Happy New Year and Welcome to 2018.
Within the context of New Year’s Resolutions, and the focus on caring for and creating the ‘better you’ peddled within any one of the many self-help books promoted at this time of year, I see a shift from a focus on having less, to a focus on having more. To be health-‘ful’ by limiting what you give your body, to have more time by limiting how you use your time, to be richer by limiting how, where and when you spend your money: they all require a fine balance so close to being contradictory, and in complete contrast to the holiday feasting.
It’s an analogy which I see, in this time of austerity, being applied across the health and social care sector. Not to focus on cuts, but to focus on what we have and what we can do within that context. And whilst this appears to be a laudible approach, I have not yet found an ‘off-the-shelf’ self-help book on the health and social care sector.
This is because missing from the discussion is the reality that we have been working at this for over eight years now. At what point can we say that we have applied all of the efficiencies possible? Not to say that there is no place for review, but that a focus on what can be saved now leaves the sector exposed to the real risks associated with a failure to future proof.
Last month I had the privilege to hear Professor Gillian Ruch speak at the Social Work Summit. She spoke about relationship-based approaches to service delivery, and raised the concept of austerity as an ideological choice about making budgets balance, not about looking at the needs of the population.
Often when we plan for our sector, we think about celebrating our aging population who may use health and social care services. But what we need to be aware of is that we also need to celebrate and value our aging workforce without whom the sector as a whole risks folding. Consideration then must also be given to the necessary interaction with and effect of this on the rest of the population, especially given the economic contribution of a sector which employs 1 in 13 Scots. But this has to happen not just in relation to workforce planning, but to all of the aspects of health and social care. To plan for the sector as a whole, we must to consider the needs of the population as a whole.
If carefully and thoughtfully planned, implemented and resourced, there are currently many opportunities for the sector; the reform of many of our partners, the new health and social care standards, self-directed support, integration, and so on. But my concern is that the pre-requisite context is not a given, and the current impact of winter on an already under-resourced and under-valued sector, means that change will come too late.
At the time of writing, we await the response of the Health and Sport Committee to the evidence given in relation to the ‘Save Our Bield’ campaign. Whilst I support the call to create an independent commission to review the crisis in the Scottish care home sector, I am wary that to consider the outcomes of this in isolation from the sector as a whole – from care at home through to acute provision – would be limiting and wasteful. What happens in one part of the sector will inevitably affect another, inevitably affecting the citizens of Scotland. And so the pressure is on to consider our vision for the future of care as a whole; a vision which values our population as a whole, the sector as a whole, and the contribution that it makes to the population of Scotland as a whole.