Ian Welsh is chief executive, Health and Social Care Alliance Scotland (the ALLIANCE)
It’s hard to imagine but we will still be debating the health and social care of our nation after the referendum.
While recent years have seen a growing consensus on the need for transformative change in health and social care, it is less clear 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.
Meanwhile, 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. All of which have a significant impact on the support that enables disabled people, people with long term conditions and unpaid carers to enjoy their basic rights to health, independent living and work.
In that context, how 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?
Throughout this process we have argued, and many of the ALLIANCE’s 700-plus membership remain at the frontline of reshaping health and social care, that working with people rather than viewing them as passive recipients of services, and empowering people to control their future, might allow us to consider new ways of looking at how we design services for the times ahead
The ALLIANCE has long promoted progress in person-centred approaches particularly self management, co-production, self-directed support, community-led health, independent living, advocacy, personalisation, mutuality and human rights and person-centredness is now a quality ambition for the NHS in Scotland. Our Imagining the Future thinkpiece, produced earlier this year, articulated this vision by collecting views from a range of ALLIANCE’s members.
People must be at the centre of these changes but we share a concern that well intentioned efforts to pursue public service reform are not yet delivering the scale, nature or rate of change that is needed.
We have argued for a radical review of how we engage and work with people, a review not driven merely by financial necessity but by a sense of empowerment and involvement which drives health and wellbeing outcomes, and there is real evidence that leading-edge local authorities and others have taken up the mantle. As we move through the practical, structural, staffing and scoping stages of integration set-up, we also need to bring citizen voice to bear and make service redesign an inclusive and vital part of the process.
This kind of change is not easy and our emergent Health and Social Care Academy initiative is being developed to support this, with a unique role in doing so through the lens of lived experience. By offering a safe space for people to come together, to access support and share learning, and to do this on a cross-sector basis, the Academy aims to create a focal point for such activity, a support for all those driving it, and a space for the more radical and emergent ideas.
Whatever the result of the referendum, we need a new Scotland that is innovative, progressive, mutual and democratic in its drive to build the best health and social care system in the world.