Practice what you preach

James Mitchell, Jonathan Sher, Dr Sue Northrop, Dr Katherine Trebek, John Carnochan.

Do not merely listen to the word, and so deceive yourselves. Do what it says. Anyone who listens to the word but does not do what it says is like someone who looks at his face in a mirror  and, after looking at himself, goes away and immediately forgets what he looks like.

But whoever looks intently into the perfect law that gives freedom, and continues in it—not forgetting what they have heard, but doing it—they will be blessed in what they do.

James 1:22-25.

The Scottish Parliament’s Finance Committee is once more considering prevention. It has issued a series of questions starting with,

Why has the progress of reform proposed by the Christie Commission been so slow?

This is a good question and one that deserves a response. It goes on to ask about the varied and enduring impediments standing in the way of its own express desire for ‘the decisive, large scale shift to prevention’.

The Committee’s members might do well to start by asking themselves not what they have heard and said, but rather what they have done. A large part of the answer about the barriers to transformational change and sustained progress is to be found therein.

While the Committee’s work in this area over some time has been commendable, its members operate in a series of discrete arenas. Woodrow Wilson’s comment made during his more distinguished career as a student of politics (rather than his less distinguished period as a politician) comes to mind:

Congress in session is Congress on public exhibition whilst Congress in its committee-rooms is Congress at work.[1]

Some of the best work of our Parliamentarians is done collaboratively in committee. But, members do not always live up to this in the Chamber and outside Parliament. Even within the Finance Committee’s own deliberations and decisions, e.g. in relation to its scrutiny of each year’s draft Scottish budget, it is not evident that preventative spending is the real priority. We need consistent leadership from Members inside and outside Committee.

For every committee report on prevention, there are countless statements in the Chamber and beyond that undermine Christie principles. Manifesto commitments, party conference speeches and news releases focus on promises that undermine the ‘radical shift towards preventative public spending’ that was called for by the Christie Commission.[2]

A case can always be made for the ever-popular commitments to spend more in easily understood and seemingly desirable ways, such as 1000 more police officers or nurses, more A&E staff, a reduction in waiting times – not least in the knowledge that they might attract a helpful headline. But what crucial problems these headline grabbers will actually prevent, whether they are the best ways of allocating resources toward preventative spending has been far from clear.

This brings us to a recommendation for the Finance Committee. First, the Committee must be explicit about what ‘counts’ as prevention. That is because the great majority of existing governmental actions and expenditures can be rebranded as having some type and level of prevention element to them. For example, it can legitimately be argued that spending extraordinary amounts of money on residential care prevents further maltreatment at home. But, the logic of the Christie Commission and the Finance Committee is that priority should be given to keep such maltreatment from happening in the first place. Thus, the Committee should be clear and consistent in placing primary prevention front and centre. This has not yet happened in the Committee Room, The Chamber or the actual behavior of Scotland’s public sector.

It should also address how prevention should be counted. Prevention disappears amongst the myriad of KPIs and targets. The Committee should encourage all public bodies to consider and report on how they contribute to primary prevention and to report on how prevention fits with existing targets, priorities and agendas. Each organization should take key documents and performance indicators and critically consider line-by-line whether, if at all, they contribute to a ‘radical shift to prevention’. It is always worth remembering that not all prevention is created equal; so, there must be rigorous attention paid to the evidence about whether the good intentions here are matched by good (genuinely preventative) results.

The Finance Committee has the potential to be an influential committee in the Scottish Parliament. It should begin to judge itself by what it does. That then gives the moral authority to judge the rest of Scotland’s public bodies by what they do, too. Committee members should also trawl through their own speeches and statements (and those of their parties) and consider where primary prevention truly sits right now – and where it will sit in the forthcoming manifestos for the 2016 Scottish elections and the 2017 local elections.

There is a tremendous opportunity for the Committee’s Members to lead by example individually and collectively. As the passage from John I:25 reminds us, the challenge and the goal is: ‘ . . . not forgetting what they have heard, but doing it—[then] they will be blessed in what they do’.

[1] Wilson, Woodrow (1981 [1885]), Congressional Government, Baltimore, Johns Hopkins University Press, p.69.

[2] Report of the Commission on the Delivery of Public Services, 2011, p.x.