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.

Olivebank & Omega3

Evaluation of an initiative to provide omega-3 rich snacks to preschool children at Olivebank Nursery in Musselburgh

(Article provided by Dr Jane Mackenzie from QMU)

 Senior researchers at Queen Margaret University, Edinburgh have recently worked with nursery children in East Lothian to improve their diets.

The University’s experts in nutrition collaborated with Olivebank Nursery in Musselburgh to encourage children to eat more oily fish as part of a balanced diet.  This follows directly on from some preliminary work carried out by the staff at Greengables Nursery in Craigmillar, Edinburgh.

The work was carried out by Nutrition Graduate, Elina Scheers Andersson, and was supported by a grant from the Organix Foundation, a charity which funds research projects that help develop understanding of the links between food quality and children’s health.

Dr Sandra Drummond, Senior Lecturer in Nutrition and Dr Jane McKenzie, Senior Lecturer in Biochemistry and Metabolism are aware that nursery aged children in Scotland have very low intakes of oily fish – the key dietary source of Omega 3 fatty acids. These fatty acids are essential for normal child development during this critical age.

Dr Drummond explained: “As a nation, the Scots are not consuming the recommended intake of oily fish, such as salmon, mackerel, sardines and fresh tuna, and young children’s intakes are particularly low. Optimising intake of Omega 3 fats will help children to reach their full potential and improve their long term health.”

As it is understood that very few children are familiar with oily fish, the research team aimed to encourage children to become more aware of fish – where it comes from, what it tastes like, and how they can incorporate fishy snacks into their every day diet.

Nursery staff worked closely with the research team to promote a range of fun and interesting activities. A visit to the local fishmonger introduced children to different types of fish. There were also opportunities for hands on food preparation sessions such as making tasty snacks from fish they’d bought from the shop.  The snacks, including smoked mackerel pâté, salmon fish fingers, tuna meatballs and smoked salmon and spinach tartlets, were then offered to the children at the nursery in place of the regular snacks.

The majority of children found the range of omega-3 rich snacks as enjoyable and acceptable as the regular snacks. Substituting some of the regular snacks with those made with oily fish increased the intake of valuable omega-3 fatty acids significantly. The impact of this initiative on the children’s overall dietary intake requires further evaluation, however the results from this study indicate that such an initiative can be successful within a similar vulnerable population.

Dr Drummond concluded:” This research can impact positively in many ways.  Taste preferences are learned at an early age. If children are given the opportunity to develop a liking for oily fish at a young age, this preference can persist throughout their life. By developing an awareness and liking for oily fish, young children may be able to influence the food choice of the whole family.”

Professor Petra Wend, Principal of Queen Margaret University, said: ”This project is an excellent example of the relevance of Queen Margaret University research work and ensures that academic knowledge is being applied to a real life community setting. The work fits well with Queen Margaret’s philosophy of improving quality of life and allows us to have a positive impact on the health of our younger members of society.”

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

Forest school leaders Autumn Gathering

East Lothian Countryside rangers have been actively supporting the development of Forest school in East Lothian.

A number of rangers have trained as forest school leaders and they play a key role in supporting school based staff in using woodland environments as a learning & development space in a way that is safe and limits the impact on the environment.

Leigh Shearer took the lead in organising a gathering of staff who have trained or are training in forest school approaches. The idea of the gathering was to provide an opportunity for mutual support, learning and networking. The afternoon was a great success and the sun even shined.

Report enclosed

2010 Gathering report

Scrapbook project

The logic model that guides the work of the test site  in East Lothian has four short term learning outcomes. One of these is about the physical or built environment in the target communities and how well it supports children and families to lead healthy lives.

To develop a better understanding of this we have started a small project based on work we learnt about from the Equally Well test site in Glasgow city. The idea is to bring communities together with services responsible for the built environment in a dialogue that uses a common language. The planners in Glasgow City understood that the professional language they use about the built environment is not one shared by all, and tried to get round this by getting people to keep scrapbooks of images and thoughts about their communities – what was valued, what could be improved? In this way it was possible for the planners and the community members to have a more equal conversation.

We are asking parent and community groups in the Support from the Start target area to keep a scrapbook of their thoughts and views about their environment from an early years perspective. When the scrapbooks are complete we will hold a dialogue session and ask services and professional to come and view the scrapbooks and hear what the thinking is behind them. So far a preschool nursery, a parents group, a dads group and a community group are keeping scrapbooks if you would like your early years group to take part in this project let me know and I will arrange for you to get the scrapbooks and disposable cameras.

Steven Wray

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.