Taking control

Ian Welsh’s CV is a captivating read. A teacher to trade and a former deputy head of a large comprehensive school in a mining community in Ayrshire, he has also dabbled as a young professional footballer, campaigned for and later been a director of a rejuvenated Prestwick airport, served as chief executive of Kilmarnock Football Club, and latterly was director of UK Services for the Rehab group, now known as Momentum, where he dedicated himself to supporting people with disabilities and others who face social and economic exclusion.

Alongside this, he had a political career and has served as a councillor, council leader and was elected to the Scottish Parliament in 1999 as the member for Ayr - only to become the first MSP to resign a year later, admitting that he had found the lack of direct involvement in decision-making difficult to adjust to.

“It all coalesced,” he explains. “The teaching career and the early political career would have been my early battle ground, if you like. Some of the issues around health, education, housing, social care, I guess would have been my proving ground.”

Now, he is putting those varied skills to use as chief executive of the Health and Social Care Alliance Scotland, which was previously known as the Long Term Conditions Alliance Scotland (LTCAS).

“I guess the attraction there was that this was a different type of membership organisation than any I had seen, driven around the voices of individuals who had long-term conditions and many of the organisations in Scotland who supported them,” he says, adding that it was also an “exciting opportunity” to reconnect with politics more directly.

Welsh has a keen interest in disability issues. His wife recovered from a brain injury and one of his sons has cerebral palsy, and so as an unpaid carer, he also has personal experience of the day-to-day issues people face. He describes himself as a “reconstructed municipal socialist” and the ALLIANCE he now leads as “a small organisation that plays in a big league,” adding that it is the strength of its members that gives it its “cache and influence.”

“We think it is important to create leaders and not followers. That is part of the reason why we have repositioned ourselves as the Health and Social Care Alliance Scotland, to remind professionals that people with long-term conditions live and work in a whole range of environments that don’t begin and end with a hospital stay.” For instance, in a novel move, the organisation was asked to pen the Scottish Government’s self-management strategy, ‘Gaun Yersel’ back in 2008 and now administers the self-management fund as part of efforts to empower individuals to take control of their own lives.

“Taking that person-centred message into the professional arena has been a very important burden of responsibility for us. But it is also important to say that in many ways we are also pushing at an open door. This is not an issue about us campaigning long and hard against an obdurate set of professional groupings,” he says.

“What we’ve done, I think, not on our own, with other colleague organisations and individuals, is to allow everybody to reconnect with a mission. To try and translate that, hopefully, into sets of improvements, sets of processes that then begin to coalesce into a force for change.”

Certainly, there are significant changes on the horizon. While the current efforts to integrate adult health and social care services have been described as a “once in a generation opportunity” by Public Health Minister Michael Matheson, such a description is “too apocalyptic” for Welsh. However, he agrees that the opportunity for structural and cultural change is upon us - spurred on by the combined fiscal and demographic challenges we face - and relishes the opportunity to be part of it.

“That opportunity to take the message to a new cohort of professional groups, to offer practical advice to administrators about how they can redirect their budgets, to offer toolkits to demonstrate how people can be more heavily involved in decisions about their future and how that makes decisions better is an important part of the process. And that takes concerted action. We are still a working population in health and social care that has multiple levels of professional silos. And you don’t change that ‘once in a generation’. You need to change that progressively from year to year. From professional to professional. From training programme to training programme. Day by day, around a vision for change.

“So I do accept that maybe the ‘once in a generation’ bit of this that I would concur with is there is a larger vision for change here at the moment that is stronger than it has been and we have to mobilise within that to make the changes.”

Welsh is a passionate advocate for the third sector being a key part of that change and his responses are peppered with examples from amongst the ALLIANCE’s members and partners. Be it the £5m investment from Macmillan in transforming after-care treatment, Alzheimer’s Scotland’s investment in dementia nurses and champions, Arthritis Care’s “fantastic” online work, Breakthrough Breast Cancer’s service pledge, the impact of IRISS as a thinker on health and social care research, or NESTA’s work on co-production - Welsh says the sector has a “fantastic showcase of deep reaching, innovative, flexible, nimble, penetrating and practical solutions that are available to the NHS and statutory sector services.”

Last week legislation that will put people who receive social care services in the driving seat was passed by the Scottish Parliament. The Social Care (Self-Directed Support) (Scotland) Act aims to ensure that people can live as independently as possible, enabling them to participate in their communities and to choose how their support is provided.

Welsh welcomes the legislation and the philosophy behind it.

“The philosophy for us is putting power into the hands of the service user. We will be acting in a very determined manner to try and maximise the opportunities for that within it, even in a sense beyond the Bill because selfdirected support has been a fantastic enabler for many individuals to take some control over their own lives.”

However, he acknowledges that it will also require “significant cultural realignment”.

“It is a de-stabiliser as well for established organisations who need the safety of a budget that is not going to be dismantled before their eyes, and I can understand that. So that is why it takes a bit of time. And to be honest with you, although there are many articulate disabled people who argue for this, there are just as many concerns, parents, and I’m a parent of a disabled son, who find the prospect of taking control of their money to be challenging.

“So there are challenges on both sides. But we are very firmly on the side of the angels in this regard. It is an enabling and an empowering experience for disabled people, for a disabled person to be able to control the support and investment that the community makes in them. And we would like to see that extended.”

As part of this the ALLIANCE will be undertaking a dialogue process and working with the Coalition of Care and Support Providers, the Joint Improvement Team and Self-Directed Support Scotland to, Welsh hopes, begin a process of widening the debate around self-directed support to health settings as well.

The collaborative is one of many items on the ALLIANCE’s to-do list. During the course of our conversation, Welsh hands me a list of the organisation’s current work and it is as extensive and wide-ranging as his own biography. It includes ongoing projects such as ‘Walking Towards Better Health’, which for the last year has been seeking to improve understanding of the physical, mental and social benefits of walking, as well as future work such as the Carers Voices Project that will see the ALLIANCE seek to capture the experiences of carers across Scotland with a view to informing future policy and service provision. Welsh says he is also delighted that the organisation has been asked to be a commissioning partner in the process around co-production as part of the newly launched National Person Centred Health and Care Programme, which will build on the success of the Scottish Patient Safety Programme. It will also take a lead role in the independent Life Changes Trust, which is backed by £50m from the Big Lottery Fund, which will look to transform the lives of young people leaving care and those of people with dementia and their carers in Scotland over the next ten years.

This panoply of projects are about “facilitating, showcasing, and demonstrating new approaches”, says Welsh, but they also help build a clearer picture about what the ALLIANCE itself is all about.

“We do have a campaigning arm and lobbying presence. But I think we are much more about getting behind the efforts, getting behind the direction of travel in a practical way,” Welsh says.

“So, taking the message out to all those who are engaged in health and social care settings to promote that clutch of activities - selfmanagement, self-directed support, recovery, advocacy, independent living, asset-based approaches - but to try and demonstrate as well through practical positive partnership working that we all need to be the force for change.”