Something has gone wrong and it needs to be put right
This is the time of year when we think of people in our lives and how they matter to us.
It is unlikely that the Health and Social Care (HSCP) sprung to mind, but if you are well and happy this Christmas it is likely that they had something to do with it.
I’ve been battling for years to understand how they work and only now discovered that, although overseen by Highland Health Board in the north, they run it differently from Argyll and Bute.
Three years before the system changed here, NHS in Highland had taken over from the council responsibility for social care, meaning it managed and held the budget for the whole thing.
I spent some months this year seeing how very well this seemed to work, what they describe as” joined up thinking”. Compared to here, the services were amazing and I was even more impressed with the “can do” attitude. There seemed to be resource to support patients to try for goals, and if unsuccessful, explore other possibilities.
The motivation engendered in service users by the continuance of hope, and the availability of professionals, working closely with voluntary agencies, was notable.
We were all sent out details in 2015 of the Scottish Government’s decision to integrate health and social care. Argyll and Bute chose the alternative model, putting together a group of people with separate powers, duties and liabilities to plan and run their services.
This is called the Integrated Joint Board (IJB). They are proud of the fact that they are the only people in Scotland to run everything they are responsible for, including justice, in this way.
GPs, on the other hand, are independent practitioners under contract to the government.
What all this means to you and I is that if you have questions, concerns or complaints, it is extremely difficult to know who you can approach for help.
As our vice chairperson put it, “it is difficult to know where to turn”. I thought I knew my way around the health care system, but the layers of responsibility now baffle me.
There seem to be protocols and rules in place that limit spontaneity and even hard won professional autonomy.
The one consistent thing seems to be a general lack of communication.
There have been recorded instances of excellent resources of which even front line staff are unaware. Being directed to online resources leads to frustration about out-of-date sites, telephone numbers and details of staff who have long since left.
The public have a great appreciation of front line staff but their attitude to management was described to me as “deeply ingrained anger and mistrust”.
As we can’t have a service without governance this is a really critical situation, and has arisen because, in various ways, the HSCP has not been honest with us.
Dr Donald Macaskill, the CEO of Scottish Care, describes “the system being there to serve rather than become an end in itself”.
Something has gone wrong, it needs put right, and it will take more than a Christmas card to sort it.
Barabel Mckay, chairperson of Mid Argyll Health and Care Forum.