New Year, New Ambition for Shared Accountability for Care in Scotland
Last year the Scottish Parliament debated a framework Bill to establish a National Care Service (NCS). From the outset I’ve suggested we should be more ambitious than creating a new care service. In the face of increasing fiscal challenges our public sector reform must aspire to a system wide approach to community wellbeing, care and support that has people, homes and communities at its heart. Across the life stages everyone who needs social care needs support from unpaid carers, community and voluntary sector partners, and the right housing, education, transport, employment and leisure opportunities to help them live their best lives. Those who suffer most from lack of coordinated care and support are people who experience poverty, homelessness, addictions or have multiple physical or mental health conditions including frailty, dementia or sensory impairment, and people who experience BAME associated inequalities. Integration of health and social care alone has had little impact on these systemic inequalities. To improve lives and wellbeing for all who need social care, we need proactive and preventative integrated care supported by targeted action on the wider determinants of health and wellbeing. That means strengthening our collaboration with community partners and the third sector and working more closely with community planning partners to pull all the levers that improve lives and opportunities.
So I’m pleased to see the Minister for Social Care, Mental Wellbeing and Sport has now confirmed there will be no backtracking on the 2014 integration Act and that further amendments to the NCS Bill should build on what has been achieved through integration. You can access her letter here. I’m disappointed it has taken 2 years to get to this position but let’s look forward and focus our collective efforts on designing the right shared accountability and governance arrangements at all levels.
At a national level we should start by reflecting on how the previous Ministerial Strategic Group (MSG) for Health and Social Care operated. What was lacking in the collective vison, leadership and direction from the MSG that means almost 10 years on we have yet to realise the full potential of the 2014 legislation. How can we make sure the new national oversight arrangements for the NCS have a more transformative impact? We need creative, compassionate and courageous leadership at all levels and from all sectors at that table, and by people who are prepared to cede power to experts by experience.
At a local level we need flexible, joined up care and support designed by local people, care providers, communities, housing, health and local government partners. The updated draft planning and performance reporting statutory guidance is helpful but we need to walk the talk at some pace on relational commissioning that wraps care and support around the individual and their family, building on their strengths and on the assets in their community networks. And we need to revisit and strengthen the relationship between integration authorities and Community Planning Partnerships to harness the levers the latter can pull around economic development, regeneration and community wealth building to enable collective investment in social care and housing as good, fair, green work.
While care and support must be of the highest standards, that doesn’t mean a ‘Once for Scotland’ model. Transferring solutions, no matter how well tested in one place, will fail if they are implemented without regard for local context, culture, relationships, transport, housing and infrastructure. That’s a particular issue for remote, rural and island communities where resilience, ability to thrive and to attract and retain a workforce requires considerable innovation and creativity. Different models are ok if they are contextually appropriate and deliver comparable outcomes.
Our national health and wellbeing outcomes were a good place to start but a decade on we seem to have a hierarchy of outcomes where the easy to count process and waiting time data trumps what really matters to people who have chronic care needs. I’d like to see a refreshed set of outcomes that track continuity and coordination of care and whether people are supported to live the lives they want and to die well in the place they call home.
I was pleased to see the brief on continuity and coordination of care that IFIC Scotland developed for WHO was at the heart of IFICs second annual survey To truly impact on continuity and coordination of care we must value and invest in the community workforce, both the statutory and independent sector, along with our unpaid carers, community and voluntary sector partners, housing and technology enabled care. Investment is more than addressing inequity in wages, terms and conditions. It means support for interdisciplinary and cross sector workforce development. Teams that learn together, learn to respect each other’s knowledge and skills, build relationships and trust, are more effective at communicating and coordinating care, and retain their staff. You can’t legislate for the culture change we need. We will change culture in our current and future workforce one collaborative conversation at a time, particularly when these conversations include the voice of experts by experience.
Senior Associate, International Foundation for Integrated Care (IFIC)
Director, IFIC Scotland
Honorary Professor, University of the West of Scotland
Trustee: Kilbryde Hospice and Compassionate Inverclyde