Issue 2: March 2012

NICOLA STURGEON'S AMBITIONS FOR CARE & HEALTH

By Professor Richard Kerley

‘A Healthier Scotland‘ is one of the central objectives that the government has carried over from the last parliament into this.

Developing this emphasis in creating a healthier country over the next 5 years is a key aspect of the Programme for Government presented by the First Minister in September of last year.

As Alex Salmond said then in his speech to Parliament:

“While building on our current strengths, we will also be bold and innovative in facing up to the scale of the challenge we all face - not only in Scotland but throughout the world. We will not shy away from difficult conversations or decisions wherever the needs of the people of Scotland are at stake..……we will help generate a shared vision of what success looks like. We will take every opportunity to develop with the public, NHS staff and other partners a compelling vision for the NHS and for care in Scotland. Our vision is of fully integrated care allowing everyone to live longer, healthier lives, for as long as possible at home or in the community. We will give importance to the role people can play themselves, supported as appropriate, to play a fuller part in their own care.“

Both the programme for government and the autumn launch of the Scottish budget signalled an increased emphasis on preventative activities, to be achieved through the government Change Fund - ‘Reshaping care for older people’.

Both the programme for government and the autumn launch of the Scottish budget signalled an increased emphasis on preventative activities, to be achieved through the government Change Fund - 'Reshaping care for older people'.

The Cabinet Secretary for Health and Community Care recently outlined her developing thinking on some of these themes in a keynote speech to a MacKay Hannah conference and in an interview with Scottish Policy Now.

Although the main focus of the conference was on caring for older people the Cabinet Secretary also made it clear that her concern was appropriate care for all, regardless of age and life stage. The logic of an early emphasis on older people, was that care demands tended to be associated with all those in the later stages of their lives and that the issue was clearly a UK wide policy concern that cut across health provision, care, benefits and taxation, as well as the concerns of the families of older people.

She argues that there needs to be recognition of the inter-relationship between various forms of benefit and other provision and that this had to take account of wider public discussions on the right balance of contribution between taxpayers in the wider society and the beneficiaries. In her words, the outcome of the Dilnot Review [Commission on Funding of Care and Support] had been to produce ‘reasonable recommendations’. She also cautioned that some of the Dilnot recommendations were:

“.. not fully compatible with the provision of Free Personal and Nursing Care as available here in Scotland“.

the signals of change are there to see with some partnerships already adopting the public title of 'Health and Social Care...' rather than the former style of Community Health Partnership.

Her reminder of this inter-relationship between various forms of welfare benefit and care services was an echo of the dispute between Holyrood - then with a Lab/Lib coalition - and a Labour government in Westminster over the introduction of Free Personal Care and the implications of that Scottish budget block commitment for attendance allowance, a reserved welfare benefit.

A major emphasis in what Nicola Sturgeon said was on the benefits to be achieved through the integration of health and social care and the means by which this might be achieved. She stressed that the plans being developed were to be the subject of consultation, as they were clearly of major importance to large and growing numbers of people who were anxious that the best possible arrangements should be put in place for themselves and their families.

The Cabinet Secretary argued that the integration of care services was to be based around some fundamental and essential features:

Clear integration of approach between different organisations, joint accountability – primarily between health organisations and social work organisations, flexible financial mechanisms that would give priority to people rather than financial procedures and an emphasis on strong clinical and professional leadership

The major aspects of change require legislation, but the signals of change are there to see with some partnerships already adopting the public title of ‘Health and Social Care …’ rather than the former style of Community Health Partnership. Given the fairly critical report on CHPs produced by Audit Scotland some months ago which observed that ‘…the added value of such partnerships is not entirely clear...’ perhaps the change will be welcomed by many of those directly involved. A clean slate can help organisations.

A number of those organisations - particularly those associated with local government, earlier seen to be the likely loser in all of this - will be comforted by her wish to "...avoid the pitfalls that can accompany centrally directed, large-scale structural re-organisation and staff transfer." The proposals the Cabinet Secretary puts forward for consultation are interesting and clearly welcomed by many of those engaged in anxious debate about the future of health and social care, including CoSLA, Health Boards, Directors of Social Work and the Chief Medical Officer. A number of those organisations - particularly those associated with local government, earlier seen to be the likely loser in all of this - will be comforted by her wish to ‘...avoid the pitfalls that can accompany centrally directed, large-scale structural re-organisation and staff transfer’.

A number of those organisations - particularly those associated with local government, earlier seen to be the likely loser in all of this - will be comforted by her wish to "...avoid the pitfalls that can accompany centrally directed, large-scale structural re-organisation and staff transfer"

However there are potential problems signalled in the proposals she has put forward. When she spoke to Scottish Policy Now she indicated that her ‘starting point…’ for planning was that each of the new partnerships would be based on the pattern of local authority boundaries. They would be independent of both the local authorities and the health boards and would each have their own ‘accountable officer’. To many readers that might just seem like a nicety of jargon but it has the potential to create institutional pressures that see a third party – the new Health and Social Care Partnership – with some degree of independence and accountability pitched into the middle of a long recognised and regretted pattern of resource competition between existing health boards and local authorities.

The Cabinet Secretary acknowledges this will be hard work but is confident that it can be made to work. Her personal interest and commitment in making it work is clear – what is less clear is whether the major cultural and institutional changes that are needed will be available this time round.

We asked her whether her use of the different words of ‘older‘ and ‘elderly‘ signalled any kind of definitional change that had implications for care, as age categorisation has such an implicitly tied relationship to both universal and discretionary benefits, to taxation and to various benefits in kind. Like many of us she ‘….[I] don’t use those words deliberately – it’s not planned..’. It may not be planned, but it has major implications for the balance of spending on both younger and older people, as the work of the Independent Budget Review; the recent comments of the Auditor General and an article by Charlie Jeffrey in this edition of SPN make readily apparent.

There is clearly more change on the way for our health and care services, it’s driven by the need to provide more and better health and care and it looks likely that it will not be more of the same.

By Professor Richard Kerley

Issue 2: March 2012

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