Creating the Conditions for Change

Let’s Repower Scotland’s Health and Wellbeing

Sections in this page

This is a time of exciting change in how our health and social care services in Scotland are shaped and delivered – a decisive shift to prevention, people empowered to self manage and an ever more integrated service. All this will repower Scotland’s health and wellbeing. Professionals and service providers will have to change the way that they design and provide care and support. People who use services are already experiencing improvement, particularly those engaged in self management or in self-directed support.

Relationships between the people who use support and services and those who provide them must be built on mutual respect and empowerment. This requires support to enable people to build their confidence and capacity to take more control over their lives and wellbeing.

This resource describes steps you can take to create the right conditions to support and enable this change.

Get ready for change

Stopping and starting lots of initiatives can be a barrier to change. It takes time to build confidence and capability in new ways of working, to embrace new relationships and build momentum for sustainable change. Policy makers and commissioners should allow realistic timescales for changes in culture and practice. There should be consistent messages for extended periods as small changes in the language and presentation of new concepts can cause confusion and delay their adoption.

When we build links between initiatives and see the bigger picture it makes more sense. Keeping that in mind is key. All these changes may seem too much, but their impact as a whole will be to improve Scotland’s health and wellbeing.

Joanne McPeake, Project Lead, InS:PIRE Programme, Glasgow Royal Infirmary, NHS Greater Glasgow and Clyde

“I think the third sector has the potential, especially in the socio-economically deprived areas to have a huge influence on health and wellbeing, but it’s not quite there yet… I think there is a skill issue with some people, a funding issue and a management issue.”

Brenda Friel, Health Improvement Lead, Inverclyde

“I think working for an NHS organisation there are a lot of barriers such as health and safety, risk assessment, lone working policies that might make it a bit more challenging to work in a true asset-based [way], working right down to a grass roots level.”

Create time and space for shared learning

Education and training alone will not lead to changes in practice. Also staff can feel overwhelmed if they are subject to multiple priorities and they suspect that there will be a new buzz word along soon. So it is important that there are clear messages about what needs to be different and why, why different ways of working may be more beneficial and how existing skills and experience can be built upon.

Offering practitioners a safe space to learn and to share their learning with peers can help them join the dots and embed improvements within everyday practice.

Gavin Paterson, Development Officer (Self Management), the ALLIANCE on a workshop with Aberdeenshire Health and Social Care Partnership

“Understandably, the idea of taking off the professional hat can make health and social care professionals uneasy, but it is important in correcting the power imbalance between patient and professional.”

Senior leaders can enable change

People working at the point of care need freedom to try new approaches, acknowledging that some of these may fail. This needs permission and authorisation at the highest level, otherwise innovation and improvement will become stifled by risk averse practitioners and managers.

Ross Grieve and Linsay Graham, Making it Personal facilitators, Thistle Foundation and Personal Outcomes Partnership

“I’d say the most successful projects we’ve been involved with are the ones where the managers of teams and services have been up for this from the start and have put in place space, time and permission for practitioners to do things differently.”

Participant in ‘Community Connectedness; Assets Powering Practice for Health and Wellbeing’ at the Gathering, Feb 2015

“This needs a massive mind shift from service delivery and quality assurance concerns to accept people powered solutions.”

Understand the local resources that keep people well

There is still uncertainty around how health and social care integration will work in practice and what will it mean for people’s lives and for their existing support and services. Understanding this context and the different cultures of the organisations is an important first step when introducing new approaches.

Andy Crawford, Head of Clinical Governance, NHS Greater Glasgow and Clyde

“People are establishing their roles, their identities, power bases and the collaborative environment we describe in co-production suffers as a result… on a more positive note I think there are examples I have of working with people in social care and people in the third sector where some of the way they work, their values illuminate possibilities and opportunities for us in health.”


Involve key influencers

It is important to identify, involve and support the key champions and influencers – including people who use services and unpaid carers– who will lead the change locally.

Understand who can take the work forward effectively and is likely to make the biggest difference.

Keeping it Personal (KiP) final evaluation report.

“Some of the challenges faced by the KIP heart failure group highlight key issues around group membership and influence. Failure to recruit a GP to the group was problematic given that they were key in helping to action and deliver the improvements the group wanted to make. Whereas, the carers in the KiP dementia group led with creating and delivering the dementia and carers cafés themselves.”

Spread success quickly

When there is enough evidence of what works, make sure there is rapid spread of that success to other areas. Often new projects run for too long and are evaluated too late for the learning to be useful.

Don’t start from scratch – spread, scale up, build on previous success and adapt the approach quickly before momentum or funding are lost.

Eddie Fraser, Director of Health and Social Care, East Ayrshire Health and Social Care Partnership

“We continue to evaluate forever and there is no spread. This is locally as well as nationally- there is very rarely spread. So there are pockets of excellence then…. eventually the money runs out for it because it’s not recurring and there are real risks there.”




Sources of inspiration:


People Powered Health and Wellbeing ‘Shifting the Balance of Power’. An ALLIANCE programme co-produced by members and stakeholders.

Health and Social Care Alliance Scotland
349 Bath Street
Glasgow G2 4AA
Tel 0141 404 0231

Twitter logo@alliancescot Registered in Scotland
No. 307731 Charity number SC037475

The ALLIANCE is supported by a grant from the Scottish Government