Imagine a tap running with water pouring into a wash hand basin. Now imagine that there is so much water coming out of the tap that the basin is overflowing. Now imagine the water pouring onto the floor and you are handed a bucket and mop to clear up the water on the floor, but more and more water keeps coming out of the tap and the floor is getting wetter and wetter. Soon you are joined by more people to help you mop the floor, but you are still struggling to mop up the water on the floor as more and more water comes out of the tap.
This seems a strange scenario, but in a way, this reflects what our public services are doing.
We have more and more people arriving at A&E, so we increase spending to get more nurses and doctors. We have more and more people dying from substance use, so we increase spending on recovery programmes. We have more and more young people dying by suicide and struggling with their mental health, so we increase spending on crisis services. We see more and more anti-social behaviour in our communities, so we increase spending on policing.
Maybe someone should think about turning the tap off?
But that’s difficult when there is less and less money available as it’s being used to fund more crisis services, and this is the challenge the Edinburgh Integration Joint Board faced recently. With a budget of £700 million, but an overspend of £50 million, the joint Council / NHS Lothian group tried to cut £4.6 million from 64 charities across Edinburgh that are doing early prevention work with families, young people and the elderly.
It was easy to target these groups (including Venture Scotland) as they don’t offer crisis services. Instead, they work within their communities, supporting the most vulnerable preventing them or delaying them from needing crisis services which are under so much pressure – cutting these services simply lets more water come out of the tap.
At this year’s SCVO Gathering conference, I attended a presentation by Professor Kezia Dugdale and Professor Nicola McEwen from the University of Glasgow’s Centre for Public Policy in a frank conversation about the money behind Scotland’s public policy landscape and the challenges in moving money from crisis services into preventative services. You can’t simply close A&E departments, can you?
I was encouraged to hear Professor Dugdale and Professor McEwen point out that, in some circumstances, it is possible to stop funding the crisis service at the same time as increasing spending on a directly related preventative service, however, people’s lives are multi-faceted so it’s not always simple to change one thing in someone’s life and to know the direct positive impact.
And this is the problem with this debate – we need money to maintain the crisis services but also need to fund a diverse array of prevention services, whose full impact will take some time to filter down to stop the crisis from happening in the first place. Some of the impact will be seen in weeks, others in months and for much of the impact of prevention work, it will be seen in years.
I watch with great concern the reports on our young people and the rise in anti-social behaviour, the rise in drug use among teenagers, the rise in referrals for mental health support and the continuing rise in suicide rates.
The resultant crisis is the increase in young people not in education, employment or training – currently about 1 million in the UK. This is going to have a devastating impact on our economy and maybe, just maybe, our governments will finally realise they have to do something to reverse this trend and begin to see that criminalising or financially sanctioning these young people might not be the best way to get them economically active.
Perhaps investing in prevention by properly funding youth workers to get alongside these young people, to support them to work out who they are and what they want for their futures, to build trusted relationships and give them some hope in their lives, might just be a better way?
Maybe a crisis is needed to change the way we think about services and how we boost our economy, give people hope, improve people’s physical and mental health and create a better world. If so, Venture Scotland will be here to be part of that solution.
And together, perhaps we can start to turn off the tap.
David Brackenridge, CEO
