What can collaboration across the UK’s four health and social care systems teach us? And how can it best support the whole system change that is so desperately needed in health and social care?
As we approach the 10th anniversary of the publication of Gaun Yersel, A Self Management Strategy for Scotland, the Health and Social Care Alliance Scotland (the ALLIANCE) hosted a summit to consider these questions with delegates from across England, Wales, Scotland and Northern Ireland.
Defined as “supporting people living with long term conditions to live and die well on their terms”, self management empowers people and unpaid carers to be leading partners in managing their health and wellbeing.
Gaun Yersel was written by people in Scotland living with long term conditions, coordinated by the ALLIANCE, and working with Scottish Government. This took boldness on the part of the Scottish Government: to take a step back – and share power.
Doing so signalled that to understand self management, it is essential we fully incorporate the lived experience of people who are taking steps to self manage. If this had not been the case, I do not believe the strategy would emphasise that we need to build capacity in our communities; the heart of where people live their lives and do their ‘self-managing’. This understanding further resulted in the Scottish Government committing £2 million a year from 2009 to the Self Management Fund. Designed and driven by the ALLIANCE, the fund has invested in a broad range of third sector projects around the country that take innovative approaches to working with, and supporting, people.
One such project is the Mindspace Recovery College in Perth, which supports around 270 people a year. A recovery college is like any other institution where people come to learn and share together. The difference is that learning at a recovery college is delivered jointly by experts by training and experts by experience.
Mindspace has just been voted as Scotland’s Self Management Project of the Year. It is a community project directed at recovery in all forms that helps people improve the self -management of their mental health.
The former chief executive of NHS Scotland, and now CEO at internationally renowned Institute for Healthcare Improvement, Derek Feeley, recently commented that the Self Management Fund for Scotland was one of the best investments he made in his time at the helm, and which still benefits people today.
Hearing from what’s going on elsewhere in the UK at the ALLIANCE’s four nations summit demonstrated that we are in a strong position in Scotland: self-management is a core driver behind much of the health and social care policy that has been developed over the last five years. But across all four systems there is still too wide a gap between policy and implementation. Although there are examples of good practice and learning to build upon, we now need to focus on the whole system change that is required.
As we all know, health and social care systems are under considerable strain. However, rather than seeing this as a threat, we could use it as an opportunity to disrupt the status quo and secure buy-in for transformational change from those who would not usually get on board.
Self-management provides one such opportunity. It offers a model that begins by recognising that the person is in the driving seat, with an active role in managing their own health and wellbeing. A health and social care model with support for self-management results in a completely different experience than the traditional model. We know that this way of working is good for staff as well as for people.
The ALLIANCE has played a leading role in promoting the self-management agenda in Scotland and we will continue to ensure it is shaped by people’s personal experiences. Through the Self Management Fund we help to build capacity in our communities and third sector to support this way of working. Through the Self Management Network Scotland we bring together a community of interest to share learning and develop good practice in self-management. Our work with Scotland’s House of Care programme supports a transformational shift to the whole system.
But we all need to get better at sharing our learning with each other. This is not the time for competition; we need to be collaborative and action focussed. The ALLIANCE and many others are now developing a partnership across the four nations to continue cooperation on this agenda. We know that stories help shift practice and need evidence models that are focused on gathering stories.
A ‘command and control’ approach will not deliver the whole system change we need; rather, it will work against it. We need to focus on relationships: creating and sustaining trust to help develop true partnership working that build on the strengths of individuals and professionals. There must be adequate resources and support to help develop a model of change that recognises the importance of co-production as well as quality improvement. As one of our self-management champions, Donna says self-management does not mean that everything is perfect and rosy, but is about being able to manage the good times and the bad.
I firmly believe that we can afford to be positive about the outlook in Scotland. Collaboration between the four nations can support people to live and die well on their own terms.
Sara Redmond, partnership and practice development programme manager, Health and Social Care Alliance Scotland (the ALLIANCE).