Welcome to my Blog

I was the Head of Policy and Public Affairs at UNISON Scotland until my retirement in September 2018. I now work on several policy development projects, so all views are very definitely my own. You can also follow me on Twitter. I hope you find this blog interesting and I would welcome your comments.

Wednesday, 20 March 2019

Big challenges require radical action

It’s time to get radical if we are to address the vast challenges facing Scotland and the rest of the UK. 

Let’s start by understanding the scale of the problems facing us. In my New Year blog, I suggested four new ‘giants’:

  • Inequality. One million people in Scotland live in poverty, including 230,000 children and 140,000 pensioners. Poverty is not just a condition, it is a matter of life and death. Healthy life expectancy can vary by as much as 20 years between the most and least deprived areas of our country. 
  • Climate change. The latest UN report says we have twelve years to simply limit a climate change catastrophe, by keeping the increase in global warming below 1.5C. Our health, the economy, our diverse fauna and flora, as well as wildlife, are all at risk.
  • Disempowerment. The UK is over-centralised and too many powers stop at Holyrood while others are taken from local government. Economic power continues to be grabbed by big corporations, mostly unchecked by regulation or industrial democracy.
  • Broken society. Too much emphasis is placed on economic performance and too little on the impact on human beings and the communities of place and interest they live in. Automation at work is used to exploit the workforce rather than liberate them. Isolation, intolerance and our consumer culture are contributing to a broken society, where we patch and mend the mental health consequences, rather than tackle the root causes. 

I have been working on the Scottish Labour Party’s policy development process for the 2021 manifesto. The first stage consultation paper highlights a large number of challenges and invites members and stakeholders to suggest ideas that will develop Labour’s vision of real change.

I would argue that while Scotland has adopted some progressive policies, certainly compared with the UK government, they have all too often focused on process rather than radical action. This is the ‘safe' middle ground that the US Congresswoman Alexandria Ocasio-Cortez recently challenged. She said:

“Moderate is not a stance. It’s just an attitude towards life of, like, ‘meh.’ We’ve become so cynical, that we view … cynicism as an intellectually superior attitude, and we view ambition as youthful naivety when ... the greatest things we have ever accomplished as a society have been ambitious acts of vision. The ‘meh’ is worshipped now. For what?”

There is nothing ‘moderate' about the vast inequalities in Scotland, homeless people on our streets, the growing mental health crisis, climate change or the uncontrolled power of global corporations. The establishment tells us to be pragmatic and stick to incrementalism - when what is needed is systemic change.

Let’s take just three very recent examples of proposals for radical change.

It has taken today’s children to demand that my generation takes climate change seriously. As Phil McDuff argues, climate change is the result of our economic and industrial system – we need to re-evaluate our relationship to ownership, work and capital fundamentally. 
I wouldn’t normally regard the Scottish Land Commission as a body ready to consider radical solutions. However, today’s report says that most of the disadvantages of Scotland's current pattern of land ownership are related to a concentration of decision-making power. It noted that in some parts, that hampered economic development and caused serious and long-term harm to communities and there was an "urgent need" for mechanisms to protect fragile communities from the "irresponsible exercise of power".
Progressive think tanks like the New Economics Foundation have long argued that we need a new approach to local economies that challenge the economic orthodoxy of inward investment. Last week they built on their long-term criticism of personal allowances with a proposal that replaces those allowances with a weekly national allowance.
Radical change isn't easy for political parties. The two biggest Scottish spending budgets that could be shifted by preventative spending are acute hospitals and prisons. However, a minority of voters understand the case for moving resources and are much more likely to be concerned about ward closures and reductions in the use of custodial sentences.
The typically dismal mainstream media reaction to Richard Leonard’s conference speech on free bus travel reflects the establishment’s need to stamp on radical change. The problem they face is that policies like this are actually growing in popularity. Radical progressives are having an impact far higher than their ‘incrementalist’ peers. Just look at the way Alexandria Ocasio-Cortez’s Green New Deal has started a meaningful discussion about climate change in the USA.

So, radical change isn’t easy, but the challenges that face us deserve radical solutions. And more and more people, of all ages, are recognising that reality.

Thursday, 7 March 2019

London showing the way on fossil fuel divestment

Pension funds need to consider the long-term impacts of their investment decisions. That is particularly obvious when it comes to fossil fuel companies. The evidence is unequivocal that companies cannot burn all their reserves if the world is to avoid catastrophic climate change.

That analysis doesn’t come from a Friends of the Earth or Greenpeace briefing – it is the view of Mark Carney, the governor of the Bank of England. Others have made the moral case, he highlights the financial risks of investments in companies who could find their assets ‘stranded’ as the world acts to tackle climate change.

Last night, I was speaking at a seminar chaired by the Deputy Mayor of London, in an impressive venue, the Living Room at City Hall. I was outlining a trade union perspective on divesting fossil fuel investments from my experience in local government pension funds.

View from The Living Room in City Hall

Some London funds have already taken this decision, and others are quietly moving away from these investments. The seminar heard from Southwark Council who are one of several in London who have clear policies. Leadership from Mayor and GLA is crucial. The Sainsbury Foundation also spoke at the seminar, highlighting their helpful guide to divesting and reinvesting.

It is a sign of progress that the case for divestment as set out by Platform London, is broadly accepted. The discussion in the panel session and workgroups was around the practicalities.

I outlined the importance of action on climate change and the role of the public sector in leading by example. I described the public sector duties in the Climate Change (Scotland) Act 2009 to reduce emissions, introduce adaption measures and work sustainably. This legislation had significant cross-party support in Scotland and is currently being updated in a Bill being considered by the Scottish Parliament.

While the ambition in Scotland to tackle climate change is undeniable, action on fossil fuel divestment in Scotland has been slow. This is despite national and local campaigns and even resolutions passed by councils who are the administering authorities for pension funds. Presentations have been made to Pension Boards, and a parliamentary inquiry by the Local Government Committee highlighted the issue.

There are some barriers to action by pension funds. Officials tend to adopt a conservative approach to change and dislike what they perceive to be political considerations. Too many funds are small and don't have the expertise to consider this issue thoroughly. This is one of the reasons why Scotland is looking at a structural review, which would enable funds to develop a team with the necessary expertise. 

Fiduciary duty is often wheeled out as a last-ditch defence, and it was raised by several speakers last night. I wrote a briefing on this issue for UNISON in 2015, which explains why this shouldn’t be an issue. It cites Scottish and English Law Commission reports and an opinion from Nigel Griffiths QC. In essence, pension funds are entitled to take environmental and social issues into account so long as they do not risk material financial detriment to the fund. 

Also, pension funds are not exempt from the public law duties that apply to the administering authorities. All investments involve a degree of risk, so fiduciary duty doesn't mean taking no risks. Ethical investment is rarely any riskier than other investments, and legal challenges are rare so long as funds follow a proper process.  

UNISON has also produced a useful guide on how to divest from fossil fuels. That starts with gathering information on investments before influencing the fund's investment strategy. It is import to emphasise that the policy should not only decarbonise but also adopt positive investments in the low carbon economy. 

The discussion last night also highlighted concerns over shareholder engagement strategies and the ‘Green Wash’ produced by some companies and investment advisors. We need more genuinely fossil free funds to invest in, not vague commitments like ‘low carbon’.

The campaign to divest from these risky and unnecessary investments is making steady progress across the country. The practical experience of funds is helping that development as are the growing number of national and local campaigns. London is showing great political leadership on this issue.

Monday, 25 February 2019

The Economics of Arrival

Every month economists and commentators pour over the Gross Domestic Product (GDP) figures, and at budget times we worry about the projections published by the Fiscal Commission and the Office of Budget Responsibility. Including those great fan charts that show the wide range of forecasts that are supposed to measure economic growth.

Since the 1930s GDP has become the primary target for government and international comparison. This has led to an era of mass consumerism and an expectation of endless GDP growth. Despite what we know about the environmental impact of growth on our finely balanced planet, the solution to all our economic and social ills is apparently even more growth.

A new book by Katherine Trebeck and Jeremy Williams, ‘The Economics of Arrival’, invites us to consider a future where economic progress might not mean endless growth. In Scotland, we know Katherine best from her work at Oxfam on the Scottish economy and the Humankind Index. This book is a natural expansion of that thinking.

Before anyone dismisses this as anti-growth, the authors acknowledge the benefits that economic growth has delivered. In the decade to 2012, all countries accelerated their achievement in the Human Development Index. There have been dramatic reductions in child mortality and levels of poverty, common diseases are being controlled, and more children are attending school with a consequential increase in adult literacy. We live in an extraordinary age, and much has been achieved. 

However, you just knew there was going to be a ‘but’! Growth on its own does not automatically help people to move out of poverty. Growth only translates into real progress when resources are shared, including on collective institutions and socially constructive purposes such as health and education. 

For example, Egypt under Mubarak regularly posted growth rates of 6-7%, but 90% of the population never benefited. The United Nations Development Programme identifies different forms of negative growth. These include ‘jobless growth' that does not create employment, ‘ruthless growth' in which the rich get richer, and the poor get poorer, and ‘futureless growth' that comes at the expense of the environment.

Much of this book aims to explain how the fruits of growth are coming to an end. As we prioritise growth over security for all we are seeing an increase in the diseases of affluence, environmental degradation, and even stalling life expectancy, as the recent ScotPHO report shows. If we are in a global growth race, when do we reach the finishing line?

The authors persuasively argue that improvement in people's quality of life is not on an endless upward curve as social progress is decoupled from GDP growth. Alternative indexes show that social progress slows when countries reach middle-income status. This can drive demands for spending that equates to ‘failure demand', not dissimilar to the approach described in systems thinking.

They ask us to embrace the concept of ‘Arrival’ and making ourselves at home. Countries need to become better at focusing on the quality of the economy instead of its size - pursuing further growth risks undoing the achievements already realised. This is not a new concept. Even Adam Smith back in 1776 imagined a country that had “a full complement of riches”. 

This book does not offer a new system of post-growth economics that we can switch over to. It recognises that moving to these alternatives will be an evolutionary process. There is no grand top-down vision – it is something that people and communities need to discover together.

Making ourselves at home means sharing wealth more widely, rather than permitting a few to pathologically hoard it. Getting things right the first time and so avoiding the harm and costs that come with a blinkered focus on more. Surveys tell us that we are at our happiest when socialising and engaging in meaningful activity, not when consuming.

This does require a profound cultural shift as well as an economic and political one. Practical measures might include shifting taxation from income to luxury goods, wealth, land and unearned income. Shared and better work, ending the economic reliance on unpaid work, mostly done by women. This is also where the ‘foundational economy’ can contribute, developing a circular economy, co-operatives and new business practices. All of this has to be underpinned by a vibrant and responsive democracy.

There are some examples in the book where these principles are present. Some South American countries and, perhaps surprisingly, Japan. GDP growth in Japan stopped growing in the mid-nineties, but they score highly on almost every other measure, even though they are reluctant to accept they have arrived and challenge their work-based society. Costa Rica overperforms on alternative indexes, delivering longer life expectancy and higher wellbeing than the US, but with just one-third of the ecological footprint.

Of course, there will be massive resistance to change from those who perceive that they benefit from the current system. The authors distil Meadows ‘4 Tasks' approach:

  • ·     Highlight the failures of the current system. 
  • ·     Paint a compelling picture of what a new economic model might look like. 
  • ·     Work with people who have power in the current system, or who could gain it. 
  • ·     Support people who are seeking and delivering change themselves, and those who are open minded, leaving those who are unlikely to change where they are.

A key ingredient of change is the development of alternative measurements to GDP. There has been some work on this in Scotland and elsewhere, including the Oxfam Humankind Index for Scotland. These show that there are better ways of measuring genuine progress than a simple increase in economic activity.

No single project will change the system, but many small steps over time will. This book suggests steps for international institutions and governments. Steps for business, cities and local communities. And steps for individuals. There is no avoiding action!

In conclusion, as the authors say, the last few decades of growth have brought immense benefits, but those gains have been unevenly shared and are at risk of slipping away as the environment and society come under increasing pressure. We need to reimagine progress beyond more of the same. This book is a great starting point.

Friday, 8 February 2019

Austerity is killing us

Two reports published today show that the increase in life expectancy in Scotland has now stalled and that health inequalities have worsened.

One report compares life expectancy trends in Scotland to those seen internationally. The other report explores the relationship between stalling mortality improvements and socioeconomic inequalities.

The international comparative report shows that 2012-2016 life expectancies in Scotland increased by 2.5 weeks/year for females and 4.5 weeks/year for males, the smallest gains of any period since the early 1970s. The best estimate of when mortality rates changed to a slower rate of improvement in Scotland was the year to 2012 for males and the year to 2014 for females.  Among the UK countries Scotland has the lowest life expectancy, with a life expectancy 2 years lower for women, and 2.5 years lower for men than in England.

Of the 24 high-income countries for which data was available, nearly all had smaller life expectancy gains in 2012-2016 than in the immediately preceding period. Denmark is notable for having maintained mean life expectancy gains of around 10 weeks/year among females across the period 1997-2016, and even greater gains among males.

The second report concludes that as mortality improvements in Scotland stalled in 2012-2017, socioeconomic gradients in mortality became steeper. With increased mortality rates over this period in the most socioeconomically deprived fifth of the population.
This table shows what we already know and what additional information this reports gives us.

Dr Gerry McCartney, Head of the Public Health Observatory at NHS Health Scotland, said:

“What we see here is a worrying trend. Life expectancy not only gives an indication of how long people are likely to live, but also serves as a ‘warning light’ for the public’s health. In addition, the fact that socioeconomic position now plays a bigger role in how long you live than it did before is cause for concern.”

The question is why these figures are going in the wrong direction, bucking a long standing trend since the Second World War. Gerry suggests that austerity is the strongest factor:

 “There are likely to be a number of factors at play. The strongest candidates are recent policies that address recent economic setbacks which have reduced spending on benefits, squeezed incomes and trapped people in poverty – these may all have contributed. Cuts to council budgets and pressures on key local services, such as social care, could also have had an impact. There have been some severe flu outbreaks in recent years which will have increased demands on services too.”

He suggests three key actions:

• Protecting budgets that determine our health, like social care, housing, benefits etc. And ensuring they are provided according to need.
• Reducing poverty for all groups and protecting the most vulnerable.
• Maximise the take up of the flu vaccine.

While pension funds may regard these figures as having something of a silver lining, they are bad news for almost everyone else. Governments and policy makers should be taking particular notice, and develop appropriate responses. Austerity isn’t just damaging the economy, it is literally killing us.

Monday, 28 January 2019

The Common Good

Austerity has undermined many of the local institutions that bind our communities together. Cuts to our libraries, community learning, youth work, day centres and grants to voluntary organisations have all contributed to a sense of isolation.

While action on individual social isolation is essential, we also need to think about the role of social infrastructure. This relates to the physical conditions that determine whether personal relationships can flourish. When social infrastructure is robust, it fosters contact, mutual support, and collaboration among friends and neighbours. When degraded, it inhibits social activity, leaving families and individuals to fend for themselves.

I was brought back to this concept by reading Eric Klinenberg’s book ‘Palaces for the People: How to Build a More Equal and United Society’. He looked at two districts in Chicago after the 1995 heatwave. They had similar socio-economic characteristics, but one district had a much higher death rate. The difference wasn't cultural or about how much people cared about each other – it was that poor social infrastructure discouraged interaction and impeded mutual support.

Libraries are the best example of Klinenberg’s ‘Palaces for the People’. They are accessible and organised by professional staff that uphold a principled commitment to openness and inclusivity. A cafĂ© might be, but it depends on the degree of openness, cost etc. Similarly, an early years centre where parents meet up at the same time is social infrastructure, but not a childcare centre in a commercial area where parents pop in and out to match their working hours.

Some might argue that this is less important in the internet age. Klinenberg argues that communication technologies work best when they direct us to physical spaces that everyone can access. Ironically, the sort of areas that the tech giants create in their own workplaces. The excesses of internet culture and the ‘echo chamber' patterns of use, add to the problem. It feeds what social scientists call ‘bonding social capital’, but starves us of the ‘bridging social capital’ we need to live together.

Mark Zuckerberg’s vision of Facebook as social infrastructure is flimsy because it cannot give us what we get from churches, unions, sports clubs and the welfare state. The primary aim is to keep us glued to the screens.

Safe, green spaces are another essential part of social infrastructure. This includes parks and gardens, but also in the design of housing developments. Studies show that the greener the immediate surroundings of a building, the lower the rate of crime. Although this only works when they are well maintained and so used by residents, creating passive surveillance and feelings of greater ownership and control.

Social infrastructure is also essential for health – the more physical environmental deprivation, the worse the community’s health. For example, with the opioid crisis in the US and rising levels of poor mental health in the UK, we overlook the importance of social cohesion and social support. A 2017 Harvard study, by Michael Zoorob, shows that communities with strong social capital were more likely to be insulated from the opioid crisis. Other studies point to the value of community gardens or allotments to us. Chicago has spent $2.5m on its inspirational 21,000 square-foot City Hall roof garden. In Singapore, the open spaces associated with housing projects are used for exercise, meetings, affordable dining and markets.

Public sports and leisure facilities have been squeezed due to austerity cuts. In Iceland, they have free swimming pools or ‘hot pots’ that are used by people from all walks of life – one per 2,750 residents. Mind you, the rule that everyone must strip naked and wash off in a public area before entering the tubs, might be a reform too far for Scotland! 

Organised sports can build similar social interaction. In the UK, 80% of people who play organised sport have friends in the organisation, a much higher rate than for other organisations. Along with people who regularly attend church, they are more likely to volunteer in other civic projects.

In Scotland, we have a historical manifestation of social infrastructure in our local Common Good funds. A 2014 Scottish Government report identified more than £300m in these funds covering moveable and heritable property. These were often donated by landowners when they sold development land for towns. Several modern day tech entrepreneurs invest some of their gains into good projects, as did old ‘robber barons' like Andrew Carnegie. However, none of this is at the scale necessary to create the social infrastructure we need.  

Another feature of our crumbling social infrastructure is the decline of the high street in most of our towns. If you listen to some voices, all that is required is a cut in business rates. What we actually need is to rebuild them as social infrastructure. Doncaster is one town that is fighting back, with the opening of a new cultural and learning centre, and retail shops that offer something different. Others talk about replacing the acquisition of goods and services on the high street with local experiences. 

Community Hubs that bring together public services are another idea that could contribute to the revitalisation of our high streets. I discuss this in more detail in my Jimmy Reid Foundation paper on public service reform. 

George Monbiot highlights projects in Barking and Dagenham, including ‘maker spaces’ equipped with laser cutters and other technology. Places where people meet, discuss ideas and start projects. Turning old warehouses and churches into community facilities where people can start collaborative businesses and welcome new arrivals to the area. As George says, “Perhaps it’s not the whole answer to our many troubles. But it looks to me like a bright light in a darkening world.” 

Since the 1980s, anti-tax ideology has whittled down the public funds we need to build and maintain critical infrastructures - austerity has been the last straw. As we replace crumbling physical infrastructure, we should also consider how it might contribute towards strengthening our social infrastructure. A modern version of the Common Good.

Thursday, 3 January 2019

2019 - the big challenges ahead

Happy New Year! Traditionally a time to think ahead and a good time to consider the big challenges facing Scotland and the wider world.

At present, Brexit dominates the policy discourse and, within Scotland at least, the constitutional implications for devolution or another independence referendum. Important though these issues may be, they are, in military parlance, grand tactical issues. We also need to think about the strategic challenges facing Scotland over the next ten to twenty years.

I was reading Nicholas Timmins biography of the welfare state; ‘The Five Giants’, which captures the mood of the post-war period and Beveridge’s five giant evils – Want, Disease, Ignorance, Squalor and Idleness. You can easily make the case that these evils still abound in Scotland and the rest of the UK. However, it got me thinking about what those ‘giants’ might be today.

For me, there is one overwhelming evil – inequality. One million people in Scotland live in poverty, including 230,000 children and 140,000 pensioners. If you are disabled or a member of a minority ethnic group, you are significantly more likely to be in poverty. Poverty is not just a condition, it is a matter of life and death. Healthy life expectancy can vary by as much as 28 years between the most and least deprived areas of our country. 

Almost all political parties accept that poverty is a bad thing. The difference is when you discuss not just poverty, but inequality. Scotland’s richest 1% have more wealth than the bottom 50% put together. As Rebecca McQuillan points out in today’s Scotsman, it’s the same worldwide. We have an economic system that is designed to make the wealthy few richer, at the expense of the many. 

The Tories argue that you can address poverty without worrying about inequality. I have noticed a concerted right-wing effort to challenge the seminal work on this issue, ‘The Spirit Level’, which explains why more equal societies do better on almost every measure. Despite all the evidence, trickle-down economics is still championed by some. 

At the recent Living Wage awards, an SNP minister quoted The Spirit Level favourably, so this should point to a consensus on the direction of travel. The problem is that the SNP government has been unwilling the take the necessary radical action.  There has been plenty of processes, but policy measures have generally been timid. Being better than England is not enough.

My second modern giant would be climate change. The latest UN report says we have twelve years to simply limit a climate change catastrophe, by keeping the increase in global warming below 1.5C. As today’s Scottish Environment Link report shows, our diverse fauna and flora, as well as wildlife, are also at risk, with consequences for food and pollination. As with other challenges the international response has been too timid and Scotland could do more - including the Climate Change Bill currently going through Parliament.

My third modern giant would be disempowerment. The UK is over-centralised and London sucks in too much power and resource. While devolution has been an important step forward, too many powers stop at Holyrood and others are taken from local government. Economic power continues to be grabbed by big corporations, largely unchecked by regulation or industrial democracy. Devolving power must be accompanied by new forms of deliberative democracy, which give citizens a real say in how our society is run. Strengthening collective bargaining could have a similar impact in the workplace.

My fourth modern giant would be a broken society. Too much emphasis is placed on economic performance and too little on the impact on human beings and the communities of place and interest they live in. Much has been written about the economic impact of an ageing population, without considering the opportunities. Automation at work is used to exploit the workforce rather than liberate them. Isolation, intolerance and our consumer culture are contributing to a broken society, where we patch and mend the mental health consequences, rather than tackle the root causes. We need to focus on creating a good society.

The policy challenge with these modern evils is that governments tend to work in departmental silos. I know from my own work experience how difficult it is to agree, let alone deliver, solutions that cut across departmental boundaries. For example, health inequality has little to do with a health department that is focused on managing the NHS. It requires cross-cutting action on housing, social security, employment and the environment. Even the four modern giants I have suggested above, cut across each other in so many ways. 

Chasing solutions without fully understanding the causes of the problems that face our society is a process doomed to failure. So, in 2019, let’s try and raise our vision beyond the immediate challenges and look at the long-term measures needed to create a more equal Scotland and work with others for a better world.

Wednesday, 21 November 2018

Health and care integration report card - could do better

Audit Scotland tries hard to use building language in their reports, but it was obviously a real challenge when it comes to health and care integration.

Audit Scotland has recently published their assessment of the progress with health and care integration in Scotland. Helpfully, as I was preparing a presentation for an English conference on how we tackle this issue in Scotland. You could be forgiven for missing this report as it came out on the day of the Brexit resignations.

As usual they introduce the report with a helpful infographic which captures the key challenges. Integration Authorities (IAs) manage a huge proportion of the Scottish budget (£9bn) and are supposed to achieve £222.5m of savings - an increase of 8.4%.

The positives are that IAs have started to introduce more collaborative ways of working and there are a number of case studies in the report that highlight best practice. This shows that the system can work, however, yes you knew there would be a but, “there is much more to be done”. 

The building language then starts to break down.

They main problem is that financial planning “is not integrated, long term or focused on providing the best outcomes for people who need support”. This is caused by the financial pressures on health boards and councils, compounded by health boards not including their acute services to the process of budget shift. Long term planning is difficult when budgets are set annually, with little medium term, let alone long term, strategic planning. However, an overall underspend by IAs of nearly £40m, does not inspire confidence either.

This doesn’t mean that there is no resource shift because the ISD cost data published yesterday shows a loss of 429 hospital beds. This data also shows that community services are getting more resources, with only a 0.1% increase in hospital spending as against 4.8% in the community sector. GPs have pointed to the fall in the amount devoted to GP services, but this may be related to service redesign. Either way, while there has been some shift from acute to community, progress is slow because of the overall financial position. 

The report also highlights a lack of collaborative leadership and strategic capacity, not helped by a high turnover in IA leadership teams and squabbles over governance arrangements. Cultural differences between partner organisations is another barrier to achieving collaborative working along with the necessary skills to work in partnership. This was predicted, and has been a problem all over the world (see Petch et al) with care integration.

Another lesson from the international evidence is that change cannot happen without meaningful engagement with staff, communities and politicians. Something the report says has not yet been achieved in Scotland. Honesty about the scale of change needed is indeed challenging, particularly when it can involve closing hospital services. Lengthy and technical IJB papers have not helped to engage members on these boards.

Workforce planning is crucial to the success of care integration. While the National Workforce Plans have now been published, they are still largely at the process stage, particularly in social care. There needs to be a better understanding of future demand, how this is likely to be met and what it will cost. Needless to say, Brexit looms large over this issue. Attempts by some IA leadership teams to promote the privatisation of services has not helped to build confidence. As UNISON surveys have shown, the procurement rules are not being followed properly. If they were, the two-tier workforce provisions (s52) would end this nonsense.

Data sharing and incompatible IT systems are another problem. There are too many local fixes rather than considering a single national solution. Interestingly, the report points to bringing staff together under one roof, rather than solely relying on IT. This is something that the Quality Care Commission recommended in 2015.

Many of the challenges facing care integration in Scotland can be fixed as local best practice shows. There are some national actions that can help, but there is nothing in this report that wasn’t predicted or points to unresolvable structural failure. The underlying problem is austerity - making big service change is doubly difficult when the budget simply isn’t keeping up with increased demand.