What is transformation in health and social care?

On International Human Rights Day read the first blog in our series of ‘What is transformation in health and social care?’. In this instalment, from an anonymous blogger, the concepts of person centredness, compassion and the ‘patient’ as the expert, in a human rights based context are explored. human-rights-day


With International Human Rights Day on 10 December and a continuing focus on health and social care integration, this seems a good time to find my voice on a subject that has been bothering me for some time.

That subject is the extent to which the current health policy landscape in Scotland is awash with concepts such as Person Centredness, Compassion and the ‘Patient’ as the Expert.

I completely understand the intent behind these concepts as shifting the power in care from the clinician/service giver to person accessing services. I believe that intent is very genuine.

However, I do not believe that for all their intent they are or will achieve the outcome intended. The reason is this: most policies/most intents are qualified by the context in which they are applied.  Being person-centred can be compromised by a lack of resource, or a lack of time. Being compassionate can be compromised by a strain in the care giver because of lack of time or other stressors. The expertise of people accessing services in their own needs and wants may need to be qualified by the care giver because of clinical expediency, resource constraints, etc.

So, concepts such as Person-Centredness, Compassion and the ‘Patient’ as the Expert can all be qualified by the context in which they are enacted. The problem for me is that I see them being espoused and promoted as if they are not. And what that masks is that the power to decide when to withhold an element of compassion, or be less person-centred or to not go with the expert opinion of the person accessing services still rests with the care giver or the decision/policy maker in the background. So, do these concepts really lead to an equal sharing of power? And how do we hold people to account when it is not?

So, I would like us to stop offering these concepts as the underpinning concepts of care. I just want us to talk about rights.

Human rights have stood the test of time for longer than all these other concepts. They are internationally accepted.  And there is a key difference. The difference is not that human rights are not unqualifiable. Most human rights are absolutely qualifiable. The key difference between rights and these other concepts is that there is no unilateral position. In person centredness, by putting one person ‘in the centre’ you are instantly putting the other parties somewhere else. By describing one person as the expert, you are again by default assigning a different role to other parties. What is that role? It is never fully defined and therefore the power behind that role is not fully understood or visible, but it may well still be there.

With a rights based approach, the basis of everyone’s role is equal because it is based on one role for everyone – that role being one of a human being.  Care givers have a right to be there, to have knowledge, to have it listened to, to have it valued, to be understood as human beings who may have worries and pressures that affect how they act. People accessing services have a right to be there (whoever they are), to be listened to, to be valued wherever they are, to have choices.

If all of that is recognised then the default is to negotiate in the moment of what is wanted, what is possible, what is sustainable and what capacities each party has. I think that is true power sharing.

We shouldn’t be afraid of a human rights based approach to care. We also shouldn’t delude ourselves that other approaches offer the same thing. They don’t, because they don’t shift the balance of power openly and right into the centre so that all parties can see it, use it and negotiate around it openly. It is about basing care on the rights of all, not the needs of the needy.

Podcast: Courageous Leadership – “Walking The Journey With Others”

How can courageous leadership support health and social care integration?

In the latest Academy podcast we hear directly from Anne Houston, Director of Coaching for Life Limited, who is an experienced facilitator of leadership development programmes, to consider how leadership can encourage transformational change.  Anne offers us her thoughts on the conditions required to put these principles at the forefront and how leadership can be enabling of others within the new landscape.

Read More “Podcast: Courageous Leadership – “Walking The Journey With Others””

The Courage to Cede Power

Has Scotland missed an enormous opportunity to have the expertise of some of the 2 million voices of users feed into the DNA of the new Health and Social Care Integrated Joint Boards?

In common, it appears, with most of Scotland’s national and local politicians, I had accepted that the obligation to have one third sector member, one carer member and one service user member on each of the new boards ensures the voice of the ‘customer’ is built into the new structure. Read More “The Courage to Cede Power”

The Power of Prevention

Time and again, we hear that preventative projects work and yet nothing changes and resources continue to be targeted at acute care.The integration of health and social care services provides us with a unique opportunity to rethink how best to meet the needs of communities across Scotland, and importantly to embed the values of prevention and anticipation into the commissioning of support and services.

This event, held in partnership with the Serenity Café, will:

– Show how cost-effective preventative approaches are in comparison to crisis response

– Challenge attendees to put their money where their mouth is and decide which services to invest in given a pot of money

– Highlight one innovative example of funding outcome-focused preventative work: Perth and District YMCA’s social impact bond

Please email event@alliance-scotland.org.uk to register your space.

Palliative Care: from acute to the community

On Monday 18th January, the Academy hosted the next event in our Integration Series. This event, hosted in partnership with Marie Curie, focussed on the theme of palliative care. The presentations and panel discussions covered service development in an integrated setting, the difference good palliative care can make and the Scottish Government’s recently published Strategic Framework for Action on Palliative and End of Life Care.

We asked delegates to share with us some of their questions and reflections about the future of palliative care in an integrated setting and these were their thoughts.

Read More “Palliative Care: from acute to the community”

Palliative Care: from acute to the community

The planning of Health and Social Care Integration needs to have a greater focus on palliative and end of life care. This event would aim to encourage Joint Boards and partners to think about how this care could improve under the new organisation.

Short inputs in a panel style discussion from:

  • Members of the Marie Curie Business Development Team who could discuss service development in an integrated setting;
  • Members of Marie Curie caring services team who can discuss the service on the ground;
  • Individuals from the Marie Curie Expert Voices Group (made up of former carers) who can discuss how good palliative care can make a real difference;
  • Discussion of the policy/strategy relating to palliative care and how that fits with integration.

The Strategy on Palliative End of Life Care will be published in December.

To register please email event@alliance-scotland.org.uk 

Lived experience: a vast and often untapped resource


Recently I had the pleasure of participating in the Health and Social Care Academy’s ‘Putting Personal Experience at the Heart of Integration’ seminar. It was an interesting and thought-provoking evening. I had been asked to give a short provocation on the topic of ‘How do we achieve a two way dialogue in health and social care?’ and suggested that we will not achieve our aim of a genuine two-way dialogue until we placed lived experience right at the heart of the design, delivery and review of services.

Read More “Lived experience: a vast and often untapped resource”

What more is needed to ensure lived experience is at the heart of integration?

On Wednesday 2nd December, the Academy hosted an event called ‘Putting personal experience at the heart of integration’ as part of our Integration Series. The evening was chaired by Lisa Curtice, Director of the ALLIANCE’s People Powered Health and Wellbeing (PPHW) Programme and featured provocations by David Howie and Linda Jane McLean from the PPHW Reference Group, Louise Christie from the Scottish Recovery Network and Andy Crawford from NHS Greater Glasgow and Clyde.

Read More “What more is needed to ensure lived experience is at the heart of integration?”

Putting personal experience at the heart of Integration

One of the goals of health and social care integration is supporting people to play an active role in health and social care, both at individual level and in planning, decision making and improvement.

The event, part of the Health and Social Care Academy Integration Series will:

  • Highlight how people can be decision makers in their own health and social care and in support and services (person perspective)
  • Share how we can listen and act on views and experiences (practitioner perspective)
  • Explore how we can involve people in the planning and quality of their own care in order to create effective engagement and ensure positive outcomes (clinician perspective)

The Integration Series are a set of short events focussing on key themes in relation to health and social care integration.   This series is designed to help people deliver integration in a way that reflects not just the structural requirements of the Public Bodies (Joint Working) Act, but that makes real the ethos clearly set out in guidance.  This demands new ways of working, including: shifts to preventative approaches; co-production with the third sector and with people and communities; a focus on the outcomes that matter to people; and a human rights based approach.

The Integration Series will offer a space for us all – including people who use services, frontline staff, service and policy planners and leaders – to share learning, inspiration and collectively seek to address some of the challenges in delivering this transformation.

Email event@alliance-scotland.org.uk or call 0141 404 0231 to register your place.

A full agenda will be available shortly.