Exclusionary planning leads to poor preparedness

Chief Executive of Scottish Care, Donald Macaskill, critically reflects on the Winter Preparedness Plan.

There are just a few occasions in life where the output is less important than the process. The latest Scottish Government and COSLA jointly badged ‘Winter Preparedness Plan’ is just such an example. Indeed, the document is illustrative of what Eisenhower described when he wrote: ‘Plans are nothing, planning is everything’.

The process by which the Winter Plan was developed and has subsequently been disseminated is illustrative of the utter inadequacy of its contents. Any plan worthy of the name requires a consistent and agreed set of goals and priorities. It is not at all clear what this Plan hopes to achieve other than scraping through some winter challenges. It has no vision or goal for the future of health and social care in Scotland. 

The Plan claims to be for the whole health and care system but in truth it is only addressing (and it does even this poorly) the short term needs of the acute and secondary NHS. The perverse politicised, media influenced focus on delayed discharge, accident and emergency waiting times and unplanned admission – all worthy and critical in their own way – has resulted in a plan which speaks to part of the system and not the whole. It is a plan that only mentions social care in a tangential way and only when it plays a bit part in the support of the great NHS.

A whole system plan would address the critical symbiotic relationship between the NHS at acute level and primary, community and social care. This does not. It is both social care lite and social care tone deaf. It wholly fails to appreciate the critical increasingly dysfunctional nature of social care provision across Scotland.

Part of the reason for such an inadequate appreciation of the challenges of workforce recruitment and retention, of provider sustainability, commissioning malaise and unpaid carer exhaustion, is put simply because those around the decision- making table and the writers of the Plan seem to have been ignorant of those realities or only able to recognise them to the extent to which they impact upon the NHS.

In truth failing to include social care providers and representative bodies in drawing up this Plan is both reckless and symptomatic of the lack of broad whole system thinking which has and is still bedevilling planning in Scotland. It does not take a rocket scientist to surmise that if you ever want to address delayed discharge you require a thriving and flourishing social care sector and that that means recognising and rewarding frontline staff so that they feel valued. The much trumpeted £12 an hour is now wholly inadequate given the Real Living Wage will be that figure from April 2014. After a summer of dither and delay, the opportunity to retain staff within social care and to recruit and attract more has well and truly been lost.

A healthy social care sector is the key to unlocking critical NHS issues, but it would appear our political leadership at local and national level haven’t even noticed the door. Real preventative care and support can only happen where people live at home or in a homely setting and it is this which is in turn results in preventing unnecessary hospital admission and which in turn frees up hospital capacity thus reducing A and E delays.

I hope in moving forward that any planning activity in 2024 truly includes, involves and respects social care and that as a whole health and social care community we start to treat the disease which has become rooted in our society, and which is known as a National Hospital Service (NHS) Myopia.

End of page.