At the ‘2 Million Expert Voices’ ALLIANCE conference on 23rd May the afternoon brought a panel and Q&A session based on the Five Provocations for the Future of Health and Social Care. These have been generated through cross-sectoral discussion groups tasked to consider what is needed to transform Scottish society so that all citizens are able to thrive. The provocations are: courageous leadership; nurturing transformation; target culture; emphasising humanity and ceding power (see http://academy.alliance-scotland.org.uk/about-the-academy/five-provocations). The three panel members each focused on a different provocation in their talks.
Jackie Maceira, convener of the Scottish Disability Equality Forum, illustrated the importance of emphasising humanity when he described his experience of applying for self-directed support not for personal care but for a personal assistant so that he could remain involved and active in the community. He was taking an approach that was considered somewhat novel, trying to do things in a flexible way to achieve what was meaningful. Barriers that arose around which category to ‘put’ him in, or “but we don’t do it that way” were subsequently overcome, a social worker represented his request to the panel and ultimately he received the personal assistance. Jackie’s message of hope was that life-changing outcomes can be achieved when there is an emphasis on humanity.
Judith Robertson, Chair of the Scottish Human Rights Commission, addressed the issue of nurturing transformation, pointing out that people need to know what their rights are in order to assert them and hold duty bearers to account; something we need to work on in Scotland. Judith reflected that often there are individuals within services doing things as we want them to be done, but in order for this to spread and become the norm it is vital that those people and their positive practices are truly valued and nurtured. As Eleanor Roosevelt said “Where, after all, do universal human rights begin? In small places, close to home…”.
Oliver Escobar, Director of What Works Scotland, took both courageous leadership and ceding power as the prompts for his talk, although he highlighted that ‘ceding’ power might also be seen as ‘sharing’ power… or even creating power by involving 2 million experts. Oliver emphasised the need for a shift from an ethos of individual, ‘heroic’ leadership to recognition that the best leadership is collective, with facilitators bringing together people who need to have difficult conversations. Grassroots community work alone is not enough, he stressed; those at strategic level need to be engaged in order to influence investment, aid decision-making and effect transformational change on a large scale. Oliver advocated devolution to a local level and not only the participation of lobbies but actively seeking the voice of the seldom heard. An overarching theme was the need to move from seeing health and social care integration as a question of services to seeing it as a matter of power, politics and democracy.
Questions from the attendees stimulated discussion and comments about the politics of partnership, the importance of those providing a service having knowledge about human rights, and the view from Oliver that sometimes those collaborations which involve constructive conflict can actually be the most productive. The role of advocacy for individuals was a recurrent theme in people’s stories, with one person’s reminder that even those who are empowered and capable of defending their human rights can be just exhausted by it. Tokenism and overuse of jargon were cited as barriers to participation, while positive examples from as far afield as Melbourne and West Dunbartonshire were presented to illustrate willingness to cede power and do things in a different way.
Take-home messages for me? Particular challenges may include the necessary culture shift described by Judith – maintaining accountability but moving away from a culture of blame and defensive practice and towards a culture of looking for learning. I would argue that much work can be done in the early years, in schools and in parenting support to nurture such a culture. Opportunities for doing things differently are ripe in Scotland right now, with developments such as the new Mental Health Strategy and the work of the Integration Joint Boards. Above all, I was reminded of the power of collective action by Jackie’s “None of us is better than all of us”.