ALLIANCE Chief Executive reflects on what has changed since the Christie Commission review of public services.
Ten years ago, the Christie Commission published an independent report on the future delivery of public services. At the time, I wrote that the Commission set out a radical vision for Scotland’s future – one that clearly laid out the consequences of no action, as well as suggested solutions. The Commission argued that without change, disabled people, people living with long term conditions and unpaid carers would face greater inequality and an increasing poverty gap compared with the rest of the population.
One of the significant asks of the Commission was that outdated attitudes and approaches needed to change. The report stated that generally, “services are provided to individuals rather than designed for and with them”. Damningly, the authors concluded that public bodies were frequently “unresponsive to changing needs and risk-averse”, with services that were “fragmented, complex and opaque” and limited joint working between key organisations. They called for a fundamental shift in attitudes and the design and delivery of public services; prioritising preventative action, asset-based approaches, and personalised services that were built around and co-produced with communities.
Ten years later, Self-directed Support (SDS) – an early pilot scheme at the time of the Commission’s report – has been passed into legislation as the way that Scotland delivers social care, centred around individual choice and control. Recent research by the ALLIANCE and Self Directed Support Scotland, “My Support My Choice”, indicates that 74% of people feel that SDS has improved their social care experience. While implementation is still varied and there is more work to be done, when realised well SDS responds to many of the recommendations of the Christie Commission. Similarly, the Commission mentioned the then newly launched Self Management Fund – which has since granted over £20 million and funded 325 projects to support the development of co-produced projects that increase the capacity of the people of Scotland to live well with long term conditions.
However, we cannot claim to have fully implemented the Commission’s recommendations – nor to have avoided all the bleaker outcomes it warned against. In 2019, the Scottish Government estimated that 24% of families with at least one disabled person were living in relative poverty; a substantial increase on the estimate in the Christie report. Ten years of austerity have negatively impacted local authority budgets, with an ensuing impact on disabled people, people living with long term conditions, and unpaid carers. The COVID-19 pandemic has further exacerbated these inequalities and left many third sector organisations who provide key services in financial crisis.
Scotland has taken some significant steps in responding to the recommendations of the Christie Commission with improving partnership working, innovative practices and good connections and relationships with people at community level. Crucially, the Christie philosophy is at the heart of the Independent Review of Adult Social Care.
The challenge now is how to fulfil and develop that vision in a current context of austerity, pandemic, remobilisation and public service reform. This means fully acknowledging the third sector as a partner – with sustainable and secure funding for the third sector critical – and people at the centre.