We can all create a different future, says Dr Lisa Curtice
Predictions of the challenges facing health and social care in Scotland present a gloomy picture. Scotland has one of the lowest life expectancies in Western Europe. Men living in the most deprived areas of the country can expect to live 11 years less than those in the least deprived. By 2035, the number of people aged 75 and over is projected to increase by 82 per cent. The number of people with long-term conditions is expected to double by 2030, as is the number of people with dementia.
Meanwhile, the Centre for Public Policy for Regions at Glasgow University reports that the public spending cuts still to come will be the harshest yet.
But are we asking the right questions about the future? Suppose that, instead of asking when the tide of disease will overwhelm us, we asked what is most likely to keep us well? Or, rather than wondering how to further stretch an overburdened public sector, we asked what we could do differently, what we could stop doing at all and what contribution we could all make to creating a different future?
An alternative vision is available, not just from boffins, but from practitioners, third-sector groups and citizens. Their views provide unequivocal steers about the kind of care people want. Few want to end their life in hospital, although at present half of us do so. Most express a preference to die at home or in a hospice. Carers say they need to know whom to contact for help before a crisis drives them to breaking point. People want support that is co-ordinated and offered when they need it, the information to make decisions for themselves, to be respected as an individual, and to be enabled to live their life to the full.
What would doing it differently look like? It includes enabling people with long-term conditions to be more in control of their lives. The Self Management Strategy for Scotland, “Gaun Yersel”, published jointly by the Alliance and Scottish Government in 2008, was written by people living with long-term conditions and their unpaid carers. It led to the creation of the Self Management Fund for Scotland, which has supported initiatives to enable people with long-term conditions to grow in confidence, learn from others in similar circumstances, try different experiences and make new friends.
A different path also means establishing strong relationships between agencies, such as the NHS, local authorities and the police, and those who use services, so that each becomes part of the solution.
If staying or becoming well is the aim of public service delivery, then relationships between practitioners and the people they support will change, as will those between services and communities they serve.
The Alliance has published reports that show how professional practice can change when the conversation between practitioner and patient is about what matters to the person, rather than what the professional can “fix”. A re-evaluation of what creates health, such as an emphasis on having something meaningful to do, puts the spotlight on life outside the hospital or day centre. The community then becomes, not the source of problems, but a reserve of assets to invest in and nurture. The People Powered Health and Wellbeing programme at the Alliance brings together experienced third-sector partners to help make co-production the usual approach to health and social care.
It is these cultural changes that the integration of health and social care must enable. Reporting in 2013 on reform of public services, the Scottish Parliament’s local government and regeneration committee concluded that efforts “are not yet delivering the scale, nature or rate of change that is needed”. It is already too late to carry on doing as we have always done. Now is the time to back frontline staff and citizens to create the change they want to see – and changes in health trends will follow.
• Dr Lisa Curtice is programme director for People Powered Health and Wellbeing at the Health and Social Care Alliance Scotland www.alliance-scotland.org.uk