Public bodies in Scotland have been encouraged to adopt preventative spending and seek to improve outcomes. But success may take some time and the called-for decisive shift may turn out to be a gradual one
John Swinney, Scotland’s Cabinet Secretary for finance and Sustainable Growth, wants citizens to be more active. To find out why this of interest to the minister we need to start with the word ‘outcomes’.
That word together with ‘preventative spend’ are now very much part of the vocabulary of Scotland’s politicians and public service professionals. These two terms are generally used together, with an acceptance that by undertaking preventative spend there will be improved outcomes.
Most recently, the linkage between the two is made in the Scottish Government’s programme for the current year. The programme, sets out the Scottish Government proposals for better public services that are built on self-styled ‘pillars of reform’.
The first pillar is stated simply – a decisive shift to preventative spend. The programme itself gives a reasonable summary of the issues associated with preventative spend. For example, some interventions will ‘quickly improve outcomes’, while others will deliver benefit ‘over a longer term’. Although that longer term is not set out, the programme states clearly that the focus on prevention means that government will ‘continue to have a focus on outcomes’.
So it’s clear. Public bodies should move to preventative spend, improve outcomes and of course save money for the public purse in doing so. Except of course it’s not clear. While we probably know what preventative spend means, outcomes are harder to define and the longer-term nature of their realisation makes planning for them more difficult. And in any event, just how do we link prevention to outcome?
Interestingly, it was Swinney himself who gave, an easily understood example of the link between outcomes and spending of a preventative nature. His theory was that by directing public money towards sport and physical activity, savings of millions of pounds for the NHS in Scotland would be achievable. These savings would come simply by the population becoming physically more active and therefore healthier.
Swinney calculated that a 1% increase in sport and physical activity would generate savings to the NHS of £3.5m each year alone. He reckoned that these savings would come from reduced spend on treating coronary heart disease, stroke and colon cancer.
Crucial to Swinney’s argument, however, is that this could not be achieved by government alone. Government can direct funding towards encouraging sport but personal responsibility must be part of the equation. He argues that we need to take more responsibility for our own wellbeing and that unhealthy lifestyles will impact adversely on our health.
It’s a convincing argument and the link between a policy outcome and the promise of savings is clearly an attractive one for the finance cabinet secretary. The benefits from Swinney’s call for a more active nation are, however, likely to come over a long term. Politicians elected for a four- or five-year term are understandably interested in demonstrating improvement within an election cycle. Benefits that will be seen by the next generation are a long-term ambition but may not be a short-term vote winner.
This means that while ministers talk of a decisive shift, the shift in practice could be a gradual one. The challenge then will be for politicians and finance professionals to balance these competing tensions and find a new way – a way that enables us to plan services and to allocate resources based on our new-found outcomes.
Don Peebles is policy and technical manager at CIPFA in Scotland. John Swinney will be speaking at the CIPFA in Scotland annual conference in Dundee on 15-16 March
