Piloting an Approach to Identifying Preventative Spend in the Scottish Budget

Chapter 5 – Conclusion and Next Steps

This report set out a methodology for budget tagging planned preventative spend and piloting this across a pilot covering a range of Scottish Budget portfolios. This exercise allowed for the creation of broad metrics across the Scottish Budget lines piloted to be created, including indicators of overall preventative spend, and spend across the different levels of prevention. This exercise highlighted a number of key points regarding the use of the Preventative Budgeting Tool, which form the conclusion to this report.

A cross-Budget indicator of budgeted preventative spend is possible.

The budget tagging pilot process and results show that an indicator of planned preventative spend can be developed through a tagging approach, which is robust, consistently applied across portfolios and proportionate.

However, given the varied nature of data collection and approach for each Level 4 line, and the subjectivity with which preventative spend tags are applied, the estimates of planned preventative spend are considered experimental, with some margin for error and limits on the extent to which detailed results can be compared. The preventative budgeting approach is still being developed and refined, and assessments could be revised upon further roll-out across the Budget.

The publication of this report is part of the process for seeking feedback and engagement with partners to develop and test this approach further.

There is significant planned preventative spend in the Scottish Budget 2025/26, with spend recorded across all Portfolios piloted.

The results showed that around £3.0bn of planned spending across the pilots could be tagged as preventative (around 15% of total planned spending piloted), with a further £0.8bn tagged as enabling prevention (4% of total planned spending piloted). This included spending across all three levels of prevention. Acute/responsive/ treatment and other/ general service categories made up the remaining 81% of the planned spend piloted.

Within this planned preventative spend, the results show that primary prevention was around £0.5bn, around 18% of total planned preventative spend, and 2.7% of planned preventative spend overall. Secondary and tertiary prevention accounted for 42% and 40% of total planned preventative spend (6.4% and 6.1% of total planned spend overall). The results also showed the system-wide relevance of prevention, with preventative spend being recorded across all portfolios of the Scottish Budget covered in the pilot.

It is important to consider nuance in presenting results

The results also show that, while the budget tagging focusses on planned “preventative spend”, where the objective of budget lines are prevention as a primary purpose, it is important to consider all planned spend in any consideration of prevention across the full system of Scottish public services. Other types of activity, such as acute/ responsive/ treatment activity, have a role to play in prevention, even if not directly. In particular, changing the way responsive services are delivered can support prevention.

Given this is a relatively new and novel approach, it is difficult to assess what the “target proportions” are for where these indicators should land. The clearer use for the metrics in the first instance is likely in tracking performance over time, which outlines the importance of applying this approach to future Budget years.

Planned preventative spend in Scotland targets a range of outcomes, both directly and indirectly

Through the pilots, planned preventative spend across Scottish Government portfolio spend (excluding the Health Board pilots) was tagged against a set of drivers of demand for public services and outcomes. Budget lines could be tagged against one “main” outcome targeted by the spend, along with any secondary impacts on other outcomes. We found that the preventative spend was largely targeted at drivers that reflected the remits of the Portfolios included in the pilot, for example with a high level of direct spend targeted at adult ill-health, child ill-health, and offending. However, a large amount of preventative spend impacted a number of outcomes indirectly, such as inequality/ poverty, training, community cohesion and discrimination.

The preventative budgeting and outcomes tagging are a step in a wider process to develop tools for supporting decision making

The approach to tagging preventative spend set out in this report is the first step in developing a system for identifying preventative spend, linking this to outcomes, and eventually building in other evidence that supports budget decision making.

The Prevention Unit will also be looking to further development of the preventative budget tagging approach going forward, including: broadening out the estimates across the full Scottish Budget, expanding the capability of the tool to assess the impact of preventative activities, developing estimates of budgeted vs actual spend, and embedding this approach in local and national budgeting systems.

The Preventative Budgeting Tool will also be developed in future to consider metrics related to impact, timescales and quality of evidence, as well as elements important to Public Service Reform, such as how whether budget lines reflect person-centred service provision, or the extent to which activities bring decisions closer to communities.

Next steps

In line with the intention set out in the Public Service Reform Strategy and Spending Review, the pilot programme described in this report will be expanded to cover the full Scottish Budget over Summer 2026, with a view to then exploring how this information can be used as an input, alongside other evidence, to support decision making at part of the Budget 2027/28.