We’re living in interesting times – just as the political landscape is dramatically changing, so too are our national support systems.
Like the rest of the developed world, services in Scotland are being continually adjusted to match the current environment.
Our growing average life expectancy is proof that, over the years, these changes have been improving most (but not all) of our nation’s health. The speed of change over the past century has been dramatic, and we no longer worry about the scourge of infectious diseases. The concern now has shifted to how to prevent ill health, how best to live with conditions that have no cure and the fear and anxiety caused by loneliness and poor mental health.
The demographic shift in the past 60 years and persistent health inequalities has prompted calls for radical change in the design of our caring services towards a focus on the personalisation of care,
Central to that are two key initiatives. First is the structural integration of health and social care services, a major public service reform. Second is the Scottish Government’s 2020 Vision for Health and Social Care which reflects the need for everyone to be able to live longer, healthier lives in a community setting wherever that is possible.
However, developing a new culture of health and well-being in Scotland needs us all to work together. Words like innovation, self-management, integration, collaboration and co-production are becoming much more familiar in policy documents and are being made real in the plans for integrating health and social care services across Scotland
Major reviews of our health and social care services are required to inform the new world, our direction of travel, and turning point reviews underway include nursing and pharmacy services, delayed discharge, Stronger Voice, medical training and supply and the review of out-of-hours primary care services, chaired by Sir Lewis Ritchie.
The latter is a good example of the spirit of collaboration between people with lived experience and professionals required to make sustainable improvement.
The review has a simple but challenging task – how to provide safe, person-centred and effective care between the hours of 6pm and 8am, at a time when it is becoming harder to recruit doctors to such services
However, it is crucial all these reviews interact since no single person, organisation or service can respond to all of our needs. With resources under strain, there is a greater need than ever for joint effort. This means we must start looking beyond the usual health buildings, towards communities and utilise preventative approaches which many third sector organisations are putting into practice.
Our links worker and ALISS (a local information system for Scotland] partnership programmes, for example, are currently working jointly to support people to access local community resources to help them stay well.
Exploring such approaches adds to the growing body of evidence demonstrating that spending on prevention can deliver better solutions and outcomes.
It’s an especially good time, therefore, to reflect on citizens’ understanding about how our support systems operate. It is clear from information about attendances, that many of us could avoid having to visit an out-of-hours centre, or A&E if we had better knowledge of how the health system works, how to self-manage a condition and how to be better prepared to avoid a crisis.
A common conclusion of these national reviews, in particular the new collaborative approach to unscheduled care, will be a greater need to share effort and expertise and to find ways to improve connections between providers of support, such as the independent, third and public sectors.
The Health and Social Care Alliance Scotland and Sir Lewis’s review share the same vision – that people are put at the centre. Guided by our 1,000 strong membership, every ounce of effort at the Alliance is directed at preventing people developing poor health and enabling those with long-term conditions and unpaid carers to have a strong voice and enjoy their right to live well.
• Ian Welsh is chief executive of the Health and Social Care Alliance Scotland