Robin McAlpine – 14 October 2022
One of the responses I received to what I wrote last week was to question if it is realistic to believe that Scotland can turn around its problems in ten years. So is it? Is it better if we just accept that deep, structurally-entrenched failings in our society are problems that we can’t defeat in one political generation?
Just to recap for anyone who missed it, in last week’s piece I set out a rough fiscal plan (tax, borrowing and public spending) for the first ten years of independence. One of the approaches it took was to propose a targetted investment programme to break the cycle of ‘failure demand’.
It proposed that investing seriously in changing the conditions which create social failures which in turn create a heavily drag on public services can permanently improve the viability and quality of those services (as well as save lives and improve society).
The cycle of failure demand is well-studied and non-controversial. If you have a national obesity crisis you get heart disease, cancer, diabetes and joint-related health crises. If you have a low pay crises you get a housing, welfare, food and health crisis. These secondary crises cost more than fixing the causes of them, but because you’re already wrestling with the impacts you have no money left to invest in proper prevention.
So the question isn’t whether the economics of breaking failure demand cycles is sound, its whether social policy interventions can do it in a comparatively tight timescale. And it is probably worth stating that ‘conventional British wisdom’ is that it is not. In recent decades UK policy-makers have mainly tried to mitigate the causes of failure rather than prevent them.
Here’s the thing; Britain is a failing nation and has been for a while. In that context the expectation that big social interventions will fail because ‘that’s what they do’ has become a self-fulfilling prophecy. To get a sense of what is actually possible it is necessary to move beyond British politics.
Let’s take a problem, a big problem. Imagine that by some stretch you’re the country in Europe with the worst record of deaths caused by heart disease. In the UK the response would be to scrape together money for NHS cardiac services and set some targets.
But what if you tackle the cause? What if you shifted your agricultural subsidies to foods which were heart-positive? What if you very actively promoted alternative diets, not just with some adverts but with a fully, end-to-end coordinated strategy including advocates and educators in every community? What if you actually started growing different crops?
What if you change the laws on product labelling so people know precisely and unmissably how much salt, sugar and fat is in the product – and how much is healthy? You could improve and expanded your collection of food consumption data to inform policy. You could prescribe medicines which prevent heart disease developing as fast. You could even build absolutely loads of local, cheap sports facilities to get people active.
How long might that all take? What if you could get most of this fully going in five years? And what difference might it make ten years after actually doing it all? Let’s stop mucking about here. What I am describing is Finland in the late 1970s. Within a decade of these measures being implemented heart disease was reduced by about 25 per cent.
To put that in context, in today’s money, cutting a quarter of the demand on the NHS from heart disease would save the NHS £200 million a year in direct costs and be worth closer to half a billion pounds a year to the whole economy.
Let’s take another example, a shortage of quality, affordable housing. Can you reverse that in ten years if you just decide to build a million new high-quality, well-designed public rental houses? Well also in the late 1970s Sweden decided it would – and completed them in eight years from planning to occupying.
Or say you have an economy without the engineering capacity you need to capture the value of a massive national economic opportunity? Can you come up with a way to turn that round 100 per cent in ten years? When Norway discovered it had oil it did just that. We know the outcomes of exploiting its own oil rather than being exploited for it.
In every case you can see that a government that wants to break failure cycles and puts its mind to it can do it. In every case you can see that, ten years later, the problem you started with has been substantially tackled.
But even this doesn’t capture the point properly. After all, Scotland cut heart disease by about 20 per cent over ten years in the devolution period and it didn’t bother with all that fancy-pants stuff that Finland did. That shows that all you need to do is manage public services better, just like the centrists said.
This completely misunderstands the whole point. Because after the best part of a decade of decline Scotland’s heart disease rate flatlined and has been stuck there since. After a decade of the Finnish plan heart disease in Finland… just kept falling. And falling.
In fact over the course of the 1980s, 1990s and 2000s heart disease in Finland fell by over 80 per cent. Sweden has regularly returned to building absolutely first-rate new housing developments. And Norway’s oil industry has kept going from strength to strength.
What happened was that Scotland largely spent more money to try and counteract the terrible impact of industrial supermarket food and junk food takeaways. By comparison in the other three countries they made major structural changes not just to deal with the outcomes but to deal with the cause.
They ‘inverted the spiral’. Where before they had policies or a historical legacy or cultural expectations which were creating a downward spiral of every-increasing negative outcomes, afterwards they had created conditions which were constantly and continually reducing negative outcomes. A downwards spiral became an upwards spiral.
That is at the heart of what I am arguing. Can you end everything bad that is happening in Scotland in ten years? No. Can you make very serious progress in tackling the underlying conditions which are causing the bad things to happen in ten years? Yes. Yes you can.
Will that make a difference in the ten year period itself? Yes it will. Things will start to reverse, but at first the results can be impressive without being startling. But if you do it properly will it create a legacy? Absolutely. It is a legacy of continual improvement. Even once you stop spending to tackle the structural problems, the structural problems will have alleviated enough that the negative symptoms they produce just keep reducing.
Or let’s put that another way; once you build 33,000 public sporting facilities they are always there and once you make them local and easy to use they are always local and easy to use. Just to be clear, that represents more public sporting facilities in Finland (population 5.5 million) than all public and private facilities in the entire UK (population 67 million).
Almost my entire professional life has been spent in and around UK public policy (mostly but not only in Scotland). An observation I noted early on was that you will always do well in the civil service to say (in an erudite tone of resignation) ‘that is a multi-generational issue’. As in ‘sorry mate, no point even talking about this’.
Britain is failing because Britain doesn’t really believe that ‘public success’, success because of concerted public action, really works. Only billionaires are believed to be able to get anything done in Britain. That is the legacy we live with.
It is a legacy with which Scotland can break. We don’t need to absorb this idea that big change is beyond our reach, that ten years is not ‘serious time’, that our failures are so deep we might as well shrug.
I’m not being naïve or excessively optimistic in believing this. I’m a fan of evidence. The evidence says that big interventions to solve big failure cycles returns big rewards in timescales shorter than you might believe and leaves a legacy that lasts much longer than you might think possible.