The fight to transform the health of the nation

Picture: Greg Macvean
Picture: Greg Macvean
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EVERY year NHS Scotland hosts a meeting bringing together staff, partners from local and national government and the third and independent sectors.

This year saw addresses by NHS chief executive Derek Feeley, Cabinet secretary for health and wellbeing Alex Neil, and minister for public health Michael Matheson. All spoke, as in previous years, of the challenges as our population ages, finances tighten and UK welfare reform impacts, particularly upon those already marginalised.

Picture: PA

Picture: PA

Something felt different though about this year’s event. It followed publication of the Scottish Government’s new A Route Map to the 2020 Vision for Health and Social Care and, like the route map, emphasised not just improving services, but a paradigm shift in how we support the health and wellbeing of our population.

Central to this is the language of “co-production”, where people and communities are equal partners in design and delivery of support and services. Allied to this is the idea that health and social care is not limited to caring or medical tasks, but enables people to enjoy their right to independent living, participating as active citizens with support that focuses on what is important to them.

Co-production has a long history in the third sector. Our own organisation, the Health and Social Care Alliance Scotland, has been among those at the forefront of advocating it. This is rooted in the collective expertise of our members, many of whom have been developing co-production since before the creation of the NHS. For example Diabetes UK, formed in 1934, campaigned for creation of the National Health Service, whilst arguing that people with diabetes should play an active role in managing their condition. Organisations like Angus Long Term Conditions Support Groups work locally to enable people using, and delivering, services to work together, shaping provision that makes best use of all the community’s resources.

Volunteers vital

The Scottish Recovery Network harnesses the value of lived experience through peer workers employed as part of many mental health teams across Scotland. Macmillan Cancer Support and British Red Cross enable thousands of highly trained volunteers to work alongside health and social-care professionals. Many hundreds of examples across our membership demonstrate the power of co-production to drive real change in service design and delivery and, crucially, impact. We hope to spread this impact further through the People Powered Health and Wellbeing Programme, part of the National Person Centred Health and Care Programme, embedding co-production across Scotland.

Involvement of people and communities, along with frontline staff, was highlighted in last week’s report from the local government and regeneration committee. Having examined progress towards the agenda set out by the Christie Commission, the committee concluded that “the best examples of Public Service Reform arise when local communities and front-line staff are fully engaged in the process of designing and procuring services”.

Strong drivers for transformational change exist in Scotland, all with co-production at their heart. The new 2020 route map talks of “people powered health and care services”, achieved through a “shift in the balance of power” and building “up and on the assets of individuals and communities through a focus on achieving social change”. This will be supported by publication in December of Scotland’s first National Action Plan for Human Rights.

Integration of health and social care

There is also the move to integrate health and social care, building on the Reshaping Care for Older People programme and Change Fund that has sought to direct investment towards developing and embedding new models of support. It is heartening to see mainstream policy discourse centre on ideas that, even a few years ago, felt peripheral. However, we share the local government and regeneration committee’s concern that “well-intentioned efforts to pursue public service reform are not yet delivering the scale, nature or rate of change that is needed”. Integration of health and social care should offer a prime locus for driving transformation. This will only happen if people who use support and services, and the third sector, are equal and active partners. We will be arguing for legislation to be strengthened so that it much more strongly drives change, underpinned by co-production. As a sector we deliver more than a third of registered social care services, invest significantly into our health service and form the foundation upon which individuals and communities across Scotland bring their own assets to bear. The importance of our collective role in shaping the integration debate, and enacting its aspirations, cannot be underestimated.

As we set our sights on the 2020 vision, it will be crucial that the emerging health and social care partnerships address more than merely structural integration. They must get beyond adjusting terms and conditions or immersing themselves in fiscal capacity and grasp the opportunity to enable local cultures of empowerment, community capacity building, innovation and self-management, catching imaginatively the spirit of a public sector reform agenda that puts people at the centre.

• Ian Welsh and Shelley Gray are chief executive and director of policy and communications respectively at the Health and Social Care Alliance Scotland,

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