ληwr. Welcome to the 10th meeting in 2016 of the finance committee of the scourge parliament, which could remind everyone present to turn off in mobile phones, tablets, or other electronic devices. We have received apologies from Gavin Brown MSP, and Jackie Baillie MSP has indicated that she will arrive late in the meeting, as she is attending another committee for its first item of business and also understand that Leslie Brennan MSP may have to duck out at some point to go to another committee, which is also at the same time to apologise to offer to all our guests for that. That is often just very hectic running towards the end of this session. Therefore our first item on our agenda is to consider whether reckon a draft annual report on legacy paper in private at our future meeting. Are members agreed? Yes. Members have indicated their agreement. Our second item of business is to take evidence in a round-table format on prevention. We have been monitoring progress on the decisive shift to prevention throughout i chi na trifwc o'r llwybu cyfraithol nad oedd gan y Dechcelerau Pwgol, oedd unrhyw o'r adroddiau agglu pwgol ar y cysylltu. Nidrwynat i'r llwybodaeth o'r rhagwm ddifuiaid, felly ar gyfer ddifuiaid y ddiw hamdwyno arllun o'r rhyfrannu fyddai, yn gyfysgogledigon i gyfysgogledigon oes math i gyfysgogledigon oeddu. Mae oeddyndu gymhrebu a'r rhyf wnaeth i gyfysgogledigon i gefysgogledigon i gyfysgogledigon to overcome those challenges and I'm hoping to spend around 30 minutes on each of these themes. How this will work basically is that I'm going to actually ask Rachel to kick us off in a wee minute because what she said in her responses that progress is being made by many organisations on the ground in terms of the way in which they are looking at work and prevention, so I'll allow you to continue from that. Once you've spoken then anyone just simply indicate to me if you want to come in and you can either comment on what Rachel said or you can add your own comments and we'll try and keep the discussion as free-flowing as possible and involve as many people as possible in the discussion. So without further ado, Rachel. Thank you convener and thanks for the opportunity to open. I would emphasise that it is our opinion that there is an awful lot of good practice around prevention and I think that came up very clearly in the submissions from the other partners around the table who were giving their own examples. In terms of nursing and the nursing workforce, we've been doing some work over the last couple of years to really highlight where nurses are starting to make significant inroads around reducing health inequalities in particular and dealing with prevention. We published a report just over a year ago which profiled a number of nurses working across Scotland dealing with areas such as criminal justice, bloodborne viruses and people with mental ill health and suffering from homelessness and looking at the impact those nurses were having in trying to prevent further ill health or further negative outcomes for those particular people. What I would say is we came to a number of conclusions. One is quite often those nurses were managing to do what they were doing because they were working slightly outside of the system. They were willing to take risks. I dare say many of them were coming towards retirement and on that basis were perhaps able to take more risks than perhaps their younger colleagues felt able to do but the work that they were doing was absolutely fantastic and we were really proud of the college to showcase that. We've also done some work recently looking at prevention within remote and rural areas and how nursing staff are working particularly with older people who may find themselves particularly isolated because of where they happen to live and again that has shown some really fantastic examples in our remote and rural health boards of where nurses working with colleagues across health and social care and often with agencies beyond health and social care are doing fantastic work and using what they do have available to them to really make a step change difference. The health visitors that we have we have been successful in securing 500 new health visitors which are currently going through training and I think that the reports including the one from your own adviser to the committee has particularly shown the need to ensure that. There has been work through the CNO's review of health visiting to extend the work that health visitors does. There is now additional visits within the pathway and I think that early intervention is really key within that universal package available to every single family within Scotland as a core embedded approach to how we stop long-term health conditions and long-term inequalities arising from the very beginning. So they are just some examples. I think our difficulty often in Scotland is how to scale those examples and to take the learning from those particular individual projects and programmes and turn that into a far more sustained way of working and just briefly to touch on your second question. Sometimes that's because the way in which we define what we think of a success in the public sector doesn't always work in our favour to do that. Thank you very much. Thanks. I enjoyed the paper from the RCN as usual. You say that you feel very little has changed in the last five years and I'm interested to know if other people feel that's the case as well. You talk about reducing demand in hospitals and presumably freeing up resources for other purposes. Should we just go ahead and close a few hospitals and that would free up resources? If only life were that simple. In terms of the first comment, we were referring specifically to some of the issues that we raised with committee five previously when we responded to your first inquiry in this and some of the issues we raised there certainly haven't been addressed. Have there been changes on the ground? Yes, I would say that there have. In terms of freeing up the acute sector, what we have is an issue where we have an aging population with complex needs. One of the difficulties that we're going to have in terms of freeing up resource is everything in the acute sector becomes more expensive. The more we try to deal with people with complex needs at home, the more we're looking at our acute sector becoming one where the needs ever more complex, the specialities that we're going to need, the number of staff that we will need will become more expensive. I don't think that it's a simple equation between freeing up money from the acute sector and freeing that up to put into primary prevention, primary care. It's simply not a simple equation. If it were, perhaps politicians would have already gone down the line that you're suggesting and to date that's not been something that seems to have been particularly palatable as a way forward. I would hesitate to say that it is a simple equation. What we have to do is be clear what we want our acute sector to do in the future and to do that we also need to be clear what it is that we want to provide in the community and we have to be much clearer about our priorities. That comes really back to the work that we did with the academy of medical raw colleges last year on sustainability and the work that we've continued as a college and I hope members of the committee have seen our recent work on targets which we are continuing. Unless we can be absolutely clear what our priorities are as a country and politicians are clear what they are in terms of how they go out to the public sector and beyond to ensure that there is a single joined up coherent framework that sets out what those priorities are, is clear about what success looks like and allows those who have control of the money to choose where to spend that money wisely to the best ends, I think that we probably are on a bit of a hiding to nothing. Some of those questions will then answer your other questions about what we choose to invest in and indeed what we choose to disinvest in. They will be hard decisions to make over the coming years. I largely reflect what Rachael Hamilton has been saying in terms of—oh, sorry, did you say Colin followed by Justina? It was much more interesting than I am anyway. Really just two points I think pick up on Rachael. There's a bit which I tried to focus on briefly about what we mean by shift anyway and I think it's as much about a shift of stance, how we use resources that are already there, as it's about major budget shifts in the current budget, because the honest truth is that if you look at your own projections of the likely current budgets in Scotland across the next five years, major shift within them is profoundly unlikely because of the pressures all around the system. What I would say, and I think it is heartening, is looking across a whole variety of local services in schools. It would be a good example. They are thinking prevention and early intervention in a quite different way now, so have you said to me, are there more teachers there or no? Are there different resources there or no? It's how people are thinking about and using those resources, particularly with vulnerable children and families, how they're thinking about the type of teaching that will engage children who struggle with some conventional forms of academic teaching and so on. I think there is a bit when we talk about shift, I think a huge shift of attitude and stances taken place. That hasn't always meant that if you looked at the budget of a council, for example, you would note major chunks of money going from A to B, but it's how people are using resources in the ground. Indeed, I think a lot around localisation and people working together in quite new and innovative ways across services and agencies at very local levels. Again, it's about prevention. They are coming together to try and stop predictably bad things happening to communities and to households, and by working in new and innovative ways, they're doing that. I think that the second thing that it picks up in perhaps the hospital community issue, there are some areas where, if we are convinced that there is long-term payoff in developing preventative capacity in communities, I wonder whether we shouldn't see it as an investment proposition and not a current budget proposition. Of all of this, it's about the current budget and it's highly pressurised just now. I'm not sure how much will actually happen. If we are confident that we understand the preventative levers, we could borrow and fund things over time that will reduce the future pressures and cost structures within our system. I think that there is a bit of looking at the meaning of prevention, if we're going to get benefits across 30 years by intervening now. Normally, when we have that proposition, we treat it as an investment proposition. We borrow, fund it, so that the flow of costs and the flow of benefits more or less fit together over time. I wonder whether we're not looking enough or if we're an actual investment model would make sense if we want to get a significant shift to prevention. A lot of people around the table will reflect what Rachel and Colin have been saying in terms of all the themes across different policy areas. In terms of justice, what have we achieved over the past five years? I think that there is a better understanding of the importance of the early years for justice as well. In our written submission, we commented that John Carnacan didn't ever achieve his ambition of 1,000 new health visitors rather than 1,000 new police officers within his time at the violence reduction unit. I think that we would all welcome the 500 new health visitors who are coming into post to support the Children and Young People Act and we will see the impact of that in the justice system as well. I think that we're all very bought into that argument. In terms of justice in particular, I think that the progress that we've made over the past five years has really been that people are beginning and only just beginning to see that prevention can happen at all stages of the justice system. It isn't just about keeping people out of first-time offending and we can all introduce more preventative thinking, as Colin has said. I think that people are beginning to ask more of the why question, why are people offending, not just what have they done and when did they do it, but why have they done it? We need to answer those why questions around bereavement, trauma, loss, mental health, learning disability, addictions and all those linked factors. We've also achieved over the past five years some very promising evidence in relation to mentoring support. That's been delivered largely through public social partnerships and they are everything that Christy talked about in terms of co-design, co-production, working together between the third sector and the public sector, delivering that sort of real hands-on practical support to people in the justice system in a very stickable way. It's asset-based, it's person-centred and so on. That's only been possible thanks to a very significant investment from the Scottish Government and other funding partners and that's really let us deliver that sort of proof of concept. We know it works. It's had a real impact on individuals. We've talked about investment rather than spending. I think that it's very important. We've already seen a significant return on some of those new models of investment and it doesn't always take a generation to achieve that. The third sector point of view, there's a strong feeling that there can be no decisive shift in policy unless there is a reciprocal shift in the way that funds are allocated. I'm not talking about the funds themselves, I'm talking about just where they go and who allocates, who brokers them. Diversion and prevention are generally seen as non-core activity and therefore always come second place to the provision of those core actions and where funding goes directly to a major provider of core funding, then that is quite clearly their priority. It is much more common, we're finding, and very much over the past decade, that non-core external activity is the first target and always will be when savings and changes have to be made. While we might be seeing, as has already been said, really innovative work within larger organisations to change the way they do things, nevertheless that is not reciprocated. That tends to be in-house, it tends to be held in-house because the prime responsibility or the prime motive appears to be how do we keep this particular silo operational. The third sector has suffered quite badly over the past decade and continues to do so as we see a retrenchment. We do believe that there is a sense in which this is a loss, it's not, this isn't a bleed, it's not likely to be any different, but we do believe that there is a loss of opportunity because there's an awful lot of potential resource, a lot of good thinking, a lot of real innovation, a lot of goodwill that could be better used. We just feel that there is an opportunity to think rather bigger, and maybe we can't do that until we make prevention a core activity rather than a non-core activity. Thank you, Nick, to follow by Leanne. I just, to open, would endorse what the previous speakers have all said. I think we're seeing a lot of evidence of prevention from very small-scale projects such as Operation Modulus in the Gorbils, working with 12 people who were very long way from the mainstream, which produced real significant results, and we can actually start looking at costings emerging with cut-downs in graffiti, no evictions and things like that, so we can actually see evidence of savings coming through small projects on prevention. I think the problem that we're finding is that models of prevention, where people set up initiatives that are aimed at prevention, can very, very quickly get drafted into the mainstream because of needs. For example, the other week, we've been doing work around health and social care integration, and I'm speaking to a group of district nurses who had set up a programme that was originally about preventing people going into hospital, and it was set up to provide family support, and it very quickly became a model about helping people get out of hospital, because that was the need that they had said that, although both are prevention and both will lead to a reduction in bed usage, you could argue should you be... Is it... No, there aren't... That we're not doing the economic analysis of saying, is it better economically to be stopping people going into hospital, or is it more efficient to be getting people to come out, and I think there's a need to develop more efficient and more robust models to economically evaluate whether or not we place care or we place support in this sector or we do something here, there, and I think Colin's idea of borrowing now to achieve what's wrong, we need good to do that, we need good sound, robust models to be able to say, right, if we do this now, we will save this in 10 years, 20 years, 30 years time, so we can make that, and I think we need... That's one of the things that we need to be developing more of. Elaine Toofield, by Eileen? I just wanted to say about the third sector. There's lots of really small organisations doing significant pieces of work which are really fundamental to prevention, and that's... I'm talking about small lunch clubs, coffee clubs that make a real difference to people and are a way of engagement and helping them progress. However, they are the things that often will get cut in terms of funding first. Trust and foundations will often pick up those costs like ourselves, and they'll pick up costs such as running costs, admin, heating, lighting, which will often get missed as well. If we're going to help with prevention, we need to think of those small scale models. Also to come on the back of Nick's point, we recognise the importance of strong evaluation with all the work that we do, but we want to really try and get people to measure the difference in the impact they're making first and foremost and understand what that looks like before we can really understand what the economic value is. If we know we're making the difference first, then we can look at the replication and then the economic value of that. So I would say that we need to get better at helping people to demonstrate the impact they are and how that feeds into the bigger systems and structures, which I think a lot of people find challenging just now, particularly in the third sector. I absolutely echo and reiterate everything that has been said so far on the themes of using the resources that we already have, when being much smarter about how we do that, about sustainability and the amount of short-term funding versus long-term investment, and about joining up to get some national traction on all the issues that have been talked about. We seem to have spent a lot of time on lots and lots of good practice and lots of pilots going out and lots of examples, but we tweak around the edges rather than have anything that really gets to the number of the whole thing. Our response was particularly talking about the safer use of medicines. It's a part of the equation, but it runs as a thread right through the NHS. We spend £1.4 billion on medicines, which is only the second only to salaries in the NHS, but we know that only about half of those are used as they should be, so there is a huge amount of scope there for safer use of medicines. Talking about unplanned admissions to hospital, we know that a huge number of the unplanned admissions to hospital thousands are actually because of medicines-related incidents. If we can focus more on preventing those, which we would say is using pharmacists where you have medicines and where you have patients getting the expertise where we really need it in the system, if we could save on even a small percentage, because I know that you all know the maths on how much hospital admissions cost. We would actually be saving a huge amount for the NHS, but more importantly we would be keeping people safe at home in their own homes where they want to be. We have to start to think cohesively as a whole about how medicines fit into the whole health picture and the health and social care integration agenda. I was two-fold questions to two of the contributions so far. I am a fan of the third sector, but to be devil's advocate for a minute, does it really matter who does it? Surely the important thing is that we are doing preventative spend, investment, etc. Does it matter if it is the public sector of the third sector? For Colin Mayor, whose paper I thought was great, you are saying that we cannot measure prevention because it is all about attitude, so it is all inside people's heads. How do we measure it? We are the finance committee, how do we measure those things? To me, prevention is about how we stop negative outcomes happening to people and how we promote positive outcomes by definition. Therefore, as the law now says, all public authorities will have a duty to show how they are improving outcomes and how they are preventing negative outcomes. The guidance for that comes out very shortly. To me, prevention is about how we improve outcomes, particularly for people who, in the past, would have experienced negative ones. We can track that, and we should be obliged to publish that and be accountable for that to ourselves, to our local communities and populations. Focusing on the outcome, prevention is another way of talking about outcomes. If we can predict where negative outcomes will occur, we have a duty under law now to intervene and ensure that that does not happen to people. We will have to give an account of that, and we will have to measure those. Prevention is the same as outcome. I think that we are using different languages often in quite similar ways. The languages around co-production, for example, are often languages that are saying, do it in this way because the ways that we have done in the past have excluded people. The language about prevention was to be intimately linked with the language of community empowerment and co-production. It is a very simple example. I was at a meeting recently where a group of quite articulate community representatives were complaining to a council that changes to the allocation of personal care at home was leading to older people being lonely and isolated. It was myself thinking that that is a really weird proposition about a community. That the answer to the loneliness of older people in this community will be a salaried state personal care worker. Where is the community in that? Do not we have to then do some of the capacity building stuff and so on that is saying, we will never be able to stop loneliness as public services? You as communities need to be active at noticing where older people are isolated, integrating them with activities and so on. The third sector, I think, going back to Alan's point, is an absolutely critical role there because it is much more able and mobilising communities than the public sector has historically proven to be. A lot of the languages that we use are all linked to outcomes. How do you prevent negative ones? How do you ensure positive ones? The answer is that if preventative intervention was working, the outcomes will shift. If they do not shift, preventative intervention is not working. I think that we call too much prevention because the type of thing it is without asking the question, did it actually produce the result? Because if it does not produce the result, it has not been preventative. It has just been another thing. Okay, thank you. Yes, Alan, do not worry, Alan, I will let you in, but I have a few other people before you, I am afraid. Andrew, you are followed by John. Yeah, I agree with what Collin has just said. Our submission to the committee highlighted a number of examples in the third sector, where preventative work is going on. For example, the food train, which run in a number of different local authorities in Scotland, which provide a volunteer-delivered service to older people in terms of food and nutrition. The good morning service, which makes the phone calls to older people to make sure that they are well and staying well. I think that volunteer-delivered service is where the third sector comes into its own in terms of some of this work, not solely where the third sector thrives, but really good examples in that. I guess one of the things that the alliance would reflect on would be about the culture within statutory services. I think that comes into sharp view when you have different policy initiatives. In the last few weeks, the Government has produced the national clinical strategy, which has lots of really good stuff in it, about self-management, harnessing personal and community assets, the sort of things that Elaine was talking about earlier on as well, the types of local things in communities. Those shifts are really necessary, but are they going to happen without the necessary culture change? What are we doing to invest in that change management that needs to happen to push us towards a preventative approach? How can you change a culture when there are lots of practitioners working in really tight budget circumstances and within a target-driven system, quite often, which is working around about restricted eligibility criteria or targets and indicators that are based on measuring service failure rather than individual outcomes? I have the subject and sector-specific knowledge that many of our colleagues have around the table, so my remarks are probably more general. I am also struck by the interrelationship of your three questions and how inevitably we drift in and out. A couple of observations, it seems to me that there is a great opportunity here for Scotland, as a relatively small nation, to move quite quickly and move several steps in this area. The progress that I would identify in the past few years is perhaps that there is a greater awareness now of prevention, preventive spend and its associated term, collaboration. There is a lot of rhetoric around prevention and collaboration and, inevitably, I think that all those remarks are tinged with a but under however, as we are hearing, because the rhetoric and the practice may be different things. I think that there are a lot of good practices, and I will return to one or two examples shortly, but there are many more much better examples from around the table. I think that the point that the improvement service makes about terminology, about what we mean by prevention and about its potentially comprehensive and long-term nature, as has already been mentioned, is a really important point. I identify and, as a person who has moved from the adversarial world to the cooperative, consensual world as a mediator, and it is writ large in this world, that love prevails. I am interested in what I think is a global trend, and that is a move from an unhelpful competition in the adversarial sense towards a greater awareness of working better together, collaboration. I think that what comes out of some of the papers and where some of the frustration lies is that an understanding of better working relationships and of the need to work better in partnership and relationship is now quite profound and quite enlightened. However, the but is that there is a long way to go in terms of turning that into practice, but, certainly across sectors and within sectors, there is much greater awareness or evidence of awareness of the importance of relationships, communication and so forth, rather than mere systematic change, and it makes companies get stuck on systems. You asked, however, in this section about progress.  I had the privilege just 10 days ago of giving the keynote address at the Scottish Knowledge Exchange Awards, run by an interface, which is an interface between the university publicly funded sector and small businesses as another creative folk. It is a great example of people getting together and doing all sorts of exciting things that are essentially preventative in their nature by nature of what they are. The Scottish University's Insight Institute, run by my colleague Charlie Woods, brings universities together to be more collaborative and to create and develop new ideas. In the very building just a few weeks ago, the Apologies Scotland at 2016 was passed and received royal assent last week. That does not sound immediately like a preventative measure, but of course it is, because of what underlying premise of apology is that people are able to say, I am sorry for what happened or I am sorry that that occurred or whatever it might be. We know from the evidence and experience that many fewer claims will be brought. That is preventative spend. From my own experience in the work that we do, a significant number of public sector leaders have now trained in mediation skills and collaboration, and they are taking us into their various organisations and using collaborative and preventative techniques. I think that we have come back to training in due course. The Scottish Government has begun to appreciate the value of using mediation, for example, to nip things in the bud, and there are lots of buds attached to that as well. Evidence of some progress is much rhetoric, a lot of awareness, and the buds will come under your challenges and solutions headings. That brings me swiftly on to the challenge that lie ahead, and I am hoping that we will look at that. We will look at the challenge that lie ahead in ensuring shift towards prevention. Mark, to Fobby Laisley. Thank you, convener. It is quite handy that you have moved on, because my question was tailored around more probably the second theme than the first theme. Well, there you go. I am always happy to help. I guess that there are a couple of questions. The first is around how we tackle some of the silo mentalities that still exist. I do not mean necessarily silo mentalities between different sectors. Often, if you take health as an example, within health there can be a silo mentality between the acute and the primary, or even within the primary between different disciplines. How do we tackle that and get more of a collaborative approach, which would help in terms of the points that Alien is making, where, for example, in a lot of areas now, people are being guided more to present it at the pharmacist rather than the GP, because, very often, the GP is finding that, when a patient comes to sit down in front of them, they probably would be better dealt with either by a pharmacist or by another primary care professional, but they do not know that until the point that the individual is sitting down in front of them. That creates a pressure on GP time, and that works its way up through the system. The second question that I was going to ask was about the challenge that is always there between the quick short-term fix and the longer-term solution. It is no secret that we as politicians, whether at a local or national level, operate within a four or five-year cycle. How do we get out of the mentality that we need something that will work within five years that we can present and show that this is being fixed rather than something that maybe will take 10 to 15 years, and we can look at it and say that there is progress, but there is more to do. How do we ensure that we get a kind of a buy-in to that? Colin had noted about measuring prevention success by almost measuring outcomes, whether they are negative or positive. I wonder what the panel members think about identifying interim outcomes. For example, in health, if you are aiming to reduce cardio vascular events such as heart attack strokes or CVD-related deaths, you identify a group of interim measures and measure them. Whether it is local areas, changes in good and bad cholesterol, their weight, smoking rates or diabetes, so that there are rounds of interim outcomes. I was responding to John Swin's question and I hope that it does not take us back. However, if it is the case that there is no difference between the cost-effectiveness of various approaches, if it is the case that users are fully engaged in designing and evaluating the process, and if it is the case that accountability is roughly equivalent, no, it does not matter. However, hand on heart is not the case. If it is not the case, there is a need to say that it does matter who delivers those things. We need to be sure that we are getting not only good value for money but also buying effective services at local communities, not simply ones that fit the services that are being delivered at this moment. John Swin, are you saying that the third sector has a particular strength in the preventative arena, or are you just saying that the third sector is better at everything? No, we are talking about preventative. The third sector, as has already been stated, has a particular ability to mobilise local communities. It is very much a part, derived from the part of local communities. Generally, it is very active in mobilising those same people. For instance, if I can give you an example, we focus very much on creating peer mentors. We will take those people who we are working with initially to prevent them from going on to becoming the future offender, but we will work on making those individuals who will go out and work with their peers and do the same thing. It is a community sustainable approach, and it builds on the strengths and assets of the community, not doing to the community, but working alongside and with the community. The third sector is absolutely excellent at that. On the two questions that came as part of the second part of the debate, I think that the issue around measurements and the issue around—to borrow one of my colleagues' phrases from their written evidence—how you get to that point of productive collaboration are really linked. We did some work at the beginning of the great integration journey, where we put some principles for delivering integration out, and we did a lot of consultation. What was at the heart of that was that everything tells us across the world that, if you want to collaborate effectively, you need a shared vision. Actually, you need everyone to be able to come behind that. If you are all working to different understandings of what you are doing, and sometimes that comes down to language, I think that you can even see that in the submissions, but if you do not have a clear idea of what you are aiming at, it is very hard to get people behind you. Part of that is about what you choose to prioritise and what you choose to measure. What does success look like in this world? Unless we all know what that is, it is very hard to expect front-line practitioners to coalesce behind that single vision. We have a number of statements in different policy arenas in Scotland that do not always necessarily match. The paper that Audit Scotland produced last week on community planning, I thought, was very helpful. I know that some of it was referencing your work at the Improvement Service, but when you look at the number of indicators and outcomes that the public sector is having to work to and the disparate nature of what that is, and then you expect a front-line nurse, a front-line GP and a front-line social worker to make head or tail of that, then I think that we have a real problem. I think that there is a political issue and I think that there is a practice issue here. I would very much endorse what Audit Scotland has said about how do we streamline that. I know that people have mentioned the community empowerment bill. We now have national health and wellbeing outcomes set into the public bodies act. I know that there is a lot of support for what is in there, but how do we, as Audit Scotland has pointed out, that did not replace it just added to existing measures. Driving to work this morning, I was listening to the radio and there was a very interesting piece of local news in which it was probably the main story for the local news where it was reporting on a particular health board who had missed its A&E target by 0.1 per cent, though, if you had changed the dates at which you were looking, it had met it. Was that the biggest health issue in that area of Scotland? I very much doubt it, but what we end up with is a debate on the margins when we have in front of us some really significant issues. However, I agree with both of you that there is a political pragmatism about how you report on whether you are investing your money and your resources and your priorities in the right places. I very much agree that there is a need in the long-term outcomes to have indicators along the way that will allow all of us to see, have we made the right choices? Maybe if we haven't, we have to review what that choice has been, and we can't wait 15 years to keep putting money in the same place, but that also requires us to be brave about what we choose to measure. If what we want is a paradigm shift in how we deliver services across the public sector, whether that's prevention in terms of criminal justice or in terms of healthcare or in terms of poor educational attainment, in some ways it doesn't matter, we still need to be brave about how we look at the measures and how we look at the indicators. If we tell our public agencies that support us to do that, there is no money to develop new measures. There is nothing here, you just need to keep going with what we've measured in the past, then what we will get is what we've done in the past, and there is a really strong correlation between your two points, and I think if we can address that, then I think we will go a long way to ensure that we have a shared vision, better collaboration, that we can all be sure that we've chosen to prioritise the right things, and it doesn't matter what agency you work for, whether that's the public sector, the third sector, the police authority or the NHS, you will all be working towards the same end goal, and we're not there. I think that we've been around the table at the health committee when we've had this conversation, and I've had a conversation with Colin at Loco. I've been around the committees, basically, what I'm trying to say, but the question is firstly, if we're going to have that difficult conversation about either disinvestment or changing what we measure, from my perspective that has to be led by those on the front line, it cannot be something that is led by politicians, because then you just get into a political bun fight where different political parties will say, the reason you don't want to measure that is because you're not meeting your target rather than is it the most appropriate target. So how do we get to a situation where that is led by practitioners rather than by politicians? I think we're talking collaboration. I'm not sure you can separate them, because what politicians choose to do when they stand up in a chamber, what the media chooses to do when it does like it did this morning, and what practitioners are trying to do on the ground are inherently linked. That's why in our manifesto for the coming elections we've been really focusing on, there has to be a cross-party consensus. If whatever measure we come up with just results in a lot of argyb argy about minutio margins, then we've not got anywhere. I think, yes, the focus may be slightly different, the need for what those targets or measures or outcomes are may be slightly different, but if we can't do it in full collaboration, we will keep falling down. I would urge us to be doing that together. If you'll be patient, we'll get around to you all. Jeane to fall by Paul. I was really wanting to ask about language and position and thinking about everything that's been said. It's a very interesting discussion, but at a local level, sometimes the language is completely different between the agencies all coming together, but they're all using a language that really is quite exclusive, bureaucrees, I kind of call it. If you don't understand bureaucrees, it can be quite off-putting at a local level. I do believe that engagement at grassroots is key to all of this, and the third sector must be part of it. I just feel that it won't ever deliver really whatever political ambition we have and that shared vision they need to be involved. I was interested in your paper because you referred very much to the kind of sacred place that people hold of their own position. Our reluctance, often because they're firefighting on one hand, to actually think about how they can start to think about preventative work when they're in trays full of cases that they have to deal with and how we translate that at a local level to energise everybody to work together. I guess my question is that we start with some kind of training, or how do we deliver that message to engage across all of those partners that we need to work together? The last point about language is really important. I think that the Police Scotland response failed to mention that, but when we speak about prevention, I think that it's important to understand the distinction between the public health model of primary, secondary and tertiary prevention. Sometimes we go round the table and we don't know where we are in the prevention spectrum, so to pick up on Justin's point, if you look at the current cohort and poem at the Young Offenders Institute, we now know, as much as probably in the last couple of years we've been trying to think about prevention of further offending or reducing reoffending, we now know far more about the current and recent cohorts there about trauma, loss of bereavement that Justin spoke about. We now know that more than 80 per cent of them are excluded from primary school, so we need to be on the journey of where they were at primary school, and I would agree with Justin's point about the potential for an extra thousand health visitors, but I'll also offer it to the convener that it's not an either or with police and health visitors that you can do both. I would also mention a second point to Mr McDonald's question about working in silos and the potential to work within a five-year, four- or five-year political cycle. If we're looking for good practice, something that came to my mind during the papers is the national road safety strategy, which has been a 20-year strategy, although it's a UK strategy, has very much been embedded in Scotland over that 20 years since it was launched, I think, about the millennium. Interestingly, just as we're making some notes there, not done through legislation, not done through to the best of my knowledge any additional funding, but absolutely has delivered constant improvement over a 20-year cycle, but with or ally, with an expectation that there will be an annual review and an annual progress in benchmarking and monitoring, but also within it at the launch of it a very clear understanding of what agency had to do, what this meant for roads engineers, what it meant for the car design industry, what it meant for potentially benefit for health insurers, absolutely what it meant for police, definitely what it meant for educationalists in terms of cycle safety, road safety, etc. I think that that's a really good example of product of collaboration. I think that it's a really good example to pick up on some of Colin's points in his paper where it's absolutely prevention over a long period of time but without bending spend, are there any new money coming in as well? Just do you mean to hear about a 20-year electoral cycle? That might be advantageous to some people. Aileen to be followed by Aileen. It's really an answer to Mark's point that he had there. Health outcomes can be measured quickly, so the examples that we have with things like local services where you can prevent people, prevent asthma deaths, for instance, by better use a multi-professional approach with all the health professionals actually inputting at different places, but you can actually measure that quite quickly. That's where the sustainability thing comes in. You have a local project, which is good. It has outcomes, you can measure those outcomes, you can see the difference but it's not sustained into the next financial year because of the way the budgets work. There's no know whether that is going to be taken forward, however good something is. There's also gaps in sharing best practice across 14 health boards, things that haven't happened like that. I think that from a health perspective it's probably easier than some of the other things that have been mentioned around the table on actually getting the outcomes, measuring the outcomes, and it should be easier politically to then say that we could take that particular project forward or that policy forward in a much, much bigger way and actually get the national outcomes and traction that we're looking for on the collaboration. Our manifesto has really listed all the things where we think the gaps are, on where we could make changes to use the resources that we've already got, as I mentioned before. Things like the minor ailment service, which would need a review, but it could be available to everybody because it's a historical thing from when we had charges for prescriptions, which we don't have now. It's a slight anomaly because only the people who used to be free from prescription charges can actually use the minor ailment service. If that service is suitable for certain parts of the Scottish population, why is that not suitable for everybody? We've also been working closely with Royal College of General Practitioners, and we're looking at better clinical handovers and referral handovers between the two systems. We need that for all health professionals, so I'm sure that Rachel would agree with me on that. It has to be very much a better referral system between health and social care, and that feeds into the other one, which is about having access to one single health patient record, which would also help. At the moment, there's information on people all over the place, and to have that held in one place would be very, very advantageous for patient safety and for continuity of care. Initially, talking about a health record, which is held with the GPs, we need that to be a health and social care record, which is appropriate access with patient consent, so that the patients and people decide who gets to see their information at whatever stage in the system, but that would actually help with the collaboration. There is also an element that has to be a cultural shift of sharing that information, as well as the tools to do it, which would be the access to the health record. There was a mention about targeting resources. Through the prescribing data now, our specialist public health pharmacists are looking at data that can target which parts of the country have a different prevalence of disease or social states, and you could target resources much more efficiently in those areas. At the moment, we have very much a one-size-fits-all when we approach things nationally and contractually, but if you find that you've got diabetes that's much higher prevalence or in an old mining area, for instance, you've got much more respiratory problems. You could actually change the way we work and you could do that for deprived areas. That's very much when it's infancy at the moment, but the data is now there and we could be very clever about how we use that data. I think that that was all from the questions that came up. We also mentioned primary schools. Health literacy was another one that we put in the manifesto because I think that we need to start to teach people more about our NHS from a very young age so that they understand how we make the NHS fit for the future, how to navigate the NHS, where to go at the right time for the right help that you need. That really has to start in schools so that people understand on the medicines front that there are risks as well as benefits and actually start taking care of themselves from responsibility for their own care, which the third sector does very well, self-management and self-care, but we could build on all of that through health literacy from a very young age. I want to come in on the point that was raised about the indicators and measurements of indicators. I can only speak from what we fund through the Lloyd's TSP Foundation for Scotland. Often, when we have quite high-level strategic outcomes at a local level and national level, organisations feel that they have to be measuring those outcomes, which are far too big and not achievable. We try to work with them to think about what is your contribution towards that. What is it that you can do to help achieve positive change and get them to be much more focused and show that change? We have then built up a picture of what that could look like and how it contributes to national outcomes for children and young people in the wellbeing indicators to show that everybody makes a contribution and we should be looking at measuring that and making a better effective contribution across the board. People are realistic on what they can do, what they can achieve and how they measure it and make it accessible so that they do not spend lots of time filling forms and doing evaluations but getting on with the work and embedding it into their practice as they go and that people are involved in that process as well. It becomes their outcomes and not owned by a service or an organisation. I also wanted to mention the collaboration approach. The foundation is trying to work collaboratively across Scotland to think about how it adds values. We have recently launched a new programme where we are trying to reach communities where trust and foundations have not reached. We know that the areas where they do not often have are not applying for funds and they are not coming forward. What is the reason for that? We are working with those communities and individuals there. We are working with local authorities and we are also bringing in additional investment from other trust and foundations to look at how we can help to support what they want, how they can build out and how they can link better into the whole community environment process. We have just started that and we are working with East Ayrshire and their vibrant communities programme, but our plans are to expand that and we are looking at other communities across Scotland to try and see how we can work more collaboratively together, not just public and third sector but bringing in other trust and foundations and other businesses in philanthropy. I will pick up on the two big challenges that have been put on the table. How do we break down silos and get integration particularly around individuals, households and communities who predictably may have poorer outcomes? Secondly, how do we do that in a sustainable long-term base given political and financial cycles? The answer to the first one is localisation. In a way, the Parliament has made up its mind about this already. You passed the community improvement Scotland legislation. It says that the public sector, including Police Scotland, local authorities, the health service and all its dimensions on, will produce for each area of Scotland and within that for communities with poorer outcomes a specific local outcome improvement plan with targets. Secondly, you said that they must show that having set that plan, they fully resource it and they collaboratively resource it. You have set a new standard, which will be the framework in which we will be operating from now on in. I think that backing that creates an infrastructure that forces us to look in different ways across silos, to look at the resources that we have on the ground and how we can exploit them better. I think that there is merit in that as long as we stick with it. I think that the anxiety, if there is one about the way that politics is practised and, indeed, in fairness, people like myself in public policy practice, we keep on wanting to move on to the next thing without letting the first thing in bed. I think that this act is a very big deal if it becomes the core infrastructure to which we operate in Scotland. I think that it has transformational potential. In terms of the political cycles and sustainability, I think that a lot of our practices in some areas of our work could be looked at with respect to us. I am impressed at how bold we have been about renewing the school of state in Scotland. We are making 35-40-year punts on where population will be, how you will do education even 20 years from now, quite apart from 40 years from now, because we are locked into the bricks and water, frankly, for that length of time. Some of it through PPPs will continue to cost us very significantly across all that. Some areas of our lives, publicly, were extraordinarily bold. We make big judgments and we go for it. In other areas, I think, we tend to shy off or not sure about the 40-year horizon and so on. I think that it is the big data stuff that Aileen referred to. I think that we are now far better placed to understand long-term interventions that we need to make. That includes our long-term economic planning, as well as our long-term public service planning. I think that it is almost being willing to have a national vision in an unashamed way. It is weirdly about getting our act together at the highest national level, so we have long-term plans that we stick with and localisation right down to the most local level. That will then include empowering our own staff, so they are free to collaborate at the front-end with everybody else who is there. I doubt that we can empower communities if we do not empower our own staff at the front-end. My experience is that people collaborate very well when they can see the whites of other people's eyes. It is people like myself sitting on the top of systems that are least good at it. We think budgets, we think about our silos, we think about our accountabilities. People at the grass-loops level are often unaware of picking up on Rachel's point of all the things that Audit Scotland documented at all. They have never heard of them, they have never read them, and they are getting on with real life. I think that empowerment at the front-end, but creating a more coherent, data-based, long-term framework at the national end, is exactly what we need. It is not a contradictory combination—you need both for either to work. I have changed my mind about 10 times of what I am going to say as the whole conversation has moved on. One of the points that I wanted to make was that we need to be careful that we are not doing something that looks like it is preventative but escalates people up the system or escalates them into the system. If I give the example—sorry, Paul—of recorded police warnings, which look on paper like a very good, positive new initiative to keep people at the totally lowest end of the justice system, the risk around that is now that 16 or 17-year-olds are being pulled into that system and that will stay on somebody's record for a couple of years. If they are used well and properly, they will keep people out of the system, but it does not take much for somebody to become an offender within that system. As we know from numerous studies, it is very difficult to get back out. That links to Jeane's point about language. We have worked really hard on community justice to get away from the language of the offender. When we started to have those conversations in the community justice authority, people kept saying, well, what do you call them? It is amazing how often just the word people gets you through. Just finding the linking into various points about outcomes and how we measure them. I was at a very good event last week run by the Robertson trust about learning and impact. There was an input from the chief executive of land, Kelly Chase, who is a foundation who has funded a lot of initiatives around multiple disadvantages rather than picking, whether we look at addictions or homelessness. He said that we could hear the gasps around the room that we need to stop obsessing about outcomes all the time. We thought that outcomes were the way ahead, but he said that it is the way that we operationalise them that can lead us into more silo thinking. He said that it is like if you give a group of young children a football and send them on to a football pitch, they will all try and score the goal. The way we operationalise outcomes has become very much like that. We all want to be the ones that hold the service user through to deliver the outcome. The best collaboration around outcomes is where we are working together at all levels and are happy for somebody else to get the glory of that outcome. We do not always need to hold it ourselves. The huge backlog of speakers has been reduced to a measly three. I feel very measly, convener. Let me make a few general points and then two very specific suggestions. I want to pick up first of all on something that Rachel said earlier on about paradigm shifts. The thing about paradigm shifts is that, as Einstein said, you cannot solve the problems with the same thinking that got you into them. This is a little bit about changing our thinking, retraining our brains, as it were, and that has implications for us as individuals, for us collectively and also for our systems. I will come back to that in a wee while. I also want to recognise that there is a lot of complexity in that. It is easy to view things in a binary way. Yes, no, right, wrong. It is a very complex, multifaceted area of activity. I was interested in what Mark McDonald, the question that you posed, which has been picked up by others, is about the short-term cycle of political change and gain and need for success. I think that one of the really tough issues for politicians here is that this is long-term. It is inescapably long-term. It requires cultural change, attitudinal change, it requires investment on which there will not be obvious return in a short-term political cycle, although intellectually we understand that it is the right thing to do. I think that it presents a real conundrum for politicians. I do wonder, and I will be provocative here, if once again in Scotland we can show folks that there is a different way of approaching this. I think that a lot more people will get this than you might imagine. While you may think that the constituents and the voters are looking for short-term returns and will only vote for you if you achieve a certain thing in a short period of time, I wonder if a large number of folks are that unsophisticated or if there is an opportunity to set out perhaps a different way of doing things. Can I interject there, because we did have a Labour MP give evidence to the committee a couple of years ago from down south who thought that what was actually happening in Scotland was much further ahead of what is happening south of the border in terms of this particular agenda. Even with outside Scotland, I think that a lot of people know that we are actually trying to move along this path despite difficulties in terms of financial challenge at the moment. I think that it has been recognised here at Wales and across the political divide as well. There are lots of examples of that, convener. I think that there is a platform there, so if we are talking about paradigm shift and rewiring our brains as we have it, we are in a very good position, certainly better than many others, to try to do that, and that is above political leadership. I want to just recognise also that part of this is understanding why the symptoms of difficulty challenge and resistance exist. We now know so much more about the psychological barriers that get in the way of that kind of change. The examples will include an inbred resistance to cultural change, just as part of who we are. I say this uncritically, but there are vested interests. In other words, people who have stakes in the present systems of status quo who fear loss, who fear change, the point that has been made by you and others, we know that people, when something is not urgent, will tend to focus on the urgent and not value in the same way. In other words, they will tend to discount future benefits rather than short-term gains. We are all prone to what is called risk aversion. We know that a fixed system suffers from what is called system inertia. It is much more difficult to change a system than just to allow it to continue. If we can recognise those in our institutions and collectively understand them, we can then begin to develop options to deal with them. That is particularly under pressure. That is a real challenge for us, particularly under financial and austerity pressures that people are facing just now. All of that leads me into the point that Jeane asked about, which is training and learning. Paul, in your paper, you mentioned a collaborative leadership training programme. That is hugely about training up a whole generation of folk leaders and non-leaders in skills, aptitudes, techniques, processes and competencies that allow us and them to work more collaboratively and more preventively. That is an investment and it takes an intellectual and practical acceptance of that and what it means. If I can turn to a couple of suggestions, because you were looking for short-term gains, there are two areas in which the committee— I was not talking about the clash that exists between the need for short-term gain or the perceived need for short-term gain versus the long-term solution. I am not looking for you to give me anything for a leaflet, John. Paul, I am going to offer you, however. There are two things that I feel fairly passionate about. Let me just offer them, because I think that this finance committee can take a lead on that. We hear more again today about the, I was going to say, disaster, the challenge with which the Government is faced over the computer system that is designed to allocate funding for farmers. It is well known, I think, in the contracting industries that contracts for computer programming and processes, particularly large-scale, can never be fixed emphatically in advance. They are always works and progress. The same applies often to construction contracts. We have seen in Scotland a number of instances of construction contracts costing far more than they were thought to need to cost at the outset. I think that the procurement approach in Scotland could be examined. I think that you would find that a more enlightened, less competitive, less black-and-white approach to procurement in Scotland, and a no-procurement department that is trying to do something about this would save Scotland a lot of money. You could have more banks for less bucks. I have to see most of the reconstruction projects coming in, but they are well under budget and well ahead of schedule. That might be because things have changed. Even in the fourth budget would be a great example of that. I take that point. Let's go back to IT. There is more than just the farming situation at NHS 24 and so forth. I am just suggesting that there are ways in which one could explore how contracts are let at the outset, which should bring in preventative methodology. The final example is the justice system. I work largely within the civil justice system as a mediator, helping people to sort out disputes that are otherwise going to court. There is a grievous amount of money being spent in the civil litigation process, even with court reforms. Much more than needs to be spent. It is not just money in direct expenditure, it is time, it is reputation, it is loss of opportunity and all those that have an impact economically on Scotland and on particular businesses. There is a great deal that could be done preventively in my respectful view to reduce significantly the amount of resource directed at the civil justice system and to increase the economic value that could come within business and elsewhere through nipping disputes in the bud, through early preventative measures and through training and other awareness so that disputes never take off and gain the kind of adversarial momentum that so many of them do. Quickly on Rachael's point about indicators around A&E waiting times, the Welshers, in whether or not the elected representatives or others who should challenge their use, in the Welsh Assembly Government they took on, when they shifted funds to social care, they took on and explained what they had done. They have removed a lot of that and were hammered for ages about their accident and emergency waiting times. The minister patiently explained and explained and explained and now they have moved on and they are not looking at them. That is what needs to happen, needs to come both from the top and from the elected representatives and from the workforce that this is not an appropriate target. I think that the issue on partnership is key. Everything that we have found that partnership working is key to issues around prevention, but there is a real danger that co-operation and collaboration very rapidly becomes coercion, where the organisation that has the largest amount of money or putting the most money into the partnership takes to say, and part of this is to do with the evidence, whose evidence, when you have different sectors coming together, we have different, using different evidence to justify their way of working and some of the evidence that comes from some sectors is very hard and based on very large studies and very easy for them to present versus the evidence that would come from social care or for the third sector, which might be much softer and much easier to dismiss, but actually it probably might be more appropriate to apply. So there is a real danger there, a real issue here about how you afford primacy to which particular types of evidence. And just one final point about co-production. The one thing that we've found is that people talk about, well, this service is co-produced, we can now spread it. Actually, it's not a service that's the issue, it's the process, co-production. Every time you start something in a locality, you have to start from scratch. You can't say, this worked in Gauble's, therefore we'll do the same in Govan or we'll do the same in Castle Milk or we'll do the same in Westerhales. You've actually got to go to Westerhales. What worked was not the service that was produced, what worked was the co-production that led to the delivery of that service and that also means that those services have to be continually co-produced and you have to continually be changing them to take account of the changing constituencies that are coming through. So if you design something in Gauble's today, you can't keep it running, you've got to keep on co-producing it and it means that it's a really intensive, slow and hard to produce service but you can't just say, we've got a service, we've co-produced it in Gauble's, let's spread it across Scotland. It's about, it's the process of co-production that's key, not the service that, not the actual result, resulting service that comes out. We've got 20 minutes less left and obviously we're now moving on to possible solutions. So probably folk will only have an opportunity to speak once more so please feel free to come up with any ideas that you have at this point. The first person to speak will be Rachel to be followed by Steele. Thank you convener, I thought you were going to give me 20 minutes then, but that's... Three points as this may well be my last chance to speak on that basis. First I think there's been a number of comments that have come across today around the difference between good intent and unintended consequences and I think just as a point of clarification from what's just been said, the RCN is continuing its work on what the future measurement culture should be. We're very happy to continue talking to anyone around this table and beyond about what that should be. We certainly haven't come out and said that there are particular targets that are good or bad, but there is an issue around the consequence of how sometimes those targets are used and that was my point about this morning, which was the focus on a very, very marginal missing of a target against the scale of what we're talking about here. The second is really to come back to the point on language and I don't know if this is a positive view but I know that there's a huge amount of work going on even within the professions because you can sit a nurse, a social worker and a pharmacist in a room and we won't necessarily quite understand what we're each talking about. The RCN's been doing a huge amount of work over the last 18 months to two years as we've moved towards the go live date for integration to try and make sure that we and our members and members of other colleges and other professional bodies are in rooms together trying to understand and try to get a better dialogue going about what works. We as a college have done a lot of work with the third and independent sectors as well on that basis. Does that mean that it's all sorted? Clearly not, but I would say, as it may be some comfort just to say, that there is a track that I think that we're on. We, for example, run a day with Social Work Scotland where we brought managers of nursing teams and managers of social work teams in a room together and facilitated them to talk about how do we manage to bring these different cultures and these different ways of working together in a way that makes sense to both of those groups. Work is in hand. Is it going to be quick? Almost certainly not. Will we begin to see some change locally? I would certainly hope so. That brings me to my final point, which is about locality. We've been talking a lot about the importance of grassroots and where that drive to this paradigm shift will come from. The community empowerment bill is notwithstanding. I think that we also have to just be aware that there is the potential for an awful lot of different localities to start emerging across Scotland, which may not always quite match up. One of the issues that we're talking about is coalescing the resource that we have, whether that's a community asset, a third sector or an independent sector resource or a public sector resource. We have to make sure that we're focusing that at locality as well. The Alliance has done some very good work mapping the development of the integration authorities before they go live. At the last iteration of that at the end of January, if you look at the localities and how those have been set up, every integration authority has to have at least two. They're being done in very different ways in different areas, some around GP boundaries, some around council wards, some around natural communities. Some haven't even got to the point of actually deciding what that locality is. We then have other legislations setting out localities. We have interim changes to the GP contract, which is talking about cluster working for general practice. Again, we have to be clear that we bring together the assets that we have to a single end. However, those bits of legislation or policy or contracts or whatever they look like are being defined by different parts of government, we have to make sure that we're working together at a local level to effect the best possible change and get, frankly, the best bang for our buck because there aren't that many bucks around at the moment. That, I would certainly put forward. The issue then comes one that came up earlier around that political issue around measurement. One of the areas that we're looking at in our own work is how much willingness is there for there to be difference in measures at locality level, because what we may end up with is so easily called postcode lottery, but we've just put in place a whole piece of legislation that will involve huge amounts of variation across Scotland in the services that people may get and how they work towards those national outcomes that have been set. That may result in all sorts of headlines, but that's what's been put into legislation. How comfortable are we as a nation, as a Parliament, as practitioners, in having variation in indicators across Scotland to meet the national outcomes that have been agreed? That's a question that we're asking at the moment in our own work. In terms of solutions, I think, fundamentally, we need to stop talking about prevention as such a long-term challenge and as such an expensive challenge. I think that, just like the challenging that John was saying there, it hasn't taken a generation to have empty polemony of young people. It hasn't taken a generation to see some real impact of mentoring on people and justice system. It hasn't taken a generation to talking about your coffee clubs and lunch clubs and so on to stop those people feeling so lonely and isolated and to connect them into their communities. I think that that is all within our gift and it's not quite so overwhelming. I liked Colin's sort of glass half-full perspective in the written submission, which was about, well, Christy said that 40 per cent of spending is on failure demand, but the flipside of that is 60 per cent. It looks like it's already preventative, so I think that's a really good starting point to build on. I think that what doesn't really help is the short-term nature of funding. I think that would be the main solution as far as I'm concerned. That doesn't just apply to the third sector, but also to statutory services. We might not have 20-year electoral cycles, but I don't think that it's impossible to move towards three to five-year investment planning models that look at strategic commissioning between partners to look at what do we need, those shared goals that Rachel's talked about, how do we achieve those goals, who's got money to put in together and how can we best commission those services together. I think that all of that is quite achievable and is absolutely within our gift. Sorry, Deputy convener, to be followed by Alan. Thanks, chair. It was actually in the police paper that there were three points that struck me that I'd be interested in. They seemed all quite positive. One was the idea of a national Christy champion, quite what that would mean. The other second one was that the public remain untested as an asset. I wasn't quite sure where that would be going and how we used the public better. The third one was that New Zealand seems to have been a good example of things progressing. I wonder if you could give us any pointers as to what that meant. Thanks for that, and I take no credit for it for being here to comment on it. Sorry, Deputy convener. The first question was— A national Christy champion? Yes. I think that that point is probably the point there. I don't think that there's any around the table or probably within a few miles of here that would disagree with Christy or the contents of the report, but actually where has the drive been to take that forward? When I read it, Kenny had recalled the Aberthnut report, which again you would read into and say that there's lots of good work in it and lots of good comment, but was there a drive beyond individual leadership within the public sector, within local authorities, police, fire, elsewhere, health to do anything? I'm not saying that I take it or leave it. I think that people would look at it and say, we agree with it, but it was optional whether you took it forward. It was almost agreeing with philosophy and then you tried to weave it in. So the idea of there being some champion or drive behind that I think would be helpful beyond relying on single leadership. I think that the community has been untested. There's just a comment about maybe about valuing community's interaction. It's been untested or misunderstood, the point that Colin made earlier on about not it's not for the public sector to prevent isolation, not it's for communities to contribute to that. I think again we all know what could be done, but actually how we would move from the positions where we are, where communities becoming potentially more remote, individuals becoming more isolated, not just the elderly community but a whole spectrum of vulnerability from children sitting in their bedrooms and pretty much being on IT and potentially being exploited or radicalised or vulnerable in different ways right through to that elderly group that Colin spoke about. In the New Zealand model, New Zealand half had quite a paradigm shift in terms of moving away from prevention. That isn't to say that they haven't kept a focus on crime control, trying to reduce crime and disorder, but they've certainly moved away from large number of performance indicators and targets to three simple measurements. One reduced crime, two reduced the number of people referred to the criminal justice system, and I forget from memory the third one, forgive me. Very much an IT focus, very much an engagement with government to say we need time to make this work. We will continue to produce monthly performance figures on a bit crime, but we really need our reliance on government not to come back in two months and tell us that we've lost confidence because a certain group of crime figures are going up or down. At very much community base, one of the examples in New Zealand is that they've managed to close lots of police officers without any public opposition because their message was that we're going to be in your communities with bits of IT in our hand and deliver the services that we used to do for communities from your street corner. There's been no pushback whatsoever, so you can see—I think Police Scotland would like to have learned from that message instead of just finding it out a few months ago, if I was being perfectly frank, but they've delivered basically something that Police Scotland have delivered with an entirely different engagement with the public, an entire different result, an entire different level of support from the public and including from within politicians as well. I think that a broader part of the New Zealand preventative approach is looking upstream instead of looking at the offender and trying to prevent the offender from looking at a greater focus on victims. I think that Scotland came a long way in victims in recent years. There's no doubt about that. I think that we've got some really good practice on victims of sexual crime, domestic abuse and others. I'm not as convinced that we've got the same level of support and examination of victims of other crime groups, whereas New Zealand tends to be looking at victims right across and far more measurements internally and on far more roles focused on prevention in victims than they do have a bit of offender. 10 minutes, so folk can keep comments brief. Alan, to follow by Aileen. The simplicity of the target would have been very much my comment here. Just to endorse some of the things Paul is just saying, that simplicity is a truism that common sense never attracts funding. We need to be clear exactly what we want a classic example in the justice field. Everything is based around reducing re-offending. Is that what we want or do we want to reduce offending? We've not got it right. We've not got our focus right here. Simple targets allow for meaningful discussion. Complex targets create issues and create complex solutions, and we need more simple targets. How are we going to get there is the question. What do we want to achieve is the fundamental thing that we need to get right initially. Secondly, the development of the community justice bill has been a real eye-opener. Many of us from the third sector have been involved in the forum that I belong to has been very much involved in the wording of that bill and the formulation of the thinking behind it. It's been excellent. It's been a very long process, but it's been good because the third sector is genuinely written into it. The approach now reflects some of the third sector thinking. Prior to our involvement, there was nothing about the sector in the bill. Absolutely nothing. Just for me, I'm saying that that is an example of good practice where we're taking everybody who's involved and getting them involved in strategic thinking. Aileen Toffol by Jeane? Very briefly, it's just a word about public health. I think that if you take a long-term view on the public health and look at the bigger picture of public health in the round, there are some very simple solutions that we could use. People talked about silos. We have lots of silos and lots of different parts of the NHS that have public health campaigns. We don't join anything up at the moment. We have community pharmacies with posters in the windows six times a year. That doesn't join up with anything on the side of the buses or on the TV, drop a glass size or anything at all. If we think slightly out the box and have a bit more collaboration, there's an awful lot that we could do with very simple solutions, which would be very big on the public health picture and be very long-term, but it wouldn't be particularly expensive. Jeane Toffol by Aileen? On Nick Watson's point about what is right for the gorbls, just because we see a really good example, we can't roll it out. However, what we can do is often inspire other people by a good example. We're not saying that's what they did and we have to do it here, but when we throw down the gauntlet, I think that quite often, particularly in local communities, they will pick it up. I think that what needs to happen is more encouragement and confidence that people can do it, and not meetings where we have agencies saying, well, I don't think that you'll be able to do that because, and changing that to, we'd have to challenge this, but giving people the confidence that they can actually make that difference. Finally, just on the long-term planning, I don't see anything wrong. I mean, lots of agencies have it. We're going to be free of breast cancer by 2030. Different agencies have different times. Governments are known to say it to in terms of improving education or whatever. They do put time limits on it, and why shouldn't we aspire to a 25-year plan for Scotland? It shouldn't be restricted to a political cycle because, for the massive people who are making this work, there is no political cycle in that sense, so we can actually work towards that. Finally, I would just say that one of the real frustrations in Scotland, whether it's a Scottish Six or what, I don't know, is just that we are not good at showing ourselves and what is happening across the country. We end up with huge chunks of the country not knowing what's thinking they might know, but not actually knowing the reality of what other communities can do and what other agencies do to help them and how it works. That really has to be part of our thinking for the future, is sharing that knowledge across the country. One of the issues that we're not on a Scottish Six is that there are people who think that the junior doctors are on strike in Scotland today. Elaine Toofor by Andrew. It's one that's fallen on from Paul's about our communities and people in them and seeing them as an asset. Before we get there, we need to think about how we engage with people in the communities, how many individuals responded to this consultation for evidence, how many people knew about it and if we want to think about prevention, we need to think about how we engage with people differently, reach them in the communities, think about beyond the public meetings so that they can feel involved. For example, we can be setting up stalls in the shopping centres or places like that where people go or there are some examples of work done in supermarkets where people are generally going and you can have a conversation about what's important to them, what they would want. I think that we just need to think out the box about how we engage communities and how we build them up as community assets. The second thing is that I totally agree with the fact that people get inspired by seeing good practice and what happens. We try and encourage networking opportunities to bring people together to share good stories. I also think to make things happen well. There are local needs across different areas. I'm not saying that everything will need to be different and that one size does not fit all, but there are components underneath that that are fundamental to make things work and make things happen. That is about having a shared vision and a shared aim, so we are all working towards the same thing. We are being clear together what we mean by prevention and what we are trying to achieve for prevention. Relationships are really important. Relationships make things happen and being able to talk to each other, have open conversations and be able to come up with any new solutions and ideas and address the challenges as they emerge, as they will in partnership working. The other thing is to be flexible. We cannot be flexible and adapt as things progress and move on. We are not going to try and move forward. I would say that those are the other fundamentals that we need to think about as we progress in the preventative agenda. I add my support to what Justina was saying in Iran about longer-term funding models. Third sector organisations, some of those mentioned in our briefings, have a massive impact on people's lives, preventing them from their conditions worsening or preventing them from entering hospital, but they are operating in a one-year funding cycle and sometimes a shorter funding cycle than that. We need to learn more from five-year approaches. For instance, the National Links Worker programme, which sits with the Alliance, is a five-year approach. It has built-in learning coming from it, which is going to be learnt from going forward in different areas of the country. We really need to learn more from that. I will also make a plea for more change management capacity to bring us towards prevention. I know that John talked about that earlier on, but looking at the current models that are driving public service reform, the integrated care fund, for example, is £300 million over three years, but that in total is around 1.4 per cent of the overall health budget. We would like to see that increased so that we are talking about something a bit more transformational rather than around the edges, which is referred to earlier on. We would like to see an additional shift in investment there. That is the kind of things that we would like to see. Okay. Thank you for that. Colin seems to think that I have telepathic skills because he does want to come in, but he has not indicated, so I will let you in briefly after Nick. I agree with John. We should be sharing where it has worked and where it has done it, but it is actually the process that they did, rather than how they did and what they did. I think it is a thing to share. One final point I want to make is that we need to make sure about workforce issues. Staff in the public sector and the third sector are facing massive policy changes. One change is health and social care integration, community empowerment. Speaking to people last week, they have now got new national clinical guidelines and new mental health guidelines and new child welfare things. These are making massive work changes in the way that people are working and stuff just haven't got, because we've got cut backs, people don't know if they're going to be in their job next month or in three months' time. Everybody's acting reactively. There's not enough space for people to sit down and proactively say, right, what do we do to stop this? If we want prevention, it's got to be. People have got to have time and space to go away joint training and joint opportunities to bring people together. At the moment, everything just feels, it's certainly clear that we're seeing the people massive policy overload, especially in the public sector around social care, health and social care integration, SDS. These are massively new changes in the way and they've all been rolled out one after another, now new national clinical guidelines, new mental health. They don't know where, they don't know what's coming next. I agree that the policy is starting to put in the right direction, but think of the workforce as well when making all these changes. We've talked a lot to think about public services in the public and the third sector. There are other levers we have however around prevention, macroeconomic, fiscal, in my own context. Planning, I would particularly emphasise, if you look at what's coming through our planning system in Scotland just now, we are building housing for a population we're not going to be in 30 years time and we're building nothing for the population. We are going to be. If we do that, we will have a whole lot of people ending up in hospital 30 years from now because they're having to live in housing that's grossly inappropriate for their age, their frailty and so on. I do think we need to think about all the levers Governments in the public sector have and that includes regulatory and planning powers as well as our direct delivery and funding of public services and I think we're under exploiting some of these levers at the present moment. Thank you very much and I'd like to thank everyone for their contributions. I think it's been a really interesting form of debate and certainly the finance committee will produce our legacy paper in a couple of weeks to deliver on much of what's been said today. Thank you all for your contributions. I'm now going to call a five-minute recess to allow an actual break for members and change what this is. We convene the session. We will now continue to consider progress to world's prevention by taking evidence from the Deputy First Minister. Mr Swinney is joined for this item by Brian Logan of the Scottish Government. I intend to allow an hour or so for this session. I would like to welcome our witnesses to the meeting and invite Mr Swinney to make an opening statement. I'm afraid that it's only a small bit. I'm sure that you will agree perfectly formed committee this morning. Thank you, convener. The finance committee's focus on prevention and budget scrutiny over recent years has been very helpful in framing the debate. I welcome this inquiry and I look forward to the legacy report that is formed by the committee. The Government has set a clear direction for reform in Scotland. Prevention is its cornerstone and I believe that we're making substantial progress on that journey. We've seen through real successes in tackling the burdens of preventable disease through improved treatment and progress and helping Scots to make better choices to support their own health. The significant changes that we have made to national structure, systems and frameworks have created the right conditions for change. An important early achievement was moving to single police and fire services, with recorded crime in Scotland down 5 per cent in 2014-15 to the lowest level in 41 years. The new model for community justice will further strengthen the role of community planning partners in crime prevention and community justice services. In the Fire and Rescue Service, in 2014, the number of dwelling fires was approximately a fifth less than 10 years ago. The Fire and Rescue Service has significantly transformed its way of operation to support home visits to enhance the levels of fire safety within the home. In the most ambitious reform of health and social care services in Scotland, since the creation of the NHS in 1948, we have brought about a fundamental realignment of resources that will build the capacity of community-based services. That will mean that fewer people need to go to hospital, but it will also ensure that, where hospital care is necessary, people will return home in a swifter way than before. In Glasgow City, there has been a 75 per cent reduction in bed days lost delays for people over 65 since December last year. The Kings Fund noted last year that Scotland has made most progress on integrating health and social care in the United Kingdom. Community planning continues to be the driving force for reform at the local level, and the Community Empowerment Scotland Act gives a new impetus to community planning, placing specific duties on public bodies to improve local outcomes and tackle inequalities within local communities. The early years change fund returns tell us that every community planning partnership has embraced the early years collaborative, which provides a method for delivering change in the way that people are thinking and working to prioritise prevention more effectively. We have invested significantly in the public social partnership model of co-planning, which involves the third sector working alongside a public sector body. The LoMOS prisoner support pathway has resulted in a step change in the way that reducing re-offending is tackled, both in the prison and in the community, and the evaluation of the LoMOS public social partnership is being published today. The independent evaluation of the reducing re-offending change fund was published in February and provides a positive assessment of the ability of such services to address the needs of offenders. Our investment is designed to support long-term change in the delivery of public services by the investment in infrastructure and investment to support the delivery of effective community services that can meet the needs of individuals within our society. The Government believes that we are making progress on this long-term agenda and remains absolutely committed to continuing that journey in the period ahead. I thank you very much for that opening statement. Much of what you said has been supported by some of the people who spoke in a round-table session. For example, the RCN said that progress is being made by many organisations on the ground in terms of the way in which we are looking at work and prevention. A lot of the work that the police said, which you have touched on, is also very positive. Of course, the comment was made that we are about 60 per cent of the way towards prevention, so there are still some ways to go. I do not know how that figure is particularly measured, but I do not know whether you would want to comment on it. However, there are some issues where there appear to be concerns continuing. For example, the issue of silo mentality still appears to be extant within our public services. Apex made a comment that said that, in terms of prevention, channeling most, if not all, funding through local authorities causes intense pressure on the same authorities to retain as much as possible if they bill funds the detriment of success for innovative partnering with the third sector. We heard, for example, about how it takes less pressure off local authorities and the health service, if, for example, there are lunch clubs run by volunteers. Those are things that are just loneliness and isolation among elderly people and something falling on the kind of expensive services that I have just mentioned. I am just wondering what for the progress that the Scottish Government plans to take forward in terms of delivering, particularly to try to ensure that the third sector is not being squeezed out of the preventative spend agenda. It is a very important question, convener, and one that I would want to avoid a situation in which the third sector felt squeezed out of the solutions here. I think that the third sector is central to the services. I think that what is a challenge is finding the right models that will enable us to ensure that that is the case. In the Christie commission report, the Christie commission is thinking anchors what the agenda of the Government is taking forward on public service reform. In the Christie agenda, there was an emphasis on place, on essentially drawing together all public service organisations in one locality and focusing on the needs of that locality. In my experience, that is a very successful way of operating. However, that requires us to channel resources through local authorities who will be the key players in all localities to ensure that services can be funded in a fashion at local level that meets the needs and the circumstances of people in that locality. The needs of communities that you represent, convener, in parts of Ayrshire, will be very different to the type of services that communities require in the areas that I represent in Perthshire. We have taken a view of trying to channel resources to the local level and enable local decision making about how that should be deployed. What I acknowledge is that that sometimes causes concern within the third sector community who would rather be contracted directly with those third sector organisations. On balance, I think that the Government would find that pretty difficult to do, because we would be in danger of trespassing on good, connected work at local level, which is already under way if we were doing that directly. I think that that would be the danger. The requirement is for us to perhaps reinforce some of the dialogue with local authorities about how we can work together to make sure that third sector organisations are able to be influential in how that agenda is taken forward at local level. One of the things that the RCN said in the previous evidence session was the fact that the issue of locality is that there does not seem to be a clear view of what locality is. For example, some of them are based on council words, such as my own area. For example, another area is on the extent of GP practices or other ideas of locality. There seems to be a blurring as to what locality is and what it can potentially deliver. There will always be choices about what is at the correct level. Of course, locality in certain circumstances will go right down to streets and individual settlements where people can find solutions for the challenges that they face. The priority is to leave that decision making to localities to design the solutions that meet their requirements. However, I will be interested in the committee's thoughts about how we might intensify the process. We need to insist that all localities contribute to the agenda in the fashion that I have set out and that we do not have the danger of swallowing up responsibilities and activities into local authorities at the expense of local discretion and decision making in individual communities. Thank you. You yourself said in the draft budget response to our report last year that there is some evidence of change at a local level. We need to see this replicated more quickly on a greater scale. Culture change is necessary when we will only be achieved through greater levels of integration public service partners. The pace of progress being made by community planning partnerships needs to increase markedly. If you think in terms of developing a single joined up cohesion framework, whether that is actually happening, there has been any big shift in the last year in terms of that?  It is not. We are still on the journey. I think that we are making more progress on that journey. On the three areas that you talked about there, convener, of culture change, increasing role of community planning partnerships and the pace of change, I think that on all three, we are in a stronger position than we were when I responded to the committee last year. I do not for a moment believe that it is job completed as a consequence. We still need to encourage the change of culture and attitudes to break down boundaries between public services. We need to encourage more integration and cohesion amongst community planning partnerships and we need to continue to increase the tempo of change within our public services. Do you have confidence that that is taking place? Are there any kind of examples of any short-term preventative initiatives that we believe could be taken forward over the next few months, for example, just to let people know that the key drive in that area is continuing? The key drive in the next few weeks, convener, will be right across the country the integration of health and social care on 1 April. That must be a service change that is visible and discernible to members of the public in a very short space of time. Fundamentally, in public policy, we spend an infinite amount of time wrestling with structures and processes. What is really at the heart of integrating health and social care are the individuals who are required to use those services. The integration of health and social care is a very person-centred process where we design services to meet the needs of an individual rather than to configure the propositions and offerings of two significant bureaucracies, the health service and the local authority, to perhaps meet the needs of that individual. Health and social care integration allows us to go to the other end of the telescope and to look at the issue from the perspective of the member of the public who needs to experience integrated services to support their requirements. That is really at the heart of the agenda that we are taking forward. I welcome the progress that has been made, but is it far enough? I am thinking about, for example, in Ayrshire, we have got three local authorities and we have had to set up three integrated joint boards, each of which has to separately work with the health board in terms of trying to deliver a structure that one would have thought we could do much more seamlessly. Across Ayrshire, if we had perhaps a different structure, one of the things that was discussed also was how the planning system and the regulatory framework could be improved to help deliver on the preventive spend. The integrated joint boards seem to me almost a clumsy response, because it still requires not only joint working between health boards and local authorities, but willingness for both of them to collaborate and co-operate. Is there an issue with personalities in some of those? There will always be issues with personalities, convener. If we could remove that from the challenges that we face, life would be an awful and more straightforward. That is not a reflection on the dynamics of the organisation of which we are both members. My view of health and social care integration is that it is not about joint working, it is about changing the way that we work. I make my point that the service that a member of the public experiences has to be different. If we have been blunt about it, members of the public often can be passed from pillar to post in the public services in the area of health and social care. That has to stop with the integration of health and social care, so a member of the public interacts with health and social care service and they must experience a joined-up collaborative proposition. That is the key requirement of health and social care integration. Do you feel that, in terms of prevention, it is considered to be a core aspect of delivery or is it still considered by many organisations in the public sector to be a kind of add-on that they may wish to do, but it is not at the centre of what they are trying to do. It says that cultural change is what we are trying to do. I do think that it is. I happened very recently to be involved in a situation in my constituency that involved a fairly intense level of GP care for an elderly individual. I was overwhelmed by what I experienced of preventative planning by a GP, the objective of which was to avoid an elderly constituent having to go to an acute hospital. A level of preventative planning that the GP did in its judgment, because it would create a better outcome for the elderly constituent of mine, I was enormously impressed by how that was undertaken. The easiest thing for the GP to have done would have been to call for an ambulance and get my constituent taken to Petrol and Firmory. However, its judgment was that its needs would be better supported in a different pre-planned preventative way, and that was undoubtedly the right judgment to have made. The question then, of course, is how widespread is that approach. I detect within the system a much greater propensity to undertake that type of approach. That is just one snapshot. There will be other examples of where services are being done. I gave some examples in my opening remarks about the fire and rescue service, for example. The fire and rescue service, to me, is one of the leading examples of an organisation that has absolutely reconfigured its purpose. Of course, fire engines still go out to put out fires, of course they do, but the overwhelming majority of the activities of the fire and rescue service is about fire prevention now. It is a tremendous credit to the chief fire officer and his staff around the country for the way in which they have exercised that responsibility. When I go around my constituency to Galadies, community events and various events, the fire and rescue service is there, patiently and quietly, punting the message about fire safety to vulnerable members in the community. It is a tremendous testament of how a service, five or ten years ago, was a predominantly reactive service, is now predominantly a preventative service. I think that there are numerous examples of how that has been taken forward across the country. I agree with that from the evidence that we received earlier on, but Apex made an interesting point that said that the criminal justice system, which he touched on, was a crime at a 41-year low. The focus is on reducing re-offending, not about offending in the first place specifically, which I found interesting. We did not get any contradiction from our chief superintendent, who was here in the same session from that. There is an issue about how we ensure that the correct measures of prevention are being used. I think that the reducing re-offending example is very encouraging about the shift of emphasis, but I think that Apex gives us a salutary reminder that one of our priorities must be to reduce offending in the first place. That is not going to be just an issue taken forward by the criminal justice system. It is more likely to be taken forward by the strength and the quality of our education system in terms of nurturing and supporting young people to avoid getting down the route of offending. It will involve a heavy dependence on the effectives of parenting to encourage young people to take the correct path in life. It will depend heavily on the proactive intervention of a variety of third sector organisations. I had a cause to encounter a young man who was involved in the Prince's Trust, who set up his own business in the Prince's Trust. He freely told me that he was heading for a very, very troubled life, but he had been referred by a social worker to the Prince's Trust, where he had been introduced to the Prince's Trust's business development service. Let me say that he was a pretty creative individual, so he might have prospered in a life of crime, but he decided to prosper in a life of business and made a connection with a retired army officer who was working through the Prince's Trust. The conversation that I had with those two individuals—two people from two different backgrounds, you could never—the difference in their backgrounds was cut loss, but there was a respect between those two individuals. The young man freely volunteered that if he hadn't encountered this retired army officer, he probably would have ended up in a total mess and had been taken seriously by this army officer. The third sector is an example of an organisation focused on delivering better outcomes for young people and directing them away from offending, where the young man could quite clearly see that he was heading. The reason why I cite those examples is not to say that there is not one organisation that will be the custodian of trying to avoid young people becoming involved in offending. When we get to older age groups, in older age groups, there will also be a requirement to encourage people to change their lifestyles, to avoid getting into offending, and there will be other interventions that have to be undertaken to take a fault. I cite those examples to demonstrate that it has to be a whole system solution. It cannot just be that we rely on organisation X to stop people from getting involved in offending. It has to be a whole range of different organisations putting their part. Okay, thank you. Just one final question and I will open up the session on that. Disinvestment, or you may want to call it reinvestment or whatever it is, is that that is actually taking place at any scale. I think that the whole concept of disinvestment is quite a difficult one for us to tabulate, because what I would accept is that public expenditure is spent in a different way today than it was spent five years ago or ten years ago. We should call it disinvestment to give it a harder age, but undoubtedly money has been spent in a different way as a consequence of reform. I make no apology for that. That is a good thing. Under health and social care integration, money will have to be spent in a different way to how it is spent just now, because we must get reform out of this process of change. Okay, thank you for that. The first colleague to ask questions will be John Tuifaw by Jeane. Thanks, convener. We had a very good session just now with quite a number of witnesses, and one was called Mayor for the Improvement Service. He was really challenging even the questions that we were asking. I am also raising the whole question about whether you cannot really say that a particular pound is a preventative pound. It is very hard to measure, and he is arguing that even if prevention is succeeding, we will not necessarily see a figure moved from this bit of the budget to that bit of the budget. However, my problem with that is that how do we measure it? We are the finance committee. How can we tell at our level if it is actually happening, if there is more prevention? If it is all about attitude, how do we measure that? I do not think that it is all about attitude. I think that we should have measures of performance that enable us to test whether or not we are delivering a more preventative range of public services. For example, I agree with Mr Mayor that it is impossible to go through the budget and say that that is a pound for prevention and that is a pound for reaction. I think that that is really difficult to do. However, over time—and those things will need to be measured over time—you can look and see whether, as a consequence of our policy interventions—and this is the whole purpose of Scotland performs—are we reducing re-offending by our policies? The answer to that question will be yes or no, because that is measurable. Will we reduce emergency admissions to hospital, unscheduled emergency admissions to hospital, given the change in the dynamics of our population? As the population ages, the risk of unscheduled emergency admissions grows higher. In the context of those expected changes in trains, are we reducing that volume of activity? Those things are all measurable. We should have a pretty hard look at Scotland performs. The Government has launched Scotland performs back in 2007. We have adapted it and revised it on a couple of occasions. I am very open to it being challenged to create a framework that would enable it. In my view, that is what it is there to do. It is there to see if we are making progress on those big questions. If it is not telling us that it does not give us the right information to do that, then let us change it and reconfigure it. If we have an indicator that says that we want to increase the proportion of young people going to positive destinations out of education, I take that as a proxy for good outcomes for young people. We should be quite comfortable with that. If we are looking at a fending, if we saw a fending rising, that would be a bad outcome. We would have to look at our policy mix to say, what can we do differently to get that indicator to go the other way? I think that it is through that performance framework that we undertake that work. I would be very open to the committee and to Parliament. I have engaged in this issue with Parliament across the political spectrum on the effectiveness of Scotland performs. I am completely open to whether or not that does what we would like it to do. My feeling is that people are comfortable with the concept of Scotland performs and the bigger aim or outcome. Colmair was certainly arguing for outcomes, maybe even less, to talk about prevention. The RCN raised questions about the NHS and targets, and is that really helping prevention? There can be a focus on what we can easily measure like A and E waiting times. It may not be as easy to measure quality of mental health provision and the community. I think that that is a pretty fair point, to be honest. I have listened to a lot of commentary from professionals across a number of different sectors who say that some of the targets that we follow are not particularly conducive towards measuring whether or not we are making progress on the improvement in outcomes. Again, that is something that we should be open to considering. There will be a political desire within political debate to have some of those hard measures. Mr Mason and I sit at question time on a Thursday lunchtime at noon and sometimes the Government's performance against some of those measures is the subject of some debate in the Parliamentary Chamber, having for a friend. We have mentioned the third sector already. I just want to go back to that, because Alan Staff, who was here from Apex, was arguing quite strongly that on the preventative side of things, the third sector is better than the public sector at doing that kind of preventative work, mobilising volunteers, all of that kind of thing. Would you agree with that? Is that going too far? I think that the third sector is very good at contributing towards prevention. I do not think that they are the exclusive players that should be delivering prevention. I think that the public sector must be delivering preventative services into the bargain, but I think that the third sector has a tremendous track record to be very proud of in terms of delivering preventative interventions, but it is not something that we should just say, but we will leave prevention to the third sector. I would be completely against that, because this needs to be a concept that is owned and advanced by everyone in the public, private and third centres. My final point is that the police came up with the idea of a national Christie champion, somebody that Christie is obviously wider than just prevention, but that is quite central. Somebody that would really be up there all the time challenging us all about this. Do you think that that is a useful concept? I think that there is merit in that idea. Government needs to look at how we advance the agenda. Some of those points come back to what I discussed with the convener about the degree of progress that we are making on the journey. Ministers evangelise about those points regularly, and we are constantly pushing and pushing and pushing. Colin Mayer is a very good example of somebody who pushes and pushes and pushes on those questions, and there are many others like that. I suppose that you have had to make a choice between having a Christie champion or a public sector that was motivated by delivering Christie. I would choose the public sector that was motivated by delivering Christie. That would be my first choice ahead of a Christie champion. The paper that we were given by the Scottish Community Justice Authorities quoted John Carnican as somebody who made a case, apparently to you in the last parliamentary session, calling for the Scottish Government to invest in 1,000 new health visitors rather than 1,000 new police officers. Now that we have 500 new health visitors, was he right? I generally think that Mr Carnican is broadly correct on most things, to be honest. I suppose that it is better to look at his Twitter feed to see if I agree with everything that he has ever said. John Carnican has been a fabulous advocate of preventive intervention. Mr Carnican is not only an advocate, but he can be proud of the record that he has delivered in violence reduction, which has been one of the most significant developments in our society in many years. The argument that he advances is about taking steps to ensure that everyone gets off on life on the right footing. That is essentially the simple concept that lies behind the rational of his thinking. In that respect, I think that he is absolutely right. One of the statements that has stayed in my mind from the earlier discussion was from Aileen Bryson from the Royal Pharmacutical Society, where she said that we only use 50 per cent of the medicines and that that 50 per cent equates, and I am sure that she said that in my app to look in the report, but it is second only to salaries. I do not know off the top of my head what an NHS salary bill is, but I am sure that you probably do, but it is a lot. The pharmaceutical bill is a big bill. It may be that, but she did not have time to ask. That seems to be an area where it is also something that we hear people in everyday language just talking about the fact that they got a prescription with 40 pills, but after the third one they could not take them or they had to take them back or they were on a trial or they did not use them. Are we interested in that in terms, particularly given that some of the Opposition parties or other people are calling for a reintroduction of charging people who can afford it for prescriptions again, believing that that would contribute to public services, but it just seems to be an area that is worth investigation? We certainly are very much interested in prescribing and prescribing practice and the implications that that has for the pharmaceutical bill within the national health service. Yes, we are very interested in that. The health secretary and I work very closely with the chief pharmaceutical officer to ensure that health boards are managing very carefully prescribing practice. Obviously, a prescription has got to be issued by a qualified practitioner. For that to happen, a judgment has to be made that that prescription is necessary, so I am not a qualified medical practitioner. I cannot second guess what a medical practitioner decides an individual member of the public requires, but that should be their consideration. The prescription should not and will not be issued unless they are required by individuals. I will take a second point, which is about general health and wellbeing. If I generally look after my health better than I was looking after it before, I will be less likely to require a prescription. It is not just all about GPs and clinicians, getting their prescribing practices correct. It is about every citizen thinking, well, actually, I really should look after myself a bit better and keep healthier. As a consequence of that, perhaps I will make my own quiet contribution not to requiring many prescriptions. A wider preventative agenda must be to encourage citizens to take a greater interest in their health and wellbeing. Some of the examples, if you take—we can take forward some pretty bold health improvement messages. The ban is smoking in public places, introduced by the previous Government, supported by this Government. Indeed, the concept of it was advanced by the convener of this committee many years ago in his youth. That has made, in a very short space in time, a discernible difference in the health and wellbeing of newborn babies in our country. It is absolutely measurable and tangible in public policy reform. There will be general health and wellbeing reforms that will contribute significantly to the reduction in the need for prescribing. If a baby is born and does not have asthmatic difficulties because they have not been nurtured in the womb in a smoke-filled environment, there will be the beneficiaries of that as a society for many, many years thereafter. For every one case where that happens, the health improvement among the newborn baby population in Scotland as the ban is smoking in public places is one of the greatest successes in public policy. I quite agree, cabinet secretary, that getting everyone to take fewer prescribed drugs is desirable. However, at the same time, I agree that there are questions to be raised about pharmacutical companies, about how we buy drugs, the cost of drugs, the potential for saving on the drugs industry in Scotland, that there is an opportunity there to expose some practices, but certainly to the figures of 50 per cent not being used is worthy of more than encouraging people not to go to the doctor. I come back to my core point about prescribing. Medical practitioners are under an obligation whatever a pharmaceutical company does. If pharmaceutical companies did not do what they do, we would not have drugs that are saving people's lives today. That is really important. It is then up to medical practitioners to prescribe appropriately and to be mindful of the resources that are involved in their prescribing practices. There is also an issue about some data that looked at the performance of individuals taking medication to deal with COPD and the relationship between that and unscheduled hospital admissions. Essentially, there is a direct correlation between poor performance in taking drugs to deal with COPD and unscheduled hospital admissions. The moral of the story is that, if people had taken their drugs as they were told on the packet, they would not have ended up in hospital. That is where I come back to my general. If a doctor goes to the trouble of saying to me, here you are, Mr Swinney, take these tablets and do this and do that. If I am interested in my health and wellbeing, I feel pretty obliged to take seriously what my GP has said to me. One of the other issues that arose was the potential for much longer term planning and joint vision that we would have for Scotland and spreading that political message and highlighting how we want people to work together to prevent all kinds of things from loneliness to communities working well, caring for each other, not taking medication, being healthy and having all the agencies signed up and working in that way. It seems to me that there is a potential for doing that. I made the point that we have plans to eradicate breast cancer by 2030 and to do other things. That should not be stopped by a parliamentary session, should it? It should not and I do not think that it is. When we formed the Government in 2007, I would say that we continued broadly the direction of travel that had been established by the previous Government over an eight-year period. I would like to think that we have intensified it, we have focused it and we have obviously undertaken different policy choices on different issues that mattered to us politically and for which we had a mandate. However, in the core message and approach of what we are trying to do to improve the quality of life of people in Scotland, if I give an example, the previous Government spent a large amount of time in the early part of the last of this century trying to tackle the three big killers within Scotland in the health service. When we came in in 2007 and we did not say, okay, that is coming to an end, we carried that on. Why? Because it was the right thing to do. We are able to broaden out on to wider topics and wider challenges because such an impact has been made on the three big killers in Scotland and such an improvement has been made in the outcomes for individuals. I have cited the ban on smoking in public places, we were enthusiastic opposition supporters of that ban on smoking in public places. We were right behind the Government to do that and we have added our approach on alcohol consumption to me as the extension of that general approach that we inherited from the previous Government. Of course, there have been different things. We believe in different things and we focus on different things compared to the Government that preceded us, but in a lot of other things, much more so than we would normally admit at 12 o'clock on a Thursday downstairs, there is a general scope of agreement of the right things to do to improve the health and wellbeing of people in Scotland. That is Mark, to be fought by Leslie. Thank you very much, convener. A number of the points that I was going to raise have come up already. I wanted to ask about change funds and whether you felt that the change fund had been used appropriately, is the term that I would use across Scotland by local authorities. I have heard evidence of a very good use of change fund monies that have delivered new ways of working, which have since been mainstreamed. In other areas, the change fund money was used to effectively fund short-term projects that have now been shelved, even though they had been demonstrated to deliver very good outcomes for the individuals who were using those services. Do you think that there has been a mixed approach taken in terms of change fund? I think that, generally, the change funds have generated a good new and reformed practice in the delivery of public services. If I have one regret about them—well, probably two regrets about them—one is that I am sure that there will be examples where the money could have been better spent and more effectively spent. I am sure that there must be a naive not to believe that. The second regret is that by establishing change funds that were worth about £500 million over a three-year period, we rather were at risk of giving the impression that they were the pockets of money to drive the change, not the £60 billion of health and social health and local government spending that was spent at the same time. If I am making that point clearly enough, I think that the one danger of setting up a change fund is that people think that we have this change fund over here, which is £500 million. We will spend this on change staff. Meanwhile, we will spend this £60 billion the way that we have always spent it in health and local government. That misses the point. The point is that you should be looking at your £60 billion to say, is this the right way to spend the money to deliver the aspirations of prevention, place people performance in the Christie commission, or do we need to do that differently? That is a lesson that I have learned from that process, which is why we now are advocating our case much more strongly on the basis of using the money that is available in mainstream expenditure to meet the range of different challenges that we face as a society. Obviously, a number of local authorities have moved to a priority-based budgeting approach. It is something that we rolled out in Aberdeen when Sue Bruce was the chief executive. There are a number who have not made that transition yet. What can be done to try to m