Transforming health and social care

During the heated referendum campaign the Health and Social Care Alliance remained “stringently neutral” on the outcome, insists its chief executive, Ian Welsh, choosing instead to set its work around imagining the future and its focus on building a better, more inclusive, mutual, democratic, and person-centred health and social care system.

Speaking to Holyrood the day before Scotland’s historic vote, Welsh argues that regardless of the decision, post-referendum Scotland can’t continue with business as usual.

“We need a much more radical shift towards preventative asset-based approaches and we need to build on that progressive, self-management, community connectedness and social capital activity that allows resource shift from acute to community care.”

The Scottish Government’s 2020 Vision is that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting. And yet during the campaign a leaked report compiled by NHS finance directors laid bare the £450m cuts health boards are facing over the next two years and argued that “continued commitments are being made which are directing increasing levels of resource into hospital-based provision counter to the ambition for enhancing preventative/self-care and local community-based provision”.

The leaked document brought the challenge Scotland faces to the surface, Welsh says. He welcomes the commitment to address the balance of care, but adds that there is now a need for a “very significant national debate that translates some of the fantastic rhetoric into a practical action plan for that resource shift.”

He continues: “The Alliance is a policy, lobbying and thought influencing organisation as much as it is anything. But I am personally not immune to the practical challenges that lie around that resource transfer. Because demography is imposing greater challenges and it is conceivable that you can reduce your dependence on the acute sector and still require the same and potentially increasing levels of services.

"Equally, even activity that is essentially preventative around patient flow or patient pathways sometimes still requires significant capital investment and service redesign investment in the short term. So it is not an unproblematic area. But I do think it is the time for there to be a really significant national debate around the steps that need to be taken towards that.”

He hopes that debate can be conducted in an “uncharged atmosphere”.

“We need as a nation to come to a view whether or not the democratic demand for hospital services is reduced. And that is a really difficult thing for politicians to do, and I’m speaking as a former politician [Welsh was a council leader then briefly a Scottish Labour MSP in the first Parliament. He stood down within the first year].

"But we need to have that debate and we need to build a consensus that we are now very firmly in the game of trying to shift resources from acute to community. And although that is implicit and explicit in route map 2020, we need practical action plans to do it.”

The Alliance is ready to play its part, he says.

“From our point of view, apart from calling for transformative change and exemplifying ways in which it could be done, we have now got a platform of policy into practice initiatives. So the Health and Social Care Academy is going to be, for us, an important space in developing partnership to provide a safe space for emergent ideas and radical thinking, and making sure the voice of people with lived experience is on an equal platform alongside the professionals in health and social care.”

The organisation also has a real contribution to make in raising the level of debate about tackling Scotland’s health inequalities and trying to develop some practical solutions, he argues.

“Our cache is trying to find practical ways to address that. And the link worker programme that we’ve been developing with government and the Deep End GP practices is one way. If there is one initiative that we are currently doing that focuses on how we try and reduce health inequalities in areas of deprivation then that would be it,” he says, while stressing that we need to be much more focused on delivering a palate of practical, interlocking solutions in deprived areas.

Scotland needs to recognise that individuals and communities are part of the solution too, he adds.

“We need to work with people. And I think the energy that has been around the referendum just exemplifies just how much of an untapped resource individuals and communities are.”

There are “choppy waters” ahead in terms of resources, he warns. But he believes there are also opportunities.

“The resource opportunity is about trying to tap in to the people resource that we’ve got in Scotland. It is lived experience of people. It is people who are keen to be paying back and volunteering. Keen to be managing their own lives through illness and disability. So that is what will drive us as we go forward and we think that will be a strong agenda.”