Creating a healthier Scotland - What matters to you

Key Themes from the Conversation

During the Conversation you talked about many different topics and expressed lots of different views. While your ideas and opinions were different - reflecting a wide range of priorities and experiences - most of them fell into a number of broad themes.

Here are the key themes we've identified. We'll look at each of them in more detail in the rest of this report before outlining how we move forward from here.

LEADING HEALTHIER LIVES

Prevention - Lifestyle and Behaviours - Education

You told us you'd like to see more focus on preventing illness rather than just curing it. Education is key to healthy lifestyles, and you recognise how important it is to establish good habits early on and to encourage and promote them throughout life. Some of you commented on the need for us all to take more responsibility for our own health rather than expecting others to fix it.

You would like more support to help you and your family make the right choices, with most of your comments focusing on healthy eating and exercise. We heard that the affordability, availability and accessibility of healthy options and opportunities often made this difficult. We also heard about the impact of health inequalities, and the need to tackle the underlying causes of ill-health, many of which fall outside the traditional boundaries of health and social care.

WELLBEING AND CONNECTED COMMUNITIES

Prevention - Lifestyle and Behaviours - Education

The importance of mental health and wellbeing was raised by people of all ages across Scotland. There is still concern about the stigma around mental health and the need for education and information to tackle that. You are clear that mental health is as important as physical health and therefore should be treated equally. The importance of early intervention was raised, along with concern about the time it can take to access mental health services. There was a general view that there was too much reliance on pills rather than addressing root causes.

There is a clear sense that the focus of a health and social care system should be on wider wellbeing rather than a narrow definition of health. We heard a lot about what makes you feel well, and within that the importance of relationships and strong connections with your local community. Social isolation is a key issue - at all ages - and could be helped by more befriending services and peer support. Some people commented on how the nature of community has changed, and that we need a return to strong community values, with more spaces for local people to come together.

PERSON-CENTRED CARE

Communication - Self-management - Holistic Approach

The themes of person-centred care, support to self-manage your health, and the importance of taking a holistic approach to health and wellbeing were raised again and again. You told us that you want to be listened to and treated with respect, but most importantly treated as individuals rather than conditions or numbers. It makes a big difference when you have a good relationship with health and social care staff and they know what matters to you and your family. Lack of continuity of care is a concern.

Being involved in the decision making process, and treated as an expert in your own care and the care of loved ones, is important to you. You said that information is critical, but it has to be provided in the right way at the right time. Too much information can be overwhelming. There needs to more support and encouragement to have open discussions about end-of-life planning.

SOCIAL CARE AND CARING

Unpaid Carers - Information and Entitlements - Support at Home and in Homely Settings

Compared with health care, there is less awareness of the full range of social care services and how they benefit different people. More people are familiar with the role of social care in helping older people, or those with long-term conditions, to remain at home or in the community. Social care is also essential to enable some people, such as those with disabilities, to live full and independent lives. We heard that more should be done to remove the stigma of social care.

Many of you shared your experiences of care, and caring for others. We heard a lot from unpaid carers about recognising their role and including them as an equal and expert partner in their loved one's care journey. You highlighted the impact that caring can have on the carers' health and wellbeing and the importance of support and respite.

You want more easily accessible information about services and entitlements. Some of you raised the issue of the cost of social care compared with health care. There were a range of views on self-directed support, health checks for carers and the carers' register.

A RESPONSIVE AND SEAMLESS JOURNEY OF CARE

Access - Flexibility - Joined-Up Care

The need for more accessible and flexible services was raised a lot. You want to see the right person at a convenient time and place, and you would like more focus on earlier intervention and diagnosis. The length of time it can take to get appointments, and the need for a consistent service regardless of where you live were frequently mentioned. Your first point of contact does not always need to be with a GP and you recognise that other professionals can help you too. Information technology (IT) offers scope for greater flexibility although it is not for everyone.

You prefer accessing services in your local community, although you recognise this is not always possible. Accessible and affordable transport to services is important and can have a big impact on your experience.

We heard about the need for joined up care and better partnership working, communication within and between services, and information sharing. The level of duplication you face when telling your story can be frustrating. So is trying to find out what is available in your local area and what support you are entitled to. An easier way of signposting people to relevant information and support, in an individualised way, is needed.

PRESSURES AND PRIORITIES

Workforce - Funding - Targets

We heard how highly you support and appreciate the health and social care workforce, including care workers, and the need to value and recognise their role. You recognise the challenges staff often face, the impact those can have on the provision of care, and the need to invest in training in areas such as equalities and mental health.

There is recognition of the current pressures on the system and the need to set priorities for the future. An open and honest debate involving all sectors of society was welcomed. There was some interest in exploring a human rights-based approach and participatory budgeting.

Many of you highlighted the valuable role of the third sector in local communities but also the impact of short-term funding on the sustainability of services.

We heard how more should be done to learn from innovation and good practice, both within Scotland and other countries, with a focus on spreading what works more widely.