Asset-based approaches – the first step to transformation

It might now be considered trite to say it, but people are the lifeblood of any service.  No matter the sector or subject, the system or the team – the driving force is the people who work in it and the people who use it.

This is why the publication of Glasgow Centre for Population Health (GCPH)’s new document ‘Assets based approaches in service settings’ is so welcome.  Taking an asset-based approach to services means focussing on the potential of people who use them – not what is “wrong” with them or what needs to be “fixed”.   By recognising and making the most of people’s strengths we can promote the factors that support good health and wellbeing.  This requires an understanding that addressing complex issues needs much more involvement of the people who are at the centre of those issues – rather than being viewed as things that can be “sorted out” by professionals alone.

A couple of weeks ago I attended the launch of the new report and one thing struck me – the significant overlap between the vision in GCPH’s document and that championed in the Health and Social Care Academy’s Five Provocations for the Future of Health and Social Care.  Leadership, humanity and cultural change are terms used throughout, which suggests that asset-based approaches are one key mechanism through which transformation can be delivered.

GCPH have made it clear that it is possible to design and focus delivery and practice towards assets, rather than deficits – even despite the many constraints placed on public services. Their new publication identifies examples such as Primary Care Learning Disability Local Area Co-ordinators, the Bridging employability service and Healthy Mind, a project designed to support access to online information and resources, as practical examples of asset-based approaches to the delivery of health and social care.

All progressive steps – but remain ‘far from the way we do things’.  The rhetoric around asset-based approaches has yet to reach reality in a manner which could be described as significant.  The Scottish Government has long been committed to the delivery of these approaches and, as GCPH note, this is informing and influencing the planning and delivery of some services.  But as always we need to move comprehensively and quickly beyond rhetoric and to the practical application and incentivising of approaches which encourage people to flourish.

After all, the need to work differently is ever more pressing.

 

Andrew Strong
Assistant Director (Policy and Communications)
Health and Social Care Alliance Scotland (the ALLIANCE)
@gas1883

 

Why human rights can be transformational – Lucy Mulvagh

One of the Academy’s Five Provocations, Emphasising Humanity, is described as the need “to emphasise the humanity and human rights of the people accessing and providing support and services, to create relationships that enable people to flourish.” Here, Lucy Mulvagh explains why she thinks human rights can help achieve transformational change.

 

It was love at first sight (or should that be sound?) when I first heard about human rights. I can’t really remember a time as an adult when they haven’t figured somehow or another in my life and it’s usually a subject that’s knocking around my head on most days.

I’ve got many reasons for this passion, but primarily it’s because human rights can identify and challenge the myriad power imbalances that currently exist. I firmly believe that if we were to adopt a truly rights-based approach – as widely as possible in everyday life – then many of society’s ills and injustices could be overcome.

Using rights to support decision-making – at the individual, community, regional or national level – means it’s based on fairness, transparency, equality and proportionality instead of (political) ideology, decisions around who is ‘deserving’ or ‘undeserving’, and (unwittingly or not) prejudice, bias and stigma.

I’m thinking of decision-making that can apply anywhere and at any time: how resources and budgets are allocated and disbursed; homes and public spaces are designed, built and sustained; health and social care services; income and social protection; good quality food, heating and clothing; transport; education; employment; … you name it!

I’m very sad that there is still such a great deal of suspicion and unease about human rights in some quarters. While this is due, in part, to genuine misunderstandings about rights being purely associated with lawyers, court cases and punitive action, I’m pretty sure that some is deliberate misinterpretation and misinformation by those who are challenged by the idea of greater equality in the distribution of power.

We all have human rights, simply by virtue of being human, and it’s a bit of a personal mission of mine to help raise awareness about rights and support efforts to increase our understanding about how truly revolutionary they can be – for all of us.

I welcome the growing appreciation – and name-checking – of human rights in national policy, but there’s still a long way to go to bridge the (growing) gap between rhetoric and reality and translate rights into everyday life. In the meantime much of the focus, including in health and social care, has been on concepts like ‘person centredness’, ‘compassion’ and asking people what’s important to them.

Don’t get me wrong, of course I agree we need as much compassion, kindness, listening and understanding as we can get. But I can’t help feeling that it’s a sad indictment of how we currently relate to each other – irrespective of where our interactions take place – that these could ever be seen as transformational.  Aren’t they the basic minimum that we should expect when we relate to each other?

And what happens when, say, a service says that they listen to what’s important for people, but then they either don’t, or do but then don’t actually act on what they’ve been told?  Very often this sort of practice is deplored and decried as unacceptable, and a (public) apology may be offered, but what difference does that really make to the people and institutions involved, and are we sure there are adequate concrete measures in place to ensure it never, ever, happens again?

We can’t, and indeed shouldn’t, legislate for compassion, but we can legislate for human rights and rights-based approaches – like the right to free, meaningful and active participation in decision-making – which means that when things go wrong there will be an open and honest approach to accountability, remedy and redress.

But it’s not just about the ‘stick’ of holding people or services accountable when things go wrong. Taking a human rights-based approach to decision-making means we can start with the ‘carrot’ and conceptualise and deliver support in very different ways, nip issues in the bud at a much earlier stage, and even avoid things going wrong in the first place.

I’m committed to spreading the love about human rights – who’s with me?

@lkmulvagh

 

lucy-blog

What is transformation in health and social care? – Emma Goodlad

To me, to create true transformation in health and social care, transformation needs to be considered on an individual level as well as looking at the wider transformation landscape. This personal idea of transformation should be able to slot into the interactions people have with the health and social care professionals they come across throughout their life – but for this to happen there is a need for a shift in the way that the health and social care system across Scotland operates.  The introduction of Health and Social Care integration was promising and in theory makes absolute sense – however in practice will this turn out how we imagine it and truly benefit the individuals that it needs to?

 

On a personal level I think of transformation as the ability for me to live well with a long term condition, but also to be able to learn, adapt and develop as a person in response to this, with the support of those around me including health care professionals.  The support that I have received over the last two years from health professionals has been very hit and miss. I know I am very lucky to be receiving and have received the support I have thanks to our NHS – however this system is far from perfect and I have been victim to the postcode lottery which exists in mental health care support across Scotland. I did receive crisis support but not without a fight, but 9 months on from when I first presented to a GP in crisis I am still on a waiting list to see someone from the Primary Care Mental Health team. I have had to ensure that I am still on the correct waiting list as it seemed that one hand does not know what the other is doing. I am proactive and capable of advocating for myself which has prevented me falling through gaps – however, what about those who don’t, or those who like me have tried to advocate for themselves and seemed ‘too well’ to receive the appropriate support and treatment? It should not require an individual or their families and carers to have to fight and chase up services?

Faces

To be able to provide true transformation across health and social care in Scotland, there needs to be a shift in attitude towards person centred approaches – there is already evidence of this being demonstrated by the outcomes of projects funded through the Transforming Self Management in Scotland Fund.  Approaches like those that funded projects provide need to become more common place – putting people at the centre and working with them to design, deliver and evaluate services. The true worth of Health and Social Care Integration won’t be clear for a while, but to get the most out of it there must be true partnerships between statutory and third sector agencies, there must be a trust placed in the third sector that they already are and can continue to develop and provide a kind of support for people that is not currently available through statutory agencies and must stay where it is to protect the true nature of this work. Strong partnerships supporting these approaches are needed to move away from a postcode lottery and ensure that everyone who needs support can access it in a way which suits them and in a timely manner.  People are more likely to thrive, develop and therefore give more in return to society if approaches are person centred.  There are partnerships forming across Scotland between statutory agencies and third sector organisations which are effectively providing services and support for people in a way which is right for them, precisely because it has been designed and developed in conjunction with them.

Transformation in health and social care: ‘all that matters is what we do’

Transformation in health and social care: ‘all that matters is what we do’

Cat Macaulay

Transform, evolve, improve, change, design, innovate. Words so interchangeably used they’ve all but lost their utility. Yet, we know it when we see it. The (ongoing) transformation of health and social care is something I have both watched and lived for many years.

I work in digital public services transformation, but my professional life is not my only reference point.  In my personal capacity as a person with multiple sclerosis (MS) I have lived long enough to have witnessed the transformation of health and social care services. My own relationship with the idea of health and social care has also transformed utterly since being diagnosed with MS over 20 years ago. The challenges this has brought into my life have led me on an often difficult and equally often life enhancing journey of exploration of self, of society and its attitudes towards illness and disability, and of our health and social services.

I grew up in a Scotland where ‘the doctor’ was someone you saw very rarely and who ‘made it better’, and ‘the hospital’ was somewhere people went to give birth, die, or have emergency treatment. Both were to be avoided if at all possible. Feeling ill, minor injuries, these were things your mum or your granny dealt with. There was no internet to be consulted, just the internet of women who knew what to do until such time as they decided it was a matter for ‘the doctor’.

In the early 1990’s, the health service wasn’t really prepared to deal with someone with a progressive and incurable disease. They didn’t know what to do with someone who couldn’t be fixed, and I didn’t know how to be unfixable. I suspect we both felt disappointed by each other. For some reason none of us considered the idea that perhaps the need was to learn to live with, not focus on ‘being fixed’. The transformation I am seeing emerge now is one of embracing the idea of managing health together.  As MS clinics and nurses, new symptom management and disease modifying drugs, and patient support groups popped up I began to understand that how I lived with my multiple sclerosis would be as much an outcome of what I did as of the medical profession’s interventions.

It seems strange now but when I was younger ‘health’ was something other people did to me, rather than something I had or controlled.  As the century drew to a close that began to change. Self-management entered my vocabulary. The web gave me access to information. I began to feel more in control of how I lived with, even if I could not control what I lived with.  That’s the transformation I have seen emerge.

Now it’s not been without its teething problems: when should or shouldn’t I seek medical profession support; which of these conflicting bits of advice is the correct one; what happens when I have become convinced that a treatment or drug will help but it is not available on the NHS; do I call the GP or the MS nurse when something happens; who is my ‘go to person’?

Still, teething problems aside, the transformation in me has been significant. I feel much more confident in my ability to constantly adapt to the changes of a progressive disease. I view the medical profession as just one part of my self-management system, rather than as the place that owns ‘making me better’. Even if in my low moments I still wish that ‘the doctor’ could make it better I have become much more positive about my ability to live with MS. As I get older and experience greater disability my mind has naturally turned to care as much as health, and here too I feel more willing to explore what I can do to ensure I have the care I need. I’ve made adaptions to my home, and there are more planned. I’ve prepared an advance directive, looked at care options and costs, and generally begun to prepare for a time when my ability to look after myself may be impacted (the most annoying thing about MS is that you simply cannot tell what it will do to you until it happens).

Of course there’s a but… and it’s that I am lucky. I am still functioning physically and cognitively pretty well. Unlike most people who have had MS 20+ years I am still able to work, thanks largely to a profession that lends itself to accommodating my condition, and a highly supportive employer. I have a family who provide a huge amount of additional support with health needs and around the house. I live near NHS Tayside’s Ninewells Hospital in Dundee where I have the support of an excellent MS Clinic (MS nurses, MS physio, neurologist) and I have the future security of a pension. Without all of those would I be so positive about the transformation I have seen in health and social care, so able to self-manage, so willing to engage with professionals as part of my support team? Even with all of my advantages there are times when I feel bewildered and overwhelmed by the effort of self-management, fearful of the future. How can we ensure that the benefits of this transformation are evenly distributed and what about those who just want someone to make it better or who will never be able to independently self-manage?

Realistic medicine, the integration of health and social care services, the growth of digital public services, all suggest that both the Health and Social Care professions and the people of Scotland are on a fast moving journey of transformation in how we understand, think about and attend to our heath and care needs. We have challenges ahead. This demands we learn to relate to each other in new ways, creates new pressures and expectations on both people and professionals, needs us to find new ways of thinking about old problems, even to rethink what we regard as ‘the problems’. What seems clear is that the time of ‘being fixed by the doctor’ is transforming into the era of working with health and social care professionals in the pursuit of the best health our circumstances will allow, and the care that will ensure we can maintain that as best our circumstances will permit.

What excites me professionally about health and social care transformation is the opportunities that come in the wake of this transformation, as all of us begin to acquire the skills of creativity and innovation that are undoubtedly at the heart of delivering it. What excites me personally is the comfort of finally accepting that learning to live with is the goal, and the realisation that as someone with MS I have a chance to be part of community driving national change in how we collectively learn to help each other live, and die, as well as we possibly can. As our other national bard, the wonderful Liz Lochead, once said (albeit in a slightly different context):

Only by a shift and sharing is there any chance

For the Welfare of all our people and Good Governance.

Such words can sound like flagged-up slogans, true.

What we merely say says nothing —

All that matters is what we do.

 

(from Connecting Cultures)

 

 

Challenging the Five Provocations: Nurturing Transformation

In December 2015 the Academy published the Five Provocations for the Future of Health and Social Care, influenced by a think tank of leaders from health and social care and beyond. Since then we have tested them with a range of different audiences and deepened our understanding of what a transformed landscape would look.

This series of blogs, titled Challenging the Five Provocations, looks at this experience to dig a little deeper into the future and set out the opportunities for transformation as we see them.

Nurturing Transformation

Perhaps there is something in the word transformation itself that suggests a quick fix. But what it means is a thorough, radical and noticeable difference in health and social care and beyond. Suddenly the word transformation been adopted by every change project and even by systems change which is focused on one goal – cutting costs.

So perhaps there’s a need to qualify it right at the start. What we identify as transformation has to mean a positive, identifiable and radical shift in care where that change is needed. And transformation will embody the other provocations as well; it will cede power, it will reflect courageous leadership, it will be a change in culture and it will fundamentally emphasise and value humanity at all levels.

It is not a quick fix and so it needs to be supported and nurtured by a longer term vision and the courage and passion to work towards it; by supporting and navigating the involvement of people, the design of supportive systems and investment in them as well as the inevitable bumps in the road and the changes in political landscapes.

To nurture means to care for and encourage, this needs to be a fundamental part of the process of transformation and can’t only apply to one sector or profession but needs to be as evident in the informal communities of care as well as the formal.

What is transformation in health and social care? – Cath Cooney

The first in our brand new for 2017 series on ‘What is transformation in health and social care?’ is from Cath Cooney, Scotland’s House of Care Programme Manager at the ALLIANCE.

What is transformation in health and social care?

A good question to reflect on at the start of a new year. The word ‘transformation’ is at risk of becoming another well used but ever more elusive concept as it becomes part of our everyday language in the world of health and social care.  Somehow despite our best efforts the thing we seek to develop becomes harder to pin down.

This past year saw some of the pieces of the transformation jigsaw come a bit more into focus as I’ve grown in to my role within the Health and Social Care ALLIANCE and the House of Care programme in Scotland.

 In the House of Care programme, we use the T word a lot as well as coherence, person centredness, self management and sometimes even compassion. It’s a funny word – sometimes people move towards it in conversation and sometimes not. For me it’s a very important and fundamental jigsaw piece and I like the definition of compassion from Dr John Gillies, co-director of the Global Compassion Initiative and former chair of the Royal College of General Practitioners,

“an acknowledgement that a person or individual is suffering or unhappy and having the intention to take action to address that”.

Sometimes compassion gets a bad press as soft and fluffy – a luxury if you like in the real world of health and care but I don’t agree. It’s at the heart of the care and support planning conversations in the House of Care adopter sites across Scotland where prepared people and prepared staff develop a different kind of conversation.

It works best when there is a shift of intention towards sharing the power in the relationship and really supporting the person to be in the driving seat of their care and support.

It was heartening to read the recent social work report ‘It’s no longer them and us –it’s just us’, which also echoes the importance of co-production within a good conversation:

‘The relationship between the assessor and the assessed person is the foundations – it’s so important. It needs good communication – especially good listening – and honesty. Processes and systems should be built around this and enable it, rather than getting in the way.’

Hopeful signs perhaps that policy and practice in health and social care integration really are beginning to converge with the person at the centre.

We say we want a more human compassionate approach but when budgets are perceived as tight, services like this, which have high levels of support and satisfaction from people and their families are often cut; struggle to survive on short term funding; or are perhaps not even funded in the first place. Those services and staff are often judged against a reductionist effectiveness model, leaving the third sector to be the fertile ground for more person centred approaches and services that are informed by the voice of lived experience. We need a third sector that is truly an equal partner in health and social care.

But how can this shift in relational care be more clearly measured and evidenced? Sir Harry Burns is chairing a national review of indicators and targets. We must measure the process and the day to day business of the effectiveness of the systems but we need to include the voice of lived experience if we really want to understand what good care and support means. I hope that what emerges will also include the language of human, relational care in support of transformational  change.

There’s a growing body of evidence to show that compassion is good for us all. Whether you’re a person living with a long term condition, an unpaid carer or a staff member, I’m hoping that in 2017 we openly move towards a kinder, more compassionate approach in support of transformation in health and social care.

There was an excellent piece in a recent Sunday newspaper where Dr John Gillies spoke bravely and clearly about the need for compassion and Dr James Doty, the neurosurgeon who founded the Centre for Compassion and Altruism Research at Stanford University, quoted the Dalai Llama:

“If we say the practice of compassion is something holy, nobody will listen. If we say, warm-heartedness really reduces your blood pressure, your anxiety, your stress and improves your health, then people pay attention.”

I’d vote for that kind of prescription.

 

Cath Cooney

 

I can do Ballet like you (and many other things!)

This week’s blog was an entry to the Short Story category of our 2016 Creative Competition where we asked entrants to tell us ‘What does a fairer Scotland mean to you?’. In ‘I can do Ballet like you (and many other things!)’, Diane Cowan tells us about her love for Ballet, Pilates and writing.
Read More “I can do Ballet like you (and many other things!)”

Creative Competition 2016 Highly Commended – Short Story

‘You are the expert…What does a healthier Scotland mean to you? What does a fairer Scotland mean to you? What changes would make a difference to your life?’ This year’s Creative Competition theme was ‘Voices of the Experts’ and our entrants told us their views by submitting to our Poetry, Short Story, Photography, Film and Arts and Crafts categories.

Creative Competition 2016 Highly Commended – Susan Robinson

The Potion – Susan Robinson 

There was once a not-at-all wicked witch called Willa, who lived in Scotland, possibly not all that far from you.

Willa did not live in a crumbling down old cottage in the middle of a dark and scary wood. She lived in a very ordinary one bedroom flat in town. But she may as well have lived hidden in the heart of a dark wood, for she never saw or interacted with her neighbours; those busy people who bustled by, immersed in their own lives and worries.

Willa lived alone. She went about her daily business, hiding behind her billowing black cloak and pointed hat. People saw these accessories and made snap judgements: that Willa was wicked; mad; best to be avoided.

No one said “Hello” or “Good morning”, or “It’s a bit cold for the time of year” to Willa. Instead, they averted their eyes, hurried on past, and tugged their children away, telling them not to stare.

There was something different about Willa, she was not like everyone else, and that made people nervous and uncomfortable. They ignored Willa to her face, and speculated about her behind her back, spreading wild rumours that further fuelled the fear of her.

So Willa made her way through life, silent, alone and misunderstood. She was not wicked, nor dangerous, just very sad and lonely, battered and damaged by life’s events, and struggling on the best way she knew how.

Willa did not like going out, being stared at, and spat at, people turning their backs on her and walking away, the whispered accusations that floated her in the cold wind. But nor did she like staying in, staring at the same four walls as they closed in on her, flicking on day-time television that depressed her still. Her flat was dusty and laced with cobwebs, not for any atmospheric witchy effect, but because she was depressed and too tired to dust or vacuum. And anyway, with no visitors, what was the point in cleaning anyway?

The irony, Willa reflected was that people feared her because they did not understand her, and thought she might turn them into a toad. But if they had bothered to ask her, Willa would have explained that her form of magic was aimed at helping and healing. She could rustle up a potion to clear up teenage acne as quick as a flash, and even knew a poultice which could help reverse male pattern baldness.

She just wanted to help people, if only they would let  her. She longed to feel useful, to utilise her skills and talents. But look at the state of her, she thought in despair. How could she help others if she couldn’t help herself?

She had not done any magic in such a long time. The depression she suffered from sapped her magic from her along with her energy. Was it possible that she could create a potion that could make things better?

As she considered making a potion, Willa felt a small flicker of hope within her. A feeling long dormant, but still there, waiting to be coaxed back to life.

Willa thought long and hard about the ingredients she would need. Newt’s eye, frogspawn and rat’s tails wouldn’t do, nor would herbs picked under a full moon. This would require serious ingredients and a lot of hard work and energy. Willa decided she was up for the challenge, and set to work.

Willa’s Potion for a Better Scotland

  • Take society’s attitude to anyone who is ‘different’ from them for whatever reason (be it experience of mental health conditions, disability, race, religion, gender, nationality, sexuality or age) and boil in a large cauldron over a hot fire. Bubble until stigma and prejudice begins to evaporate. It could take some time (anything from several hours to several generations) for stigma and prejudice to fully evaporate.
  • Once evaporation is complete, a solution of tolerance and understanding will remain.
  • There may still be lumps of ignorance with the solution. To counter this, add a generous dollop of education, laced with empathy, and stir vigorously in a clockwise direction for ten minutes, until the lumps of ignorance have been dissolved, leaving behind a smooth bright yellow potion.
  • Take a handful of disparate individuals (rinse off any residue of isolation and loneliness), and using unicorn hair, being to make connections between them. Continue weaving the individuals together with unicorn hair to form strong, multiple bonds, including friendships, social networks and a sense of community and belonging. Add to the yellow potion and stir counter-clockwise.
  • Take access to mental health services and multiply provision by ten, using the incantation “must do better”. Take mental health service provision and use a mortar and pestle to grind out any unnecessary bureaucracy and excessive waiting lists, and discard. Add in responsive, appropriate services (including crisis care), and compassionate knowledgeable professionals. Blend together to form a smooth blue paste.
  • Take a well funded, flexible third sector, which can provide personalised support and act as a valuable safety net to fill any gaps in statutory provision. Add to the blue paste above.
  • Sprinkle good information and signposting about services over the top.
  • Add the blue paste to the yellow potion in the cauldron and stir clockwise seven times over a low heat, until the mixture turns bright green.
  • Finally, take a handful of opportunities for everyone to be able to access green space, sports and leisure, culture and education.
  • Add to the green potion, stirring counter-clockwise five times.
  • Remove from heat and allow to cool before drinking.

Exhausted, Willa stirred the potion one last time, before removing the cauldron from the fire. It had taken a long time and all her energy, but if it worked, it would be worth it.

With trepidation Willa drank the potion. At once she felt hope and optimism flood through her body. Things felt different. It had worked!

But it was not enough for Willa to drink the potion. She needed everyone to drink it: the people on her street; the people who work in shops, and hospitals; who drive buses; children; parents; teachers; policy-makers; decision-takers; politicians; big business bosses – everybody!

And so, Willa summoned all of her remaining strength and created a huge storm cloud over Scotland. Using every ounce of her power, Willa made her potion rain down, over the towns, cities, villages and countryside of Scotland. She hoped that her potion would land in the right places and be absorbed. She wanted children to splash in puddles of tolerant understanding and to drench commuters with a sense of community and compassion.

It rained Willa’s potion for an hour, and then worn out, she collapsed into a deep sleep, wondering if it was possible, that once the cloud had passed and the rain had stopped, she might wake up to a brighter tomorrow.

We need to talk about targets – Audrey Birt

As part of the portfolio of work I do, I’m proud to be the Associate Director for the Health and Social Care Academy, a programme of the Health and Social Care Alliance. The Academy’s particular purpose is to “drive transformational change in health and social care in Scotland through the lens of lived experience” a focus I strongly believe is a key component of transforming care.

Read More “We need to talk about targets – Audrey Birt”

People in Scotland at the forefront of change

“A social movement that only moves people is merely a revolt. A movement that changes both people and institutions is a revolution.”Martin Luther King Jr., Why We Can’t Wait

It seems extraordinary that it has been just 10 years since the birth of the ALLIANCE. A decade ago, the voice of the people who use health and social care services was muted. Now, people in Scotland are at the forefront of change. Read More “People in Scotland at the forefront of change”