Ensure everyone gets the right support, in the right place, at the right time.

Adopt a Digital Choice approach to mitigate digital exclusion and guarantee people parity between digital and non-digital health and care services.

The impact of COVID-19 accelerated the pace of digital innovation and sparked a rapid migration to online service delivery for many, including the health and social care sector.  While this is a welcome development for those who can access internet services easily and confidently, this is not true for everyone.  Although 88% of Scottish households have access to the internet, connectivity drops significantly for some population groups.  For example, only 43% of people aged 75+ and 71% of adults with some form of limiting long term condition use the internet.[i]  The consequences of digital exclusion must be recognised. We must ensure that people who are not online – or who choose not to be – do not risk losing access to essential services as we move to an increasingly digital world.

A Digital Choice approach will ensure that non-digital services and communications will continue to be guaranteed, on par with the delivery of digital services.  To promote and protect the health and wellbeing – and rights – of people accessing services, measures must be taken to mitigate digital exclusion and guarantee people parity between digital and non-digital health and care services.

Prioritise appointments of Community Links Practitioners to every GP practice in Scotland’s most deprived areas.

GPs at the Deep End, a collaborative of general practitioners, have described in detail the impact that living in complex social circumstances can have on people’s health, and in particular the experience of ‘social prescribing’ among GP practices in deprived areas.[ii] A high proportion of consultations are driven largely or primarily by experiences of social adversity, especially poverty and financial problems. Deep End GPs felt that they were often unable to respond effectively to these issues due to lack of time and difficulties accessing community-led services – which they knew would benefit their patients – and expressed frustration at the barriers that prevented them from supporting people in this way.

The ALLIANCE’s Links Worker Programme, funded by the Glasgow City Health and Social Care Partnership (HSCP), is delivered within 31 GP practices across the city.  Community Links Practitioners (CLPs) are based within Deep End practices and work with the practice multi-disciplinary team. The programme recognises the pressure that GPs and primary care colleagues are under and introduces a different skill-set to the practice team to support all staff to adopt the Links Approach.[iii]

This highly successful model improves health outcomes. It should be expanded during the next Scottish Parliament, and funding provided to ensure CLPs are appointed to all GP practices. To avert the inverse care law and further entrenching inequality,[iv] prioritisation should be given to GP practices within Scotland’s 100 most deprived areas, which have between 88-44% of their patients in the most deprived 15% of datazones.[v]

Create a ‘Right to Rehab’ to ensure everyone has access to rehab when needed and no-one is excluded by a ‘no rehab potential’.

The World Health Organisation (WHO) defines rehabilitation as “appropriate measures, including through peer support, to enable persons with disabilities to attain and maintain their maximum independence, full physical, mental, social and vocational ability, and full inclusion and participation in all aspects of life.”[vi]

Rehabilitation helps people do more than just survive their condition – it helps them really live. For people to live as independently as possible, it is vital that people living with long term conditions or recovering after an accident, operation or illness are offered tailored rehabilitation. In most cases, people’s rehabilitation will require a period of intervention by health professionals. It will also often extend beyond that treatment and into long-term support within communities.

Without the rehabilitation they need, people are at risk of readmission to hospital, likely to need repeat visits to GPs, additional care from their family or providers and may struggle to return to work and live their lives to the full. A strategic shift towards personalised, community-based services must be matched by delivering a Right to Rehab.

Alongside our partners in the Right to Rehab coalition,[vii] the ALLIANCE is calling for a Right to Rehab that ensures everyone has access to rehab when needed, and no-one is excluded by a ‘no rehab potential’. People’s needs to be met locally by having the right workforce and professional leadership. The Right to Rehab should be incorporated in a new national Health and Social Care Strategy, placing it at the heart of integrated health and social care.

Increase investment in community-based mental health and wellbeing services and guarantee people access to timely, good quality support.

The need for comprehensive mental health support has only increased during the COVID-19 pandemic. For example, SAMH reported in September 2020 that 43% of people with mental health problems felt they had not received care or treatment because of the pandemic, and 45% were coping badly with their mental health (up from 23% before the pandemic.)[viii]  Research indicates that some population groups have been particularly impacted, including women, young people, and people in poverty.[ix]

We know that disabled people and people living with long term conditions can experience poorer mental health as a result and may have different requirements that affect how they access mental health support and services. There is growing evidence that people affected by mental health issues in Scotland do not fully enjoy their right to access timely, good quality support. All too often, people are left to experience mental ill-health until crisis point or face lengthy waiting times to access services remote from them and their communities.

Investing in wider provision of community-based mental health support and services is essential if we are to address these issues. Scotland can build mental health resilience by increasing the number of easily accessible prevention and early intervention support to help people before they hit crisis point. Community centred and led projects also help to tackle the stigma of mental ill-health by bringing support to people rather than waiting for them to reach out to their GP or the NHS.

Fully incorporate housing in health and social care integration, for a more joined up and holistic approach to prevention, early intervention and the right to health.

Health and social care integration recognises that underlying social, economic and cultural determinants of health shape general population health, and aims to shift the balance of care from acute to community-based settings.[x] To achieve a joined-up, person centred and holistic approach to integration, housing and associated services should be treated as an integral part of its delivery.

Housing has an important influence on health inequalities in Scotland, through the effects of housing costs and quality, fuel poverty and the role of housing in community life.  The right to affordable, safe, and adequate housing has a critical part to play in improving health, enhancing life chances, and transforming communities,[xi] and is important to achieving Scotland’s National Performance Outcomes and the National Health and Wellbeing Outcomes.

Download the ALLIANCE 2021 Scottish Election manifesto at the link below.

[i] Scotland’s People Annual Report 2019 – Scottish Government (this link will take you away from our website)

[ii] The Scottish Deep End Project: Manifesto and Reports – University of Glasgow (this link will take you away from our website)

[iii] About the ALLIANCE Links Worker Programme

[iv] The Scottish Deep End Project: The Inverse Care Law – University of Glasgow (this link will take you away from our website)

[v] About Us: GPs at the Deep End – University of Glasgow (this link will take you away from our website)

[vi] Rehabilitation – World Health Organization (this link will take you away from our website)

[vii] Right to Rehab coalition – ALLIANCE

[viii] The Impact of The Pandemic on Mental Health Services Revealed – SAMH, September 2020 (this link will take you away from our website)

[ix] New Study Reveals Mental Health Impact of Initial Lockdown Period – University of Glasgow, October 2020 (this link will take you away from our website).

[x] Health and Social Care Integration: Housing Advice Note – Scottish Government (this link will take you away from our website)

[xi] Opinion: A view of integration from the social housing sector – SFHA, June 2018