Health and Social Care Alliance Scotland (the ALLIANCE)
Note: National Conversation on ‘Creating a Healthier Scotland’
Conversation Café event
1 February 2016, The Town House, Hamilton
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 1 February 2016, the ALLIANCE, in partnership with Voluntary Action South
Lanarkshire hosted a conversation café event to support the Scottish Government’s
National Conversation on ‘Creating a Healthier Scotland’.
Following an introductory session, delegates were asked to explore the
following discussion questions;
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What support do we need in Scotland to live healthier lives?
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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:
Accessibility of services
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GP surgeries need to be open throughout the week or appointments should
be able to be made in advance. Some GPs only allow you to book an
appointment in the morning of the same day and this can be difficult for
working people or people with other commitments who sometimes need to
book an appointment in advance.
GP appointments needs to be longer when possible and the most important
questions for GPs to ask is ‘What matters to you?’.
More local GP surgeries are required as not all people can travel to hospitals
and transport links can be hard to access. Alternatively, more funding should
be allowed to enable people to reach services near them.
Waiting times at hospitals are off-putting to those in need.
Waiting times to see some types of specialists (such as Neurological
Consultants) can be long due to staff recruitment difficulties, particularly in
more remote and rural areas.
More physiotherapists should be in post.
Receptionists at hospitals need to be fully trained to the same high standard
across Scotland and confident in being able to identify who requires the
immediate attention.
More counselling services should be made available as the current waiting list
for community psychiatric nurses (CPNs) can be up to four months.
Need to raise awareness of how to support people (mental health, first aid);
these training courses need to be made available to more people.
The Self-Directed Support (SDS) assessment period is too long and can turn
people away.
Quicker access to services when needed.
Need for good access to services i.e. information, physical access, opening
hours.
Need time – time for referral to service to be shorted, time to spend with
patients to be longer.
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Community assets
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Libraries should be a central community hub but many are closing down or
not open many days in the week.
More community learning places need to be invested in: writing courses, IT
skills, etc.
There are many assets within local communities which often remain underutilised due to a) a lack of information about them or b) a lack of transport
services which enable people to access them easily. For example, people
highlighted issues with the ‘MyBus’ service such as eligibility criteria, and
restrictions on routes and running times, which hampered how useful it was
as a service in practice.
Barriers to people engaging in leisure activities e.g. people can’t set up direct
debits at leisure centres because they can’t guarantee when their benefits will
be paid, so an additional charge could be incurred. It was suggested that
councils/local leisure centres could return to the system of allowing people to
pay monthly on a casual basis, rather than setting up a direct debit or paying
a concession price at each individual visit.
Increase free exercise for older people and free play for children.
Accessibility of information
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People don’t know what support is out there and available to them. For
example, nurses don’t have the time to point out what welfare support is
available to someone when they leave hospital, so better signposting is
needed.
How do people find out about the services in their area?
Information lines/shops are one good way of directing people to the services
out there but are reliant on funding.
If people don’t use services, how are they to know what’s available when they
need to access?
Information about health and social care services is often produced in formats
and language which many people can find inaccessible, due to jargon etc.
The internet has led to a massive expansion in terms of the amount of health
and social care information which is available to the public, but this
information can sometimes be conflicting and of low quality. What steps can
be taken to make sure that people are consistently signposted to accurate
and high quality information/advice.
Better system management for patients/service users.
The ‘value of care’
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Carers need to be recognised as playing an important role within health and
social care integration
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Greater respect for the care profession, with more qualifications, required
skills and training attached to it, would help prevent abuse in care homes.
The current status and pay of the social care sector does not adequately
reflect the massive role that its staff play in enabling people to live
independently and reducing demand on health services later down the line.
Payment of the Living Wage to social care staff (including Personal
Assistants) would be important step forward in achieving this.
Current status and conditions within the sector makes recruitment and
retention of staff difficult. High levels of staff turnover has a negative impact
on people who access support and services, as it can make continuity of care
and person centred care difficult to achieve.
Rationalise and reduce tiers of administration and release more funding to
hands-on services and carers.
Rely less on unpaid unqualified help. Better utilise and exploit less of the
volunteer sector.
The aspects of care that people identified as being most important to them
were being listened to and having services which are responsive to and built
around their own circumstances.
Better matched paid for carers.
Joined-up services
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There need to be better links between community organisations, the third
sector and the Government. Partners needs to be joined up and
communicating effectively to prevent resources being wasted through
duplication. Different organisations and services need to be working together
and not in competition, with the focus on enabling people to access what they
need.
There needs to be a simpler, more streamlined system for referrals between
different organisations and agencies. This would make it easier for the person
referring, but would also ensure the person needing support can get it in a
timely fashion.
A better referral system would be supported by more electronic information
sharing, so that all services could access the up-to-date information they need
about a person. There must be a way of creating a secure central IT system
that different services and agencies could access with a person’s permission.
Better communications with services and patients/service users, good
partnership working.
Culture change is needed for social work, GP practices, NHS to promote
sharing of community health/third sector information and signposting.
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Employment
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There is a greater need for employment opportunities for people in deprived
areas, even if this means providing greater transport links.
We need to look differently at employment. Volunteering can help build
someone’s confidence and skills and give them the structure they need to get
back into employment, but volunteering is not viable as a long-term
occupation for financial reasons.
Similarly, working part-time can also empower a person, even four hours a
week, for example. However, employers don’t want to employ multiple people
on short term contracts because the costs are higher than employing one
person full-time. Employers should be encouraged to make more
opportunities like this available.
Invest in skills development for care staff.
Prevention
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We need to rethink the Accident & Emergency/acute care model and ensure
that better prevention is in place. These services also need to work better with
social care and home care.
There should be more funding for activities in local areas, like youth clubs and
outdoor gyms, to give young people things to do.
There should also be more support for young families, for example more play
areas, football parks and other places parents can take their children. This
would help build the foundations for an active lifestyle and making healthy
choices.
Services like opticians, dentists etc. need to be equipped to spot early
warning signs that someone needs support so that people who don’t access
services through their GP or hospital don’t fall through the net.
We are all good at ‘talking a good game’ when it comes to prevention, but
action is needed to make this approach a reality and increase the pace of
change. There was a feeling that upstream/preventative services were often
among those first to be cut when finances become tight.
Peer support
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Peer support is necessary and awareness of this needs to be raised.
Peer support can enable and empower people to take a more active role in
their own health and care.
Additional/sustainable funding is needed from the Scottish Government to
support this.
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Support for older people
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Anticipatory Care Planning (ACP) should be promoted in hospices.
More holistic care is needed for older people.
Education on end of life care is needed for younger carers.
Professional carers need to have empathy, understanding, respect and the
ability to build relationships
Whistleblowing should be encouraged where abuse is taking place to
increase accountability. Better leadership is also needed.
Concerns were expressed over the increasing demands on older people’s
services and the potential for this to result in increased costs to individuals.
Education
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Educate children better about coping strategies when under pressure.
Have specialised units for children with additional needs in schools.
More support staff are needed within schools.
Education about lifestyle choices needs to be delivered regularly and
consistently. There was a target for all schools to be health promoting by
2007, but after this target was met, very few schools continued with this work.
Education in school can only go so far if these messages relating to healthy
lifestyles etc. are not reinforced at home.
Young people and young families need more support in homemaking skills,
like managing a household budget, how to cook healthy meals etc.
Children in primary school should be educated in health and social care and
how to look after themselves and their peers.
Seldom heard voices
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More needs to be done to reach people who don’t access services and
ensure that they are getting the support they need and are involved in
decision making. There is potential for this to be done through General
Practices.
Scotland has a diverse population, so we need to ensure that the needs of
people from different cultures are met and that they are involved in decision
making (especially where English is not their first language)
The role of Local and National Government
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National Government takes too much control over funding, more control
should be given to Local Authorities.
Scottish Government strategy doesn’t always filter down to people who
use/need services.
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Local authorities need to connect with the third sector organisations in their
locality to find out what services are missing and where the strengths are.
There needs to be a balance between national and local priorities. Different
local authority areas have different needs, but often decisions are made for
political or economic reasons. This leads to discrepancies between the
services available and the standards of these services. For example, there
are a lot of differences between North and South Lanarkshire. Centralisation
and sharing good practice would lead to consistent quality of support and
care.
Local Authorities need to build services in partnership with communities, so
that local needs are still being considered.
Action is needed to reduce ‘postcode lotteries’ which exist in the services
which people in Scotland are entitled to dependent on which local authorities
they reside in. This was highlighted as being a particularly key issue in
relation to charges for non-residential care services.
Government should oversee cultural change of the set-up, management and
distribution of funding with agencies working in partnership to provide more
cost effective services and having more carers/services on the ground.
Need for a campaign against sugar.
Bureaucracy can get in the way of providing good care/service.
The Third Sector
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More Scottish Government consultation work needs to be given to the third
sector so they can harness the voices of those they work with and feed that
into future policies/strategies.
More funding should be invested in social enterprises.
When funding is available, how do organisations find out about this?
The Third Sector needs to be smarter about publicising the services they
offer. They also need to get more involved with the referrals process and
commissioning so they can fill the gaps in public sector service provision.
There could be a different way of funding third sector organisations, for
example a proportion of council tax could be used to fund projects in local
communities.
Investment in the Third Sector – they can adapt to the individual’s needs and
communicate with all parties, gaining a better outcome for the individual.
Other
 We need to close the ‘feedback loop’ to make people aware that their voices
are being heard, and acted upon.
 There needs to be a consistent way to feedback to the Government when
there is a problem, small organisations are unaware how to do this.
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There needs to be greater awareness about the work done to tackle social
isolation.
Advocacy support is crucial service which enables people (who may
otherwise be unable) to have their voices heard and participate in decision
making which affects their lives.
Direct cultural change by empowering individuals to make changes in health
and lifestyle for themselves.
Implement a single tier structure outwith the ownership of central, local
government, NHS and associated network of services.
Help is need to allow people to question advice/information given about their
health.
Questions to ask the Scottish Government:
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Realistically will the report be published before purdah and when will the
actions be implemented?
How will the future funding be transparent to people who have fed into the
conversation?
Is it certain that the next Government will implement all of the outputs
discovered through the conversation?
Results of the Ping Pong Poll:
In the last five years do you think health and social care services have got better?
8 – No
11 – Yes
For more information contact:
Marianne Brennan, Events, Communications and Academy Coordinator
[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:
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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.
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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.
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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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