Has Scotland missed an enormous opportunity to have the expertise of some of the 2 million voices of users feed into the DNA of the new Health and Social Care Integrated Joint Boards?

In common, it appears, with most of Scotland’s national and local politicians, I had accepted that the obligation to have one Third Sector member, one carer member and one service user member on each of the new boards ensures the voice of the ‘customer’ is built into the new structure.

That was until I listened to Dr Oliver Escobar at the 2016 ALLIANCE conference, talking about two of the ALLIANCE’s five ’Provocations for the Future of Health and Social Care’: courageous leadership and ceding power.

Oliver Escobar is Co-Director of What Works Scotland, an ESRC and Scottish Government-funded programme that works alongside fellow academics, government, the NHS and the third sector to use research and evidence better when decisions are made about public services and policy.

As already touched upon by Oliver’s colleague, Claire Bynner, in her blog on the event[i], there is a real opportunity to democratize health and social care through the involvement of citizens in the governance of Integrated Joint Boards.

Through their consultations to help inform their strategic plans, the new organisations have taken care to listen to the views of citizens. But has the template they have been given, by the legislation, allowed them the opportunity to enjoy the full insight of Scotland’s 2 Million Experts when deciding how to spend their £8 billion of resources?

Oliver Escobar warned the conference that too many decisions seem already to have been made; that the framework of people and assumptions that is already in place will mean the new landscape will actually be very similar to that which has gone before.

He suggests that courageous leadership and ceding power are about trusting people in the design of services.

“Instead of an individualist take on leadership, we need to look at leaders as facilitators to make difficult conversations happen. Leadership is about following the experience of people using services. It is very dangerous to have heroic individuals as leaders. Courageous leadership is about collaboration.”

Oliver warns that each manager in the new integrated health and social care landscape is inheriting groups of staff and resources. As a result, decisions will be driven – perfectly legitimately – by the interests of these people. Can you really expect, he says, the head of a service to cut their staff and move towards a new social economic model or social enterprise model to deliver their work?

“The question,” says Oliver, “is how to help these decision makers and the answer is to give the 2 million experts a permanent platform. Difficult decisions need to be made and those making the decisions are currently trapped in a system that prevents them using evidence better and hearing the voices of the users.”

Oliver says ceding and sharing power beyond just consulting people has been done elsewhere. He cited the experience of Australia’s second biggest city in answer to the question from a delegate: ‘how can people be listened to when the government say it has no money?’

“We need to rethink how we make decisions. In Melbourne, faced with a whole range of local challenges, the way they made their decisions was to delegate the work of redesigning to a randomly selected group of citizens set up to reflect the population mix of the city.

“This was no small consultation. This was about redesigned for the future: drawing up a five-billion-dollar plan for the next ten years.

“The group put forward 21 recommendations of which 19 were accepted. It worked because the group started without preconceived ideas.”[ii]

And Oliver Escobar says the way we move into the integrated world of health and social care here needs to be invigorated by more of Scotland’s 2 Million Expert Voices:

“We have a lack of local democracy that is slowing progress. We need to focus on making sure we reach the citizens who are seldom involved in the decision making. We need a radical change in our approach.

“Ceding power means sharing power and creating new sources of power.”

[i] Claire Bynner blog: http://bit.ly/24vQymg

[ii] For more on the Melbourne People’s Panel read The Age newspaper commentary at: http://bit.ly/1g0n7GU