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Find out about the people behind Royal Voluntary Service in our series of guest stories from our volunteers, staff and partners.
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Prevention is at the heart of how Scotland’s political parties and policy community want to address the current social and economic situation. Instead of cutting frontline services to save money, the Scottish Government has dedicated itself to preventing need arising. This means higher quality of life and lower frontline costs. It is always better to stop someone getting ill than to cure an avoidable illness. While much of the debate about prevention has focused on early years, there is an important case to be made for prevention amongst older people.
Because loneliness is a major cause of ill health for older people the services WRVS provide can help to prevent the early stages of acute illnesses. Stopping older people getting lonely by providing community transport or good quality hot meals delivered daily is one way of preventing dementia. Social clubs and good neighbours schemes keep older people involved in a community and help those people to maintain a higher quality of life.
But one of the roadblocks to prevention is the arrangement of public services. While this is quite technical and not terribly interesting, the impact could be huge. This is because at the moment local authorities pay for prevention. They have responsibility for keeping older people well, independent and in their own homes. But if they spend money doing this, they see none of the savings, which accrue to the NHS as fewer people need to be admitted for costly treatment.
The long awaited consultation on health and social care integration aims to square this circle. It will ensure that the savings made through prevention can be put into further preventative services. This will allow a profound shift in the balance of care.
The basis of the consultation is that:
- Nationally agreed outcomes will be introduced that apply across adult health and social care;
- Statutory partners (including the NHS) will be jointly accountable to Ministers, Local Authority Leaders and the public for delivery of those outcomes;
- Integrated budgets will apply across adult health and social care; and
- The role of clinicians and care professionals will be strengthened, along with engagement of the third and independent sectors, in the commissioning and planning of services.
WRVS hopes that the release of funds to prevention will allow a substantial increase in the scope and reach of preventative services. We’re pleased that there will be strengthened engagement from the third sector. This, however, must ensure that there is a full engagement both in the preparation of plans and sign-off of plans and spending.
The proposal suggests that Community Health Partnerships be replaced with Community Health and Social Care Partnerships, which have budget holding powers and are the joint responsibility of Local Authorities and Health Boards. But the really important outcome of the proposals is the opportunity to unlock resources for prevention. Resources that are currently wasted treating preventable conditions.
WRVS will be working with Scottish Government to improve the proposals over the summer, and we hope that the proposals, when implemented, will prompt a new approach to providing services for older people. That new approach must be one that focuses on quality of life and independence for older people.
Posted by Pete McColl, Public Affairs Manager Scotland at 00:00
Wednesday, 09 May 2012.
quality of life,
The Strategic Spending Review for Scotland starts today with a statement from Cabinet Secretary for Finance and Sustainable Economic Growth, John Swinney. The announcement comes at the same time as the detailed 2012-13 budget process starts.
Both the Strategic Spending Review and the Budget are vital for Scotland, which has chosen a different path to that followed by the Westminster government. Where at Westminster the focus is on reducing public spending, in Scotland the government is seeking to guide the country out of recession through investment. The Strategic Spending Review will set the framework for spending up to the next Scottish election.
What we have is, effectively, a control in an experiment on whether investment or cuts are the best way out of a recession. It is, however, difficult to identify which areas of investment will be sustained in the Strategic Spending Review. While capital investment has been included in a Cabinet portfolio for the first time it is revenue spending that will be vital to determining Scotland’s future.
The watchword for the past year has been prevention. The Christie Commission, Independent Budget Review and Scottish Parliament Finance Committee have all published reports that have suggested that prevention must be at the heart of all public services.
By preventing need arising we can both increase people’s quality of life and reduce expenditure on public services. It is the win-win that can help Scotland out of the recession.
The Strategic Spending Review will allow us to see how much of a priority prevention will be for government in the coming Parliamentary term. Of course, prevention is, in itself a complex concept. There is very substantial opportunity to make huge improvements to people’s lives through intervention during the early years of childhood. But we can also make massive improvements in the lives of adults through intervening to prevent future need.
These are different things, both are of great value, but the debate about prevention is muddled by the subtle differences. We must act now to make sure that our ageing population continues to be an asset. By taking preventative approaches we will enable ourselves to grow older in a way that both maintains well being and avoids major medical interventions. That’s good for people and good for the budget.
It’s important that helping us to age well doesn’t distract from the important task of breaking cycles of intergenerational poverty. But it’s also important not to see the two outcomes in competition. Getting it right for Scotland’s people will mean more effective preventative approaches in the early years of life and for our ageing population. Indeed it will require early intervention to prevent re-offending, to encourage life-long learning and to limit welfare dependency.
The aim for the Strategic Spending Review should be to diminish acute spending wherever it occurs. The best way to achieve that is to place prevention in all its forms at the heart of public service provision.
What we hope Mr Swinney will do today is to seek new ways to shift the balance of care towards prevention. It’s the ultimate win-win, at a time when we need to create a better future for all Scotland’s people.
I was conducting some online research the other day about how Scottish local authorities go about offering free personal care and social care more broadly to older people. By the way, it's important to remember that those two things are not synonymous, the former is much more about the real personal stuff like hygiene, dressing and mobility whereas the latter can be about things like transport and shopping. Anyway, to cut a very long story short, basing their approach on Scottish Government (SG) guidance - newly fashioned in 2009 after lots of consultation - all local authorities use eligibility criteria to determine who gets services. Because resources are limited, those who are most at critical or substantial risk of harm are prioritised to receive services. That might be logical and fair just now but, as WRVS has pointed out, unless we, as a society, can start to move towards preventative services which mean there are progressively less and less people at that level of risk, we're very soon going to crash mightily into the buffers of unaffordability, with casualties all round.
To be fair to both Scottish central and local government they all seem committed to the idea of 'adopting a strong preventative approach to help avoid rising levels of need' (that's a direct quite from the SG guidance) but it appears that limited resources mean, in fact, that few local authorities if any can commit to providing the extensive preventative services that they would ideally like to. Reading the local authority responses to the the 2009 consultation, some of them seem very pro-prevention indeed. Unfortunately, reviewing their eligibility criteria in 2010, these two examples illustrate the spectrum of the way they are apparently obliged to function (I will spare their blushes and let them remain anonymous):
‘The Health and Social Care Department assessment prioritises assistance to those whose needs have been assessed as being within the Critical and Substantial categories. People whose needs have been assessed in Moderate or Low categories may (my italics) receive help to maintain or develop abilities or to prevent further deterioration.’
‘LOW – you or others are at low risk of harm or loss of independence. For these needs, we will not (my italics) provide services. However, we will offer advice and information about alternative sources of support.’
Let's be clear, I'm not saying this is all local authorities' fault. What I am saying is that, sooner or later, some radical funding decisions need to be made about what money goes to which bit of the public sector and to the voluntary and private sector partners that work with it. With that in mind, here's a telling quote for you from the House of Commons Health Committee Report on NHS Continuing Care from way back in 2005:
“The question of what is health and what is social care is one to which we can find no satisfactory answer, and which our witnesses were similarly unable to explain in meaningful terms."
It only takes a little dot-joining to detect the radical solution that statement might be taken to imply but I'll let you work that one out for yourselves. Happy figuring!
In Scotland volunteering in health is a hot topic, built explicitly into the Scottish Government’s strategy for the NHS and, naturally, WRVS is involved.
Andrew Jackson, who sits on the National Action Group responsible for implementing the NHS volunteering strategy, recently gave an interview to primo political magazine Holyrood, talking about just how volunteers can improve the health of others and of themselves.
Posted by Andrew Jackson at 16:05
Wednesday, 16 June 2010.
Frantic. That's what it's been like. Frantic. In a job like the one I do for WRVS (Media and Public Affairs) the General Election is somewhat akin to the football World Cup in terms of all-bets-are-off madness, tension, excitement, TV gawked at, radio earwigged too, newspapers poured over,websites scanned, tweets and blogs and every-online-thing else sucked up, junk food guzzled and tea made (I'm not a coffee drinker, that really would send me over the edge). There are those that would find this level of interest in politics rather sad. In fact, I'm one of them but I have learnt to live with myself. And, for the avoidance of doubt, I am just as excited about the real World Cup 2010 that will take place in South Africa in June.
And its far from over. The now traditional 'congratulating of the new Ministers' which charities tend to do these days (i.e. a bunch of letters, usually suggesting a meeting that vaguely resembles some sort of date, to talk about how they can work with Government for the benefit of the people the charity supports) takes up some time. Then there's the policy detail itself. Ordinarily, the analysis of party manifestos that people like me and my colleagues do pre-election would serve as the basis for understanding what the new Government will get up too but in the uncharted choppy waters in which we are now swimming, that analysis only blows up the life raft so much. The tiny little eight pager that Dave and Nick put out last week was but a sliver of the forthcoming doorstopper that will arrive next week.
The official coalition document will get down to much more detail about the full range of policies (although not to the level they will eventually need to be worked out to). Only then will the true picture of Britain's future will emerge. Although I should point out that 90% of the policies this tome will contain are essentially for England and to a lesser extent Wales. It seems to me that few people in England really understand just how much policy is devolved to the Scottish Parliament (no disrespect intended; I'm English born and bred, the son of a Scottish faither and an English mither but I now live and work in Edinburgh).
From a WRVS point of view the two biggies are care and volunteering. Both devolved. And in the case of care, the Scottish Government is tanking ahead with proposals for a Self-Directed Support (SDS) Strategy and a Bill, in response to which WRVS has offered some comment, which you can read here. SDS is similar to Individual Budgeting and Direct Payments are a part of it. It advances the 'personalisation' agenda in Scotland, which is a big feature of the English care landscape and looks as if it will only grow in importance across the UK. That's certainly what the manifestos were suggesting in all their various UK, Scottish and Welsh editions - that was an innovation that quadrupled my bedtime reading for a week or so!
Basically SDS means handing control of care to the person who gets that care to a greater or lesser degree, depending on how that person wants to play it. It means really putting them at the heart of it. If they want to, they can decide what they need and who provides it and they control the budget, which gets given to them, usually by the local authority. It's the Scottish Government's hope that SDS will be the main way care is delivered in future and that almost certainly means a pretty radical shift away from monolithic care services provided by the state or by large private or third sector providers, to a greater variety of smaller more tailored services. It's more or less a market model and WRVS' interest lies in providing the kind of great, volunteer delivered services that, while not exactly 'care' services in the formal sense, can complement such a system and make sure older and disabled people can continue to live independently in their own communities, fully plugged into the life of those communities, rather than being isolated, lonely and stuck for a friendly ear or someone to help them get out and about. So, if you're interested have a read. And hang on for some more General Election related blogging coming here soon! Promise!
Posted by Andrew Jackson
I have no idea what the form is for bloggers in general but I am aware that some of the most successful (ie widely read and influential) political bloggers are successful because their blogs are constantly current. These folk appear to have either hours of spare time every day or are so mentally – and possibly physically - hyperactive that they can toss off the daily blog as quick as a wink and get on with doing whatever else it is that they do.
The reason I haven’t blogged for so long - fun as it is, and it really is - is because I’ve been struggling to come up for air from under the current stormy sea of work in the actual world. Up in Scotland WRVS is experiencing a mini-flood of visits by Scottish politicians to WRVS services or by WRVS to various public events and it all takes organisation, preparation and of course, some performance on the day/night.
In this last fortnight (that is the last half of March) alone, we have seen:
- The First Minister of Scotland, Alex Salmond MSP, MP, welcome WRVS Chief Executive Lynne Berry – with a supporting cast of Angela Geer, Head of Older People’s Services UK, Margaret Paterson, Head of Older People’s Services Scotland and... er... who else was there, oh yes, me! – to his official residence in Edinburgh, Bute House, to talk about WRVS’ work.
- A visit to visit our Auchinairn lunch club by the Labour leader in the Scottish Parliament, Iain Gray MSP, plus his Scottish Parliamentary colleague, deputy spokesperson on finance and skills David Whitton MSP (don’t let that junior shadow post fool you; Whitton’s one of Labour’s policy-brains and ex-right hand man to two previous Scottish Parliamentary leaders). Hats off to the patient older people who are members of the club and all credit to the volunteers, particularly Eleanor Swann, and to Local Service Manager Jackie Gallagher and Service Delivery Manager Alison Love (I promised I'd include a thanks on the Blog so there it is!).
- WRVS talking about the future of older people’s care on BBC Reporting Scotland TV news and BBC Radio Good Morning Scotland, which for those unfamiliar with the UK’s northern nation is much more like being on the 6 o’clock news and Radio 4’s Today than it is being on ‘North West Tonight’. (Scotland isn’t a region after all, he said, waving his Saltire!
- WRVS at the British Irish Council Ministerial dinner in Edinburgh (that’s representatives of every administration in the British Isles) delivering a speech about volunteering, voluntarism and handing back power to people and communities to better support older people.
- Our tireless Scottish staff continue to help plan what is now approaching a dozen visits by MSPs to our Scottish services to make sure MSPs understand what WRVS is all about in their constituencies and how much our volunteers matter to the places they live.
And since I last blogged we had a phenomenally successful reception in the Scottish Parliament on 10 February that saw around 50 WRVS volunteers, various WRVS staff, including Lynne Berry, Angela Geer, Margaret Paterson and the Scottish Service Delivery Managers, meet and talk to 45 MSPs (making it one of the most highly attended Parliamentary events I have experienced in my eight years working in this field) and a host of public and third sector luminaries about what WRVS does. I measure success here by the number of people who turned up and the fact that they were buzzing about what they’d learned about WRVS.
So while I love blogging, I am not enough of a desk jockey to be able to do it as much as I’d like. After all, if anyone inside or outside WRVS is going to be interested in what we’re up to, we have to be up to something! But blogs are about opinion as well as fact, so next time I'll try to get worked up about something and let rip, right here, with some entertaining invective!
WRVS has succeeded in drawing the Scottish Parliament’s attention to the issue of community transport on the back of our ‘Give us a Lift’ campaign and a WRVS briefing sent to all Members of the Scottish Parliament (MSPs) in conjunction with Age Scotland and the Community Transport Association.
The debate on 10 December focused on extending the national concessionary travel scheme (free bus passes) to disabled people but Liberal Democrat Spokesperson on Local Government and Transport, Alison McInnes, highlighted WRVS’s hope that community transport services for older people may come to be included in the scheme as well.
This led to the approval of a motion that, amongst other things, called for “the Scottish Government to consider extending eligibility for the national concessionary travel scheme to include older and disabled people using community transport in rural areas.”
Although WRVS was arguing for an extension to services in all areas, not just rural, and while the Scottish Government is not bound to act on the motion it is a further and very important encouragement to them to look at the issue again. Here’s hoping!
Posted by Andrew Jackson