Derek Feeley Chief Executive NHS Scotland The Gathering Derek Feeley Chief Executive NHS Scotland

Partnership working Partnership working – these are the partners in developing the new online resource launched today – called- discover the third sector to Improve health and wellbeing in Scotland: Supporting better partnership across the third and statutory sectors The resource is run by a small core team from across the third and statutory sectors, co-ordinated by the Health and Social Care Alliance Scotland and supported by the Scottish Government.

6 Key Challenges Political Economic Demographic Epidemiological Population Health Changing Expectations

And so….. Questions; Is the answer to this range of challenges likely to be one dimensional? Is the optimal response likely to lie in just doing more of the same or just changing everything? How should we deploy our combined efforts to thrive in this new environment?

It’s complicated…. Too bad all the people who know how to run the country are busy driving cabs and cutting hair. -- George Burns

Health of the Population The Triple Aim Triple Aim Health of the Population Integration Best Value for Money Experience of Care 7

Quality, Quality and more Quality Mutually beneficial partnerships between patients, their families and those delivering healthcare services. Partnerships which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making. No avoidable injury or harm from the healthcare they receive, and that they are cared for in an appropriate, clean and safe environment at all times. The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, with no wasteful or harmful variation.

Our ‘2020 Vision’ EVERYONE IS ABLE TO LIVE LONGER HEALTHIER LIVES, AT HOME, OR IN A HOMELEY SETTING We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

The future – Gathering all 3 curves Co-production & assets Performance Improvement Performance Time

“The 3rd Curve” Given the challenges – hard to see sustainable route without this – can’t treat our way through this. Untapped potential of public activation Patients and families tell us that healthy living is a key outcome for them Shifting the balance of care and shiftin gthe balance of power

Assets and Co Production: In Plain English Made here by us Nothing about us, without us, is for us Building the boat not just steering it Working with us, not doing things to or for us On tap not on top Lighting 1000 fires all over the community I have a problem I want help to fix it What can I do? Lots of examples – here are some of phrases used by community groups to describe what they mean They vary in their ambition and boldness How bold and ambitious do we want to be? Do we want people to design the boat or even decide they’d rather have a bicycle?

Assets vs Deficits Deficit thinking Assets thinking Strengths based How can we create community spirit? What can I do? We’re all in this together We’re getting there Work with engaged people People have the answers People control their lives Deficit thinking Problem orientated How to fix this problem? Someone needs to sort this Us versus them Problems are embedded Do things to people People are a problem People can’t be trusted to decide/be in control A quick reminder of the differences. Assets based and deficit based approaches take policies and services down radically different routes, radically different ways of thinking and going about the business Christie and others link many of our current intractable problems in policies and services which define people by what they can’t do or their problems, treat them as passive recipients incapable of and not to be trusted with determining their own lives and so further disempowering and alienating them. They argue that doing things to people has been ineffective and resource intensive. Structural inequalities reinforce powerlessness and hopelessness and create barriers to self fulfillment and realisation of assets allowing inequalities in outcomes such as health to flourish. A lack of assets creates and sustains transient and troubled communities which are disconnected, powerless and passive. Lacking connections, self worth and empathy, they are riven by prejudice, intolerance. Sectarianism, anti social behavior, hate crimes and disrespect thrive in weak and threatened communities and on poverty and inequality. 14

Some foundations?

Use the tools (and strengths) we have Engagement Matrix Change Fund Programme Gaun yersel’ All together now Co-production guide

Making change happen Promote shift to assets thinking & behaviours Develop a shared understanding, clear & consistent message across policies & initiatives Empower & skill workforce and people/communities Support better links, hubs, joining up Support learning and sharing of what works Improve intelligence on whether we are delivering outcomes people & communities want Making assets our main approach will require major system change. It will require better support for joining up across boundaries and silos; learning and reflective practice and a focus on empowerment. 17

Theory 1 The leaders of the future need to be experts in performance, quality and co-production. They will be comfortable with complexity and conflict and generous with power.

Theory 2 Reliability of values, ethics and behaviours is likely to be just as important as reliable professional practice.

Keep it Real Don’t get lost in theory and jargon This is about people and communities There are examples of assets rich communities and fiery spirits everywhere We know how to do this We want to do it Just do it 20

Just start!!!