Thank you and Good Morning. As was mentioned my name is Councillor Christopher McEleny and I am an Elected Member in Inverclyde Council, one of the 32 Council municipal bodies in Scotland. I will also today discuss the work of the European Committee of the Regions and the Reflecting on Europe Initiative.
It is good to be here as the challenge of an ageing population, the subsequent impact on public services and our collective efforts to ensure the highest standards of integrated health and social care are crucially important to us in Local Government.
For anyone who is yet to discover Inverclyde, we are situated just 25 miles from here on the south bank of the River Clyde encompassing the towns of Gourock, Greenock and Port Glasgow as well as the surrounding villages.
Our location in the mouth of the river made it possible in the 19th and 20th centuries for the rapid development of shipbuilding and marine engineering. We therefore have a legacy of rich cultural heritage, built environment and natural, coastal and marine resource.
In recent years, the Council has sought to counteract decline and build on these resources, with the understanding that health outcomes are directly linked to socio-economic deprivation and poverty.
Transforming our local waterfront area and focussing on urban renewal in housing for example has been part of efforts through economic development to improve public health.
We plan strategically with recognition of the inter-relationship not only between health inequalities and deprivation, but stress, mental health, financial inclusion and employability.
The preventative agenda is also at the centre of our approach, which we advance in our capacity as elected local representatives with duties to community well-being.
Attempts to grow and diversify the local economy however depend on a stable population and it is known that Scotland experiences the challenges of ageing demographics and of rural decline.
Inverclyde is no exception, being one of the 12 Council areas expected to see population decreases despite the recent general growth in Scotland’s total. This downwards trend has been happening in Inverclyde since the 1990s.
We also have locally a larger percentage of persons aged 60 and above (26.3%), higher than the Scottish average (24.2%), making the need for active ageing policies that optimise health, participation and security and enhance quality of life as people age, even greater.
We see that ageing demographics not only present a challenge to the long-term delivery of public services, the workforce and finance but to the very fabric of rural and remote communities.
At the same time, public services, including in health and social care, across Scotland, UK and Europe are facing common, multiple challenges.
For example, national austerity policies and reduction in available budgets gives grounds for real concern and we are yet to see improved rates of investment in the face of increasing demand.
And this with the additional concern of the UK leaving the EU and a possible restriction in EU mobility in turn restricting our own ability to grow our economy, staff our workforce and tackle problems associated with an ageing population.
This local perspective provides the backdrop to which today’s event on Meeting the Challenge of Ageing: Putting Citizens at the Heart of Integrated Care in Europe is so welcome.
Collaboration at EU level and professional efforts to work together to deliver the best standards in care and the most innovative solutions for active and healthy ageing such as those to be discussed today, have never been needed more.
The work to develop a tool for self-assessment and facilitate peer learning, led by NHS24 is a very welcome contribution and should be congratulated.
At EU and international level, Scotland has a high reputation not only for technology, research and innovation but collaboration and exchange.
The innovative and collaborative nature of this work is a concrete demonstration of that. It shows that Scotland is recognised across the EU as having sector leading practice in the use of technology to improve health efficiency.
Reflecting on Europe
Today’s event is also welcome in that it is the first Reflecting on Europe event to be held locally in Scotland.
Reflecting on Europe is an initiative by the European Committee of the Regions to listen to the views of people on the future of the EU.
It is in that capacity that I am speaking today, as one of Scotland’s nominated representatives in the European Committee of the Regions.
The Committee of the Regions is the European body for locally and regionally elected members where we have a formal role to scrutinise and comment on EU policy and legislation to ensure it adheres with to the principle of subsidiarity.
As a body of 350 elected members from across the 28 EU Member States, we work to ensure decisions can be taken as closely to people as possible. Scottish representation is shared jointly by Local Government and the Scottish Parliament.
Given that role to ensure decisions are taken at the level closest to communities, the Committee of the Regions has been asked by European Council President Tusk to contribute to ongoing reflections in the EU on its future, to ensure the views of communities, citizens and service users are captured as part of that process.
The result is Reflecting on Europe, with the idea to create the space for local and regional authorities and for citizens to present their thoughts and ideas about the past, present and future of Europe.
Committee of the Regions members are therefore supporting a series of local listening events to ask people about the most pressing challenges at regional and local level. It is with recognition that many in Europe perceive the EU institutions as not responsive enough to the needs of people and local communities.
But we in the Committee of the Regions are listening. There have already been 90 local events held across 20 European countries, with plans for many more.
As many of you will know, all these discussions come after European Commission President Junker presented MEPs with a new White Paper on the Future of Europe which outlined five scenarios ranging from the status quo to a federal EU.
These scenarios include carrying on as now; stripping back to nothing but the Single Market; providing for those Member States who want to do more; trying to do less, more efficiently; or going further and agreeing to share more powers at EU level.
A “reflection period” in preparation for the UK’s Withdrawal and on the back of the Future of Europe White Paper was launched at the same time.
And that is what Reflecting on Europe is really about – listening to the views of people at local and regional level to feed into future considerations and options for EU integration. What are people’s expectations in respect to the EU, what are the key issues the EU should try address to improve people’s lives and enhance European citizenship.
I strongly underscore that despite the UK leaving the EU, Scotland needs to be part of these discussions. This is because no matter what formal relationship is negotiated, we will still be affected by decisions taken at EU level and also in cross-border matters.
Challenges are in general, but also in health increasingly cross-border. Areas where there are clear benefits for cross-border collaboration, such as procurement, pricing and access to medicines, as well as cost-intensive and highly specialised medical equipment, would be just a small example of what is potentially affected by the UK leaving the EU.
This is while we see across Europe, need to improve equity and health outcomes by guaranteeing equal access to quality healthcare everywhere for everyone. Integrated care is fundamental to achieving this, as are active policies for an ageing population.
While today’s event is about perspectives and approaches in integrated health and social care, to frame our reflection discussions, I will make a few comments about health issues that present themselves to me as a local politician.
The most pressing, is the issue of health inequalities which presents it to me every day. It is widely known in Scotland for example that the wealthiest males can live up to 7 years longer than those living in deprivation. Scotland also has the lowest life expectancy for men and women in the UK and that gap is widening.
While we have robust equalities legislation to protect a number of key characteristics including disability, recent statistics show that progress on tackling all forms of inequality in Scotland has slowed, and is actually increasing in many areas.
A key priority for all Scottish Councils is to close this equality gap, address health inequalities and invest in preventative spending. While are committed to prevention but also give priority focus to early years; early intervention in later years; a multi-agency systems approach; a high-quality workforce; and investment in programmes that work and improve outcomes.
But despite much progress and Scotland being the first in Europe to introduce legislation for integrated health and social care, we still too often prioritise immediate crisis intervention and crisis based services.
Top down policy-making can also come at the expense of Local Government’s ability to be flexible and shift spending and, in health and social care, shift the balance of care. We are still too focussed on input measures, sometimes without a full appreciation of their effectiveness or whether they deliver outcomes for people.
For me in my role as a local elected politician, public health resources in the round are not adequately set up to address the root causes of health inequalities. As I said in my introduction, my Council is working hard to address this but working together we need to shift the focus of resources from crisis management to the consequences of poverty, preventing it and tackling root causes.
While we are moving in the right direction, lifting more people out of poverty and breaking the cycle in many places, there remain some communities that continue to be characterised by poverty despite our best efforts.
There therefore needs to be a more holistic, cross-cutting approach, looking at the wider effects and contributors to poverty, covering health inequalities, employment and employability, learning, and financial inclusion.
We can all recognise that focussing on one factor alone will not improve health outcomes given the interconnections – poor physical or mental health is often a direct consequence of poverty. We see it happening at local level in communities and when we talk with constituents.
In the spirit of integration, we should work further to develop a coherent and unified approach also between the actions of agencies and delivery partners to deliver holistic approaches to tackling poverty and the knock-on negative health consequences.
Too many inflexible and top down targets and indicators, can disempower us as local system leaders and managers to be bold, innovative and to take appropriate risks in how and where we invest in improvement.
National level should support these local considerations around the connections between inequalities, negative outcomes and failure demand, and invest in Local Government as a means to address these.
Fundamentally at EU level, we need to continue best practice exchange, such as is being provided for in the European Innovation Partnership on Active and Healthy Ageing, because improving outcomes and addressing health inequalities, cannot in my view be done as effectively in isolation.
The Innovation Partnership also demonstrates the potential of technology and digital solutions to address increased demand on health services and make care more flexible.
Not only does technology provide a foundation for self-assessment and peer support, but it provides new opportunities for prevention, detection, diagnosis, treatment, information and communication. We need pioneers to maximise fully the use of technology in the health sector.
Active and healthy ageing and empowering older people to remain in control of their own lives as long as possible, is incredibly important to European economy and society.
Many in Europe, face the double compounding problem of people living longer and having less children which results in older individuals making up a proportionally larger share of the total population over time.
For Scottish Local Government, this challenge means greater financial pressure on social care. As people live longer, the most common need for service use is not for acute care, but rather for care related to long term conditions such as dementia.
But it also creates increased budgetary and operational pressures on other service areas such as housing and planning who must take into account the housing needs of elderly people and have a role in relation to modification or adaptation of accommodation.
We also working to prepare for an ageing workforce, plan for large numbers of people to retire over the next few years, and ensure that we can attract sufficient young, skilled professionals. All while working to provide the best terms and conditions possible for the workforce.
Supporting people and communities to ensure that they have capacity, knowledge and skills to be resilient and take control of their own and their families circumstances and outcomes is a key component of a more equal and more sustainable Scotland.
With disabled and elderly people making up a large number of the people who use the services councils provide, they have a significant role as planning partners in designing support services and this, in our view, should be facilitated through co-production.
Preventative solutions that focus on prevention and care rather than hospitalisation, provide much better support for ageing people especially those in remote areas and it is in the long-term much more efficient than institutionalised healthcare in hospitals or elderly care home.
Improving outcomes in the earliest years of life, in recognition of the effect this has on negative social outcomes in later life is also key.
This requires action across the whole population, from infants to older people, and requires us to look at reducing inequalities which are inextricably linked with poor economic, health and social outcomes.
We are already seeing locally the positive impact of preventative spending and earlier intervention on reducing demand for acute services and tackling health inequalities, both in preventative care and earlier intervention for older people.
But reductions to core budgets with little recognition of the interrelationship between all that Local Authorities do to reduce inequalities, build community capacity, resilience and assets and decrease demand for services in other parts of the system such as health and social care, is making the challenge more acute.
It also has an impact on Local Government’s ability to invest in the voluntary and community sectors.
It is for example unfortunate that so often Councils are forced to cut back on their sport and leisure provision precisely because of the financial pressures they are faced with. There is a clear physical and mental health benefits to sport and re-investing in sport and leisure is important.
For us in Scottish Local Government, more needs to be done to protect and improve mental health for all ages through investing in building individual and community resilience.
Integrated Health and Social Care
Social care is to support independent living which is preventative on its own merit. But to maximise efficiencies and ensure locally appropriate solutions are implemented, more needs to be done to devolve resource and decision-making closer to communities.
This will support flexibility and innovation, otherwise we risk creating a system which prioritises statutory duties and crisis intervention at the expense of preventative interventions and services.
We should give further consideration to the role of community development as the foundation of personal and community resilience which will improve outcomes and reduce demand throughout the healthcare journey.
This is crucial for the long-term sustainability of health and social care services and will require political leadership at both the national and local level to work with and empower communities.
With the UK’s decision to leave the EU, we have even greater concern about demographics and the potential impact on Local Government’s ability to counteract a growing ageing population. EU migration is of course a key part of attempts to grow Scotland’s population.
There are already clearly identified impacts of Brexit for the labour market and local economies, but also for service areas particularly teaching, social work and the health sector.
Free movement of people and the mutual recognition of qualifications allows skilled and experienced health professionals from the EU to work in our NHS. Our health and public services depend on EU workers.
Without them, our ability to continue to provide high-quality health and social care services for the people of Scotland will suffer, particularly in remote and rural communities.
The effects of Brexit are also showing impact on integration policies and community cohesion, a real concern for local leaders with responsibility for wellbeing.
Cross-border care, mobility of patients, workers, and retirement issues are just a selection of issues in the health field that will need to be guaranteed post withdrawal.
Full service integration needs us to look at service provision holistically.
If a more healthy and equal society is also our collective aim, all policy proposals and initiatives should be challenged as to the extent they address and target resources towards tackling inequality.
Evidence shows that there is a strong link between low skills, poor education, poor health, unemployment and poverty. More attention needs to be given to the prevention of poverty and tackling root causes.
Ultimately, investment in local government will reduce demand for health and social care provision.
If Local Government was to receive additional resource we could go further, do more and consider investing further in tackling inequalities, community resilience, mental health and testing and financing new models of social care.
Local Authorities are the sphere of democracy closest to communities. Local Councillors live and work in those communities, also relying on local social care services to help care for parents, grandparents and dependent relatives.
We know best our local communities and strive to work with them to produce the best possible outcomes in public health. We are committed to partnership working for the benefits of communities, and in the spirit of integration I encourage you to involve your local politicians to be health champions and communicate directly with people and service providers.
I would like to thank you for your attention and close with a request for you to complete the Committee of the Region’s online survey on Reflecting on Europe, for which my assistant can provide the weblink.
I will also be here this morning and look forward to hearing your views on the Future of Europe and the future of integrated health and social care.