The Health and Social Care Alliance Scotland (the Alliance), along with many of our 600-plus members, have long argued for transformative change in health and social care. Recent years have seen growing consensus on the need for radical change. What is less clear is how we are going to quicken the scale and pace of progress towards models of health and social care that are truly fit for the future.
Attempts to alleviate stubborn health inequalities and find better responses to an ageing population and rising social need are set against a backdrop of mounting financial pressures and reductions in public spending. Disabled people, those living with long-term conditions and unpaid carers are feeling the impact of rising living costs (with wages failing to keep pace), welfare reforms and cuts to – or increased charges for – many of the supports that enable them to enjoy their basic rights to health, independent living and work.
How then, do we ensure that the health and social care of the future supports an inclusive Scotland in which we are all able to flourish and contribute?
The Alliance will put that question to delegates and politicians at our upcoming conference on 19 May – asking them to “imagine our future” and debate the big questions facing health and social care. Questions like: how can we address and mitigate the impact of welfare reforms; how can we stop the burden of tightening finances falling on individuals who cannot – and should not have to – afford increased charges for support; how can the new Scottish National Action Plan for Human Rights contribute to health and social care that is built on robust foundations and centred on better outcomes for people and communities; how do we achieve a real paradigm shift while also “keeping the show on the road”; and how do we make the most of health and social care integration so it helps drive new thinking and approaches, not just reorganised structures?
The Christie Report, A Route Map to the 2020 Vision for Health and Social Care, and a range of legislation on self-directed support, integration and community empowerment all provide a strong platform upon which to consider these questions.
What is crucial is translating this policy into positive change that reaches into the lives of Scotland’s citizens and communities.
Regardless of the outcome of this year’s referendum, we have an opportunity in Scotland to commit to a radically different approach, and have already started down that path. Co-production, asset-based approaches and “people powered health and wellbeing” must be more than passing buzzwords. They must become “business as usual” and form the underpinning features of how we design, deliver and improve health and social care on a collective, not top-down, basis.
The Alliance is built on the strength, value and power of lived experience of people who interact with health and social care. The self-management agenda, Dementia Carers Voices project, Involvement Network and People Powered Health and Wellbeing programme, along with the work of many of our member organisations, are among the initiatives demonstrating the essential role of people themselves in shaping health and social care. Many of our partners within the statutory sector, including frontline practitioners, are also actively engaged in reshaping health and social care with people firmly at the centre.
It is vital that these efforts are supported and built upon and not subsumed, either by immediate challenges or the natural pull to maintain our existing paradigm, even if it no longer meets our needs or aspirations. The Alliance will shortly be launching a new Health and Social Care Academy to help support and connect those engaged in this drive.
To date, many will have been disappointed if they hoped to hear politicians on either side of the independence debate talk about their vision for health and social care. In our upcoming Future Scotland publication, Alliance member Enable Scotland describes the gap between the issues prominent in the public discussion, and those that matter to their members. Their concerns are not about a currency union or oil revenues, but about the implications for tackling the severe health inequalities faced by people with learning disabilities, and for ensuring an education system that provides the best possible learning experience for people with additional support needs.
Another contributor to Future Scotland, Andrew Lyon, of the International Futures Forum, quotes John H Schaar in saying “the future is not some place we are going, but one we are creating”. The referendum, whatever your constitutional preference, helps us to focus our minds on imagining the future. Whatever the outcome, we look forward to continuing to play our role in ensuring that our collective energies shape the fair, inclusive future we want.
• Shelley Gray is director of policy and communications and Andrew Strong is policy and information manager at Health and Social Care Alliance Scotland (Alliance). Scotland – small country, big ideas – imagining our future… conference and publication launch is on Monday 19 May 2014 in Edinburgh