Health and Social Care Alliance Scotland (the ALLIANCE)
Note: National Conversation on ‘Creating a Healthier Scotland’
Conversation Café event
7 December 2015, Eskmills Venue, Musselburgh, East Lothian
The Health and Social Care Alliance Scotland (the ALLIANCE) is the national third
sector intermediary for a range of health and social care organisations. It brings
together over 1,500 members, including a large network of national and local third
sector organisations, associates in the statutory and private sectors and individuals.
The ALLIANCE’s vision is for a Scotland where people of all ages who are disabled
or living with long term conditions, and unpaid carers, have a strong voice and enjoy
their right to live well, as equal and active citizens, free from discrimination, with
support and services that put them at the centre.
The Health and Social Care Academy aims to drive fundamental change in health and
social care in Scotland. Activities will use the lens of lived experience and look at
relational, rather than organisational aspects of change.
The Academy is intended as a much-needed cross-sector platform and focal point for
activity, a support for all those driving it, and a space for the more radical and emergent
ideas.
On 7 December 2015, the ALLIANCE, in partnership with the Health and Social Care
Academy and STRiVE hosted a conversation café event to support people in East
Lothian to participate in the Scottish Government’s National Conversation on
‘Creating a Healthier Scotland’.
Following an introductory session, delegates were asked to explore the
following discussion questions;

What support do we need in Scotland to live healthier lives?

What areas of health and social care matter most to you?
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
Thinking about the future of health and social care services, where should our
focus be?
Discussion points
The responses that these questions generated have been collated under the
following themes:
The ‘value of care’

Our future vision for the future of health and social care has to include raising
the status and conditions of the social care workforce. The payment of living
wage is central to this

Health and Social Care Workers need to be paid well (eg: Living Wage, no
zero hour contracts) and supported well (upskilled, better educated and
resourced).

Carers pay and work conditions has to be inspiring to care for older people.
As the average age is increasing we need to look at this now so we have
inspired workforce for the future.

Carers need to have enough time to provide good level of support – it is often
impossible for carers to fulfil role within required timeframes.

Self Directed Support needs to be resourced properly if it is to provide
genuine choice, control and personalised support (i.e: people need to have
adequate funding/budgets and available support options).

People need to be more aware/respectful of health and social care services
and to recognise value of these (eg: too many missed appointments wasting
resources).

Carers Support Organisations are valuable but more provision of training is
needed for Unpaid Carers.

Unpaid Carers are currently underestimated and undervalued. They need to
be better supported and should be more included in decision making.
Increase the pace of change towards prevention
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
Our current approach with respect to health and social care is largely one of
‘firefighting.’ We need to focus more attention and resource on acting
‘upstream’ to address underlying causes, rather than symptoms.

Care service provision often focus on fulfilling basic personal care (eg:
washing, dressing, eating) but need to be equally focused on supporting
people to have companionship, stimulation and activity.

Availability of counselling services for people with anxiety/depression.

More local support is needed in relation to Mental Health and Learning
Difficulties.

It is false economy to focus resources only on services/resources required at
the point of crisis and better to avoid getting to this point by investing in things
that help people stay well.

Education

Given that many of the key determinants of health are established in the early
years, we need to do much more to promote healthy eating and physical
activity within education settings

Personal and Social Education (PSE) classes aren’t currently being used to
their full potential and could be an important mechanism not only for delivering
heath related information to young people, but to support them to develop
problem-solving and self-accountable mindsets

Schools should start independent living Skills from very early age like in many
other countries. New education programs and help from third sector should
come in to this as the current curriculum and teachers may not have all the
skills to teach independent living skills at the schools. This will help individuals
learn healthy cooking, cleaning, budgeting and taking care of themselves.
Young children start learning by hands on experience and practical skills and
this goes a long way in their lives.

Education around healthy living (eg: exercise, diet, etc) should begin in early
years with more continuation and creativity required. It is easier to maintain a
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healthy lifestyle if people start when they are young rather than having to
adopt big lifestyle changes later in life.

Parents are primary educators and should have necessary guidance and
support.

Greater role for schools (eg: School Nurses/Guidance) and Third Sector youth
services/groups in improving health literacy among young people – links to
Curriculum for Excellence.

Healthy Eating (eg: healthy lunches) should start in Nursery School and
continue throughout school to become the ‘norm’.

More sport in schools – should be more availability and better facilities but
should not be made too competitive in order to remain inclusive and not deter
people from taking part.

Extend opportunities and links for further involvement of young people within
Health Literacy/Promotion beyond existing initiatives (eg: more local
partnerships, internships with health and social care services and
organisations, peer support).

Support needed for children whose parents are experiencing health issues.
Social justice

The National Conversation and subsequent action plan must recognise the
impact of many social issues such as living and working conditions, transport
and social isolation on health and wellbeing.

Transport is an issue – it is difficult to access supports/activities outside
immediate locality (eg: town/neighbourhood) which can cause isolation and/or
financial burden.

Public Transport in East Lothian is “poor” and needs to be improved.

The services need to reach those in deprived areas rather than them reaching
the services. There are many personal and financial obstacles they have to
overcome to utilise the services.

Education is key for ensuring deprived communities can live healthier lives.
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
Are we sleep walking as poverty is dragged in everywhere. We need to invest
in communities to bring everyone in the journey.

Addressing policies and processes that maintain and/or exacerbate poverty
and inequality (eg: austerity, welfare reform/benefit sanctions, etc).

Financial circumstances can have detrimental affect of people’s mental health
and waiting for social services, and accommodation should be tackled more
effectively.

Young People can be put off of Physical Activity by costs involved (eg: Gym
Membership).
Promoting Health and Wellbeing

The support we need in Scotland to live healthier lives extends far beyond the
NHS, and the national conversation and subsequent action plan must reflect
that

Greater emphasis needs to be given to ‘lifestyle medicine’, which deals with
research, prevention and treatment of disorders caused by lifestyle factors
such as nutrition, physical inactivity, and chronic stress

Regulate the projection of unhealthy food and activities on media and
encourage healthy life style in a positive way especially for young children.

Sugar Tax.

People should be educated to explore what keeps them well and facilitated to
adopt activities which keeps them happy and healthy.

More healthy eating initiatives required in local towns/villages.

More provision of fruit and healthy options should be generally available at
activities, events, etc (It’s always sweets or biscuits on offer, rarely
alternatives).

People need to recognise tangible benefits of healthy lifestyles in order to
adopt and maintain these.
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
Messages around health and prevention need to be helpful – has to be
recognition that some people will inevitably become unwell and experience
long term conditions so blanket response is not always right.

Need to emphasise and maintain link between health and physical activity.

Information/Support should be available in the places where people go to as a
matter of course (eg: supermarket, local shops, high street, libraries, pubs),
not just health centres, GP Practices, Community Centres, etc.

Social aspect of sport should be promoted.

Contact/interaction with family and friends is important to reduce isolation.

People can share information with each other and encourage each other to
make healthier choices including accessing health services and available
supports.

There are lots of social services and good news but we do not focus on them.
Promoting and appreciating information on health and health care activities
can encourage healthier communities.
Models of Primary Care

The current GP contract is too prescriptive and prevents practitioners from
operating in a truly flexible manner

Primary care remains a vitally important route through which people access
health information and support, but we need to think of ways in which to do
things differently. One proposed approach was that of ‘shared medical
appointments’ through which multiple ‘patients’ have an appointment at the
same time (typically about 90 minutes in length) with a team of healthcare
professionals representing different professions. During an SMA, participants
receive education, participate in group discussion with other ‘patients’, and
interact with a multi-professional healthcare team. The primary aim of the
model is to improve health and wellbeing and to support self-management

People need to have direct access to a much wider menu of options than is
currently available, to support and services which offer a more holistic
approach to health and wellbeing.
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
GP practices are in competition with each other which affects the quality of
care. They should be people focused and have programs to improve people’s
lives and health.

Out of hours services should be provided as people wait long times to get
appointment.

Greater recognition of the benefits of community assets and activities that
help people to live well. There should be more emphasis on Social
Prescribing/Signposting to community resources while recognising that some
people will need individual support/encouragement to engage with community
resources. It is important to develop ‘community connectors’ and capacity to
support people to access available supports/opportunities. New models such
as ‘Link Workers’ / ‘Wellbeing Officers’ are developing in this area.

GP Forums should be encouraged and patient opinion websites should be
promoted to learn about the issues and frame solution in the light of patient
views.
Relationship between people and services

We may need to change some people’s perceptions about what they want or
need from interactions with health services, as medication may not always be
the most optimal outcome for them.

People feel trapped rather rescued by these services due to the complexity of
the processes. We need to change how we are doing it making it simple and
personalised to make it more productive and useful for people.

Job pressures and systems can cause health and social care professionals to
lose sight of people as individuals.

Social Workers work on tight capacity and their role of providing support to
families is diminished by the amount of paper work involved.

Communication between services/professionals and carers/families must be
improved.

People often don’t feel listened to throughout interactions with services.

Gatekeeping processes for accessing support can be difficult, daunting and
humiliating and can prevent people from attempting to access required
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supports, especially if people lack knowledge/confidence/ability to articulate
issues and navigate systems.

People and communities need access to independent advocacy to give them
the confidence and support to take part in decision making about their own
needs and in planning services to best meet those needs, including the ability
to challenge Health Professionals when necessary.

Service Users being involved in the development of services at Board and
Advisory Group level.

People receiving support should be involved in the recruitment, selection and
training of staff members supporting them.

Regular care reviews (at least 6 monthly) are required for people receiving
paid support and must be carried out in an accessible format to ensure people
have opportunity to be involved in their own care.

Continuity of care staff with ability to recognise change and adapt
care/support provision accordingly.

In order to maintain sense of self-worth and value it is necessary for people to
be treated as individuals and not viewed as just another
number/‘patient’/‘service user’.

Having a relationship of trust and familiarity between professionals and people
is vital.

Services need to be more inclusive for all, especially people with Long Term
Conditions – Services which are supposedly universally available are often
available only to those who are “universally able”.
Supporting self management

We need to empower and support people to increase their sense of self
accountability in relation to their own health and wellbeing. This includes
providing people with clear and accurate information on how to live healthier
lives, but also providing practical tools to support, and demonstrate to them
how they can achieve this

People need to be able to access information about the sources of information
and support in their local communities which can help support health and
wellbeing.
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
People need access to good information and also need to be supported and
motivated to use this information. People need to know what support is
available locally and where to go to find out about this. There should be a
proper and a reliable system for people to find the information they need
about local resources and what is available for them and their families if they
are to engage in healthy activities.

People need more opportunities for physical activity that are not prohibitive
due to cost.

Accessibility – make access as easy and convenient as possible for people
(eg: direct referrals, more services within local health hubs, IT and digital
solutions, etc).

More accessible information is required for people with Learning Difficulties.
Information and communication must be accessible, inclusive and not solely
reliant on literacy (eg: other formats such as Makaton should be more widely
used).

Plain English should be used instead of complex medical terminology and
jargon, in order to ensure information is accessible.

Government and Services should not make the assumption that everyone can
read and/or use IT - What provision exists for ‘excluded’ people? Alternative
formats required.

There should be safe environment provided to the public which encourages
outdoor activities.

More safe spaces and opportunities are needed for children and young
people to get exercise.
Role of the third sector

The role of the third sector with regards to prevention needs to be valued and
more effectively supported.

Need more resource/capacity in communities to enable shift towards
promotion of healthier lifestyles as Third Sector cannot absorb and manage
this alone.
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
Funding requirements often make it difficult for community organisations to
provide most appropriate/relevant services/activities. More funding is required
for the Third Sector to ensure services are available.

Statutory health and social care services and the Third Sector should
collaborate and connect with each other from the very beginning to improve
lives as a preventative measure and provide support to individuals with long
term conditions. The disconnection between Health & social care and the 3rd
sector should be recognised and the role of each sector should be valued
through active engagement and proper planning. There is a need of
centralised records system and all three sectors should be able to share
information with each other.
Transformational change

One suggested ‘provocation’ for the National Conversation was to “imagine
that the NHS did not exist. What kind of service would we design or introduce
to meet the needs of the country?” I.e What is needed is fundamental
redesign rather than tinkering at the edges.

There is a need for political acceptance that NHS needs to be redesigned.
NHS has great people in it but the system is fragmented and needs to be co –
ordinated.

Health and Social Care ‘systems’ need to allow enough time for required
support/care.

Re design the services in a way which genuinely improve the lives of the
people.

Invest in local communities and support people to connect with others –
people need to know what resources exist and how to set up things
themselves if they identify gaps. Resources could be used more efficiently to
build community capacity (eg: train the trainers) to enable communities to
deliver classes/activities, etc.

Services must be flexible and meet the needs of the people who need them.

More investment and focus is needed on enabling people to have their voices
heard. There should be a framework which facilitates decision making
processes by educating people about wellbeing and then involving them in the
process of decision making and future planning. General Public/Citizens need
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to be more involved in conversation – not just people/services operating within
field of health and social care.

People should be able to access all support services under one roof. People
with disabilities should be able to access information and advice on education,
benefits, employment, and advocacy at one place.

People (individuals) can be community assets and should be recognised as
such.

Need for some Risk taking/challenging of established
perspectives/standpoints.

We are in culture of keeping everything in a system and through processes
which are complicate. The various parts of the systems do not connect with
each other and lots of money spent is not helping but creating barriers.
Discharge packages are frustrating for most of the people and they feel lost
rather facilitated. We need to rethink the way we are doing it.
Housing

There should be greater provision of accommodation purely for expectant
mothers.

Better access to housing.

Social Housing must be more available to allow independence – example
person spending 16 years on a waiting list for council housing before
obtaining own home. Eventual outcome made a big difference in improving
choice, control and independence but shouldn’t have to wait so long for this.
E health / Technology

Educate people about e health and how it can provide support to those who
need it.

Increased access to health information through various channels.

Community Alarms allowing for support/assistance to be called when needed
and for people responding to be prepared for particular situations.
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
Technology can be a benefit but some people are still frightened/reluctant to
rely on this. Important for people to have information and choice around any
introduction of technology as support as it can otherwise cause more
distress/harm than help.

Can help to provide easier access to healthcare (eg: digital options for
arranging hospital appointments, etc). However it is also important to maintain
opportunities for human interaction within everyday life as removing these can
increase risk of isolation and loneliness (eg: increased instance of self-service
supermarket tills, automated processes, etc).
Other

People’s attitudes towards people with disabilities and/or long term conditions
are important – people need to be more aware, respectful and polite within
services and society more generally.

Change in culture within Scottish society.

Honest endeavour of people doing their best for ‘patients’.

Need to avoid over professionalising caring / health and wellbeing.

Support for families to address difficulties/issues with paid care staff
supporting family members in order to ensure staff are adequately trained to
provide support.

People too often have poor experience of treatment in hospitals and don’t feel
their voice is being heard at these times.

Dying well is as important as living well. Trained professionals should be
available at the end of life.

Media has an influence on changes and decisions– it is difficult for politicians
to be truthful about things or take difficult decisions due to media response.

People need to connect with others – community is key for this. We need to
encourage a culture where people connect with others. Communities should
be able to provide support to each other. Young people can help others by
delivering the message through social media, networks and within their
schools. Community activities should be planned to connect people to people
as the alienation and stress becoming very common which causes
unhappiness and affects mental wellbeing of people.
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
What is the nature of the health records. How can patients have access to
their own records. Person centred health plans could be introduced based on
centralised information of health records and family medical history.

People with Mental Health issues and Learning Difficulties need more support
to manage other long terms conditions (eg: Diabetes, etc).

More options/activities are required for older people in order to avoid isolation
– provision should not be limited to lunch clubs and befriending services.
More opportunity for intergenerational activities needed.

Health and Social Care Strategic Plans need to be more bottom up,
accessible and ‘digestible’ with fewer, clearer priorities.

Resources should be used better (spending on Trident, etc, could be invested
in health and social care services).

Need to ensure links between the health and social care are consistent and of
high standard. There should be regular monitoring and evaluation of these
services.

Psychological assessments and social security interviews last around 40 mins
and the decisions are based on a quick chat with an individual which can
affect their lives forever. Initial process needs to be more carefully designed
as this can help invest in a more productive way.

Increase in local council budgets to enable more local funding as opposed to
funding from national Government grants.
Ping Pong Poll: We asked the question:
‘In your experience do you think health and social care services have hot better over
the past 5 years? The majority of respondents thought
7 - Yes
14 -No
For more information contact:
Stephen Plunkett
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ALISS Partnership and Development Manager
[email protected]
Cameron MacFarlane
ALISS Development and Engagement Officer
[email protected]
Amber Zafar
ALISS Development and Engagement Officer
[email protected]
T: 0141 404 0231
W: http://www.alliance-scotland.org.uk/
About the ALLIANCE
The ALLIANCE has three core aims; we seek to:

Ensure people are at the centre, that their voices, expertise and rights drive
policy and sit at the heart of design, delivery and improvement of support and
services.

Support transformational change, towards approaches that work with individual
and community assets, helping people to stay well, supporting human rights, self
management, co-production and independent living.

Champion and support the third sector as a vital strategic and delivery partner
and foster better cross-sector understanding and partnership.
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