Prevention is a fundamental pillar of Christie and is central to the Scottish Approach to public service reform. Throughout our work in What Works Scotland we have explored the different meanings of prevention, the challenges it poses and the difficulties in the effective execution of prevention work.
One of the key insights that emerged from our five research seminars on prevention was just how difficult it is to work preventatively. It is a very complex and demanding area. It is hard to predict with any accuracy just how beneficial a policy will be or when it will achieve its effect and there are often unintended and/or unseen benefits or costs, associated with any preventative action. For example, when it comes to planning and working out how to fund preventative services, it is hard to justify disinvestment now, in order to fund new initiatives to save in the future. Our research suggests that this is very much an area of developing and evolving policy and practice.
That said, there are a number of insights that have emerged from our work. These include:
Co-production can lay the groundwork for prevention. Our work with Operation Modulus demonstrated how involving communities and those who design and implement services builds trust and confidence of participants in a programme. Co-production can help to strike the right balance between upstream and downstream activities. This takes time and effort, it is an iterative process, not a transaction. A strong co-production approach to programme development has the potential to sow the seeds for further preventative work in a community.
Prevention is not only difficult to implement, it is also difficult to sustain. There are times, for example, where the immediate needs of the system can be used to undermine long term work aimed at reducing need in the future. It is hard to predict quantifiable benefits in both the short and the long term and there are often unforeseen benefits and costs associated with prevention.
The benefits of prevention programmes extend well beyond those who are the immediate targets and their effects are felt by all sectors of both society and the economy.
The community sector can act as a long-term voice for sustaining a focus on preventing inequalities. In our work with Aberdeenshire Community Planning Partnership we were able to demonstrate how community participation is key to developing good preventative practice, and to ensuring that the focus stays on prevention. This, we argue, can best be achieved by developing initiatives that work though a place-based, community organisation – an anchor organisation – and these can best host public service reform initiatives. Anchor organisations can build on local programme success to develop further initiatives, including prevention-based approaches.
Good community anchors are well placed as leaders in work that aims to mitigate the worst excesses of inequality. They can help to develop sustainable initiatives that boost the local economy, tackle poverty and reduce harm.
Good prevention work that aims to tackle inequality should be empowering and enabling and it is characterised by reciprocity. The initiatives should be enjoyable, sociable, positive experiences, and bring people together to address isolation and loneliness by building or re-building communities of geography or interest.
To be effective, prevention programmes have to offer desired and meaningful opportunities as alternatives. Effective prevention services are targeted at a population and are able to foster independence.
Implications for policy and practice
- To develop good, sustainable, prevention-focussed work funders and those who design and deliver services must combine a focus on both upstream and downstream action.If we are to tackle and prevent the root causes of inequality a prevention-focussed approach has to become the norm across all levels of the system. Currently prevention is mainly left to those working directly in the frontline. Whilst these organisations will continue to play a key role in attenuating the dire consequences for citizens and communities they need support from the centre.
- In developing and promoting prevention it is important to offer alternatives that are attractive and appealing (See Thriving Places’ family meal and homework club: parents’ experiences of social capital).
- Prevention requires innovation and collaboration across a range of different sectors. Prevention can mean that an investment by one sector will lead to a saving in another. The system has to be able to respond to this, perhaps the growth of integrated working will help here. Often, however, these savings are difficult to realise. Whilst, for example, a crime prevention programme may see fewer people going to prison, there will be little financial gain to the prison system.
- In addition, greater collaboration and integration will enable greater sharing examples of activities around prevention. Organisations will then be able to discuss how these findings can be adapted to a service’s particular needs, or to take account of the local context.
- Evaluation is key. Organisations have to develop a robust evidence base, providing insights into successful and unsuccessful local initiatives; and embracing innovation as a way of developing and improving approaches to prevention. The use of a good logic model and a well developed theory of change can help here.
- Prevention requires investment now to save money in the future. This means that prevention programmes are always under threat until they start to deliver savings and this may be a long time in the future. Other strategies and funding streams should be explored including the use of Social Investment Bonds and other public private initiatives.
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