What the ALLIANCE hustings event told us about the 3rd sector’s role in integration

Written by: Benjamin McElwee, Third Sector Health and Social Care Support Team, the ALLIANCE

Published: 13/04/2016

Benjamin McElwee, Third Sector Health and Social Care Support Team, reflects on issues raised at our recent hustings.

Less than a month to go and the Scottish Parliament election is nearly upon us.  Health and social care came to the fore during the last term of the Scottish Parliament, with the passing of the Public Bodies (Joint Working) (Scotland) Act 2014, and as the manifestos are published for the next term it looks like it’ll be a key debating point over the coming weeks.

With this in mind, the ALLIANCE held a busy hustings for members debating the key issues on 4 April 2016.  Many areas were covered, including those highlighted in our ‘2 Million Expert Voices’ manifesto, not least the integration of health and social care.

Jenny Marra, Scottish Labour’s Equalities spokesperson, highlighted the impact of ongoing cuts to local authority funding.  In some areas, this has led to paid carers covering their own travel costs, zero hour contracts and accountability as individuals at SSSC tribunals.  Ms Marra argued that care workers are not professionalised in the way they need to be and don’t have a strong voice to argue for better working conditions.

Shona Robison, representing the SNP, countered by highlighting the Scottish Government’s recent £250m injection each year to support health and social care integration.  She noted that this aims to increase community health services, move towards outcomes focused social care and ensure integration is focused on pooling of budgets – with a strong third sector voice.

Whilst it was heartening to hear all of the above – third sector representatives do not have voting rights on integrated joint boards (IJBs), and often do not have a seat at the table when it comes to the commissioning of services and strategic planning groups. Furthermore, within health, and not just social care, there needs to be a real drive towards person centred care – delivering the right treatment for people at the right time to enable the outcomes that they themselves want to see – instead of being process-driven.

Members of the audience (and the panel) raised concerns about postcode lotteries for treatment, waiting lists, access to care in the community, and carers’ breaks.  Jenny Marra said that shadow IJBs had been in place for months, and that “we need to keep a weekly, if not daily brief, on how this [disparity] is happening in our local communities, because it’s not good enough” and that there should be “much more strict legislative timescales on the sharing of best practice”, alongside ensuring greater third sector involvement on IJBs.  I personally agree with the idea of enforcing the sharing of best practice, as it is a step in the right direction towards ensuring that the silo-mentality is not, by law, allowed to continue.

Andy Wightman of the Scottish Greens argued that people should hold their local Health and Social Care Partnerships accountable to ensure they get “best practice”. Shona Robison said that the new outcomes framework underpinning integration would encourage reporting.  However, a member of the audience made the salient point that a term like ‘Quality of Life’, used in the framework, remains vague, and “people from a medical background will have a different attitude to what that means than people with a social background of inclusiveness”.

Ms Robison gave an indication that the restructuring of the health and social care landscape is far from over – and that if elected, the SNP intends for the third sector to be further involved in the strategic commissioning process, “not just bidding for contracts, but part of the discussions about what services are required in the area”.

It was an interesting session overall that acknowledged key challenges to the implementation of integration, and reiterated a commitment to achieving outcomes for people that are not merely about hitting targets and following process but that consider individual life-stories, needs and wants, and how the third sector’s involvement will be crucial in achieving this.  However, it is only by August 2017 when the first annual reports from all the health and social care partnerships (HSCPs) will have been published, that we will see to what extent these commitments have been realised.

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