Integration: losing the balance?

Written by: Ian Welsh, Chief Executive, the ALLIANCE

Published: 23/04/2019

Ahead of the third ALLIANCE Integration Conference, Chief Executive says third sector has more to offer.

The Health and Social Care Alliance Scotland (the ALLIANCE) is to devote its annual conference to integration for the third year running. The event in Glasgow next month will consider the impact integration has had over the last three years, what still needs to be done and how organisations can work across sectors to collaborate and share ideas. The ALLIANCE’s Chief Executive, Professor Ian Welsh OBE, has been telling healthandcare.scot that there is more to celebrate than ever – but he has concerns that the pressure on the public sector partners, health boards and councils, may allow some to forget that the real prize is to be won through involving the third sector and communities in service design and delivery.

“We have to start with the fact that health and social care integration has been the biggest single piece of public service reform since devolution and, in that context, represents a significant shift in the thinking about how we deliver health and social care outcomes.

“Over the past three years, we have witnessed a very significant organisational shift in the public sector landscape, transforming structures, staffing, teams and budgets, to the extent that the process is pretty well complete – as I think is reflected in the ministerial strategic group’s final report. Integration Join Boards (IJBs) have generally been good at developing strategic plans and working to underpin engagement plans, with much more of a drive towards involvement of people who use support and services in service design and redesign. The issue going forward is how this co-production can continue and that structural integration is not seen as an end in itself.

“While it is important that the third sector, independent sector and unpaid carer voices, for instance, are heard at the IJB table, the boards are still largely dominated by the public sector.

“Where I think it is much more important that the third sector is heard at a level where change can be actually made, engaging in service design and delivery.

“There is no doubt that the practice of involvement is variable across the country. Where involvement happens at a service redesign stage or a service delivery stage, it can have quite profound impacts on the experience of people using and delivering health and social care services.

“It has not just been about changing organisations, structures and services but also cultures. That’s a hard ask. Cultural differences are not just between different professional groups. They are quite often within those disciplines themselves. So I will be most interested in the next three years to ensure that that process of cultural change: the process of embedding service user involvement, developing new service models with user involvement, engaging with citizens in the communities where they live and work and of, engaging with individuals who live with their long-term conditions in communities – continues to take shape and that the IJBs demonstrate that it is happening.

“From my experience, as Chief Executive of the ALLIANCE, and as a former chair of an IJB, I see fantastic evidence across the country of good work on all of those areas and my issue would be, from an ALLIANCE perspective, that the recognition of the impact and the role of the third sector has become more tacit.

“To some extent we have gone back in five years. Five years ago, the narrative would have been that the third sector was an equal partner in the process. The most recent narrative seems to be highlighting the roles of the statutory sector. That fails to recognise that the third sector employs some 6% of Scotland’s workforce – up to 140,0000 paid staff; that there are 1.5 million volunteers and thousands upon thousands of organisations in the third sector who work in healthcare and social care; that Scotland’s unpaid carers contribute to the tune of £7 to £8bn a year. The significant partnership of all these people across the third sector was recognised back then but seems less prominent now.

“When we meet in Glasgow towards the end of next month, we’ll hear from Jeane Freeman MSP, Cabinet Secretary for Health and Sport.

“I hope she will echo some of these messages around embedding the changes in culture, about building on the strengths of the third sector as partners and about mobilising the individual user.

“If I were to ask her to promote a larger message it would be around additional investment into the third sector activities – recognising that the third sector is a huge deliverer of services and support in the system and that additional resources need to be transferred to ensure that continues to happen. I hope she can help make third sector partnerships in health and social care much more visible across the system, recognising us absolutely in the narrative as equal partners and not subsidiary partners in the process.”

The ALLIANCE Annual Conference and AGM, ‘Impact: the 3rd Health and Social Care Integration event’, will take place on Monday 20th May 2019 in Glasgow. More details here, follow the event on twitter using #ImpactConf19.

Healthandcare.scot (this link will take you away from our website) is delighted to be a media partner with the ALLIANCE for the event and to be hosting a stand there. Follow them on twitter (this link will take you away from our website) for updates.

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