Interview: Joined-up thinking key to John Swinney reform

St Andrew’s House insiders declare mischievously that, with Alex Salmond’s attention occupied by the referendum, it is actually Swinney, the Finance Secretary, who is running the country.

It may be an exaggeration, but what isn’t in doubt is that Swinney is the man with his imprint on this Government’s quiet but radical public sector reforms. They are out of the public eye, thanks in part to the dominance of the referendum debate. But Swinney’s behind-the-scenes changes may, in time, be seen as among the most influential of all this SNP administration’s policies.

MacAskill, his fellow cabinet member, applied fresh scrutiny on those reforms last month when, at a conference of police chiefs, he declared that the “single force” route that Scotland’s police service had gone down was a sign of the changes that all public bodies – such as councils and health boards – would now have to emulate. The message, says Swinney, was blunt. Not that SNP ministers intend to centralise fragmented services, but that the status quo was not an option. “The point he [MacAskill] was making is that reform cannot be avoided,” Swinney said. “Not that everything is going to follow the policing model but reform cannot be avoided and that is exactly where I am,” he declares.

The factors driving change are well-known. The first is that Swinney no longer has any spare money to play with. The second is that Scotland’s ageing population could, not too long into the future, bring public services to a standstill. Those are the imperatives, says Swinney. It is also his policy mission, he adds, to get Scotland’s public servants to concentrate on good outcomes for people – and not to fuss too much about how they get there. Put the three together and there is, he says, “a big reform agenda going on”.

Social and healthcare are high on the Finance Secretary’s list for 2013. The reforms themselves are contained in the new Integration of Adult Health and Social Care Bill and Swinney is to address MSPs in the next few weeks to outline his wider agenda. The new law will create Health and Social Care Partnerships, jointly run by health boards and councils. The aim, he says, is to replace the old divide between medics and social services with one “seamless” service. Imagine an 85-year-old lady in his Perthshire North seat who has a fall, he says. The journey to hospital is easy – by ambulance. But the journey back is less so. “If I think about my locality, it will be Ninewells Hospital, Blairgowrie Cottage Hospital, and then with any luck back into the house, with their case handed over from the health service to the local authority the closer they get to their house,” Swinney explained. “The ambition we have is essentially to make that a great deal more integrated and cohesive so that the person is not aware of the fact that the badge has changed and the uniform has changed.”

Scotland currently spends a staggering £1.5 billion a year sending elderly people to A&E departments. Experts believe half of that could be saved if, instead, those who may not need to go to hospital, are looked after in their own homes or in their care home.

“From the state’s point of view, we want that person cared for in the most appropriate circumstances,” says Swinney. “And the likelihood is that that is going to cost the state less money. The minute we put somebody into an acute hospital, the costs inevitably are more significant”.

One “horror” story identified by Scottish Government officials in Perth and Kinross found that one problem family had no fewer than 17 different groups of people looking after them – social workers, community psychiatric nurses, pharmacists and GPs, among others. Swinney argued that a more streamlined system will provide a better service and cost less.

All political sides are signed up in principle. The question is whether Swinney can make it work. He is ruling out any actual change to Scotland’s patchwork system of 32 local authorities and 15 health boards – claiming the fact that ministers have ruled this out has bought him support on the ground. “One of the things that has been a big signal that has helped people to relax into this is our view that we wouldn’t reform the number of local authorities,” he insisted. “It has relaxed people to say, well if that’s the architecture, let’s focus on the delivery, and it has removed a kind of potential derailing influence within this whole process.” Furthermore, he agrees the new set-up won’t be imposed on the public sector, and says he wants a “collaborative” approach.

It begs the question of whether public sector chiefs will simply nod their assent but carry on as normal. He acknowledges that “there is always a danger that people act in a preservation of interest perspective.” But Swinney is a believer in setting “clear political leadership” and then expecting people to get on with it.

“You have got a real sense of empowerment and liberation among the folk at the coal face who can see all this and are saying, ‘well this is what we are supposed to be doing, so let’s get on with it.’ ” He goes on: “People [in the public sector] are getting the signal to know that it is OK to find a joint solution – and people are responding to that.”

And the best way of encouraging reform, he argues, is simply to highlight best practice around the country. He recalls a speech he gave praising innovation in one part of Scotland. “Then this guy puts his hand up and says to me ‘that is an absolutely fabulous example but the question you’ve got to wrestle with is, why is it happening in that part of the country when it’s been happening in another part of the country for ten years.’ It wasn’t a terribly comfortable moment. The question for me is, why is it taking so long [for the message] to get out there?”

Because ministers aren’t cracking the whip and imposing reform? He insists that doesn’t get results. But a sceptic might suggest his “collaborative” approach is simply a reflection of the fact he does not want to pick any more battles with the public sector establishment at what is, to say the least, a sensitive time for the SNP Government. Isn’t he just trying to avoid friction? He looks down as if talking to himself. “Is there an absence of friction in the world I occupy? No.” Like all SNP ministers, Swinney has plenty on his mind right now – but this is one SNP plan that no one needs to wait two years for.

Twitter: @eddiebarnes23