The national response to COVID-19 has highlighted the value and resilience of our communities to support our health and wellbeing. At the same time, the impact of the virus has shown that the way we support the health and wellbeing of people in communities needs to change.
As we begin to transition towards recovery, this is the perfect time to start the conversation around how we can continue to build and sustain capacity for the future.
This week the National Development Team for Inclusion (NDTi) publish their most recent reports highlighting evidence and learning of the impact of Community Led Support (CLS) across the UK. In Scotland, the CLS approach is being implemented in nine Health and Social Care Partnerships (HSCPs) and is supported by NDTi, the Scottish Government and Healthcare Improvement Scotland.
A key part of any conversation about the future is to understand what we’ve learned so far in Scotland.
The importance of community
My own background is in international development and I’ve witnessed at first-hand the overwhelming strength and resilience of communities in responding to crisis, whether it’s caused by war, disaster or disease. I’ve worked for Healthcare Improvement Scotland in both community engagement and now collaborative communities, as I’m passionate about the role of involving communities in the planning of activity to ensure it truly meets needs and has the best chance of being sustained in the longer term.
“The CLS approach is based on the recognition that we need more sustainable, local solutions that truly meet the needs of individuals. Culture change is pivotal to this shift towards support that is flexible and innovative, designed around personal outcomes and a ‘what matters to you?’ approach.”
Working alongside NDTi in Scotland, I’ve been on a journey of discovery developing a programme of support for five HSCPs that began CLS in 2019. We have met with stakeholders working across different local services and across the statutory, third and independent sectors, who have all informed our work. We have also visited a range of communities – highlights include visiting a vegetable garden at a care home in Shetland, speaking with carers in Falkirk and being part of a lively discussion, fuelled by delicious homemade shortbread, with community members on Galson Estate, north west Lewis.
The CLS approach is based on the recognition that we need more sustainable, local solutions that truly meet the needs of individuals. Culture change is pivotal to this shift towards support that is flexible and innovative, designed around personal outcomes and a ‘what matters to you?’ approach. For example, one man in the Scottish Borders attended an open mic night in a local village to successfully address social isolation, rather than referral to traditional day services.
Community responses have flourished in response to COVID-19 as already pressurised statutory services were stretched thinner. In common with CLS, these responses have focused on the resources and strengths that already exist within individuals and our communities to support health and wellbeing. Yes, the statutory sector may have a role to play, but this may be as a facilitator or enabler rather than service provider.
Every community is different
A key principle of CLS is in recognising that the needs of every community will be different and therefore the solutions must also be locally adapted. Integral to success is taking time to develop an understanding of each local context and all the nuances, the individuals and relationships that make each ‘community’. An example of this is Talking Points in East Renfrewshire where staff worked with a local Muslim group to understand their needs and developed a tailored ‘community hub’ for health and wellbeing that included support from a dietician and diabetes nurse in collaboration with social care and the third sector.
“A key principle of CLS is in recognising that the needs of every community will be different and therefore the solutions must also be locally adapted. Integral to success is taking time to develop an understanding of each local context and all the nuances, the individuals and relationships that make each ‘community’.”
Again, successful community responses to COVID-19 have also demonstrated the importance of localised approaches with activity developed and led by those who best understand and can meet the needs: the communities themselves.
The values and principles of CLS resonate across the UK. However it has also been important to recognise the different policy landscape and culture in Scotland, especially given the strength of community and how this impacts on systems and processes that support health and wellbeing.
We have built relationships with key national organisations, such as the Care Inspectorate and the Scottish Social Services Council. This has enabled the flexibility required for changes to systems and processes. For example, the development of a light touch social work assessment that continues to meet regulatory requirements.
In the response to COVID-19 this same flexibility to do things differently has been key to breaking down system barriers and enabling communities. In fact, in one of the areas where the CLS journey had already begun, a key stakeholder reflected it has “helped us cope better with COVID-19”. This may be for a variety of factors already in place: that initial conversations focus on ‘what matters to you’ and in signposting to community assets, that a light touch assessment process exists that has contributed to reduced waiting lists, that collaborative working relationships have been built with the third sector and communities.
Starting the next stage of the conversation
Bearing in mind this breadth of knowledge and experience that we’ve gathered thus far, how might we build capacity, support our communities and enable local solutions that better meet the needs of people in Scotland?
The CLS reports provide some evidence and recommendations to start the conversation, including the importance of coproduction, trust and empowerment of communities.
As we transition into recovery, the challenge will be to answer this question by building on the learning so far. Healthcare Improvement Scotland is looking forward to being a key player in this vital journey that’s of increasing importance in a post-COVID Scotland.
Gillian Fergusson is Senior Programme Manager with the People Led Care Portfolio within Healthcare Improvement Scotland’s ihub.