from listening to the conversations

Firstly how incredibly generous people can be with their stories. I think this was partly testament to the fact that the parents who participated obviously had a lot of trust in the staff of the voluntary services which were the context for the conversations. However, I was also struck by how much many of the parents wanted to be able to contribute – to give back, and telling their stories was  one way of doing that.

A theme that ran through all of the conversations was services seeing the whole person,  not just the presenting problem or the assessed need. Parents wanted to be dealt with as people and not as problems. It was obvious that this was a quality of the voluntary sector services the parents were using that they valued very highly, and sadly it was often stated in contrast to experiences of statutory services.

Another and perhaps related theme was that the way services were delivered seemed to be just as important as what was delivered. In other words a friendly face, a welcome non judgemental manner, and perhaps above all a relationship with a trusted individual were valued by parents as much as the particular type or brand of support they received.

Self- help or peer support was also seen as very important – the opportunity to spend time with others in the same or similar situation was valued highly. This might be as simple as time over a cup of tea to chat, it might be a shared confidence building activities. It might also be the opportunity at the right time to offer support to somebody else, or to take on a helping role – fundraising, advocacy etc.

Another theme was about how people access services. Pride kept coming up as  barrier to people actively looking for help – ‘I should be able to cope with this’, or, ‘people will think badly of me because I need help’.  Parents valued highly services that reached out and smoothed the path into support and didn’t rely on people crossing the door on their own.  There were many stories of how people felt that they had been ‘saved’ because someone had ‘helped them across the door’  or made it easier for them to start accepting support.

On the same theme of access was the importance of rapid support in a crisis, especially access to quality childcare envronments – I was particularly struck by stories of how events -social, psychological, financial and medical, mostly  beyond our control can overturn lives often literally overnight, and leave us in a position where it is difficult to be the kind of parent we want to be. I was particularly touched by one woman’s story of having to deal with the acute illness of a loved one and trying to balance this against her desire to maintain the kind of stability she wanted for her small child. She recognised that the  stress she was under, and the unpredictability of the demands of treatment, meant that her child was not getting the secure, stable environment she desperately wanted for it. By coincidence, a worker turned up on her door with the offer of  a nursery place in a voluntary project that she had applied for before the illness of her loved one. She hadn’thought to ask for help, or been offered it, because of her situation, but the offer of support came as a ‘Godsend’. She feels this helped to provide the stability her child needed and allowed her to focus on dealing with the impact of illness without the additional guilt and stress. Who knows what that simple intervention saved in terms of stress and upset for the child and the parents, what did the alleviation of that stress save in terms of stress induced problems for the parents and child. Certainly her feeling was that both her and her child were ‘saved’ . 

Almost all of the parents Susan spoke to stressed the importance of qualitychildcare,  as the pre-requisite for making it possible for parents to get the support they need, and this was paticularly so where a child had additional needs. Many parents stressed how they felt their child had been ‘ brought on’ in terms of socialisation, language skills and emotional stability through access to the childcare offered by the services they were using.

Finally, I have been reading lots of information about the economic impact of investment in early years – for every £1 spent on early years £5-£7 can be saved from services that are not needed to address problems in later life. Anybody listening to the conversation Susan had with parents over the course of one day in Mid and East Lothian would have no trouble  believing that research.

Many thanks to Stepping Forward, First Step & Dadswork for hosting conversations with Susan.

Support from the Start – Development Session

On the 8th October the East Lothian service and community champions met together with the planning board and steering group members to look at how Support from the Start was developing, what the successes and  challenges had been and what was going to carry the work forward in a difficult financial period.

The Scottish Governments Joint Improvement team facilitated the event which started with participants reconnecting with the vision of the test site and then identifying actions that would bring the vision closer, and address the challenges.

A report on the session is linked here East LothianSupport from the Start Development Event -Final Report (2)

and a summary of feedback from participants here East Lothian Support from Start Event 8 10 – Feedback Report

The planning board will discuss the report, and implementation of the actions arising from the session at its next meeting in early December.

Reports from GUS

Yesterday Lesley Kelly, dissemination officer for the Growing Up in Scotland survey, gave a presentation about the finding of the survey to staff in Mid & East Lothian with particular reference to readiness for learning and supports for parents.

Lesley gave an overview of the findings from the survey and there was a lively discussion at the end of the session.

For me one of the key findings presented by Lesley was the type of supports that were utilised by parents whose children were not experiencing difficulties. It was clear that parents that were accessing a range of informal and community based supports were also experiencing less health, social and emotional problems in their children. In other words parents using community and family based support seems to support the resilience of children. Strengthening the capacity of community and family based support for parents along with supporting parents who are experincing difficulties to access this type of support seems to me to be good value for money, but will it be be valued an protected in the current climate. The childrens commisioner has released a press statement which raises concerns about how supports for parent can be maintained and enhanced when the pressures are for service reductions.

The other key finding for me was that  parents / carers who spend time playing with and reading to their children can influence the childs readiness to learn independant of their income status. So often the message from statistics about health, education well being can seem negative. If you have a low income the dice can seem to be stacked against you statitistically speaking. Here is a different story – it doesnt matter if you are on a low income you can still make a difference for your kids

Her presentation is linked below

GUS presentation for East & Midlothian 28th Oct 2010

Social Marketing and First Step

Social Marketing

Hopefully this will be the first of many blogs describing the developments of a practical example of the social marketing approach with First Step, a community based early years project in Musselburgh

What is Social Marketing? In a nutshell “social marketing is an approach used to achieve and sustain behaviour goals on a range of social issues”.  It is based on marketing concepts and techniques but applies these for a “social good or purpose” rather than the sales and profit goals of commercial marketing.

Social marketing is not a theory itself but draws on familiar disciplines such as health promotion, community development, sociology etc and offers a logical planning process to help achieve behaviour change

There are a number of core concepts and principles underpinning social marketing  and for more detail there are two very helpful websites to explore: the National Social Marketing Centre http://www.nsmcentre.org.uk/ and the Scottish version which is currently hosted at the following address http://www.socialmarketing-taysidetoolkit.com

What’s Happening Locally?

  • Social Marketing presentation to First Step staff in March
  • Steering group set up to oversee developments. This group will be reporting into the Support from the Start Planning Board. The steering group is chaired by myself and has membership from Health Visiting, Community Learning and Development, First Step, CHP Health Improvement Team and ELC Early Years and Childcare.
  • Initial scoping started with parents and carers that attend First Step
  • 3-day Social Marketing training attended by two steering group members
  • Representatives from West Dunbartonshire Equally Well test site invited to the Steering Group to discuss their social marketing approach with tobacco use

Next Step

  • To support First Step users identify their priority health behaviour issues

For any further information on this development, please get in touch with Morag.nicholson@nhslothian.scot.nhs.uk or tel 0131 536-3535

What can you achieve for less than £600?

 

Summer transitions

Sometimes large amounts of public money can be spent with minimal return – but sometimes very small sums can free the creativity of staff and parents to make a difference. The enclosed evaluation was sent to me earlier today. Its an evaluation report on a piece of work taken forward by staff in Prestonpans that made me think wow all that happened because of £600.

Service champions for Support from the Start have access to a small ‘simple rules’ development fund. The idea behind the fund is to provide a resource for champions to test out ideas that might lead to service redesign that will contribute to tackling health inequality in early years.

Helena Reid wanted to build on work that the integration team had been developing on supporting parents whose children are in transition from nursery to primary school.  Being ready for school and the school being ready for the children that they are to educate is, to my mind, a key area where services can support parents and children to help themselves. There is no doubt that the more a child can take advantage of educational opportunities the more likely it will escape poor health in later life.

The enclosed evaluation of a summer transition programme gives an exciting glimpse of how services can support that transition process for children that may have difficulties and engage parents who may need support in getting their children ready for school.

I was excited reading it and I hope you are.

Summer Programme Evaluation 2010 (2)

Creating Confident Kids

Creating Confident Kids is a whole school approach to emotional wellbeing, initially developed by Edinburgh schools. It is being championed by Sheila Laing head teacher and a service champion for Support from the Start.

Schools in the Support from the Start target areas in East and Midlothian are adopting this programme. An evaluation programme is built into the development which should in years to come give an idea of how well the programme is working.

Teaching about emotonal well being  it  is now part of the outcomes for the Curriculum for Excellence as outlined in Shielas presentation below, which was given to schools in Midlothian. 

Midlothian Presentation Febpart 1

Midlothian Presentation Feb 10part2a

Midlothian Presentation Feb 102b

Midlothian Presentation Feb 10part3

Dental Health in Wallyford & Whitecraig

Early year’s dental health is one focus for Support from the Start in Whitecraig and Wallyford.  Part of this focus is to examine the current and ongoing dental health status of all three year olds in these areas.

Following detailed dental inspections carried out earlier this year on 3-year-old children seen at Whitecraig and Wallyford 33% of children were found to be affected by tooth decay.  

These findings confirm that, although the majority of children have as yet no experience of caries, for some children the presence of dental caries is already well-established by the time they reach three years of age.

What is being done locally to address this issue?

  • Local nurseries are getting an extra morning each for dental health promotion with new materials (see example above) and information packs for children and parents available.
  • Tooth varnishing has been rolled out in the targeted areas allied with encouragement to enrol with a dental practice.
  • There is additional dental health promotion work underway in playgroups and toddler groups and tooth brushing schemes in P1&P2
  • Local dental practices are being encouraged to become Childsmile practices.

Cosy Kids

I am always astounded by the fact that so many homes are still energy inefficient in the 21st century, when often simple measures can make a big difference. Linking families in need with Changeworks might be the best way for professionals to make a difference for their clients.

Below is a new release from Changeworks – a charity that supports people to be more energy efficient and to improve their environment through reducing energy cost whilst being able to afford a warm home.

£100,000 ScottishPower Energy People Trust Grant To Help East Coast Infants Stay Cosy

A new project that will help hundreds of East Coast families with young children to stay warm was launched today, thanks to The ScottishPower Energy People Trust.

The Cosy Kids project will help over 200 vulnerable households and 400 additional individuals – including many new babies and pre-school children – in Edinburgh, East Lothian and Midlothian – to live in affordably warm, damp-free homes.

The project is being funded entirely by a £117,000 grant from The ScottishPower Energy People Trust. The Trust was established in January to fund not-for-profit organisations that help vulnerable families and young people who need to spend more than 10% of their income on energy bills and suffer from fuel poverty.

Managed by the Edinburgh-based charity Changeworks (formerly LEEP), the grant will involve setting up a specialised unit that will primarily work with health visitors to ensure that young children are not living in cold, damp and draughty homes which will affect their health.

The Cosy Kids project will also: promote energy efficiency grants, refer people to money advice and advocacy services, provide talks to groups of new parents about keeping their homes affordably warm and dry, educate health visitors in the area about the benefits of warm housing and visit families in their own homes to assess the type of help they need.

The grant marks a watershed in the ScottishPower Energy People Trust, which has now committed almost £1 million to projects that are tackling fuel poverty in communities throughout Great Britain.

Willie McDiarmid, Managing Director of ScottishPower, said: “The Cosy Kids project is a worthy recipient of funding from the ScottishPower Energy People Trust, which is unique in channelling funds to those organisations that are working at grassroots levels to assist the most needy members of society who are living in fuel poverty.

“The Cosy Kids project will reach hundreds of the youngest and newest members of our society who often suffer most from fuel poverty. By using existing networks of health visitors, community groups and crèches to provide advice and grants, help will be given to vulnerable people when they need it most.”

He added: “The ScottishPower Energy People Trust is one of its kind in the UK and since we launched in January this year, almost £1 million in grants have been awarded to projects which tackle fuel poverty all over Britain, many of which focus on families, children and young people. We are now looking forward to supporting many other projects that are working to eradicate fuel poverty around the country.”

The ScottishPower Energy People Trust grant will fund Cosy Kids for two years and will use a network of health visitors, community groups for mothers and toddlers, crèches and the Community Education Service to reach vulnerable families.

Simon Lee, Chief Executive of Changeworks, said: “Changeworks is already working to alleviate fuel poverty through successful initiatives such as Warm and Well, so I am delighted that ScottishPower is supporting the ground breaking Cosy Kids project. This grant will help us to focus on the families by making sure that parents get the advice, information and support they need to enable them to keep their homes warm and dry and that children get a better start in life”.

For more information please contact:

Josie Saunders
the BIG partnership
0141 333 9585/07881 816 283
josie@bigpartnership.co.uk

Ellen Arnison
the BIG partnership
0141 333 9585/07879 427 410
ellen@bigpartnership.co.uk