There has been extensive coverage in recent days about anticipated funding cuts to Glasgow City’s Community Link Worker Programme from April 2024. The news has been covered widely in The Herald, Health and Care Scotland and on the BBC
The focus may be on Glasgow, but the story comes back to the wider issue of how to secure long-term sustainability for community link worker (CLW) programmes across Scotland. The Scottish Community Link Worker Network, developed by VHS since 2021, now has nearly 300 members, all of them CLWs deployed across primary care practices around Scotland, the majority employed by third sector organisations, others by the NHS. During this time a recurrent theme for the Network has been the lack of a clear national strategy for community link working, including one that addresses longer term financial sustainability.
VHS believes Scottish Government Ministers understand the importance of the CLW role and the need to get away from annual cycles of funding and to reducing instability and uncertainty for CLWs. However, Ministers will no doubt point to the tension between devolving budgets to reduce centralisation and give local autonomy while also seeking to avoid excessive disparities and inconsistency across NHS boards.
The Scottish Government is currently undertaking a very welcome review with the relevant partners to identify the most appropriate way to address securing funding in the long term for CLWs across Scotland. Whilst at one level the issues are about local budgetary decisions, there is a widely held view amongst concerned CLWs and GPs that the reason for the current instability in CLW funding is the funding constraints inherent in the Primary Care Investment Fund (PCIF). This budget is set nationally and has not been sufficient to ensure that the commitments made in the 2018 GP contract can be delivered in full.
In response to the constraints of the PCIF, local Health Boards are making different prioritisation decisions regarding delivery of services (under what is known as the Memorandum of Agreement). Most unjustly, the formula for the allocation of central government resources to NHS Boards does not reflect the additional and often unmet needs of deprived communities. The allocation is made on a population basis, not on the basis of need. Yet it is within our more deprived communities that health needs and health inequalities are greatest. Prioritisation decisions related to the PCIF at a local level almost inevitably have a more serious impact on these communities than on better off communities. In turn, the budgetary arrangements contribute to the funding instability CLW programmes experience locally.
The Scottish Community Link Worker Network continues to demonstrate the professionalism of community link workers and the positive impact they have on their patients’ lives as well as in their local communities and within primary care. There is already a great deal of anecdotal evidence that this financial uncertainty is impacting on recruitment and retention Scotland-wide, thereby undermining existing investment in a professional workforce that plays a crucial role in the multi-disciplinary team within primary care. The financial uncertainty combines with other factors to stretch the capacity of the existing CLW workforce, including the lack of any plan to resource and implement the Scottish Government commitment to provide more mental health workers in primary care. CLWs have seen referrals for patients with poor mental health and wellbeing grow significantly these last three years. The government’s commitment was based on a recognition that many people are still struggling to access mental health care in a timely fashion and in a way that meets their needs. This has a differential impact on communities with high rates of trauma and unmet mental health needs, and therefore directly on health inequalities. If an increased resource for mental health provision within primary care is currently unavailable, the need to sustain CLWs in post is even greater.
This Autumn VHS will publish a new research report, which for the first time will map the full range and scope of CLW programmes in Scotland. Our report will demonstrate very clearly the extensive nature and complexity of work that CLWs are dealing with on a daily basis. It will show the full range of different approaches that have been taken for the design and structure of CLW programmes, with each reflecting local needs, priorities, and capacity. Whilst overall responsibility for programmes lies with Health and Social Care Partnerships (HSCPs), responsibility for implementation is split between direct delivery by HSCPs and/or NHS, or delivery by one or more Third Sector Organisation. Similar differences are apparent in the distribution of CLWs across Scotland. In some programmes, allocation of link workers was based on factors such as GP practice size and level of deprivation, others have opted for a universal approach and try to provide every practice within their area access to a CLW. This is accompanied by variation in the number of GP practices supported by each individual CLW, the accessibility of the various programmes, and referral pathways.
VHS shares everyone’s concerns about the prospect of any funding cuts to CLW provision and the implications this would have for both the CLW workforce and for Scotland’s most deprived communities. VHS will await the findings and recommendations from the Scottish Government’s current review into CLW programmes and trust that this will bring some concrete assurances about the long-term security of programmes across the country. In the meantime, VHS and the Scottish Community Link Worker Network will continue to champion the impactful work of the 300 CLWs in Scotland and raise awareness of the vital and complex role they play in supporting patients, primary care and their local communities.