Reflection: Crisis in the health and social care sector

ALLIANCE Chief Officer, Sara Redmond, shares her thoughts and reflections on the recent open letter to the First Minister.

I had been waiting in anticipation to read the Herald on Sunday’s recent article on the health and social care crisis – an article about a letter that highlights issues in the sector the ALLIANCE has long been engaging with. 

I woke up early on Sunday morning, eagerly checking the Herald on Sunday to see if the article had been published, and I was almost relieved to see it on the front page. Sitting front and centre and spread over 6 pages, it felt like recognition of the challenges that the health and social care sector is facing. Recognition not only that this was a story worth telling – thanks to writer Neil Mackay and the Coalition of Care Providers Scotland (CCPS), who worked so closely with us on this – but also that this is an issue that must now come under the spotlight. 

Hundreds of thousands of people across Scotland rely on support and services delivered by the third sector to enable them to live their lives on their terms, with dignity. There should be a social contract between the state and its people; meaning that when we need it, we can stay assured there will be support available to overcome challenges and adapt to the circumstances of our health and wellbeing. But this does not yet currently exist in Scotland.  

It was a hard but intentional decision to raise the critical issues facing the sector in a public forum. But too many years of under investment in social care and community health initiatives means that many services are at a crisis point with support and services being cut or closed. The article really brought home what this means for people – making it harder to get the help they need, whether that’s support to prevent problems in the first place or to deal with them when they happen. 

That really is the crux of why we decided to write to the First Minister. The open letter we drafted in partnership with CCPS laid bare the pressures facing the sector, including services stretched to breaking point, communities at risk, and organisations forced into impossible decisions. Our letter highlighted these realities and set out concrete asks to address them; a commitment to long-term investment in social care and community health, meaningful involvement of the third sector in planning and delivery, and a clear strategy for system-wide reform that prioritises people’s needs. 

Writing directly to the First Minister was about ensuring these concerns, and these specific solutions, are no longer hidden under the carpet, and heard at the highest level, so action is taken before this crisis deepens further. 

Naturally, there was some anxiety in seeing the article published, and I was conscious of the possible ripple effects of such a stark piece. Public forums can sometimes risk oversimplifying the issue, suggesting there is either a quick fix to apply or, conversely, no solution at all, which can feel like scaremongering. 

Yet it needed to be said, and the response has been overwhelming. Signed by 240 organisations, our members and those from CCPS, have been clear; we are speaking out as a sector because we believe change is possible, and we are determined to make it happen. The support from the sector truly has been felt, with messages of solidarity received both across social media and in private. Our motivation wasn’t just to highlight the stark challenges facing many charities, community groups and social enterprises, but to issue a call to action; we must create the conditions for real change. 

Neither the ALLIANCE nor CCPS believe this will be simple. Reforming such a complex system takes time, commitment, and courage. We are committed to working with the Scottish Government, and we welcome the direction it has set out through its Population Health, Service Renewal and Public Service Reform Frameworks. But if we are serious about reform, we must redraw the boundaries of Scotland’s health and social care system and make the third sector an integral part of it.  

That starts with confronting difficult truths about our current reality, accepting the discomfort, and committing, together with government and system leaders, to build a system that truly works for people.  

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