Piloting an Approach to Identifying Preventative Spend in the Scottish Budget

Chapter 4 – Reflections on the Tagging Process

This Chapter discusses some of the reflections of the Prevention Unit team based on applying the tool and engaging with policy teams throughout the process. It also covers changes made to the Preventative Budgeting Tool following the pilots and potential future developments.

Reflections

Through the process of developing the preventative budgeting pilots, the Prevention Unit worked a number of finance and policy teams to gather information, undertake the tagging and test results. Through this engagement, and some workshops, we gathered verbal feedback on a number of areas including: the Preventative Budgeting Tool and Guidance, applying the tool in practice, the results generated, how preventative budgeting can be used to change the way we budget for prevention, nationally and locally.

The below points provide a summary of some of the reflections drawn from the exercise:

• Using the Preventative Budgeting Tool and Guidance – the Tool was set out in an easy-to-follow format, which could be easily understood and applied. Some elements of the tool could be improved, such as developing a better approach to apportionment, particularly where areas are applying apportionment across a number of lines. In many cases, the primary purpose and target population were often burdensome to describe where budgets run into a lot of lines so this could be kept as an optional guide in the Tool, rather than mandating it’s use.
• Confidence in preventative spend assessment – In the majority of cases, finance and policy teams had a reasonable level of confidence in how budget lines should be tagged. Many of the lines are easily identifiable prevention activity (such as vaccinations, screening, preventing reoffending, early years reading initiatives, etc). Many of these activities have a clear target population and purpose. Some activities were more difficult to tag, in particular the larger areas of public service spend. Here, more work was required to break down the data and do a more detailed tagging to come up with estimates.
• Resource and time required – for most Scottish Budget portfolios covered, the activity of applying the Preventative Budgeting Tool, in the proportionate manner suggested in the guidance, took around a few days. This is largely because we designed the process to be quick and proportionate, with further work required in future to further develop the robustness of these estimates. For Health Boards, this was a more involved process – while most Health Board finance teams could have a “first pass” at applying the classification to the full budget relatively quickly, further refinement and consultation with clinical and public health colleagues took longer and depended on the level of detail explored by the Health Board.
• Budget data– the data available below the Level 4 lines varies significantly, from high levels of detail in some cases to very little in others. Tagging larger lines can be more involved and require further analysis. The ease of developing proportions to apply to lines can vary depending on the data available. In some cases, the way budget entries are titled or described made tagging less straightforward and required local knowledge of the activities sitting within the lines tagged.
• Outcomes tagging - The outcomes tagging was attempted across all the activity within the Level 4 lines (except NHS Boards). The main outcome targeted by the activity was easily identifiable in most cases. Tagging secondary outcomes was subject to more user discretion and subjectivity. Reviewing outcomes tags with more evidence in future would help improve the robustness of these estimates.
• Joining up with other processes – there was a clear sense that any ongoing system of reporting preventative spend could be integrated into wider exercises such as the Strategic Impact Assessments being developed as part of the Budget.^[19] This could reduce duplication and allow for joining up of budget tagging and other exercises in future.
• Impact – the preventative budget tagging and outcomes tagging are useful, but it’s ultimate use in supporting budget decision making would require additional information and evidence on the impact of different activities. Feedback suggested that further indicators be included in future versions to help tag against the impact of different budget lines. This will be considered in future versions of the Tool and Guidance.

Action taken based on feedback

• Refinements to definitions – some tweaks were made to the definitions and guidance to clarify the links between tertiary prevention and acute/ responsive activity to avoid the overestimation of tertiary activities that were predominantly reactive. This included adding “treatment” to the “acute/ responsive/ treatment” category. We also refined the examples used for each area of the budget to help with classification.
• Refinements to the Tool and Guidance – we developed an updated version of the Preventative Budgeting Tool to address some of the challenges with apportionment. This included separating each budget category and level of prevention into distinct columns to make it easier to apply proportions to each budget line to cover these different categories.
• Integration with other budget tagging exercises – we are working to align the preventative budget tagging exercises alongside the other tagging exercises (such as the Strategic Impact Assessments) developed as part of the Budget process.

Areas for future development

In addition to the actions taken to refine the Tool noted above, we will also be looking to further development of the preventative budget tagging approach going forward. Some areas for future development include:

• 2027/28 Budget process – this includes progressing on our commitment from the Spending Review to develop a Budget-wide measure of budgeted preventative spend and explore how this can be used in the 2027/28 Budget process. During this process, we will look to include capital as well as resource spending in these estimates.
• Budgeted vs actual spend – Once the preventative budgeting framework is established over a full Budget, we will consider how subsequent publications could explore the difference between ”budgeted” and “actual” spend. This could include looking at changes in Budgets after revisions are made through the year (“Spring Budget Revisions” and “Autumn Budget Revisions”) to see how estimate of preventative change over time.
• Expanding the impact element of the framework – this includes developing further indicators of the impact of preventative activity on the outcomes mapped through the tool. This could include developing a set of criteria or indicators for capturing the impact, timescales and evidence available for different lines. It could also include other elements important to Public Service Reform, such as how whether budget lines reflect person-centred service provision, the extent to which activities bring decisions closer to communities, or cooperation between different delivery partners and organisations.
• Supporting integration with local finance systems – alongside the budget tagging work, we will be looking to improve replicability of results by exploring opportunities to tag more systematically through national and local finance systems.