Together, we can rebuild it
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Influencing policy and practice
In this blog, Sarah Boath, Head of Programme for CHEX reflects on the challenging funding landscape, discussing the need to think of health and wellbeing services not as short-term projects to fund with money in a siloed budget, but as a long-term investment of resources, time, skill and commitment.
It is just over a year since I came into post at CHEX and, unsurprisingly, the ever-pressing issues of funding and resources, or lack thereof, have come into increasingly sharp focus. The funding issues facing community and voluntary organisations, health and social care partnerships, health boards and local authorities are stark, exacerbated by years of cuts and lack of investment, and only set to get worse.
The recent widely-reported situation facing CHEX Network members in Edinburgh, threatening services and jobs, is just one example of how budget cuts have affected community-led health organisations and community participation in formal volunteering across the country.
We need collaboration, not conflict
The temptation in this kind of zero-sum environment is to retreat into our silos and protect our own team, sector or community. But as hard as it is, there has never been a more critical time to talk honestly about how we can work better together to address Scotland’s worsening health inequalities, which, as our Director Susan noted earlier this year, should be causing much more outrage than they are.
Feedback from across the CHEX network highlights that there are many positive and collaborative partnership-working relationships across sectors at local and individual levels. However, the wider systems and structures, within which practitioners and organisations operate, are creating conditions more likely to lead to conflict with each other, than genuine collaboration to address inequalities head-on.
A complex network, not a false dichotomy
When allocating very limited budgets we often seem to be faced with a choice between acute services and preventative services. This is a false dichotomy, which fails to consider that each of us requires a complex network of formal and informal support to maintain our health and wellbeing. Decisions are being made to reduce or withdraw funding to a huge range of community, voluntary, council and NHS services, and it seems not enough consideration given to the real-life implications of these decisions.
It sometimes feels to me that we are playing Jenga with the building blocks supporting our health and wellbeing. Decision-makers are trying to remove just enough to cover the budget shortfall, while hoping desperately that the leaning tower doesn’t completely collapse. And every financial year there are fewer and fewer bricks to play with, and the tower gets ever-more rickety.
We know the answers already, but policy and research isn’t translating to action
The policy profile of our country’s health inequalities has never been higher. Countless reports and academic articles stress the importance of early intervention and the wider social determinants of health in addressing the persistent health inequalities we face.
However, within this seemingly-supportive environment, the decisions that affect our services and resources are increasingly informed, not by evidence or policy, but by the twin priorities of meeting statutory obligations and balancing the budget.
What we need to stabilise the tower
We can harness our collective knowledge, skills, experience, and commitment to address these inequalities, but we need to move beyond talking about funding on its own, critical as it is.
We need to think of the services which support our population’s health and wellbeing not as short-term projects to fund with money in a siloed budget, but as a long-term investment of resources, time, skill and commitment.
We do not need to start from scratch, we just need to better understand what is already happening, often in the most challenging of circumstances.
I have worked across the public and voluntary sector in various parts of the country. I know that the increasingly shrinking number of practitioners and volunteers in communities are engaged in fantastic practice every day. They have practical, pragmatic, and often cost-effective solutions to our seemingly-intractable problems.
However, this practice and insight often goes unnoticed and unrecognised by those making decisions around funding and resources. In a time of limited resources our biggest resource is our people, and they need to be treated with kindness, respect and compassion, and to be supported to work in this way with people.
The community-led health sector needs better communication, transparency, honesty, and the opportunity to be treated as equal partners in finding the solutions.
We need leadership at all levels that is brave enough to change the well-beaten and destructive track we are on and create the space where we can collectively develop and implement long-term preventative work which leads to a healthier future for everyone in our communities.
Read more on what we think fair and efficient funding looks like for the third sector in Scotland in our recent response to the Social Justice and Social Security Committee’s recent call for evidence.