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21st November 2015

Prevention through Enabled Communities

The Scottish Government has seen the need, since 2010, with the launch of the Public Services Reform (Scotland) Act 2010, to reform how public services are delivered so as to be more accessible and effective, despite the continued reduction in funding of these services. The Christie Commission was set up to look at opportunities to carry out this reform effectively.

Positive Prevention

Prevention was seen by the Commission as the way forward. Despite a positive reception, progress on the Commission's recommendations was slow. The Scottish Parliament's Finance Committee called for evidence on why progress towards this vision of the Christie Commission, a greater focus on preventive services, has been so slow and what needed to be done in order to increase momentum.

Health and Social Care Alliance Scotland (the Alliance) is a group which represents the interests of its members in Scotland. Members include small scale third sector and voluntary groups, as well as individuals, representing the viewpoints of people using health and social care services across the country.  The Alliance in October of 2015 submitted a response to the Scottish Parliament's question, spelling out in detail what needs to be done. It supports an increase in prevention and a change of focus from reactive service provision towards local resources for genuine helpful, individual response to person-centred needs. The response signposts a solution to the worsening dilemma of increasing demand on services by an ageing population, and the shrinking of public service budgets in a time of austerity.

The Alliance Response

The response is worth reading in its entirety, please see the link below. The main points the Alliance make to promote prevention are as follows:

  • Health services today face different needs: rather than being to detect and cure illness, they face a population with chronic multiple needs: often the individual has multiple health and social needs which call for a holistic, integrated approach. Yet traditional services, and their commissioning, focus on specific, acute public health needs.
  • Commissioning needs to change to being outcome based: to encourage and reward longer term successes rather than regular statistical analysis of need. This will need longer-term consistent funding to allow helpful outcomes to emerge and be developed, rather than annual bidding for contracts.
  • Personalisation and co-production are highly effective: so services need to include the user's viewpoint on what has worked and what does not. Digital technology is a good tool to enable this.
  • Power, including funding and accountability, needs to move closer to local communities with smaller person-driven services. Public funding, for example the fund to reshape the care of older people, and the fund to support integration of health and social care, have yet to move in this direction, and also require an increase to become more effective.

The response of the Alliance is refreshing, and clearly expresses the ideals of the voluntary sector. Although idealistic, it does point to a viable solution. We can only hope that the innovative changes it proposes can lead to healthier and happier communities best served by the resources which are controlled as locally as possible.

The response of the alliance is available at

Tony Clarke – QCS Expert Scottish Care Contributor

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