In this blog, VHS External Affairs Lead Sarah Latto explores what we know so far about proposed reforms to Scotland’s health landscape, and poses some questions about what we don’t yet know.
It has been a month since the Scottish Government published their five-year Programme for Government, and I think many people are still reeling from the scale of reforms it proposed. As the first Programme for Government after an election, I expected it to be ambitious. However, the proposed changes will fundamentally change how our health and wider public services are designed and delivered beyond recognition.
As stated in our initial response to the Programme for Government, we at VHS are very positive about the strong focus on prevention and community-based care. We are also happy with the clear emphasis placed on tackling poverty – one of the key causes of health inequalities in Scotland. However, the potential impact of some of the more structural reforms proposed has been more difficult to fully comprehend.
The government has proposed that the current 14 territorial health boards will be replaced by 2 boards covering east and west Scotland. This is part of a broader programme of reform, or ‘simplification’, designed to make our health services more efficient whilst improving outcomes and experiences for Scotland’s people.
Local Authorities are also earmarked for considerable reform, with the current 32 authorities set to be replaced with a two-tier structure of 6 to 10 ‘strategic local authorities’, and 120-160 ‘community authorities’. Given that up to 80% of health outcomes are determined outside the health system, these proposed changes to our local governance will undoubtedly have an impact on our wider health landscape.
So, given the scale of the changes proposed, what does this mean for other health commitments, and where does the third sector fit in?
When announcing the proposed changes, the government committed to a 3-month period of consultation. However, the details on this, and how the third sector can engage, are uncertain. Government Minister Maree Todd MSP, when asked about this at our Scottish Community Link Worker Network Conference on the 22nd of September, encouraged third sector representatives in the room to engage with the period of consultation, but couldn’t say how or when.
There is also not currently enough concrete detail about the proposed reforms to make an informed or decisive response. Whilst it is recognised that this was a deliberate move to ensure reforms are being shaped with input from key stakeholders, making such announcements with this level of ambiguity risks uncertainty and even alarm in the short term for those working in or with NHS boards or local authorities.
At the inaugural meeting of the Cross Party Group on Health Inequalities held last week, discussions were themed around prevention and health. However, the scale of proposed reforms and the impact that these could have on ambitions around prevention was raised by several attendees. There was widespread reflection that any significant change in policy can’t be shaped by structural change alone – its success is reliant on embedding strong relationships and voices of experience.
With all of this in mind, it does leave us with more questions than answers at this stage. Some of the questions we are grappling with are:
- How should the third sector and those with lived experience engage and share views around the proposed reforms, and what are the timescales?
- How will the proposed structures facilitate local partnership working and shared decision-making, particularly if Community Planning Partnerships, Health and Social Care Partnerships, and Integration Joint Boards will be subject to change?
- What will a ‘community-first’ approach to health and care look like in a health system where decision-making appears to be more centralised?
- Given the focus on simplification and cost-saving, how will the government protect ambitions to shift to a prevention-centred health system?
- How will relationships or partnerships with local or community-based third sector organisations be sustained?
We do not have answers to these questions yet, and we may end up with even more questions in the coming months. However, we will embrace every opportunity to raise these questions with those in government. We will also continue to work with organisations across the third sector, and beyond, to ensure that the voice of the third sector is heard loud and clear during this period of seismic change to Scotland’s health landscape.
Do you have information or reflections on any of the questions posed in this blog? If so, join the conversation! Email me on sarah.latto@vhscotland.org.uk.
