Community-led health: What we’re at risk of losing

Sara Redmond, ALLIANCE Chief Officer, on the challenges faced by community-led health organisations in delivering prevention.

There is a gap between what Scotland is calling for in the prevention agenda, and what our current system, across all sectors, is resourced to deliver.

Published this week, ‘Prevention Under Pressure’ sets out the experiences of community-led health organisations across Scotland, and the strain they are under to support the health and wellbeing of the people who rely on them. The research was carried out by the ALLIANCE, in joint partnership with Community Health Exchange (CHEX) and Scottish Communities for Health and Wellbeing (SCHW).

Their testimony forces me, once again, to confront the impact of declining capacity across the community health sector: a sector stretched beyond the limit, closing services and losing the ability to reach people at the point of greatest need.

These organisations are at the frontline of tackling health inequalities and addressing the social determinants of health, such as poverty, unstable housing and food insecurity. They are uniquely positioned to reach individuals characterised by ‘missingness’ and other groups who – for a host of reasons – do not take up offers of care from statutory services. Their knowledge and embeddedness within our cities, towns, and rural and island areas constitute a vital link between individuals and both the community assets and clinical pathways that support good health and wellbeing. Yet the picture outlined in ‘Prevention Under Pressure’ mirrors the experiences of organisations in our ‘Stretched Beyond Limit’ report, where 57% were unsustainably reliant on reserves, and only 3% felt they were financially stable. This vital link is clearly at risk of breaking.

At the same time, we have seen the publication of the Scottish Government’s definition of prevention and the launch of their Prevention Unit. This is another welcome step to establish upstream approaches across Scottish Government directorates, yet one which, in my opinion, risks overlooking the role and agency of communities in identifying their own needs, and instead primarily frames prevention around reducing pressure on public services.

While a helpful outcome – and clearly necessary in this time of widespread financial pressures – the role, and potential, of community organisations is about much more than reducing pressure on statutory services. Their focus on an asset-based approach to health creation, strengthening the factors that support good health and wellbeing, and helping individuals and communities to flourish, is at the core of what they do.

This is what we risk losing. As identified in ‘Prevention Under Pressure’, while complex and crisis-level referrals rise, alongside funding cuts and reduced joint service delivery, organisations set up for community development and preventative work are left handling unacceptable risk and unmanageable demand. This research, and more that we have heard before, indicates that our systems of community health, wellbeing and connection are losing resilience.

High-level strategies will only take us so far. What matters is whether they translate into real commitment: to Fair Funding principles, to meaningful involvement of the third sector in strategic decision-making, and to partnership built on trust and genuine collaboration. I hope this report gives us, and our colleagues across public services and government, a shared and honest starting point for that conversation. We will be using these findings to inform our engagement with cross-sectoral partners in the months ahead, and I’d encourage anyone working in or alongside this system to read it, share it, and to get in touch.

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