Back on 1st September 2016 I represented VHS at a discussion organised by the Glasgow Council for Voluntary Sector on what makes for a ‘good society’. The aim being to share what is being done by different sectors in terms of poverty alleviation and inequality and to focus on what more can be done. The meeting was part of a series of focus groups being organised by the Web Memorial Trust, Edge Hill University and Glasgow Caledonian University. Here are my reflections on what I heard discussed.
VISION OF A GOOD SOCIETY
Where there is no more health and social care postcode lottery that is able to meet and deliver services to individuals at the point of need. A society where individuals take responsibility for their own health and wellbeing through responsible self-management. A society that addressed the needs of those looking/caring after someone being treated as an equal partner by all health and social care professionals who recognise at times there is a need for carers/relatives to act or speak on behalf of the cared for person they look after without the need for official power of attorney when seeking help for the good of the cared for individual. A society where welfare is shared equally across those in need. A society where individuals/communities look out for each other.
WHAT CHANGES ARE NEEDED TO REALISE THIS VISION
The number of GPs, health centres, dentists, social services etc need to be equalised across Scotland according to population, to meet the needs of every community. Access to health care treatment and medication needs to be more formalised to ensure everyone entitled to the same standard of care and prescription medication. However, there also needs to be consideration when there are limited resources, such as alcohol and drug treatment services. Individuals should not for their lifetime be prescribed methadone indefinitely – there needs to be a programme/policy to ensure individuals can off this prescription substitute. In addition, residential rehabilitation should not be afforded to individuals on multiple occasions, there needs to be a maximum number of rehabilitation placements afforded to individuals, who must be informed of this.
People should be given written information at the point of diagnosis that provides guidance on how to manage their condition and where appropriate how to access disability assessments/access to aids etc at a later date as a condition progresses, rather than wait until a condition is severe. Carers – in particular relatives who are caring for someone – need to agree within the family who should be the named contact so care/social providers can speak direct to them as well as the cared for person when looking at needs and, where applicable, take a lead from carers/relatives on the best approach to address issues. This is necessary to ensure any cared for person who does not have good insight into their own needs and wellbeing gets the right type of care/services at the right time (this would apply particularly for those with a mental health condition). Individuals should have a named contact with contact details (nurse/social worker etc) when circumstances change for them or for those they care for to avert a crisis.
Health and social care partnerships (planners and strategies/policies) should consider reverting back to a single joint assessment of need when assessing the looked after person: the carer/family member’s health should not be compromised if we are to continue to reduce hospital admissions and prescription medication for those who are not coping. Welfare reform in Scotland needs to consider and take into account when dealing with multiple household claimants the level of financial support being awarded and in particular the number of disability cars within one household. Those with a disability car should not be exempt from meeting their own tax, car insurance and repair costs as many welfare claimants may have higher free financial reserves than those working – consideration for this type of policy would save the state thousands of pounds that could be re-distributed to those in need or crisis. The state already covers the cost of the mobility car and should not have to cover the upkeep costs for adults.
Access to local community services would allow communities to help look out for each other and build relationships, reduce isolation and offer choice to individuals. Funds need to be put in place to ensure successful running and ongoing serviced development at community level. Access to relevant training and information could be offered directly by health and social care providers (free places could be offered to the community for each training session delivered by a statutory provider). GP practices should have a dedicated counsellor or some form of personal support for patients experiencing low self-esteem or feeling depressed, where the GP can fast track patients directly – without the need for referral – to NHS mental health services. This would reduce waiting lists and the number of anti-depressant prescriptions prescribed – a financial saving in the long term.
Government and citizens need the chance to debate and be co-producers of research/evidence to give people skills and knowledge before outcome decisions are reached. The concept of public service has to come back. Public sector has a responsibility for communities and they should think about the consequences of their decisions. The state needs to recognise people and communities who help themselves and value/risk people’s knowledge/experience: ignoring this determines future inherent barriers.
HOW CAN YOUR WORK OR VOLUNTEERING CONTRIBUTE TO ACHEIVING THE GOOD SOCIETY
Help where possible to create, train and support locality based services that offer through type care/support. Collate local based information on needs and wants on behalf of the voluntary section to assist health and social care planners. Access locality based statutory service providers and ask them what needs they think are not being met for their patients and seek possible solutions. Politicians/government have to take responsibility for thinking ahead for what workforce, skills and experience the society needs – effective planning, training and managing is required to meet future workforce shortfalls, rather than seek these skills outwith the country (this only creates inequality in other nations). Remind ourselves what our core values are. The voluntary sector continues to be seen negatively by the state and this needs to be changed by small/medium organisations, not large corporate voluntary sector bodies who have vested interests.
Margaret Totten is a VHS Board member. She has been an active volunteer at grassroots level within the voluntary health sector for over 20 years.