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FINANCE COMMITTEE

AGENDA

25th Meeting, 2010 (Session 3)

Tuesday 16 November 2010 The Committee will meet at 2.00 pm in Committee Room 1. 1. Inquiry into preventative spending: The Committee will take evidence from—

Ian Curryer, Corporate Director for Children and Families and Lead Officer for Early Intervention, Nottingham City Council;

and then from—

David Crawford, Executive Director of Social Care Services, and Maureen McKenna, Executive Director of Education, Glasgow City Council;

and then from—

Ron Culley, Team Leader, Health and Social Care Team, Sarah Fortune, Policy Mananger for Finance, and Robert Nicol, Team Leader, Children and Young People, COSLA; Ruchir Shah, Head of Policy and Research Department, Scottish Council for Voluntary Organisations.

2. Subordinate legislation: The Committee will consider the following negative instrument-The National Health Service (Superannuation Scheme, Pension Scheme, Injury Benefits and Additional Voluntary Contributions) (Scotland) Amendment (No. 2) Regulations 2010 (SSI 2010/369).

James Johnston Clerk to the Finance Committee

Room T3.60 The Scottish Parliament

Edinburgh Tel: 0131 348 5215

Email: james.johnston@scottish.parliament.uk

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The papers for this meeting are as follows— Agenda item 1

Submissions

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Agenda item 2

Note by the clerk

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Finance Committee

25th Meeting, 2010 (Session 3), Tuesday 16 November 2010

Inquiry into preventative spending

Submissions

Submissions have been received from the following— • Nottingham City Council • Glasgow City Council; • COSLA; and • Scottish Council for Voluntary Organisations.

The Committee agreed to take evidence from Nottingham City Council in relation to its “Early Intervention City Programme”. This approach aims to “to work in partnership to improve outcomes for children, young people, adults and families who are very likely to experience difficulties and to break the intergenerational cycle of problems in the long-term”.

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SUBMISSION FROM NOTTINGHAM CITY COUNCIL

Nottingham is seen as one of the leading lights in driving the shift towards effective early intervention. After an innovative two-year grant-funded pilot programme, this paper outlines the next steps to create a mainstreamed approach. What is Early Intervention? Early intervention is high on the national agenda as a key principle to achieve better outcomes at less cost. Early intervention is an approach to prevent a problem which is likely to escalate. It is often targeted and intensive and may be a model of support or a prescriptive programme. There is a clear, interlinked relationship with prevention, which is seen as a broader continuum of more universally applied support systems to increase protective factors and decrease risk factors. There is an embryonic and emerging evidence base for early intervention nationally. It is not a one-off fix, but a sophisticated process and a way of thinking that could be applied and tested across most services and systems. Establishing what works best at local level, providing effective return on investment, is critical and long-term. It Costs More to Act Later, but it’s a Long Game It is estimated nationally that if the number of offences by children and young people was reduced by 1%, it would generate £45 million in savings to households and individuals per year. The cost of educational underachievement has been projected at £18 billion per year by the London School of Economics for the Prince’s Trust. Statistics highlight intergenerational cycles; daughters of teenage parents are three times more likely to become teenage mothers, and 65% of sons with a convicted father go on to offend themselves. Inequality also impacts; a child living in poverty is more likely to have poorer health, lower attainment and less earning potential. It is widely accepted that significant savings can be made through effective early intervention, in the long-term, but clear cost / benefit models in the UK are yet to emerge.

• Benefits are not necessarily accrued to the organisation that invests. Innovative and collaborative funding models need to be developed.

• It is hard to prove what hasn’t happened, or to demonstrate causality. Comparator groups should be used where possible in carefully structured evaluation.

• The benefits from early intervention may take many years to be fully realised and costs may increase initially. The key focus should therefore remain on outcomes.

A Sophisticated Process, not a ‘Magic Wand’ A single intervention made early, however well designed and delivered, cannot be expected to ‘fix’ matters. Early intervention is therefore a process and there are critical windows where interventions can be more effective. Scientific research supports the importance of what happens in pregnancy and during the early years in a child’s life in laying the foundations for virtually

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every aspect of a child’s future development. Supporting parental skills, behaviours and health is one of the most important social policy issues today. Alongside a solid and nurturing whole family context and home environment, high quality early years provision is key to supporting good outcomes at age five, which is a critical benchmark for future achievement. It is much less expensive to invest in support during this early phase than a teenager who has become entrenched in negative and destructive cycles of behaviour, social exclusion, crime or drugs. Parents are often more receptive to support, for themselves or their children, during this stage. The role of adult services also provides important opportunities to support strong parenting and aspiration. However, problems do not always arise in the early years of a child’s life. Children, families and adults of all ages can benefit from effective early intervention support. A good example is the Department of Health funded Partnerships for Older People Projects (POPPs) in pilot areas nationally, which have developed services such as telecare systems, rapid response services and home support, promoting well-being, independent living for longer and less need for higher intensity or institutional care. Every £1 spent on POPP services, creates a £1.20 additional benefit in savings on emergency hospital beds. A one year delay of one older person entering residential care saves £26,000. Early intervention is a 0-100 age agenda. Evidence-base and Fidelity Matters Internationally, there is a growing evidence-base for a number of specific early intervention programmes. Some are being trialled in the UK, including the Family-Nurse Partnership from the USA, ‘Stronger Families’ from Canada and the ‘Triple P’ parenting programme from Australia. Nottingham is currently implementing a number of these. The University of Colorado have ‘blueprinted’ a number of ‘model’ and ‘promising’ programmes after rigorous evaluation. Steve Aos, a leading cost-benefit analyst in Washington, has developed a model to prove financial benefits. New learning from the work of the Dartington Centre for Prevention Action in the UK has proved that if an evidence-based programme is delivered without fidelity to the prescribed design, then the effect is often neutral or even negative. This sheds a stark light on many poorly implemented pilots. This year, the Centre is launching a transferral pilot of the USA ‘blueprints’ in the UK, to test whether similar outcomes and financial benefits can be achieved. This cost / benefit work in the USA has led to more collaboratively funded approaches across organisations, where money is pooled in the interests of a common outcome or social impact bonds are created through private sector investors, to release public sector savings later. The financial climate in the UK and emerging place based budget principles could drive similar approaches. The Centre for Excellence in Outcomes (C4EO) made a national call for best practice approaches this year and has produced a paper of collated local

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models and approaches with proven impact, alongside key themes to make early intervention work. Going Forwards Nationally Early Intervention is a key priority for the Coalition Government. Graham Allen, MP for Nottingham North, was recently appointed to chair a national review of early intervention aiming to ensure that children at greatest risk of multiple disadvantage get the best start in life. This will link to the work of the Secretary of State for Work and Pensions, Iain Duncan Smith and the Children’s Minister, Sarah Teather. Potentially, Nottingham could become one of 12 Beacon Sites nationally, taking part in implementation and evaluation pilots and sharing best practice. Going forwards, it is indicated that early intervention should be a shared responsibility nationally and locally, where evidence is gathered collectively. Sector-led improvement through stronger commissioning and innovative approaches to funding and delivery are also important, including co-producing services with the citizens who use them. Nottingham’s Early Intervention Programme Approach Early intervention is embedded within the Nottingham Plan and is a priority for all theme partnerships. The Programme was launched by One Nottingham in April 2008, through £4m Area Based Grant funding, and has achieved strong national profile. It is strategically driven by the Children’s Partnership, due to the intrinsic links with the ‘Aspiring Nottingham’ and ‘Family Nottingham’ themes, and has primarily focused on children and families. There are five strands: A City definition was agreed in November 2007 by the One Nottingham Board: ‘Our aim is to break the intergenerational nature of underachievement and deprivation in Nottingham by identifying at the earliest possible opportunity those children, young people, adults and families who are likely to experience difficulty and to intervene and empower people to transform their lives and their future children’s lives.’ 1. Governance – aligning priorities, decision-making and workforce

development Strong ‘Nottingham Early Intervention City’ brand created with national and

local profile. Workforce Core Training Standard created, incorporating ei approaches

and principles. Currently developing the local authority commissioning process around ei

as a key principle. Ei definition and key principles being revisited to establish a unifying City

philosophy. 2. Projects – 16 pilot projects provided the opportunity to: Pilot two evidence-based programmes from other countries.

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Adapt or create nine new programmes to create evidence. Re-engineer some existing work to catalyse impact. Gain and share learning around specific models, research and integrated

processes. Enable some quick wins and positive support for over 15,000 children and

families.

Clear indicators of strong / weak impact are monitored. Generic learning from the integrated processes and workforce systems around these programmes has been collated. Better links between some services and systems have been forged, adding value for families. 3. Learning and Evaluation – strengthening local evidence and research

into practice Methodologies created to structure and monitor collectable outcomes from

projects. Partnership with the University of Nottingham – analysis of local barriers to

adults and children’s mental health joint working, establishing local factors for engaging fathers, focused PhD student placements, starting work to research victimisation risk factors.

Nottingham established as a key partner within a national network of experts.

Work underway to identify a ‘Nottingham EI Package of Programmes and Services’.

4. Finance – understanding costs and benefits Conceptual cost / benefit model developed for two programmes. Emerging cost / benefit approach being developed for family level (FIP

families). Menu of costs being created, providing a foundation for Total Place work

to build on. 5. Knowledge Management – better understanding our children and

families Household intelligence on children informing planning of local provision. Insight work linking adult and child data to explore the best engagement

strategies. Ethnography work and case studies of FIP families undertaken to show

how services and non-state support connect around families, informing Total Place work.

Set-up and Development of the Approach £4m from the Working Neighbourhoods Fund was pooled to trial innovative early intervention approaches. £190,000 infrastructure budget was pooled to fund a small infrastructure team to drive a programme approach.

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Early Intervention Definition The definition was agreed through all Strategic Partnerships and finally at the Local Strategic Partnership Board meeting, 23rd November 2007: ‘Our aim is to break the intergenerational nature of underachievement and deprivation in Nottingham by identifying at the earliest possible opportunity those children, young people and families and to intervene and empower people to transform their lives and their future children’s lives.’ It was recognised that there is a permeable boundary between different levels of support: Preventative work should be targeted where children, young people and families may have impaired outcomes. Early intervention work should be targeted where children, young people or families are very likely to have impaired outcomes if we do not intervene early to change the trajectory. Specialist intervention happens when the child, young person or family has impaired outcomes. Each Strategic Partnership was requested to produce a contextualised ‘Statement of Intent’ in support of this definition. Whilst it was agreed that Early Intervention has a 0-100 age range, it was agreed that in order to narrow the focus at the start of the programme, impact would be targeted at families and the 0-18 age range. Early Intervention Priorities and Projects Each Strategic Partnership identified two or three key projects, which included new work, realigned work and mapping studies. Evaluation was planned alongside delivery. The criteria for the projects was to:

o Focus on tackling intergenerational issues o Focus on those activities that, if delivered, can reduce the

number of specialist interventions o Focus on bringing partner resources together to have more

impact o Target work at individuals or families who are very likely to have

difficulties or impaired outcomes without effective support or intervention. (This is subtly different to prevention which is targeted at those individuals / families who might have difficulties).

Each sponsoring Strategic Partnership retained responsibility for the commissioning and performance management of their approved projects, and reported on progress, supported by the Programme Team. Longer-term Early Intervention Work It was agreed in November 2007 that the Early Intervention work would be structured around five themes:

Governance

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Projects Finance Learning and Evaluation Knowledge Management

Achieving improvement required secure and operational partnership arrangements, allowing data to be used in a way which facilitated early intervention and reinforced the commitment to a holistic, family-centred approach. This approach needed to build on existing Children’s Trust style arrangements and emerging structures for locality based services. It was agreed that an evidence base of what works would be developed throughout the programme, in order to shape continual improvement. Nottingham was selected as one of the 12 national Local Area Agreement Demonstration Areas for the work on Early Intervention. Learning from the Early Intervention Projects Characteristics of the projects that are working well:

Intensive and focused on behaviour change. Evidence-based and delivered with strict fidelity. This tends to be

supported by an effective supervision model with a clear trajectory of early indicators to monitor, for example, the Family-Nurse Partnership.

Targeted at specific groups, at critical times. Where there is consideration of the whole context and causes, rather

than symptoms. Caseloads allow time to build a good relationship between the worker

and family / child, and a strengths-based approach is used. This links to decreased direct demand on social care, or a more effective relationship.

Where there is strong leadership and management by the project lead. Where deliverers are clear on specific early signs of risky behaviour,

engage the child / family in an assessment and have access to a clear referral process. For example, referrals into drug treatment have increased by 327% from DrugAware schools. Referrals have been at an earlier stage, treatment time has been shortened and success rates have been higher.

Where there are good communications in place so that a service is visible.

Some projects are reporting positive early indicators and anecdotal evidence, but it is too early to see the designed longer-term outcomes. One example is the 11-16 Life Skills Curriculum. However, intensive consultation and co-design of the programme has ensured strong engagement at an early stage. Some of the longer-term projects will be difficult to measure, as there are few credible or common tools to assess softer outcomes like aspiration and positive decision-making. The Raising Aspiration project aims to provide an evaluation tool for local use that may at least provide consistency for comparison of the impact of different projects. Some projects, like Active Families are showing positive engagement and impact, but the unique nature

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of the model and the targeted cohort means that a comparator group is difficult to find. Characteristics of the projects which are not working well:

Evaluation is poor and does not reflect the positive impact reported by workers.

The intervention is not for a consistent reason, for example mentoring, and is therefore difficult to evaluate.

When a project is implemented on top of an unstable system or where there has been turbulence and high vacancy levels in the delivery team.

Where referral numbers have not been high enough. This suggests that the service is either not visible or not needed.

Decommissioning process and sustaining some work longer-term Project funding ends in March 2011. During Winter 2010, a process will be undertaken to:

decommission projects safely use learning from projects to propose some specific changes to

mainstream systems propose the route to mainstream some projects

Broader local challenges to consider:

How to create a pervasive culture that respects both families and other professionals. Empower professionals to push past the cultural stopping point with families and take responsibility as a lead professional. There are few incentives currently.

Establishing a common language and processes across agencies. Remove obstacles to joint working across appropriate services for

children and adults. Situating universal services at the hub of a continuum of early

intervention support. Outreach work for vulnerable groups requires home visits and support

outside the ‘9-5’. Relationships with the ‘state’ can be a negotiation. The image of

services is important in gaining trust. There are implications for the new Family Community Teams.

Good quality assessment is important and the Common Assessment Framework should be the key process for children. Alignment of assessment for adults and children, and the impact of adults on children is not in place consistently.

’Forgotten’ members of the family are often the ones holding things together, and need support. Needs are dynamic not static.

Consider how to support resourceful families to use non-state support. Ensure the right people are targeted by programmes and that fidelity is

maintained

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Phase Two – the next steps for Nottingham, Early Intervention City Bold and dynamic senior leadership has supported the Programme through the first phase, and will be increasingly required to drive Phase Two. There are a number of proposed work strands going forwards: Building the Early Intervention Strategy

Continue to build the high profile ‘Nottingham, Early Intervention City’ brand, linking related high profile work under this, including Total Place.

Join elements of the Early Intervention and Aspiring Nottingham agendas more formally. Raising aspirations is an important part of our early intervention approach.

Develop the early intervention definition and principles as a unifying philosophy, across services for adults and children.

Further embed early intervention principles within the commissioning process for services for children, families and adults.

Establish a benefits realisation strategy through commissioning to project and actively manage long-term financial benefits to organisations and outcomes for citizens.

Review emerging international policy and evidence and continue active engagement in the national conversation.

Identify Early Intervention champions locally to support the leadership of the strategy.

Programme approach

Continue work to create a Nottingham Package of Early Intervention Programmes and Services for Children and Families.

Create a parallel package for adults and older people. Identify key programmes and models to systematise. Identify specific programmes and models for quality reviews or

improvement. programmes, ensuring standards of implementation and return on investment, as part of a benefits realisation plan.

Identify areas to create greater links or pilot integrated models between services for children and adults.

Explore the feasibility of emerging innovative funding solutions and models to shift resource.

Create quality standards for evaluation of programmes and services, including costs.

How will we know we have been successful? The measures to demonstrate success will include:

Accelerated outcomes in the Children and Young People’s Plan. Accelerated outcomes in priority areas for adults and older people. Evidence of prevented costs. Greater investment in early intervention and less in crisis end services,

in the long-term, through a commissioning model to shift resource. Strong engagement and co-design of solutions with vulnerable groups

of citizens. Evidence of greater use of non-state support and personalised support

for resourceful families and individuals.

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SUBMISSION FROM GLASGOW CITY COUNCIL Glasgow’s Early Intervention Investment Programme Proposal Introduction This paper describes Glasgow’s Early Intervention programme, an investment of £2 million which is matched by resources by partners. The programme brings together individual services integrated into a holistic, long-term approach across the city. The investment builds upon:

• Existing mainstream provision through health, social care, education and the police and the comprehensive partnership and joint working arrangements between the agencies.

• The vision set out in the “Glasgow Child and Family Services Plan”, “We want every child to be supported to achieve their full potential and contribute positively to their communities, throughout their lives.”

• An approach set out in the paper “Mind the Gaps” which commits partners to achieving a step change improvement in the health, attainment and well being of children and families.

The Need for a Targeted Strategy Partners in Glasgow already invest substantial resources in mainstream services aimed at supporting children and families in the city through health, education and social care services. There are also evidence-based existing interventions such as; vulnerable 2s in early years, Intensive Support and Monitoring Service; Multi-Systemic Therapy, Multi-Treatment Foster Care; and enhanced residential care. Other programmes are also in place to make a contribution to improving the prospects for children and families, such as Family Futures, Child Smile, nurture classes and Early Years Employment Training. The Early Intervention Programme targets investment in the early stages of children’s lives to reduce costs and deliver benefits later on. The experience of other localities, such as Peterborough, in analysing the cost of what are described as ‘chaotic’ households, shows the need to target resources. This targeting may take the form of prioritising resources more to those parents and children in the ‘chaotic’ or ‘just coping’ categories, as illustrated in the figure below.

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Targeting strategy

Thriving

Coping

Just coping

Chaotic

Number in each category

Resources targeted to category

Categories

This evidence has led us to a two pronged approach to early intervention. The programme is:

• Broad-ranging – implementing programmes across a wide spectrum of Glasgow that will generally increase the chances of children and their families being able to realise their potential, and avoid the pitfalls that get in the way of these aspirations

• Targeted – providing very specific support and intervention to those in most need in order both to address their challenges and reduce the impact of the circumstances in which they find themselves; this targeting will be equally important for families in the ‘just coping’ category in order stop them falling into the ‘chaotic’ category, as it will for working with families who are already leading ‘chaotic’ lifestyles

The following section now summaries the individual programmes, their linkages, and the investment. Programme Summary Triple P (Positive Parenting Programme) Triple P is a fundamental element of Glasgow’s early intervention approach. We are adopting an established, well codified, evidence-based programme that has been applied internationally, which offers a quick and easy start to tackling problems with vulnerable children and their families. The key features include:

• The application of Triple P in Glasgow is population-wide, targeting the 56,994 families (0-16 years) across the city

• Training of 800 Triple P practitioners is underway, all current staff rather than new ones

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• Seminars for every Primary 1 parent and child • The programme is supported by a dedicated website and proactive

media coverage • Triple P will be managed at a local level by a Parenting Co-

ordinator with responsibility for delivering the programme and achieving results

• Seminars for parents in every local authority early years centre Triple P demands considerable investment, particularly up front, but one that has broad reach. While it is being offered across Glasgow to all families through the entry point of Primary 1 and through early years, the aim is to ensure that at least 60% of Glasgow parents will have access to appropriate Triple P programmes. The programme also offers very targeted interventions that have been woven into the wider range of early years programmes. Triple P puts in place a culture of improved parenting across Glasgow that will over time reduce the costs to the city and deliver enhanced benefits. Specialist Parenting Interventions This programme builds on the population-wide focus of Triple P and targets families in the city who are in the more vulnerable categories. Targeting is city-wide but focuses upon primary schools in areas of highest needs. Key features of this programme include:

• Additional training for social workers and CAMHs workers – resulting from this training will be more effective team-based intervention programmes

• Targeting families in Primary 5-7 who are at risk of becoming looked after and extending Triple P to include family-based initiatives centred around their local school

This initiative targets vulnerable families with high needs across the city, gaining buy-in by primary schools. It also taps into community resources that might be leveraged to provide additionality to the above investment. Supporting Vulnerable Children This is a city-wide initiative that aims to fill the gap in free nursery provision for the under 3s. The programme introduces a targeted, needs/assessment-led grant related to the level of vulnerability for children categorised in Bands 1 and 2 as appropriate. Key features of this programme would include:

• Managers of nurseries bid for support for individual children and families; referral routes are through professionals in contact with vulnerable families with support targeted at the most needy families

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• Support includes a range of options: free 15 hr placement for the under 3s (namely children aged 2-3); additional hours (above the 15 hr entitlement) for the 3-5s; support for parenting

• In the first year, an estimated 120 additional places could be provided for vulnerable 2s

The initiative will create the opportunity for more families to engage with the Triple P process through targeting two specific categories: the under 3s and those who are vulnerable. The key culture change messages of Triple P can also be conveyed through the interventions at nursery level. Early years employability training also links to this initiative. Kinship Care This is a further targeted programme to deliver tailored Triple P. There are over 560 Kinship Carers in Glasgow providing care and support to children with a range of complex needs – 1,000 children and young people across the city receive allowances for Kinship Care. The aim here is to provide more support to these Kinship Carers. Key features of this programme include:

• Adapting Triple P to provide a Kinship Carer-specific programme of training and support

• Developing an information pack for Kinship Carers that gives them more information on what is available and how to access support

• Potential crèche facilities/after school support to enable Kinship Carer engagement

Cross-programme integration is reinforced through this programme in that it targets vulnerable children in a particular type of care, and enables them and their carer to receive support to address their needs, utilising the resources of Triple P. Permanency This programme targets children who become looked after, and subsequently might move to foster care or adoption. The focus is on building capacity and capability at the start of the process to ensure that effective decisions are made, since these decisions early on will have a significant impact on achieving positive outcomes later on. The aim is to focus on appropriate decisions at the 0-3 age band, and to make them expeditiously. Key features of this programme include:

• Applying learning from a pilot project in New Orleans, tailoring to the situation in Glasgow, and requiring changes in practice should this model be adopted

• Additional qualified social workers to increase assessment capacity • Additional clinical resource to broaden assessment capacity • Increasing adoption placements

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The programme aims to take a different approach to permanence. A specialised resource through the Contact Service and additional clinical resources will be used to complete all permanence assessments on 0-4s as they are accommodated. This process will use specific tools and interventions with families, complementing the messages of Triple P, but tailored to this targeted group. This type of early intervention will both deliver benefits and reduce costs in later years. Family Support Services These pivotal services provide direct support to those vulnerable families to provide evidence-based interventions required to enhance the core elements of the Triple P programme. Currently, there is a programme of support delivered by the Cordia Services and Addaction. Cordia Services and Pregnancy Services This is an existing city-wide service which two elements to it: Cordia Home Care – provides targeted support to families through a dedicated core team. It has a current caseload of 415 adults and 614 children who receive holistic services that include:

• Visiting families to assess risk and dangers • Direct intervention around daily routines • Protection of children from impact of parental substance abuse

Addaction Pregnancy Support and Early Years Service – provides direct support to pregnant women with addiction issues, with a current caseload of 119 adults and 226 children. Services include:

• Pregnancy support service offering advice on parenting, during pregnancy and post-natal

• One-to-one service primarily at the home • Support for rehabilitation • Observation and advice on parenting skills

Partners considered changing the services to one that provided Family Support through Family Support Workers directly linked into Children and Families Services. This proposal draws on the findings in “Mind the Gaps” to provide specific interventions to the families with vulnerable under 3s to tackle the problem of parental neglect. It runs in parallel with Triple P to target this more challenging category of parents and their children. An assessment will determine both the need for, and the nature of, the parenting intervention that is required. It will be completed in the home for all families through a programme of observations by Health Visitors, who would then be able to access day-to-day support quickly and easily. Those families

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whom are deemed to require a home-based intervention will be allocated a Band 3 Family Support Worker who will work under the supervision of the Health Visitors, both to undertake the observational elements of the assessment process and to work with parents to consolidate Triple P interventions acquired from the parenting programmes. Social Work services are currently undertaking a piece of work that will be considered in January, to determine whether family support should be continued through Cordia and Addaction, through Family Support Workers linked to Children and Families Services or an alternative model. Summary of the Integrated Programme The individual programmes that make up the early intervention investment are both broad ranging and targeted, as illustrated in the figure below.

E N W SW SE0

1

2

3

4

5

6

7

Addaction

Kinship care

Supporting vulnerable children

Cordia home care/Family support workers (N&E)(across all ages)

Triple P

Permanency Services

(across all areas)

Area

Age

Specialist parenting intervention

E N W SW SE0

1

2

3

4

5

6

7

Addaction

Kinship care

Supporting vulnerable children

Cordia home care/Family support workers (N&E)(across all ages)

Triple P

Permanency Services

(across all areas)

Area

Age

Specialist parenting intervention

E N W SW SE0

1

2

3

4

5

6

7

Addaction

Kinship care

Supporting vulnerable children

Cordia home care/Family support workers (N&E)(across all ages)

Triple P

Permanency Services

(across all areas)

Area

Age

Specialist parenting intervention

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SUBMISSION FROM COSLA Introduction 1. COSLA is happy to have the opportunity to respond to the Finance Committee Inquiry into Preventative Spending, and welcomes the Committee’s consideration into looking at this important and challenging area, particularly given the current financial climate. COSLA has for a long time recognised the need to move towards preventative rather than reactive spending. COSLA’s submission recognises that this is particularly important given the increasing financial challenges which we are all now faced with, and highlights the need for immediate action to develop a model jointly across the public sector which will support and allow for the process of early intervention and prevention. Background 2. Members of the Finance Committee will be aware that COSLA has recently submitted evidence to the Committee as part of the review into the Budget. Within the submission, COSLA highlighted the need to seek to use resources differently by engendering transformational change now through early intervention which diminishes the need for reactive services in years to come. The process of early intervention and transformational change is also supported by the recent findings from Independent Budget Review Panel. The review highlighted the need to consider how expenditure growth can be contained whilst making difficult budget decisions, and stressed that these considerations need to be set in a more strategic longer term framework to shape the future scope and model of public service provision and move to an agenda of transformation, and that this work needs to start now. Financial Environment 3. COSLA is aware of the highly challenging financial implications for the public sector in the years to come, and in recognition is acting now to identify how these challenges can be managed. The challenge facing the public sector is not only limited to the short term but there is a long term problem growing and this must be recognised. As set out in our evidence to the Committee’s Budget Strategy Phase a joint workplan has been to identify the implications for local government over the next two spending reviews and this is being taking forward on a partnership basis between Local Government and the Scottish Government. These are unprecedented times we are facing, and this approach sets the framework to allow us to jointly seek solutions. We have been working collaboratively on a joint basis with the Scottish Government, and we very much welcome the opportunity to work alongside the Parliament as well. 4. Our previous submission to the Committee highlighted the jointly agreed workplan, and outlined that the overarching approach is to determine what level of funding Local Government would require if it were to continue with current policies and consider this against the expected resources available over the next spending review. A sophisticated model has been developed to map out expected expenditure over the next six year period (two spending reviews) and this incorporates demographic change and other changes in

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service demand. This work is set apart from other models in the public domain which only set out the impact of the reduction in resources. 5. Local Government is well aware of the expected financial forecast going forward; however the financial model goes one step further, in the fact that it also highlights the growth in demand. The financial model shows that even if there was no anticipated decrease in resources going forward, it would still be very difficult to continue with the current level of service investment due to the increased growth in demand, and indeed it is clear that demand is becoming the main driver affecting the level of expenditure. There are therefore some very difficult times ahead for local government and its public sector partners to meet these challenges. Not surprisingly, given the financial forecasts, the model highlights a significant gap between expenditure and income and has therefore set the platform to enable some serious discussions as to how the gap can be closed. 6. COSLA would like to highlight that the work being undertaken by the Finance Committee needs to complement the work which local government is undertaking in relation to meeting the financial challenges ahead particularly in relation to early intervention and prevention. There is potential otherwise for significant overlaps which would be counter-productive, leading to unnecessary duplication and possibly mixed messages about what needs to be done to address the fundamental issues. COSLA would also support the recent findings from the Independent Budget Review Panel and their recommendations that work needs to commence now to shape and model the move to an agenda of transformation, and would again highlight the need for the work being undertaken by the Finance Committee to support this approach. 7. At the moment, we are still unclear as to the level of resources that will be available to Scotland until we know the outcome of the Comprehensive Spending Review, and it is difficult to fully comprehend how this outcome can be achieved. Also, if commitment is given to protecting areas such as the NHS, and indeed investment in acute services, this will have a knock on affect on the overall resources available to other areas of the public sector, including local government, and it may be very difficult to support any early intervention and prevention investment. COSLA would support the Independent Budget Review that given the scale of the financial challenges ahead; there should not be any ‘protectionism’ of areas. COSLA would also support their view that that this work needs to commence now to develop a model which will support and allow for this investment at an early stage, recognising that this is even more immediate given the financial challenges. COSLA would ask that the Finance Committee fully support this approach and ensure that any recommendation recognises the immediate need for a structure to ensure this model is developed and supported. Areas to be considered 8. There are some key areas that need to be considered if we are to move to trying to prevent, rather than deal with negative social outcomes. The current financial environment and challenges which lie ahead makes the need

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even more immediate, as the current level and mechanism of service provision is simply unsustainable going forward. These areas include:

i. We need to find and develop a model that would allow us to redirect resources away from crisis intervention to crisis prevention. That means all community planning partners will need to find a means of better supporting preventive services (like housing support, health screening, family support, community policing) and managing reduced services at the acute end (e.g. care home provision, acute hospital provision, prosecution).

ii. Further thought also needs to be given to disinvesting in the services which serve to consolidate the reactive service provision. This will create political challenges insofar as that translates to providing less service in some areas. A carefully constructed narrative will need to be devised to explain why current service models are not addressing social problems at their root, followed by difficult disinvestment decisions.

iii. Ensuring that any changes to the current rigid resource structures and allocations are supportive to allow for investment in sustainable services and interventions, and that this is achieved within a longer term strategic framework, against a backdrop of challenging budgetary constraints. Early Intervention 9. Members of the Finance Committee will be aware that the total public sector spend in Scotland (around £33billion) represents a considerable public resource to create a Scotland that is fairer, smarter, healthier and safer. However, there is a need to redirect resources from reactive services to preventative services. Currently, resources across local government, the NHS and criminal justice are heavily weighted towards reactive intervention and crisis intervention supported by large institutions: hospitals and prisons and care homes. In short we spend large amounts of money dealing with ‘negative outcomes’. However, personal outcomes could be greatly enhanced if we invested differently, preventing rather than reacting to negative outcomes. A radical transformation agenda is required in order to turn this situation around. The rationale for undertaking this transformation is mainly about improving individual lives and personal outcomes; and there is a growing evidence base which suggests that moving towards early intervention and prevention could also be economical. 10. It is also worth noting that the principles of early intervention are not limited to the early years – it can apply as much to a criminal justice context or indeed to health and social care of adults and older people. These general principles are described below. Early Intervention and Prevention 11. Members of the Finance Committee will be aware that if early intervention is to be seen as a high priority, consideration has to be given to areas that can be de-prioritised in order to release the necessary resources required to deliver on this agenda. What is more, equally difficult decisions will have to be made as to which aspects of early intervention should take

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precedence. Given the challenges ahead, it may be considered that any transformational agenda which promotes early intervention and prevention will largely be financed through a process of disinvestment and reinvestment. 12. COSLA would like to stress to the Finance Committee that whilst it is accepted that an early intervention approach will require radical reprioritisation and transformation of services, this does not guarantee immediate results or savings. This is perhaps best illustrated with reference to an in depth study of approaches to children’s social care carried out by academics from York University in 2007. While the research acknowledged the benefits of early intervention, it added the important caveat that such an approach must be outcome focussed rather than based on any premise around cost savings: “The case for early intervention lies in the improvement of outcomes for children and families rather than short-term service savings. It is likely to depend on the development and integration of a wide range of specific services. The longer-term case for prevention also has to be made on the basis of outcomes not cost savings – and if cost savings do result, they may well benefit other agencies rather than those offering prevention. In the immediate future a shift to preventive services will almost certainly cost money.” (Beecham and Sinclair, 2007) 13. COSLA would argue that we need to be bold and radical in designing a new approach to public service provision. If we simply continue as we are, we will continue to deal with the same negative outcomes. We would hold that transformation is predicated on simultaneous action at three levels these being: a. Disinvestment and Reinvestment within individual public sector organisations; b. Disinvestment and Reinvestment between public sector organisations; c. Investment and Disinvestment at a Government level. Disinvestment and Reinvestment within individual public sector organisations 14. If early intervention and prevention is to be the cornerstone of public services into the future, there will need to be a step-change in the way care and support services are commissioned. Rather than only addressing illness or crisis interventions, services will be commissioned to promote and prolong well-being. 15. This will involve a difficult transition requiring the vigorous decommissioning of institutional services that are designed to address negative outcomes to be replaced with a full spectrum of intensive and preventive alternatives. For example, for people with learning disabilities, some councils have invested in supported employment programmes (producing cost savings of 50% from day centres); supported living; peer-support initiatives; and a wide range of community inclusion approaches. This releases formal services to be targeted at those with the greatest needs, often in partnership arrangements.

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16. Individual public bodies will need to consider how best this disinvestment and reinvestment can be taken forward: but there are opportunities across the public sector: Councils could gradually disinvest in care homes in order to support older people at home; Health Boards could gradually reduce secondary care capacity in order to invest in health visitors or family nurses; and police services could gradually disinvest in emergency response in order to support, say, violence reduction activity. Disinvestment and Reinvestment between public sector organisations 17. Community planning arrangements will also be hugely important in shifting to an early intervention approach. The scale of investment in different parts of the public sector requires to be unlocked if we are to move towards an early intervention approach. Two areas of work could be considered by way of example: the Integrated Resource Framework and disinvestment in prisons. 18. The Integrated Resource Framework (IRF) for health and social care is under development as part of our focus on Shifting the Balance of Care. Its purpose is to enable partners in NHS Scotland and Local Authorities to be clearer about the cost and quality implications of local decision-making about health and social care; the programme is being developed jointly by the Scottish Government, NHS Scotland and COSLA. Key to the IRF is the principle that in order to make best use of available resources, partnerships need to understand the costs associated with the activities they plan for, invest in and deliver across the entire resource spectrum; and examine variation in practice and outcomes for patients and service users in different localities. By providing Health Boards and their Local Authority partners with the information required to plan strategically and review services more effectively, and by developing financial relationships that integrate resources around populations instead of organisations, partners will be able to realign their resources to support shifts in clinical/care activity within and across health and social care systems. 19. There is clear international evidence that more effective integration improves people’s experience of services, and enables better models of care to be provided; but there is less compelling evidence to suggest that integrating resources in and of itself will generate savings. Indeed, it should be noted that almost every developed healthcare system has wrestled with the challenges of resource integration. 20. Nonetheless, there is reason to believe that the IRF can produce savings to the public purse if it leads to different models of care being commissioned – more preventive, rehabilitative, anticipatory and self-care at one end of the spectrum and more non-institutional based palliative care at the other - which will require greater investment in primary and community care, and significant disinvestment in secondary care. Indeed, the biggest challenge of all is how we reduce unplanned admissions which is the main consumer of acute and therefore Health Board resources. Freeing up acute resources via the IRF is dependent on reductions in this area.

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21. The McKinsey Report commissioned by the Department of Health in England identified potential savings of between 3-4% within 3-5 years if the NHS can successfully shift care into more cost effective settings. An even greater figure could be extrapolated for Scotland given the relative density of our acute sector. 22. Leadership will be the critical factor in driving through successful change. The few successful examples of integrating resources in England required exceptionally strong local leadership across health and local government, which made possible radical service redesign, changes to budgetary arrangements, and increased public and professional involvement in decision making. At a national level, we need political commitment that proposed disinvestment in health and social care services will be given due consideration, especially in light of any opportunity costs associated with current arrangements. 23. In Scotland, both the Scottish Government and the Scottish Parliament have given strong political leadership with regards to the criminal justice system and the balance between prison and community sentencing necessary to change outcomes for offenders and improve the long term safety of communities. However, there remains a commitment to significant capital investment in the Scottish Prison Service and new prison builds. Capital investment in crisis management facilities could be reconsidered in light of the current economic environment and the political commitment to sentencing policies which support an early intervention and prevention agenda within the criminal justice context. Investment and Disinvestment at a Government Level 24. As part of a broader move towards early intervention and prevention, we need to cultivate public understanding and community buy in to this mission. To a large extent, people understand prisons and hospitals more readily than they do intensive family support or the role of the health visitor – that is also why there is political reward in being seen to protect these institutions. Citizens expect their relative with a heart problem to be admitted and treated in a hospital within a short timeframe. They expect an individual who has committed a crime against society to receive a sharp custodial sentence. To that end, if we are to transform public services, we need to bring individuals, families and communities with us. That calls for Leadership at a national level and willingness to make difficult political investment decisions as part of the Scottish Budget. COSLA would ask for the Finance Committee to recognise that this cannot be done through encouragement alone, but nationally they need to lead by example and put in place a model that allows for this to be done. Examples of Early Intervention Programmes Homelessness 25. While there are many highly successful initiatives and programmes in place across Scotland to reduce and respond to homelessness, increasing economic pressures require an overarching strategic, corporate, collaborative

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approach to ensure maximum benefit from scarce resources. Homelessness and its prevention have traditionally been seen as strictly the domain of Housing Services – whether within the context of council service planning; community planning; or inspection. Yet, often, by the time individuals are within the orbit of Housing Services, prevention or early intervention can be too late and homelessness service provision has to be invoked. Rather, work is needed with Health Services, Education, Social Work, Community Services, Voluntary Sector, Scottish Prison Service, Community Justice Authorities, Drug and Alcohol Partnerships, DWP, Employability Services, Police and other services and agencies to develop holistic strategies and pooled resources to prevent homelessness. 26. The 2012 Steering Group on tackling homelessness, chaired by Councillor Brain Goodall on behalf of COSLA and attended by the Minister, Alex Neil, and by Cllrs Harry McGuigan and Margaret Davidson, has identified a need to shift resources to homelessness prevention and early intervention in the face of significant financial challenges. While bricks and mortar solutions to provide more housing, both for homeless households but also for the large numbers of households on housing waiting lists across Scotland, are clearly needed, there is also a role for reducing levels of homelessness as early as possible. Outcomes sought include improved tenancy sustainment, reduced homelessness presentations, shared responsibility for and resourcing of homelessness prevention across community planning partnerships, improved outcomes for individuals and households. 27. The Steering Group has gathered a number of good practice examples which have informed a knowledge exchange programme, a corporate approach to homelessness, and a Scottish Government programme on extending good practice across local authorities, RSLs and partners. North Ayrshire Council have retrained Homelessness Officers to enable them to intervene earlier to identify and provide support to households at risk of future homelessness, shifting resources from acute intervention to early intervention and preventing the considerable economic and personal costs of homelessness, for example, by mediating between young people and their parents to reduce friction and potential homelessness. Parenting Skills 28. A further example of initiatives relating to early intervention is around parenting skills. COSLA is supportive of parenting skills programmes which support the early intervention agenda. Throughout the summer COSLA and the Scottish Government have jointly met with a large number of Councils, and it is clear that there are varying approaches to take forward parenting skills programmes across the country, to meet their local circumstances. An example of this is the Triple P Postive Parenting Program with NHS Greater Glasgow and Clyde. Managing Short-term Pressures 29. Members of the Finance Committee will be aware that the services most threatened by efficiency drives and service cuts are often the low level services designed to support the principles of early intervention and

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prevention. There is a short-term logic to this: these services can often be cut back without infringing on statutory duties or requiring a reduction in core staff. 30. COSLA recognises that a conservative approach to managing budget cuts will make the reform agenda more difficult to progress because it is exactly the shift to preventive services that will allow councils and their partners to alleviate pressure in the longer term. Indeed, efficiency measures can often serve to place additional pressure on acute services, the result of which can be an over-reliance on rationing strategies to manage demand. To put it starkly, short-term efficiencies could entrench service models that are not sustainable in the longer term. 31. At the same time, it is highly likely that efficiency savings and service cuts will form a part of public bodies’ strategies to meet cost pressures. In recognising this problem, it is insufficient merely to encourage councils and their partners to re-focus on the early intervention agenda. That is unlikely to happen on the scale we would hope for unless there is further discussion about political priorities, public understanding of risk and resource flows, and we would hope that the Finance Committee strongly recommends that this needs to immediately happen. Conclusion 32. COSLA is pleased to contribute to the Finance Committee’s review into preventative spending. COSLA is fully committed of the need to invest in early intervention, and the need for the public sector to work together now in order to create the framework and model which allows us to move towards achieving this outcome, within the financial challenges which we are all faced with. COSLA would be happy to provide the Finance Committee with further information to support their review. COSLA August 2010

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SUBMISSION FROM THE SCOTTISH COUNCIL FOR VOLUNTARY ORGANISATIONS

About SCVO The Scottish Council for Voluntary Organisations is the national body representing the interests of the voluntary sector in Scotland. It does so through its policy committee which is elected from its membership of around 1300 Scottish voluntary organisations. SCVO’s mission is to advance the values and shared interests of the voluntary sector. As part of this, we provide the sector with information and assistance; support them to improve their effectiveness and efficiency and to represent their views to Government and other public bodies. Further details about SCVO can be found at www.scvo.org.uk.

Introduction SCVO welcomes this opportunity to respond to the call for evidence by the Finance Committee on Prevention as part of the Budget Phase Enquiry. SCVO is responding with a voluntary sector perspective to this debate. Our response builds on previous submissions to the Finance Committee’s Budget Phase enquiry and our submission to the Independent Budget Review. SCVO is also working jointly with the Scottish Parliament Futures Forum to host a discussion seminar exploring Prevention on the 1st of September 2010 with the aim of generating wider discussion on the voluntary sector’s offer around Prevention and public services.

Key facts Scotland’s voluntary sector employs around 45,000 voluntary organisations, about half of which are registered charities. The sector employs around 137,000 paid staff and involves roughly 1.3 million volunteers. Together, these organisations manage an income of £4.4 billion a year – that’s equivalent to the turnover of the Scottish tourism industry. 42% of the sector’s income comes from government grants or contracts. Many voluntary organisations also choose to describe themselves as social enterprises or Third Sector organisations depending on who they are talking to. Third Sector is the Scottish Government’s term to describe charities, voluntary organisations and social enterprises. The voluntary sector is a major provider of public services, particularly to local government and the health service but also for Scottish and UK government departments. These services include very substantial provision of social care, rehabilitation services for drug and alcohol users and employment initiatives.

Finance Committee questions 1. How can public spending best be focussed over the longer term in trying to prevent, rather than deal with, negative social outcomes? Our main contention here is that we must do public services with people, not to people. An important concept in focussing minds on prevention is to think through the impact of service interventions. By working with communities and the organisations that support them to design preventative services (i.e. co-

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production), not only will difficult changes to our public services be better informed, but there will be greater buy-in from the users of these services themselves. We can do this by taking a holistic approach to service delivery. This requires a culture change. Service-commissioners will need to focus on the alignment and interaction of different services and their providers, both within commissioning bodies such as a local authority as well as across them. This must go beyond the tokenistic ‘place at the table’ for a third sector representative on a Community Planning Partnership. SCVO’s own research shows that while essential to establish an effective overview for local planning, this is not sufficient to ensure genuine co-production of public services – involving communities, users and service deliverers. Aligning the community-based initiatives provided by voluntary organisations with specific health services and social care services can provide an outcome that exceeds the sum of its parts, increasing effectiveness and reducing duplication. One example of this in action is the Total Place initiatives, currently being piloted in a number of local authority areas in England. Could we support a Total Place initiative in Scotland?1 2. What evidence can you provide from the UK and abroad to show that promoting preventative spending has been effective? The policy call for this kind of evidence has only been growing in response to the recession and public spending challenge. However there are a number of reports which explore a response to the demographic challenge. In their discussion paper, Right Here, Right Now: Taking co-production into the mainstream, researchers from NESTA and the New Economic Foundation have calculated that costs related to ageing for the public sector will rise to £300 billion by 2025 (UK). They argue that, “the current model has tended to disempower people, to induce a dependency culture and to create unnecessary waste in the system because services have been shaped with only minimal recognition of users’ assets as well as their needs.” Their contention therefore is that “co-production should become the default model for public services”. We agree. In their research, Smart technology and community care for older people, Alison Bowes and Gillian McColgan (2006) found that while there is growing recognition that only a more preventative agenda will be sufficient to respond to current and future pressures, there is much less clarity about how to do this in practice. Against this background, their paper has set out ten potentially ‘high impact changes’, drawing on emerging national and international evidence to identify approaches which currently seem most promising. These include; greater personalisation, assistive technologies at home, healthy lifestyles, concentrating on the whole health and social care system and on the broader social and emotional aspects of rehabilitation.

1 More on Total Place at http://www.localleadership.gov.uk/totalplace/

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More recently, the University of Stirling, West Lothian Council and Age Concern Scotland have also carried out research into the role of technology and prevention for Older People. They specifically looked at the role of “smart technologies” in increased independence and choice. Kerry Allen and John Glasby (2010) reported that, “Evidence on the cost-effectiveness of the approach is still at an early stage, but shows positive results. We were able to show that costs were controlled, and that smart technology has illustrated a potential to assist providers in making effective use of limited budgets, whilst still effecting service improvements. In the West Lothian case, objective evidence of performance demonstrates particularly effective provision;” Crucially, these approaches promote independence (rather than dependence), user empowerment, community-based interventions, autonomy and mutual support for potential service users. We would argue that these principles are essential to preventing more expensive interventions such as institutionalised care. Voluntary organisations play a major role in delivering these services with users. You will find examples of voluntary sector interventions in our response to the next question and a number of case studies and at the end of this report. 3. The Finance Committee has recommended that the Scottish Government continue to direct its spend towards preventative programmes. Which programmes should be prioritised? Just as short-term cuts are not the answer, ring-fencing specific areas of public spending is similarly misguided. For example, ring-fencing health spending will simply mean deeper cuts in other areas, and will also act as a barrier to reform. Programmes therefore need to support greater alignment, such as the alignment between health services and social care. This will be essential to reducing duplication and increasing effectiveness. Secondly, these programmes will need to have a strong element of co-production, where communities and users are involved in the prioritisation, design and delivery of the services. The voluntary sector is noted for being able to engage and provide services to the hardest to reach service users and can inform the impact of any programmes to these groups. Many voluntary organisations are also set up by and led by service-users. These advocacy organisations sometimes provide the only channel for otherwise excluded voices on the impact that any new shared service arrangements may have on them. Voluntary organisations provide a range of preventative services that are grounded in the community and with users. These can be broadly categorised as follows:

• Community-based alternatives to health and social care. These services reduce pressure on hospital beds and in-patient facilities by supporting community care, particularly in hospice outreach, home helps, support for carers, self-help and mutual support groups, and

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through the provision of community-led structured activities, sports and healthy lifestyles for young people

• Alternatives to custody and routes out of prison. These services are diverting individuals from Scotland’s burgeoning prison population through addiction treatment programmes in communities, sector-led employability programmes, befriending and mutual support groups

• Tackling poverty and inequality. The third sector pioneered Scotland’s financial services sector through the co-operatives and mutuals movement. Supporting the growth of credit unions, housing associations and co-operatives more generally will play a major part in providing cost-effective solutions to tackling economic inequality and multiple deprivation in Scotland’s communities

• Most grass-roots sport is delivered through the third sector. This plays an important role in building community cohesion and helping individuals develop life skills and confidence. It also contributes towards preventing health problems from arising in future

• Developing skills and tackling unemployment. Governments and political parties at both Holyrood and Westminster recognise the role the sector can and does play in providing employment routes. Third sector employment initiatives do three things. They build skills, particularly among young and long-term unemployed people; they make use of existing skills, for example through retraining people facing redundancy; and they provide direct community benefit

• Alternatives to waste. The third sector plays an increasingly large role in the green economy, in areas such as renewables and recycling. It does this through community-led renewable energy initiatives, recycling social enterprises and environmental volunteering projects.

Finally, programmes designed for prevention will need to build on collaboration rather than competition. The voluntary sector is already used to collaborative working on shared areas of concern, through sector networks and umbrella organisations, service-delivery consortia and the use of shared assets. The voluntary sector can therefore brings insights into what works well and potential pitfalls in such arrangements into any wider debates on designing effective preventative programmes. 4. To what extent is preventative spending effective in addressing the financial impact of demographic change? We need to think of preventative spending as not just about reducing demand but also investing in supply. For example, voluntary organisations are a major channel for channelling the contribution of older people through volunteering and trusteeships. Their contribution, currently valued by Volunteer Development Scotland at £625m or around £2200 for each volunteer aged 60+ will grow as the population gets older2. 2 These figures are calculated for people aged 60+ by Volunteer Development Scotland, based on data from the Scottish Household Survey and the Annual Survey of Hours and Earnings.

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Preventative spending should therefore involve a modest investment in enhancing the channels for older people to become active in their communities. 5. What are the main barriers to trying to focus spending on preventing, rather than dealing with, negative social outcomes? Is a focus on preventative spending less likely in the current financial climate? We understand that for some public authorities the upfront costs of investing to save will be seen as a barrier at a time of intense downwards pressures on any costs. Of course this is a false economy. The cost of prevention is much lower than dealing with the aftermath when needs become acute. SCVO has had initial discussions with Audit Scotland who are also exploring their own ideas around ‘spend to save’ scenarios within their performance audits. Nevertheless, for voluntary organisations, the impact of the public expenditure reductions is already being felt. It has led to short-term panic cuts by local authorities – of so-called ‘non-essential’ services - and is already damaging our capacity to deliver. This comes just at a time in the current financial climate when the services that voluntary organisations provide to the most vulnerable are needed the most, and thus very much essential. For our sector, the cuts are also exacerbating pre-existing funding constraints on our sector such as poor procurement practice, the move away from grants and a lack of parity for our sector in negotiating terms of contracts. 6. How do we ensure that we monitor the impact of preventative spending over the longer term and shape budgets accordingly? There are compelling tools now available to measure savings in budgets allocated to acute services, when smaller investments are made in preventative options, such as the alternative community-based models delivered by the voluntary sector. One measure, much lauded, is Social Return on Investment. SROI measures the ratio of return for each £1 invested in a preventative intervention, and has been the focus of much recent pilot projects and critique. The SROI model is useful at formalising some estimation of the savings made or possible and is a useful learning tool but is not always accurate if used purely for the ratios. A more recent option, Social Investment Bonds, builds on SROI to assess the actual savings made to a service ‘outcome’. It passes on a percentage of this saving to an investor. In return this investor must front-load a voluntary sector preventative intervention in agreement with the public authority seeking the saving. For example, this approach is currently being piloted in Peterborough prison to reduce reoffending rates. The pilot has been arranged by Social Finance, which presents itself as a new breed of ‘social investment’ organisation. One of the main ‘investors’ in this case is the Big Lottery Fund,

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and the preventative intervention is being delivered by a prisoner rehabilitation voluntary organisation.3 Future tools that have been mooted or are being developed include modelling the interactions between interventions provided by voluntary organisations, public sector and private sector in a localised area. The aim here is to understand that no single organisations is an island and we can get a more reliable picture of cost flows and total savings by modelling a more complex collection of interventions. SCVO is currently working with Professor David Bell and his team at Stirling University to engage further research in this area with a focus on health and social care. 7. Is the effectiveness of a preventative spending programme influenced by whether the relevant services are provided by the public, private or voluntary sector? The charities, social enterprises and voluntary organisations that make up the Third Sector already generate significant savings for the public purse through delivering alternative community-based options that prevent greater need further down the line. Recent research shows that Scotland’s third sector is better trusted than local authorities, banks and the police and delivers higher quality care services than either the public or private sector4. However, many of these interventions work because the voluntary organisations are coordinating their activities in partnership with other organisations in voluntary, private and public sectors. The question is not which sector is ‘best’, but what qualities do organisations from each of these sectors contribute to the service delivery mix when each on their own would not be sufficient to generate the overall outcome. A major part of the game-plan here should be recognising and identifying what already works on the ground, learning why it works and supporting key agencies and local organisations to infuse this into other areas. We are not starting from a blank sheet of paper. Unfortunately, the contribution provided by voluntary organisations, essential to the mix of different services in area, is not always recognised by public authorities tasked with prioritising spend. Public authorities need to change their approach and look more closely at who is delivering essential services.

Conclusion – doing things differently Shared services and efficiency savings agenda will not be sufficient to tackle the projected gap between demand and service supply. If we are to genuinely meet the needs of an ageing population, higher unemployment and increasing inequality during the age of austerity, then we will need to radically change public services to focus on prevention. We will need to do things differently.

3 See http://lcjb.cjsonline.gov.uk/Cambridgeshire/3776.html and http://www.socialfinance.org.uk/ for more details 4 From an Ipsos Mori poll conducted in March 2010

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Public services will need to be better designed, by being co-designed and co-produced with their users. There will need to be a greater focus on collaboration, with greater recognition and support for service delivery consortia. And there will need to be a better alignment of acute health and social care services with preventative services. Voluntary organisations have a major role to play in all three of the above. The good news is that we do not need to start from scratch. There are already incredibly effective preventative services delivered by a host of voluntary organisations, often in partnership with public and private sectors. We need to recognise and identify these services, to learn from, replicate and scale-up what works.

Voluntary Sector and Prevention – the evidence Case studies: 1. Alternative community-based approach in health and social care: The Food Train is a grocery shopping, befriending and household support service for older people in Dumfries & Galloway. It aims to support older people to live independently at home. Its preventative services address the difficulty older people face getting their weekly grocery shopping, doing jobs around the house and the growing isolation that comes with failing health. The Food Train also aims to provide a wide range of supported volunteering opportunities for people of all age and ability. From its early days of a few deliveries every week to a handful of customers, Food Train is now a thriving multi award winning charity with 6 local bases providing support services to older people promoting independent living, and is now expanding across Scotland http://www.thefoodtrain.co.uk/ 2. Alternatives to custody: Routes out of Prison Working with prisoners before they are released from Addiewell, Barlinnie, Cornton Vale, Dumfries, Polmont Young Offenders Institution, Kilmarnock and Greenock, and for a number of weeks after, the Wise Group’s Routes out of Prison project helps prisoners acquire the life, social and employment skills they need to rejoin society. The Wise Group employs Life Coaches, many of whom themselves have a background of offending, and are using their experiences in turning their lives around to help other ex-offenders. In partnership with the Scottish Prison Service, Apex Scotland and Families Outside, the project has had a direct impact in the reduction of ex-offenders re-offending and increased employment levels and reconnected families. Participation in the Routes out of Prison project is offered to prisoners serving sentences of between three months and four years in the prisons mentioned above. To date the number of prison sign ups over 2 years is 3,522 and the number of community engagements is 1,473 with 223 people gaining employment or training. http://www.thewisegroup.co.uk/content/default.asp?page=s5_2_1 3. Tackling poverty and inequality: Govanhill Housing Association Since its establishment in 1974, the Govanhill Housing Association and the Govanhill Community Development Trust (GCDT) have invested over £100

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million in the community by improving over 2200 homes as well as adding over 150 new homes to the local housing stock. But the work of the Association is not just about houses. Together with the GCDT and the voluntary commitment of local people, the Association has concentrated on fostering an environment that will also improve the lives of Govanhill residents by providing preventative services, support and accommodation for a diverse range of needs including those of families affected by addiction, young single homeless people, homeless women, people with mental health problems and learning difficulties, very frail elderly people and older people suffering from dementia. In 2010 the work of the Association and GCDT continues to evolve. Recent expansion has supported the formation of a second subsidiary company, GREAT Gardens, which provides training for young people at the same time as improving the environment. In addition, the Association runs the Govanhill Social Inclusion Project (GOSIP) which has set up a BME women’s support group, a BME Residents’ Group and a One Door Shop for BME residents. http://www.govanhillha.org/home 4. Grassroots sport: Edinburgh Spartans Community Football Academy

The Edinburgh based Spartans Community Football Academy provides north Edinburgh with a community inspired and managed facility to help develop the sporting, social and life skills of local people of all ages. The Academy provides young people with a modern, fun place to go, where they can be active in a safe environment. Its vision and future aspirations include a number of specific key social aims and objectives. These are:

• To provide new opportunities for more people to participate in sport and recreational activities – more people more active.

• To provide learning and development opportunities for people – through education courses, work experience placements and volunteering.

• To have a positive impact on social targets such as health improvement, increased employment opportunities and crime reduction.

• To help strengthen community cohesion by becoming a focal point for a range of community based activities and programmes.

The Academy has recently received a cash injection of £900,000 from the Scottish Government Social Investment Fund. Enterprise Minister Jim Mather MSP has expressed confidence that the funding can help Spartans reach individuals where the public and private sectors do not operate. http://www.scottishsocialenterprise.org.uk/news/144 5. Collaborative approaches: Scottish Third Sector Consortium for the Future Jobs Fund (FJF) Introduced in the 2009 Budget, the Future Jobs Fund (FJF) is an employment programme designed to create additional jobs, primarily aimed at unemployed young people aged 18 - 24. In 2009, the Scottish Council for Voluntary Organisations (SCVO) created the Third Sector Consortium, to bid to deliver

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FJF jobs across Scotland. The Consortium consisted of 214 third sector employers, with joint coverage of all 32 Local Authority Areas in Scotland. The Consortium model proved to be highly effective and it subsequently submitted three successful bids giving them the capacity to create a total of 2,278 FJF jobs in the Scottish Third Sector over the life of the programme. To date, the Consortium it has already placed over 1,300 people into jobs that deliver a host of community benefits that include: helping to deliver more services to vulnerable people, increasing recycling, improving waste management, tackling climate change, involving more children in sport and supporting financial inclusion projects with more than 150 different employers across Scotland. In 2010, the Consortium model gained recognition by winning the UK DWP Supplier Excellence Award in the Third Sector category. The Consortium was particularly commended for the speed in which it commenced delivery and brought itself to scale. http://www.scvo.org.uk/futurejobsfund 6. Environment and Alternatives to Waste: New Caledonian Woodlands Good Wood Project The Good Wood Project is based in Edinburgh and runs for people experiencing mild to moderate mental health issues. The project uses community-based environmental conservation as a forum for improving physical health, mental health, well-being and confidence among participants. The project also links with other local agencies so that it is able to act as a gateway for participants to training courses and other activities which better equip them for employment in the future. During the pilot phase, over 70% of participants went on to engage in voluntary, further education, health/fitness or employment activity beyond the end of the project period, while attendance rates were consistently high. http://www.newcaledonianwoodlands.org/projects/goodwood.php

References Scottish Council for Voluntary Organisations – www.scvo.org.uk/economy Scottish Voluntary Sector Statistics 2010, SCVO www.scvo.org.uk/evidencelibrary/Home/ReadResearchItem.aspx?f=asc&rid=1078 'The billion dollar question': embedding prevention in older people's services - 10 'high impact' changes. Kerry Allen and John Glasby. Health Services Management Centre, University of Birmingham. August 2010 http://www.scvo.org.uk/EvidenceLibrary/Home/ReadResearchItem.aspx?f=h&rid=1134 Smart technology and community care for older people: innovation in West Lothian, Scotland. Alison Bowes and Gillian McColgan. West Lothian Council, University of Stirling and Age Concern Scotland, 2006. http://www.ageconcernandhelptheagedscotland.org.uk/our_work/policy/research

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Right Here, Right Now: Taking co-production into the mainstream, David Boyle, Anna Coote, Chris Sherwood and Julia Slay NESTA, New Economics Foundation and The Lab, 2010

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Finance Committee

25th Meeting, 2010 (Session 3), Tuesday 16 November 2010

The National Health Service (Superannuation Scheme, Pension Scheme, Injury Benefits and Additional Voluntary Contributions) (Scotland)

Amendment (No. 2) Regulations 2010 (SSI 2010/369)

1. The Committee has been referred the National Health Service (Superannuation Scheme, Pension Scheme, Injury Benefits and Additional Voluntary Contributions) (Scotland) Amendment (No. 2) Regulations 2010 (SSI 2010/369).

2. The instrument amends various existing regulations that relate to NHS pensions etc. The Executive note explains that the main aims of the instrument are—

• To allow those who have retired between 1 April 2008 (the date of introduction of the 2008 section of the scheme) and 1 October 2009 (effective date for 1995 section members having the choice to move to the 2008 Section of the Scheme) to be able to join the 2008 section of the scheme on return to NHS employment;

• To provide for Pension Credit members (i.e. those who have rights in the scheme as the result of a pension sharing order on divorce) to be able to take their benefits before normal retirement age on an actuarially reduced basis;

• To provide a calculation for the revaluation of Additional pension which also covers a situation where there has been negative inflation;

• To allow those who have AVC proceeds totalling less than £2000 who are unable to or unwilling to secure an annuity because of the small amount, to take payment in the form of a lump sum; and

• Technical changes in relation to employee contribution tables, scheme valuation and GMP

3. The Subordinate Legislation Committee has considered the instrument but noted in its 55th Report, 2010, that it did not need to draw the attention of the Parliament to the instrument on any of the grounds within its remit.

4. The Committee is invited to consider whether it wishes to make any recommendations to the Parliament on this instrument.

Allan Campbell Assistant Clerk to the Committee