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The voice of Scotland’s vibrant voluntary sector

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Let users design care services to tackle rising costs

This opinion piece is almost 5 years old

Ian Welsh argues ordinary service users and their families could help create more cost effective social care services

Collectively local authorities across Scotland already spending £3.1 billion a year on the delivery and commission of social care, with some £569m of that outsourced to the third sector. But the clear message from Audit Scotland’s recent report Social Work in Scotlandis that without significant transformation of the way things are done, spending will need to increase to the tune of £667m a year by the year 2020.

Social work services are critical to disabled people, people who live with long-term conditions and unpaid carers. Often they enable them to fully realise their human rights, whether that be to live independently, have friendships and relationships or to vote. They underpin some of the most basic expectations we have a society.

Ian Welsh

Whilst self-directed support has increased the level of choice and control people have over their support, it is becoming clearer that this has not, yet at least, transformed the landscape.

Ian Welsh

But now is the time to think differently.

Social work services must now better acknowledge the importance of ensuring the public and service users are involved in shaping the future of statutory services, social work or otherwise. Our five provocations for health and social care, developed by the Health and Social Care Academy with support from a cross sector collective of leaders, has identified ceding power as a crucial step in the right direction. The experience, knowledge and expertise of services users and their unpaid carers is invaluable in helping to establish what services are needed, and ensuring the human rights of service users and their families.

Those who have seen real co-production in action will testify to the significant social benefits of involving people in the design and delivery of their care. It brings communities of interest together, creating services for a purpose and building confidence.

The alliance's People Powered Health and Wellbeing programme has recently acknowledged that the economic benefits are complex and tricky to evaluate as the financial savings can spread much wider than just the health or social care system. Coproduced services might incur initial costs in one area, but produce results in others. For those commissioning services this has the potential to be a disincentive, but the bigger picture suggests that coproduced approaches save time and money.

Despite this, attempts to engender coproduced solutions as a matter of course have been limited.

One of the key findings in the course of Audit Scotland’s research was that some people didn’t feel like they could speak up about the services they receive “in case the care they received was reduced or changed” or to protect the “feelings of the people providing care”. Whilst developments such as self-directed support have increased the level of choice and control people have over their support, it is becoming clearer that this has not, yet at least, transformed the landscape.

Whilst in its infancy, the impact of health and social care integration on the coproduction agenda has been limited. In reporting to MSPs on their progress, health and social care partnerships recently said a lack of clarity in the long term status of the Integrated Care Fund, which aims to support improved outcomes, preventative approaches and tackle inequalities, was proving a structural challenge to thinking differently and creating new solutions.

Transformational change shouldn’t, however, solely be driven by the state. The third sector is already proactively developing its own solutions and coproducing rights-based services despite the financial constrains under which they operate.

People who use support and services bring a wide spectrum of skills and knowledge, which is largely untapped by local authorities and Health and Social Care Partnerships. Collectively we must heed the warnings within Audit Scotland’s report and maximise these resources if we are to see effective engagement, participation and coproduction of solutions that support people to enjoy their right to live well.

Ian Welsh OBE is chief executive of the Health and Social Care Alliance Scotland



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