We read with interest EVOC’s article ‘Edinburgh Health and Social Care Partnership’s new Chief Officer, Never Afraid to Challenge: Interview with Judith Proctor (15 August 2018)’ and were heartened by some of her commitments ensuring that local third sector organisations would play a key role in helping to address some of the current challenges faced.
This we would say is crucial throughout Scotland at local levels. Equally so is the involvement of those who use the services,as social care users have, until recently, had very little say in decisions about the local delivery of integrated services.
We agree it is important to invest locally in a wide range of services, including those to support the various Self-Directed Support options, advocacy for decision making, and so on. One way is to commission local Disabled People’s Organisations such as LCIL who provide a range of helpful services and are run by disabled people themselves.
Good social care has many functions other than merely “keeping people safe” – what about supported risk taking? When thinking about ‘reducing loneliness’, we also need to look at quality of life and having enough to live on (charging for social care should be abolished to this end). Going further than involving people in the community there need to be real opportunities to participate in local decision making.
Users of social care services may also find the phrase “hospital at home” alarming. It is reminiscent of the Scottish Government’s ill-advised “There’s no ward like home” advert that included the image of the older man, Mr McCluskey, surrounded by health and social care workers on an elongated sofa.
We have seen a generalised focus at all levels on health outcomes for individuals throughout the integration process. Getting social care packages in place for people already discharged – to prevent ‘bed blocking’ – is important, but so too is their wider integration back into their family, community, and so on. Social care has much wider implications which merely include the preventative well-being agenda to improve lives; it must also realise people’s human right to Independent Living.
Later in the interview Judith expresses the need to think about ‘how we are supporting older people and [disabled people] to link into their community and be active citizens’. Revitalising the local third sector is one way of ensuring this.
The legislation applying to social care includes the duty to engage with those who use the services. Yet we know there are still barriers to adult social care users having true choice and control, partly because of the tensions between local procurement and Self-Directed Support. Involving them in how Partnerships plan might prevent such tensions occurring.
Our 2015-16 Health and Social Care Integration Engagement Project, which worked with disabled people and Third Sector Interfaces (including EVOC), recommended:
“Disabled people have the lived experience of the consequences of other people’s decisions about their health and social care, so their perspectives should be one of the primary sources of evidence when designing and implementing health and social care services.”
Inclusion Scotland are running a national, Scottish Government funded People-led Policy Project, a policy panel and core group of adult health and social care service users who will actively use their lived experience and expertise to influence policy going forward.
This project will gladly engage with CEOs of local Health and Social Care Partnerships. Indeed, we believe this kind of ambitious, radical change to involving people in decision making – People-led Policy- needs to be happening at local levels too.
Dr Pauline Nolan
Policy and Localisation manager, Inclusion Scotland.
Inclusion Scotland is a ‘Disabled People’s Organisation’ (DPO) – led by disabled people ourselves. Inclusion Scotland works to achieve positive changes to policy and practice, so that we disabled people are fully included throughout all Scottish society as equal citizens.
Sources: “Health and Social Care Integration Engagement: Opportunities missed and challenges to be met” Inclusion Scotland