Integration to prevent poverty

• Written by: Peter Kelly — Poverty Alliance — Director
• Published: 17th June 2018

Reforming the way public services are delivered has been on both the political and practice agenda in Scotland for many years.

It was the Christie Commission report in 2011 that perhaps best captured the urgent need for reform in the way that we deliver services in Scotland.  Their finding that some 40% of public spending was on so-called ‘failure demand’ (spending to fix problems that could have been addressed earlier) focused the minds of everyone involved in the delivery of public services.  Shifting resources from fixing problems after they occur to preventing them in the first place should always be our priority whether we are operating in the public or voluntary sectors.  Prevention should be and is at the heart of the continuing development of health and social care integration.

Of course, throughout the period since the Christie Commission in 2011 and the passing of the Public Bodies (Joint Working) Act 2014 (this link will take you away from our website), public services have been operating in the shadow of austerity, meaning that efforts to focus on prevention have been under pressure.  Policies like the two child limit and the freeze on most working age benefits have had a significant impact, and levels of child poverty have begun to increase once again.  Bringing about the integration of health and social care was always going to be a challenge but in this context, with increasing poverty levels compounding Scotland’s stubborn patterns on health inequalities, that challenge has been amplified.

Yet it has also underlined precisely why integration, and the accompanying focus on prevention, is so required.  Increasing poverty will make the task of addressing Scotland’s stubborn pattern of health inequalities all the more difficult, but also all the more necessary.  In amongst the various challenges that Integration Authorities face, it is vital that they remain true to the National Health and Wellbeing Outcomes and are focused on tackling health inequalities.

This can be done, in part, by further integrating rights based approaches within health and social care.  We have seen some progress in this area in recent years, with Self-directed Support allowing more people to make informed choices about their care. But there is much still to be done, with the pace and scale of change not yet being sufficient given the stated ambitions of the integration agenda.

We also need to do more to truly embed a more holistic, person-centred approach to care. Innovations like the Links Worker programme have been hugely welcome and impactful in addressing the social determinants of ill-health, but we still hear too often about ‘hard to reach groups’ when we should be talking, conversely, about ‘hard to reach services’.  Making services easier to access for people living on low incomes may pose challenges, but it is fundamental to achieving a fairer Scotland where everyone is able to access the rights, services and support to which they are entitled.

Reforming and streamlining our health and social care service was never just about saving money.  Fundamentally, it has been opportunity to recast our public services in ways that the Christie Commission, and many others, has sought to do.  This means much more than developing more coordinated service delivery, important though that may be.  It is about putting those who use those services at the heart of their design and development; not just participation for participation’s sake, but true co-design and co-production that has poverty and inequality alleviation as one of its key guiding principles.

With a new Scottish social security system being established based on principles of dignity, fairness and respect, we find ourselves at a potentially transformative juncture in Scotland’s journey towards a more just and compassionate society.

The ongoing integration of health and social care must be seen as part of this journey.  It has the potential to transform lives and contribute towards a loosening of the grip of poverty and inequality.  Two years on from the start of Integration Authorities’ formal operations, the time is right to re-commit our efforts to ensuring that it does.

The Poverty Alliance can be found on Twitter at: @PovertyAlliance (this link will take you away from our website).

Peter’s Opinion is part of the ALLIANCE’s ‘We Need To Talk About Integration’ anthology which is available at the link below.

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