Hugh’s blog: The Future of Health and Wellbeing in Scotland

One of the things we as a society have learned in the last few months is that health and wellbeing have to be everyone’s top priority.  Covid-19 has put that into stark prominence as never before.  Beforehand there was frequent news about the time-bomb that awaits in terms of obesity, diabetes, heart disease, cancer and other conditions associated with an aging population.  Whilst government has actioned several initiatives we have not firmly grasped the need to drive forward the changes necessary to address these issues.  Change that will take decades if not generations.

Emerging from Covid-19 surely gives us a once in a lifetime opportunity to grasp the nettle and make fundamental changes to put health and wellbeing to the forefront of everyone’s agenda.

Public Health Scotland (newly operational) has six National Priorities:

1. A Scotland where we live in vibrant, healthy and safe places and communities.
2. A Scotland where we flourish in our early years.
3. A Scotland where we have good mental wellbeing.
4. A Scotland where we reduce the use of and harm from alcohol, tobacco and other drugs.
5. A Scotland where we have a sustainable, inclusive economy with equality of outcomes for all.
6. A Scotland where we eat well, have a healthy weight and are physically active

Priorities 1,2,3,4 and 6 can only be achieved in communities.  Personal behaviours, social relations, physical environments and income create health and wellbeing, and living and working in communities we have control over these. We are blessed that in Scotland we live in a wonderful physical environment with access to country and the outdoors. So what is the NHS for? Surely it is there to patch us up when we fall sick or have injuries. It does not and cannot ensure we live long healthy independent lives.  Yes, we must continue to invest in the NHS but not to the exclusion of major investment into the areas that allow health and wellbeing to be created.

What does this fundamental change mean?  One example.  In developing a new village we insist the developers prepare an environmental impact assessment which are likely to involve safeguarding agencies, e.g. SEPA and SNH, to protect the natural environment.  But do we insist that the development has the facilities for healthy active lives? Are there cycle paths away from roads? Walkways, community areas and halls, exercise areas and appropriate schooling built into the planning and development process?  We all know the answer.  And yet health is our top priority isn’t it?  Surely commitment to health and wellbeing would regard these as an investment not a cost?

There is no doubt we have the means.  The question then becomes, do we have the will? The determination to put narrow-minded agendas behind us? To cross boundaries and work together? To accept the risk of failure but accept that not taking that risk creates even greater problems for the future – our own, our kids and grandkids.

Public Health Scotland, through its Operating Model and the six National Priorities, recognises that it is in community that actions need to take place.  Its workforce comes from within existing statutory agencies, both NHS and local authorities, so they need a fundamentally different approach. This will, in the main, be contrary to all their experience within public service.  Going from slow moving, bureaucratic, silo based, hierarchical systems to a fast moving, innovative and ‘can do’ mentality for local decision making will not be easy.  This requires dynamic leadership and has to be spelled out in every message, every meeting and every publication.

Expertise exists to facilitate this process.  It exists and works in the community.  The challenge is for the statutory agencies to tap into that expertise.  In fact, the fundamental change required cannot be done without the complete involvement of the community sector.  Not just lip service but a full partnership approach during all planning and implementation phases.  It is difficult to understand why anyone would not utilise the people with the longstanding knowledge, skills and expertise of the community where the changes need to happen.

What does the future look like if we make that fundamental change?

• Everyone accepts that their health is their own responsibility and knows what is required to maintain that health. They understand what is needed to self-manage their health as they go through the various stages of life.
• Achieving health and wellbeing is an enhanced part of education from nursery, through school and in tertiary education – learning about exercise, diet, relationships etc.
• In making changes, whether individual or society wide, time is spent to ensure health and wellbeing is positively impacted by the change.
• The training and education of doctors and other health professionals ensures they embrace the work of other professionals, whoever or wherever they are in the community. Utilising the full range of people who can help clients get back on track to health and wellbeing after relapse or illness.
• Spend on community facilities that promote healthy living is a statutory requirement and an increasing spend for the authorities. Health, social care and community resources are as one.

The only way we can collectively create a future where we live fulfilling lives for longer, put off the need for assistance to carry out our daily tasks, and live in our own homes for as long as possible before dying is to utilise all the knowledge and expertise available. Then truly fundamental change can happen.

Hugh McLean is Chair of Lorn and Oban Health Options Ltd.  Healthy Options is a community health initiative which encourages people to get healthier and fitter.