• By Dartington SRU
  • Posted on Thursday 06th May, 2010

Vote Prevention Action – we’ll stop at nothing!

As far as it has been possible to tell from all the speechifying leading up to this week’s UK General Election, where prevention matters are concerned the political parties stand united.The truth is, the subject has barely been mentioned by any of them.So what might be done to get prevention higher up the the political agenda of whoever finds themselves with the power to decide in the weeks following the May 6th vote?The context is not auspicious. In Europe, public sector services have been artificially protected from the economic disaster of the last two years. But only until now. Beginning this year, or early next, there will be disinvestment of between 15 and 20 per cent in children’s services. The scale of the cuts is unprecedented. Nobody working in the sector will have experienced anything so severe.Maybe there is a glimmer of hope. Perhaps radical approaches to familiar problems – prevention and early intervention being prime examples of the possibilities – will have their day.In which case, what might a new UK government do in order to benefit from a preventionist manifesto? For a start, it would make it a priority to change the relationship between central and local government, and between local government and the general population. Telling people what to do has been an interesting social experiment, and, in an era when it was necessary to spend large amounts of money quickly, it may have been necessary.But the evidence from public health prevention shows that we seldom alter our behavior just because we are told to. Sustained change is the result of people wanting to be like other people. We will drink less, we will read to our children more and hit them less, if we believe others are doing likewise. Working in tandem with experts and communities, government can sponsor these small positive shifts in ordinary daily life and see them spread benignly but virus-like through society.There is ample evidence, too, that the impact of proven prevention models is greater when workers and consumers are involved in their design and implementation. Involving children’s center staff in the introduction of a parenting program such as Incredible Years, for instance, will increase the chances of it being delivered as intended and with enthusiasm. Explaining the benefits to participating parents and their children will improve the chances that they will complete the course.

The end of the age of target practice

Government can also help by changing the pattern of accountability. We are emerging from an era of targets – sometimes useful, sometimes probably not, invariably set by government departments and their agents. By now, most people are ready to acknowledge that there have been far too many.In future, priority should be given to interventions that achieve better outcomes for children at zero net cost. In other words, central and local government should accept that they are accountable for the health and development of children, and for the money spent. Here too, prevention, early intervention and other evidence based approaches can help. They have the potential to improve child well-being and at the same time to save money, as experiments in Birmingham and Manchester have begun to demonstrate. And the capacity to improve outcomes at zero net cost can be a dynamic force in prevention science. It is not about miserliness; it describes the result when money saved through prudent investment in evidence-based approaches is re-invested in new services. Organizations such as The Social Research Unit and Social Finance are developing and testing new technology in this area. The UK Treasury has opened up the possibility in the Total Place scheme of changing financial rules to encourage local government to follow suit by exploiting the opportunities to achieve better human development at a lower price. These ideas deserve to be supported and they warrant rigorous testing.In the past, Whitehall has been an engine of change. It has sponsored Sure Start children’s centers; it has funded more than a thousand pilot projects intended to improve the lives of children and families. With lower spending power and fewer people able to spend, central government should focus on establishing a framework that will promote local innovation, and make sure it is properly tested and the results become widely known. In other words, central government can help local government, schools and communities to learn – and each can learn how to contribute to the other’s appetite and capacity for learning.What might this mean in practice? Following the example of the Greater London Authority by establishing clear standards of evidence to create a framework for the 32 London local authorities would be one way forward.A single source of expertise concerning what works, at what cost and with what benefits would be a boon. So would an economic model that explains the financial underwriting and returns of different investment portfolios. Making operating systems available to help communities, schools and local authorities to decide how to spend their limited resources would also help. Managing research and evaluation funds to propagate innovation is something else central government can do better than local government. Mechanisms for sharing knowledge, including the the compelling evidence about what does not work, may turn out to be as valuable as direct investment in local services.

Sounds good, feels good, but, by golly, it doesn’t do any good

Progress in this direction might be quicker if political parties were required to put their ideologies to the test. A glance through the party manifestos reveals that all harbor well intentioned but dubious ideas. Take smaller class sizes, for example. The principle sounds good, it feels good but there is little evidence that it does any good. And of course it is expensive. Increasing the number of independent schools is another illustration. By some calculations, pupils in independent schools achieve more than those in state schools. And last year’s report by the Panel on Fair Access to the Professions showed that although just seven per cent of children are educated in independent schools, more than half of the present UK population of solicitors, doctors, judges and other professional people are likely to be among them. But will turning state schools into independent schools boost pupils’ ability? Maybe; maybe not. Let’s find out before we impose the idea on the nation.Then there are uncomfortable aspects of ideology that deserve closer examination by possibly reluctant scientists. Richard Wilkinson and Kate Pickett’s The Spirit Level suggested that the inequalities in society may be more damaging than poverty. It is a testable proposition; so let’s test it. [See: Leveling differences and raising spirits. Nearly everything we report on these pages is about an addition to children’s services. In future, we would like to run more stories on innovation that involves subtraction from children’s services. What happens when we reduce clinical assessment? What happens when we halve the rate of children in state care, or in detention? Insight into the effects of financial cuts has the the potential to propagate a new class of evidence based approaches, developed with the same science that produced the prevention programs regularly described in Prevention Action.They require children’s services agencies, schools included, to stop doing things, and, in the process, to improve child outcomes – at zero net cost.If Prevention Action were a political party it would be tempted to represent its manifesto as a new social contract.
  • A vote for us means a different relationship between the central and the local – based on the search for knowledge.
  • A vote for us means a new kind of accountability. We will reward activities that lead to better child health and development at zero net cost.
  • A vote for us means government will start doing what it does best – creating a framework and infrastructure for local innovation, for example, by establishing prudent standards of evidence.
  • A vote for us means more science and less ideology, or at least a preparedness to test our assumptions, intuitions and prejudices by assessing their impact on children’s health and development.
See:Wilkinson R and Pickett K, The Spirit Level: Why more equal societies almost always do better, Allen Lane. (It is also available as an ePub and an eBook. Publication in 2009 coincided with social activism in the form of The Equality Trust to carry the findings further.)Unleashing Aspiration: The Final Report of the Panel on Fair Access to the Professions, Cabinet Office, 2009

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