Learning from 25 years of preventative interventions in Scotland

7. Building Support and Collaboration for Prevention

Introducing preventative interventions can be challenging and often requires organisations to work together in new ways. The case studies highlight a number of approaches that have been taken to build support and collaboration for preventative approaches. This includes:

• Developing evidence for change. Many of the case studies outline how, prior to implementation, extensive work was conducted to marshal and collect evidence in order to build a case for change. For example the implementation of FNP was informed by the evidence from multiple randomised control trials in the US and England. For Smokefree legislation, research was commissioned to estimate the number of deaths from second hand smoke in Scotland, and a review of workplace smoking policies and an international evidence review of the health and economic impact of regulating smoking in public places was conducted. This evidence helped inform the public and stakeholders about key issues relevant to the proposed legislation.
• Building political consensus and strong alliances. In 2017 the Scottish Government passed the Child Poverty (Scotland) Act. The Act was unanimously supported by all of the political parties in Holyrood. Political consensus around the need to address child poverty paved the way for the introduction of the SCP which was championed by a range of anti-poverty organisations. The level of cross party support for the SCP is notable in the context of significant spending challenges. For example, all five of the main political parties in Scotland pledged, in their manifestos for the 2021 election, to double the SCP weekly payment. A broad consensus was central to the success of Smokefree legislation. In the lead up to the Act and in its implementation, powerful alliances were built involving a range of charities and organisations.
• Conducting extensive public consultation. The case studies illustrate how the introduction of new prevention interventions have often been supported by extensive public engagement. For example, prior to the introduction of Smokefree legislation a detailed public consultation had been conducted, with around 600,000 questionnaires distributed. Twelve public forum meetings were also held in different cities as part of the consultation, and an international conference was hosted. These activities likely helped build public understanding of the issues the legislation was intended to address, and opinion polls in the period leading up to the passage of the law demonstrated a steady increase in public support^.
• Co-designing interventions with users. Some of the interventions included within the case studies were carefully developed with direct input from end users. For example, the design process for PRIME (a road safety intervention designed to improve the safety of motorcyclists) involved direct input from motorcyclists in order take a “user-centred” approach and ensure that motorcyclists accepted and used the approach. Co-design can also be an important means of improving accessibility and maximising take up. The SCP was designed in consultation with members of each of the six priority groups identified in the 2018 Child Poverty Delivery Plan. Detailed considerations in relation to how to maximise impact and take up were set out in the Equality and Fairer Scotland impact assessments.
• Developing clear communications. In North Lanarkshire, local media, signage, materials for families and community events were all used to communicate that the local authority was breastfeeding friendly. For the introduction of the smoking ban a cross-sector communication team was established with marketing and comms colleagues within the SE and in major charities (including ASH Scotland, Cancer Research UK, Macmillan Cancer Research, British Heart Foundation, and Chest, Heart and Stroke Scotland) and organisations (like the British Medical Association). A wide-ranging suite of communications campaigns and media was developed. A flyer to raise awareness of the legislation was sent to every household in Scotland, and a pack was also developed for MSPs to use in engaging with constituents which helped sustain political co-operation.
• Incremental rollout and expansion. Many of the case studies (such as FNP and Childsmile) set out how preventative interventions have been rolled out incrementally over a number of years and the model has evolved over time in response to evaluation evidence and local experience.
• Engaging constructively with opponents. Whilst the majority of Edinburgh residents were in favour of 20 mph limits the consultation highlighted some opposition and concern from bus operators and taxi drivers about the impact of 20 mph limits on their operations and journey times, as well as concerns over enforcement of 20 mph limits. The City of Edinburgh Council pledged to work with bus operators and road safety partners to resolve these issues.

7.1 New Ways of Working

Many of the case studies have involved new ways of working and several have involved what could be classified as complex interventions. For example, Childsmile involves a large number of stakeholders from across healthcare, education, community and the voluntary sector, with the shared goal to improve the oral health of young children and reduce socio-economic inequalities.

FNP is another example of a complex intervention, the aim of which is to improve outcomes for children and families through the development of a relational, therapeutic relationship between the nurse and the client.

Several of the preventative interventions involved breaking down silos between organisations and organisations working together in new ways. For example, the Housing First case study describes how the pathfinder programme was seen to have acted as a sector ‘disruptor’: changing how services worked together to address complex needs.

The importance of multi-agency working was clear within a number of the case studies and was integral to their success. For example, BFNL established a ‘whole system’ programme involving joint working between the North Lanarkshire council, NHS Lanarkshire, Scottish Government, and community and voluntary sector organisations. The integration element focused on embedding breastfeeding support into existing services. This included early years education, community hubs and via revised workplace policies.

This wider system of multi-agency working was also central to the success of the Caledonian System which involved working with a wide range of services, including: Children and Families Social Work, Police Scotland, the Court service and also housing, health services, drug and alcohol support services, Victim Support, Women’s Aid and a range of other voluntary and statutory services.