Creating a healthier Scotland - What matters to you

Pressures and Priorities

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.

Many of you shared your appreciation for the important role that health and social care staff have in keeping us all healthy and well, and you recognise the pressures and difficulties they often face. You said that health and social care staff should be valued and respected, and that this should be recognised through good pay and conditions. It's important to you to have confidence in the knowledge, skills and expertise of staff. There were suggestions for more investment in training in some areas such as equalities and carer awareness, mental health and dementia. You highlighted that all staff should have a 'cultural and gender-sensitive' approach to their work.

"It's vital that we invest in and listen to frontline staff. They provide services on a day to day basis, and they're the ones most valued by patients."
Scottish Women's Convention consultation response

"An empowering culture is necessary to enable the practice of values around dignity and respect carried out with humanity and kindness. Disabled people firmly believe this is possible, even where resources are constrained."
Glasgow Disability Alliance consultation response

"Train NHS staff to be more culturally sensitive to many different cultures."
Scottish Health Council event, Glasgow

"Scotland's health and social care workforce should be well paid across all roles and sectors, and must have access to training and development opportunities."
Alliance event, Paisley

We heard a number of comments about the pressures on the social care workforce due to distance between clients, travel arrangements and staff shortages. This can affect the quality of care provided and may mean there is only time to meet basic needs.

"Current status and conditions within the (social care) sector makes recruitment and retention of staff difficult. High levels of staff turnover has a negative impact on people who access support and services, as it can make continuity of care and person-centred care difficult to achieve."
Alliance event, Hamilton

"We often hear that carers have no time to travel between houses and their resources are not being used effectively or efficiently."
Coalition of Carers in Scotland event, Eyemouth

Staff across a range of professions told us they were driven by knowing they make a difference to the lives of those they care for. We received a few comments about the impact of national targets on staff.

"There needs to be more respect for professionals and freedom for them to provide the right care, and less bureaucracy."
Alliance event, Edinburgh

"…the use and impact of targets therefore needs to be reconsidered and that where targets remain, they should be more focused on contributing to the shift in balance of care and delivering a reforming and preventative agenda that improves outcomes."
COSLA response

A number of you talked about how much you valued having a free NHS. Others felt that support should be more targeted and we could save money by reconsidering universal services.

"Keep it public and avoid creeping privatisation. I'm so proud of Scotland's NHS. People before profit."
Scottish Health Council event, Glasgow

"The group discussed the payment of winter fuel payments and free subscriptions. While it was recognised that these benefits are paid universally as it is cheaper to do that than operate a system of means testing, it was felt that many people benefit from this who do not need to, and that the money could be better spent elsewhere."
Health Scotland staff event, Edinburgh

There was general recognition that the current system of health and social care is under financial pressure, that change is necessary, and that clear priorities need to be set. The need to shift the balance of care from the hospital setting to the local community was highlighted, along with the importance of better partnership working and a move towards patients, carers and different sectors as 'equal partners'. The wider role of personal responsibility also came up in this context. Some organisations welcomed an open and honest debate, involving the public as well as partners, on the difficult choices which prioritisation will require.

"We do appreciate that the facilities provided by a modern health service cannot be limitless, that there are many conflicting interests, and that demands, and therefore strains on the system will grow. Perhaps we cannot take the NHS for granted any more in the way we may have done in the past. Therefore we would like to suggest that the time may have come for a new charter of patients' rights and responsibilities, with a strong emphasis on the rights of those who are most vulnerable, and an equally strong emphasis on the responsibilities of those who are most able to exercise them."
Ullapool Medical Practice's Patient Participation group response

"There is overwhelming agreement, most recently emphasised by Audit Scotland, that while it remains one of the safest health services in the world, the NHS in Scotland is now facing unprecedented pressures. Doctors therefore welcome the decision by the Scottish Government, with cross-party agreement, to embark on an open and honest debate with the public about the future of the NHS in Scotland."
Scottish Joint (Medical) Consultative Committee response

Some of you suggested different approaches that could be taken to prioritise and deal with pressures, such as a human-rights based approach or the use of participatory budgeting to set health budgets.

"The right to health can help inform decision making, including about resources and priorities. We recognise that in the current environment this is challenging. But the difficult financial climate itself gives greater impetus to the need to redesign services and develop new approaches, on a fair, robust and legal basis."
Scottish National Action Plan for Human Rights (SNAP), Health and Social Care Action Group response

"If it's not broke, don't fix it!"
Coalition of Carers in Scotland, national event

"I think we should spend less time and money on developing better systems and services in localised areas and look more at what is being done elsewhere, with a view to speedier adoption of proven good practice."
Individual response, NHS Tayside Public Partner

Throughout the Conversation we heard examples of good practice and innovative ways of working. You would like to hear more about these through good news stories in the media, and for services to get better at sharing their learning. You told us that 'new isn't always better' and that you would prefer that projects shown to work well were rolled out nationally. Some people suggested we should also be learning about what worked in other countries, like the Nuka approach from Alaska and the Buurtzorg approach from the Netherlands.

You recognised the important role the third sector plays in delivering projects across Scotland. This was particularly true at the Alliance events, which included many representatives and volunteers from third sector services as well as people who had benefited from them. There was support for a more sustainable approach to funding of third sector services. Short-term funding cycles were seen as a barrier to creating a healthier Scotland. Some feedback highlighted the disproportionate impact of service cuts on physical and mental health in vulnerable groups.

"There is a feeling that short-term funding for projects is damaging in that it allows good practice to fall by the wayside, and that long-term sustainable funding could provide more certainty and thus better outcomes for the service, staff and the community."
Alliance event, Stirling

"More funding for third sector organisations could mean continuous support to communities, which in turn would take pressure off the health and social care sector."
Alliance event, Paisley

DID YOU KNOW?

• Around 380,000 people work within Scotland's health or social care services. This includes doctors, nurses, midwives, pharmacists, ambulance staff, social workers, carers, dentists, allied health professionals and support services. 160,000 of those are employed directly by the NHS and 200,000 are part of the Scottish social service workforce.
• Participatory budgeting is a tool for community engagement. More information on participatory budgeting activity and initiatives across Scotland can be found at www.PBScotland.scot