Citizen’s Basic Income – Brave enough or stupid enough?

The Health and Social Care Academy have released a new insight paper around Citizen’s Basic Income. Assistant Director of Policy and Communications at the ALLIANCE, Andrew Strong writes about the debate surrounding CBI. 

Evan Davis’ opening lines in this 2015 Newsnight piece to camera tell you a lot about the divisive nature of the concept behind a citizen’s basic income (CBI).  The Dragon’s Den presenter turns to camera and, with a sigh, says “few countries have been brave enough… or perhaps stupid enough to adopt it” before rolling VT on a report its introduction in Finland.

CBI isn’t a new idea – but has been often met with such cynicism when introduced to discussions about the future of social security.  The idea is simple – scrap the existing pensions and social security system, with its riddle of mazes and bureaucratic assessment processes, and replace them with a flat, tax free payment to every adult.  This would not include any form of means testing or conditionality and is paid on an individual basis to everyone, in cash, who can then decide how they spend it.

One of the most interesting aspects of CBI is that it throws up unusual alliances from across the political spectrum – as people who have interest in both increasing and reducing the state’s influence in people’s lives see it as a catalyst to reaching their aims.

Its recent re-emergence coincides with attempts across Europe to introduce it – at varying scales. In Scotland, this includes two pilot sites in Glasgow and Fife where anti-poverty measures are being trialled.  The Scottish National Party, in Government at Holyrood, passed a resolution at a recent party conference supporting the principle of a universal income.

Within this context that the Health and Social Care Academy’s new insight paper links CBI to “emphasising humanity, values and flourishing”, one of our provocations for the future of health and social care, as it places an overdue emphasis on breaking down the existing ‘them’ and ‘us’ relationship which has evolved over time between people and the state in relation to social security.

Our paper argues that a basic income has the potential to transform the relationship between people who live with long term conditions, disabled people and unpaid carers and the state – but its certainly not a magic bullet.  Policy makers must closely consider both the political and the social impact of introducing a CBI and the difference it could make to existing service provision and the potential unintended consequence of shrinking state support.

Close consideration and learning from the pilot sites should give us some insight and enable the debate to move on from simply “bravery or stupidity”.

 Andrew Strong

Assistant Director (Policy and Communications)

Health and Social Care Alliance Scotland (the ALLIANCE)

Health and Social Care Academy: Emphasising Humanity and Human Rights: Citizen’s Basic Income

Power – a health issue!

In our latest blog Elinor Dickie and Emma Doyle of NHS Health Scotland explore how power, and how it is shared between individuals, communities and statutory bodies, can affect health inequalities. 

Unequal distributions of power, income and wealth are the fundamental causes (or the main causes) of health inequalities. At NHS Health Scotland, we know a lot about how having, or not having, income and wealth impacts on our health, but we are just starting to explore the relationship between power and health. Unlike money or wealth, power does not belong to any one person, but exists in the relationships between people and groups of people. We know that those who have power over their lives and the environments in which they live are likely to have better physical, mental, and social well-being. So power is protective of health.

We’ve defined power as the ability to act in a particular way, as a capacity, shared resource or relation. It is a complex concept which includes the ability or capacity to do (or not to do) something and to exercise influence or control in a variety of different ways. People may have power in some situations, such as at home, but less power in others, such as at work or in their community.

If you have power, you are more able to make or influence the decisions that affect aspects of your life, such as where you live and where your children go to school. You are more likely to understand choices available to you and have some confidence that you can make your voice heard in decisions that relate to you and to the community in which you live. When you are able to do this, it seems normal. You might not even recognise it as power.

 However, if you don’t have power, you are likely to feel this lack of control in many parts of your life. You may feel that your voice goes unheard, or is not valued or respected, or that others know better and you will have little sense of control, even over the things that are important to you. People who do not have power may have limited choices, may not be able to make informed decisions and may not get the services that they need.

This means that empowering people at the individual, community and national level is necessary to improve health and wellbeing and to tackle disadvantage and inequality. So how do we do this?

One way is to think about power as a fluid resource, not a limited one. There are many different sources of power, positions of power, and spaces or levels where power is exercised. Understanding this helps us to identify where there may be opportunities to tackle inequalities in how power is distributed. For example, where can power be shared, where can it be ceded and where can it be claimed? We can start by understanding human relationships – who holds power over a certain matter? What influences them? Who or what do they listen to – research evidence? Public opinion? Corporate interests? We are all part of a complex social and political system in which power is exercised to advantage some groups over others.

We need to work with individuals and groups, as well as with the processes and structures that determine the interaction between communities and the state. It’s for us to think about our role in the system and how we can use our power to bring about change.

The Community Empowerment Act is an important new piece of Scottish legislation with opportunities to reduce health inequalities, giving communities greater control through the redistribution of power –  but that depends on us really understanding what power is and where power lies. In partnership with Glasgow Centre for Population Health, we have produced a new animation which explores these issues further.

It’s time for all of us to be part of creating a fairer, healthier Scotland.

‘Consultation is not co-production’ in the development of a suicide prevention strategy

Emma Goodlad, Grants and Impact Officer at the Health and Social Care Allliance Scotland (the ALLIANCE) blogs for the Academy this week. Emma powerfully makes the case for meaningful public involvement and co-production in the development of a suicide prevention strategy. 

New statistics published earlier this month reflecting the impact of suicide on people in Scotland were somewhat worrying, with a sharp increase in deaths by suicide in 2016. With suicide being the leading cause of death for young people in Scotland and the biggest killer of men aged 20-49 in the UK, the new suicide prevention strategy being developed by the Scottish Government needs to be forward thinking and brave in its aims and ambitions.

To develop a truly effective and useful suicide prevention strategy, one which guides people and professionals across Scotland on how to support people who are experiencing crisis because of intrusive suicidal thoughts and ideations, the Scottish Government needs to be led by people with real lived experience of suicidal thoughts, attempts and those who have lost loved ones to suicide.

This cannot simply be a consultation. When asked to be consulted on the recently published Mental Health Strategy, some third sector organisations expressed that they felt that the Scottish Government has a culture of over consulting, but under delivering on the feedback. People feel that they have opened up and told very personal, and often quite painful, stories of their own lived experience to try and guide and influence policy and strategy but are not seeing their experiences reflected in the final outputs.

To make sure that they are doing the right thing by people they need to put lived experience at the heart of the process from the very beginning to ensure that consultation is undertaken in an appropriate, sensitive and realistic way where people feel like their voices are truly heard and being used to improve the lives of others in the future.

As someone with both lived experience of attempting to take my own life, and working at an organisation who works in partnership with our members to influence and develop Scottish Government policy and strategy, I can see both sides of the coin. I understand that the state cannot realistically meet every demand or provide the necessary changes to services and support overnight, however when I most needed support I was let down by the very system we are told to tap into and ask for help from. If there was a clear suicide prevention strategy with realistic outputs and therefore outcomes, I may have never reached the point where I felt I could no longer cope and tried to take my own life. On the other hand I may still have reached that point and if I had, again, a clear and realistic strategy could have ensured that there was a clear pathway of support on hospital discharge to support me in the time between discharge and CMHT appointment.

Instead I was discharged, still in a state of disconnectedness from the world, with no involvement of my family in the lead up to my discharge from a High Dependency Unit and no coping plan put in place to keep me going until my appointment 8 days later with a Community Psychiatric Nurse. My family, friends and I were left to muddle through that week and deal with my ongoing depression and suicidal thoughts with no professional support purely because I had seen liaison psychiatry while still in a blur, recovering from the after effects and trauma of an overdose and had lied, like so many others, about still feeling suicidal because I was terrified that I would be sectioned under the mental health act.

I was lucky to have an incredible support network who got me through that incredibly difficult period and who now actively support me to look after my mental health and identify any issues.  But what if that happens again? Would anything be different? Yes, it would be, but not necessarily because the support services are any different, but because my family and I know what needs to be different and would fight for different support.

Consultation is not co-production. I want my voice to be heard by policy makers, I want my experience of the darkest period in my life to be used for good.  But I don’t want to be involved in a tokenistic consultation where nothing really changes, because the Government are afraid of raising expectations and letting people down if they cannot meet them.

I want to be part of a strategy which is brave, forward thinking and truly strives to make a difference in people’s lives and isn’t another strategy which goes into desk drawers across Scotland. I want to be involved in the development of a strategy where the consultation is a two-way discussion which is open and honest about what is realistic, what the challenges will be and work together to find realistic solutions to overcome these.

Let’s not forget that they have done this before. In 2008 members of the ALLIANCE worked with the Scottish Government to develop and produce Gaun Yersel’ The Self Management Strategy for Scotland. Gaun Yersel’ 9 years on is still held up as an excellent example of effective co-production to produce a realistic strategy document.

I call on the Scottish Government to be brave, put aside the fear of raising expectations and let’s work together for a Scotland where death by suicide rates are reducing, not increasing and strive for a support system to be held up as an example across the globe.

‘It’s about unleashing, not controlling’

On 26th June, the Health and Social Care Academy hosted ‘Emphasising Humanity over Bureaucracy in Social Care‘; an event that explored what emphasising humanity looks like in practice, not just for those receiving care but for those providing it. 

 William Kløverød Griffiths Policy and Information Intern, Dementia Carer Voices spoke at the event about the work of Dementia Carer Project and the emerging themes from the pledges that have been gathered. In this blog William writes about the You Can Make a Difference campaign and the importance of celebrating the kindness of people with dementia, their families and carers.

President of Institute for Healthcare Improvement, Don Berwick, has been credited with saying “The heart of improvement is not in controlling, it is in unleashing.” For me this really sums up the work of Dementia Carer VoicesYou Can Make a Difference’ campaign. The work we do is about unleashing not in controlling what people do, their messages and their stories.

The campaign is about celebrating and unleashing the kindness and dedication of people with dementia, their families and carers. It is to emphasise that they are equal partners in the care they receive. To this end we collect the stories and experiences unpaid carers have in providing care to their loved ones. Dementia Carer Voices are building a range of multi medium case studies, asking people what matters to them. It is our hope that these will provide useful evidence about the lived experience of the lives of unpaid carers. In that regard, we hope to be a platform to unleash the messages of unpaid carers.


The project also shows the lived experiences of people with dementia, their families and carers to those who work in the health and social care system. It is a difficult and underappreciated role that health and social care staff do every single day, day in and day out, but it is essential to the health and wellbeing of millions of people. Thousands of people come into contact with NHS Scotland every day, an estimated 37,000 people living in care homes in Scotland, and many more receiving home care visits. If our campaign can unleash some compassion, care and consideration into every one of those human contacts, then we will make our health and social care system better.

So the work we do at Dementia Carer Voices is about unleashing the passion and kindness of unpaid carers. It is about those people who sit by our beds, knock on our front doors and who we speak to on the phone. It is about the people who treat us when we are unwell, about those who offer kindness when we are vulnerable and are able to make a difference in people’s lives. To all those who follow the five must dos of caring for someone, and place the person at the centre of their care.


When I first joined this project a little over two months ago, I took out a selection of the pledges we have received over the years. Just over 13,000 people have made a personal pledge to make a difference, giving people the opportunity to commit to, to share and celebrate the difference they and we can all make every time we meet someone. That is what this project is about, it is about unleashing the voice of people with dementia, their families and carers. These are people seldom heard, but with our project hopefully gives them the chance to express themselves and take this message to people who make policy.

Dementia is everyone’s business. It is not about buildings or organisations, it’s about the people within and the people we meet, on every occasion it’s about people and relationships. It’s about the life and love stories of families all across the county. So I truly hope the people the pledges, the life and the love stories are about unleashing what matters, who matters and about unleashing the parts we can all play in every moment, every day and every time.

If you would like to learn more about the project, or to sign up to our mailing list, please email









How can we work in ways that will enable everyone to flourish?

On Monday 26th June, the Academy will be hosting Emphasising Humanity over Bureaucracy in Social Care, an interactive event that aims to explore what emphasising humanity looks like in practice, not just for those receiving care but for the care workers too. What would human rights look like if we focused on the human rights of the system? 

Speaker Helen Sanderson poses the question of how we can work in ways that will enable everyone to flourish in this blog written ahead of the event: 

The Guardian, in November last year tells the story of Jean. Jean works for a home care agency in the north of England. She starts work at 6.30 am, and completes 23 calls in 12 hours. She drives 20 miles between appointments, and is not paid for her travel time, and earns £64.80 before tax.  Jean is on a zero hours contract. She does not know how many appointments she will have each week, and therefore how much she will be paid. Her list of appointments comes through on a Friday.

It is stressful work, she says, and she feels she has little support.

“It’s a lonely job…you are in the care on your own, you get to peoples houses and often face problems on your own. They tell you all of their worries and then you take them home. Often at night I’m tossing and turning worrying about them.” But Jean still loves her job.

Jean’s experience could explain why there is up to 40% turnover in home care. Yesterday I spoke to a manager of a large home care organisation in the south of England. She said that they lose 50% of their new recruits before their 6 month of employment.  How close is Jean’s experience to Alan’s?

 Michael Marmot, in his book ‘The Health Gap’ tells Alan’s story.

Alan was a picker in a warehouse, and Michael described in detail his daily experiences of work and ends the story with this statement.

“It was as if his employers had taken everything we know about the damaging aspects of work, concentrated them in a syringe and injected them into Alan.”

The damaging effects that he refers to are high demand with no control over the work task, high effort and little reward, social isolation at work, job insecurity and working antisocial hours.

I am not suggesting that every carer who works in home care experiences these damaging aspects, but I am sure many do, and it does resonate with Jean’s experience.  In changing home care most of the focus is on the experience of people using the service, or on making efficiencies. Both of these are important, however we must consider the experience of the staff. If we don’t not only will turnover continue to be very high, but we are also building health challenges for the future. The challenge therefore is to create a different way of delivering support for people at home, that is truly person-centred, where they have choice and control, and delivered by an engaged, happy workforce.

There is a lot of interest in happy workplaces. It almost sounds frivolous to talk about happiness in home care.  Ron Friedman, in his book ‘The Best places to Work’ talks about how meeting psychological needs are at the heart of employee engagement and wellbeing.

The psychological needs that he refers to are autonomy and relationships. It is clear that having choice and control matters to staff as well as people using services, and that having friends at work is critical to productivity and happiness. Jean has no autonomy over her work – she is told where to go and when, and for how long. She describes the work as lonely.

We care trying to build choice, control, and relationships into the DNA of Wellbeing Teams. Wellbeing Teams are small, neighbourhood, self-managed teams inspired by Buurtzorg. (link:

 For people who are supported at home

People choose what they want support with (their outcomes and priorities), how they want to be supported, when and where. We enable them to choose their team too, either through looking at the team’s one-page profiles or a 30 minute film of a team member introducing themselves. No more than four team members work with an individual, to provide consistency and to develop good relationships.

For team members

The team meets every week to share information, address any problems or issues and support teach other. Each team member has a buddy. The team shares the roles needed in a self-managed team together, and they choose the roles based on their strengths. Each person has a coach to support them to become confident in their role (for 3 – 4 months) and then the team has a coach to help them work well together. The team develops the rota/schedule together after the team meeting.

There are two Wellbeing Teams starting in Dumfries, and we will be learning from practice in how to deliver choice, control and focus on relationships.

Michael Marmot is compelling that we need a radical change in the way we think about health and society. This means not only ensuring that older people are supported well at home, but that the health and happiness of staff is critical too.

If you are interested in attending Emphasising Humanity over Bureaucracy in Social Care please email to register your place. 





Carers’ Week Chaos and Concerns

Lynn reflects on yet another Carers’ Week in the context of a tumultuous General Election.

When I was asked to write this blog for Carers’ Week, I was conscious of the looming General Election. I did some fine-tuning post election on three hours sleep last Friday; still trying to make sense of it all (and not doing very well!).

Here we are then – Carers’ Week. It’s my second as an “official” full time carer – someone who provides 35 hours or more of care for the princely sum of £62.70 a week.

It’s not a landmark I want to celebrate, for a number of reasons.

I miss being in full time work; I miss earning a decent wage and I miss being valued by society. As a “scrounger”, I am deemed to be a leech sucking on taxpayers’ money. That’s what many in the political world would have you believe and yet, carers are essentially a significant, poorly paid public service, which underpins our communities and our economy.

Carers’ Week should be a spur to action – to improve carers’ experience and outcomes and to improve the way we treat disabled people. However, it seems only to elicit the usual platitudes about unsung heroes (my least favourite phrase). For many, Carers’ Week serves to remind us of how little progress has been made; in many ways, we are going backwards. The services and supports we need are not always there; the right services and conditions for our loved ones are eroding fast.

This past year has seen many of my friends and fellow activists fighting local authorities over destitution level care charges and further cuts to crucial care services. I’ve watched families brought to breaking point by a deeply flawed interpretation of legislation, which was meant to transform our broken social care system.

Continued cuts to respite and community support; further benefit reductions and cuts to pupil support all combine to leave families coping with more than most can imagine.  Dealing with constantly challenging behaviour; lack of sleep; learning to use medical equipment; physical lifting and turning; washing; wiping and changing beds are a daily part of our lives – yet public services meant to make life easier often fail to work with us. The facets of good public service, outlined in the work of the Health and Social Care Academy seem quite elusive. Rather than ceding control to families to achieve good outcomes, carers feel that they have no control over their destiny.  Carers’ Week often hides the less sanitary and salutary aspects of caring.

It has also coincided with the fallout from last week’s election – an election marked by chaos and change. Those concepts are not unfamiliar to carers and yet, there is no comfort here.

The result doesn’t help appease my worries for the future. It won’t do much to secure much-needed investment for social care or other services we rely on. It’s also unlikely to shift the debate on the value of unpaid care or the pitiful level of Carers’ Allowance.

Carers are a pretty cynical bunch – we will continue to be cynical as we wind our way through another Carers Week. And we’ll be watching what happens post election – with more than a passing interest!


‘Future leaders need to play key role in shaping transformation of health and social care’

Later this month, more than 1,500 people will descend on the Scottish Event Campus in Glasgow over two days for NHS Scotland’s annual showpiece event.

The official theme chosen for this year’s gathering is ‘Working differently across boundaries to transform health and social care’, a reflection of the consensus that transformational change is now needed if Scotland’s health and social care services are to be fit for the future.

In this vein, the Health and Social Care Academy has recently been working closely with a group of people that we think are essential to this transformation effort, our ‘future leaders’ in health and social care.

We worked alongside Scotland’s Universities and Colleges to support students of health and social care disciplines and young people who are living with long term conditions or in caring roles, to co-design and deliver regional ‘hub’ events, aimed at initiating a discussion among their peers about what the future of health and social care should look like. After all, these young people will be providing the care and support of tomorrow.

This culminated in a national event last month held at Glasgow Caledonian University, which brought these future leaders together with the ‘leaders of today’ if you will – senior figures from the Third Sector, the Scottish Government, Healthcare Improvement Scotland, NHS Education for Scotland, NHS Health Scotland, the Scottish Social Services Council and more.

It’s fair to say that if anyone had any initial concerns that the future leaders might be nervous or overawed by the unique audience they had assembled in front of them then these were quickly put to bed! The future leaders confidently and articulately fed back to the delegates about the key issues that they and their peers had identified, spanning a wide range of areas including;

  • Examining the application of performance targets within health and social care in favour of a ‘more progressive’ approach
  • Further embedding the concept of health and social care integration in the way that undergraduate courses are taught, with more opportunities for students of different disciplines to learn and problem-solve together
  • Improving health literacy and better involving the public in shaping and driving change in health and care
  • Recognising and fostering leadership at all levels, including better tapping in to the wealth of ‘hidden talent’ that exists at delivery level

A strong plea from the future leaders was the need to create a culture and attitude towards risk that enables change to be instigated and fully realised, including giving people permission to develop bold and radical solutions.

They felt that current staff and ‘the system’ needed to be accepting of the new ideas of people entering the health and social care workforce. In the words of one student “they need to be prepared to work with this ‘bright spark’ that we have, or else it will just go out”.

So what next?

We heard that the future leaders would welcome opportunities for further ‘learning exchange’ in the future, noting that events bringing ‘future’ and ‘current’ leaders together in this way (and particularly on an equal footing) were pretty rare. Some of our current leaders have already made offers of mentorship, which is great. If this is something that you would be interested in offering to our future leaders, we’d love to hear from you.

In the more immediate term, we’re delighted that a number of the future leaders will be accompanying the Academy to the NHS Scotland event later this month.

So if you’re there, check out our ‘Spotlight session’ on the afternoon of Day 2 of the conference to hear what they’ve got to say, and keep your eyes peeled for our ‘Future Leaders Vision of Health and Social Care’ poster presentation in the exhibition space.

Chris Doyle, Policy and Information Officer, Health and Social Care Alliance Scotland (the ALLIANCE)

For more information, email


* Leanne Patrick, a Mental Health Nursing Student at the University of Stirling recently wrote for the Nursing Times sharing her reflections on the event. Read the article ”Wicked problems require creative solutions’ on the Nursing Times website.

“Kindness is the language which the deaf can hear and the blind can see” – Mark Twain

 “Kindness is the language which the deaf can hear and the blind can see” – Mark Twain

This is the quote that sits above me on the noticeboard. It is one the welfare rights team here at Deafblind Scotland embody.

Working in any Welfare Rights team can see you assisting those with complex needs, from different backgrounds to ensure they are given fair representation that is all the more complex when those who need support have a hearing and sight impairment.

Many people living with sight or hearing loss do not have the means in which to research what benefits would they could be eligible for. Even if they did have this information, making a phone call or filling in a form would be very challenging or impossible. We feel that with the correct support those with dual sensory loss can flourish and feel confident to seek advice on welfare rights and even challenge decisions.

We assist those in their preferred communication whether that is speech/hearing, British sign language, Deafblind manual, Deafblind hands-on signing and so on. Those who seek help may be deafblind or may have been assessed for a visual impairment. We understand people with a visual impairment can also struggle to access benefits. We can offer communication support such as large print, braille or moon (a system of raised shapes, which can help blind people, of any age, to read by touch). It is imperative that the service user understands what we are applying for on their behalf and that they are happy for us to do so.

We make home visits which service users prefer as they do not have to organise a guide or transport and endure the stress and anxiety that comes with an unknown journey. Our job is to assist them in their welfare rights and treat them as an individual and put the control in their hands where at some points in their life they feel this has been taken away from them. This could be something as simple as reading and interpreting letters for them or attending appeal hearings with them.

We work in partnership with other mainstream organisations and also take welfare rights referrals from them

As a charity Deafblind Scotland have around 750 members with about 95 accessing the guide service. They are guided and given communication support to get to medical appointments, go shopping, go to the bank, socialise at clubs or whatever else the service user would like. The service user builds up a partnership with the guides and from these visits guides have referred members to Welfare Rights. Service users know that the Welfare Rights team have the same understanding of their various health conditions or communication needs. This puts them at ease and feel more comfortable accessing the service.  Different services may not be able to easily explain what they need, understand the communication they need and most importantly deserve to have.

We have received positive feedback from service users such as; “Just to say thanks so much for all your recent help, advice & support with the PIP process. I really have appreciated this so much as I know I really couldn’t have managed this without your involvement. It’s a really stressful process to go through and you really helped in easing a lot of the stress and pressure for me”. “It’s really wonderful that Deafblind have received the financial funding to start and hopefully continue this vital service and support for the most ‘vulnerable’ members in the community.” Messages like this spur us on and let us know that the assistance we are giving is person-centred.

Deafblind Scotland’s Welfare Rights team has been supporting those with dual sensory loss and visually impaired adults since August 2014 and has raised more than £800,000 for those we have assisted.

Emphasising Humanity

In this blog post Pat Tyrrell, Deputy Director of Nursing and Midwifery at NHS Highland continues our #EmphasisingHumanity theme and talks about the importance of this, not only for patients but staff working within the health and social care systems.

Our health and social care systems are full of those who care deeply about the people with whom they work – both their colleagues and the people for whom they provide care and support. Minute by minute, hour by hour, day by day, we see interactions and services which are designed to respect the rights and needs of our fellow humans. This design delivers time and time again the kind of care that supports and helps the most vulnerable in our communities meet their potential and flourish with love and compassion.

We also know that the experiences of many people, both working in the health and social care systems and those experiencing the services of these systems, is not always a fulfilling one. People are often left feeling dehumanised and devalued, on the receiving end of transactional processes which fail to recognise and respect their needs as human, sentient beings.

We cannot talk about emphasising humanity in health and social care systems without recognising that this must include everybody within that system – staff and patients are not separate entities when it comes to considering the basic needs which we all have for relationships that respect our rights and which are based on compassion and kindness.

In Reinventing Organisations, Frederic Laloux states that “Extraordinary things begin to happen when we dare to bring all of who we are to work.” He also recognises that “In a forest, there is no master tree that plans and dictates change when rain fails to fall or when the spring comes early. The whole ecosystem reacts creatively, in the moment.”

Here he recognises what we know to be important – that we respect and honour our individuality and diversity and that as individuals we interact with others in a way that enables each and everyone of us to develop and to adapt in ways that meet changing needs and contexts.

It was on many of Laloux’s principles that Jos de Blok, the founder of Buurtzorg, the Dutch community based nursing service, established his new organisation on in 2006. This was in order to address the problems which he identified within a fragmented and transactional health and social care system in Holland – a system which met neither the needs of the patients nor the staff.

‘Humanity beyond bureaucracy’ is the mantra of all the nurses who work within the self organised teams in Buurtzorg. They work in teams of no more than 12 people, where respect and dignity are at the heart of their approach towards each other and towards the communities with whom they work. 10,000 frontline staff are supported by an organisation of 45 backroom staff. And there is no hierarchy. Decisions are made and enacted by teams, based on the needs of their patients and staff.

System design is important in enabling this. I have been fortunate enough to spend time with one of these teams in Rotterdam and know only that the positive visceral and emotive which I have experienced told me that emphasising humanity in everything that we do is a core essential of success in health and social care systems.

There is an urgency to redesign our health and social care systems in Scotland. As we advance with this redesign we must recognise both the individual and the system components that enable human flourishing. We can now make unprecedented decisions which challenge existing organisational paradigms and halt the perpetuation of poor experiences. We just need to be truly human and brave.



Rediscovering Humanity – The Building Blocks of Good Public Service

Lynn Williams, unpaid carer, argues that humanity should be at the heart of every political decision driving public service reform

Caring for someone you love often plunges you into the heart of a public service maelstrom. The last few years in “Chez Williams” have brought numerous professionals into our lives – physiotherapists, OTs, a whole gaggle of different hospital consultants, specialist nurses and so many others. (I’ll leave our recent DWP/ATOS experience for another day!)

In reflecting on all that has happened to us, there has been one factor clearly evident in every good experience; professionals who have treated us both with tangible humanity.

The consultant who hunkered down on his knees to speak face to face to my husband – who saw the funny and deeply intelligent man behind the wheelchair; the specialist nurses who understand my husband’s needs and who have helped us to laugh during difficult periods which I can’t even begin to describe; the local rehab OT who took time to get to know us, to listen to my husband’s desires for his life and who worked with us and identified a service we didn’t know existed.

Humanity, compassion – and yes, the word of the moment, co-production. At the heart of those positive interactions, my husband has been treated with deep respect, with honesty and with the humanity that should form the foundation and building blocks of strong and effective public services.

This doesn’t mean that those working with us can always offer practical help or provide answers to our questions. Often, we just have to find our way through the next challenge. However, with someone at the end of the phone; with someone who has taken the time to understand our wee family, the challenges we face become more bearable.

If only that humanity was more evident in all aspects of public service; if only a desire to maximise quality of life sat squarely behind every commissioning exercise and at the heart of service and policy development.

The sad fact is that the lives of disabled people and their families are often reduced to numbers; to a unit cost in the equivalent of a factory production line. This culture is sadly too evident in the work and myriad of papers that drive the work of the still new Health and Social Care Partnerships.  “Commercialisation” of public services can effectively squeeze out humanity or compassion for our fellow citizens – the criminality of charging for help to get to the toilet, to get out into your community are perfect, if somewhat disturbing, examples of this.

Like others, we have sometimes become lost in a maze of jargon, bureaucracy and confusion, deftly described by the Christie Commission seven years ago. Families are sadly still left to fight the public services which are supposed to be helping them.

In that fight, people are left exhausted and de-humanised; that was not what was envisaged in the journey to transform health, care and other services. Unfortunately, compassion and good outcomes often happen in spite of policies like integration or self directed support.

My husband and I are incredibly grateful to the many professionals who have touched our lives. They have helped us deal with dramatic changes and some dark days. Our experience should not be the exception and therein lies the challenge.

How we “measure” the humanity of public services must be considered by the Burns review of health and care outcomes; humanity should be sought in every manager and director who wants to progress their career in public service.

Humanity should be at the heart of every political decision about the services which profoundly impact on people’s lives.