Rural communities continue to face barriers that limit access to essential services, including healthcare, childcare, specialist support, legal advice and public transport, according to a new report from Holyrood’s Equalities, Human Rights and Civil Justice Committee.
A shortage of affordable housing and adequate infrastructure, combined with a higher than average cost of living, were also found to pose significant challenges to the sustainability of rural communities.
The Committee’s report calls for targeted action to be taken to ensure that these communities are able to fully access their rights. The Committee want to see the Scottish Government recognise the distinct needs of different rural areas, consider rural populations throughout all stages of policymaking, and factor the findings of the report into a future Scottish Human Rights Bill.
While the Scottish Government acknowledged the issues raised during the Committee’s inquiry and highlighted the work it is doing, the Committee’s report says that this has yet to translate into sufficient improvements in the lives of people living in rural areas.
The report backs calls for the Government to carry out multi-year engagement with, and investment in, community-led organisations. The potential of these organisations, who are often best placed to understand local need and design effective solutions, appears to the Committee not to be currently being used to its full potential.
The report also highlights concerns over rural housing shortages. The shortage undermines workforce recruitment, drives depopulation and restricts the ability of young people to remain in their communities. It calls on the Government to provide an update on what it is doing to improve the situation.
The Committee also heard about barriers to health that were created by distance and travel costs. In its report it calls for urgent action to be taken to address the centralisation of essential health services, such as those relating to maternity in regions such as the Highlands.
Karen Adam MSP, Convener of the Equalities, Human Rights and Civil Justice Committee, said:“Rural communities deserve equitable access to services, opportunities and rights and often face greater financial challenges than urban areas of Scotland.
“During this inquiry rural people clearly told us that they cannot access essential services, including healthcare, childcare, specialist support, legal advice and public transport.
“We want to see the Scottish Government build on its work to date by undertaking targeted action to deliver better access to services and combat the rural premium.”
Holyrood’s Finance and Public Administration Committee has called for early fiscal action from the Scottish Government, and the next administration following May’s election.
In its budget report published yesterday, the committee wants an urgent review of social security spending and reform of local government taxation.
The committee has also made immediate recommendations to address pressure on local government finance and improve budget transparency – including clarity on baseline figures and ‘new’ money.
Finance and Public Administration Committee convener Kenneth Gibson said: “This is our final budget report ahead of the Scottish election.
“Some recommendations are directed towards the government for immediate action others will be for the next administration to take forward after May.
“Frustratingly, some cross-party concerns set out in this report have been raised before with the government during this five-year session of Parliament – including issues of financial transparency, which have only been partly addressed.”
The Health Social Care and Sport Committee is recommending Parliament agrees to the general principles of the Non-surgical Procedures and Functions of Medical Reviewers (Scotland) Bill.
The Bill seeks to regulate non-surgical procedures including cosmetic treatments such as fillers, Botox, certain chemical peels and microneedling. In its Stage 1 report, the Committee says patient safety must come first and that it agrees it should be illegal for under-18s to access these treatments.
The Committee is supportive of the two-tiered approach to regulation being proposed by the Scottish Government. This would mean procedures deemed ‘higher risk’ could only be undertaken in permitted premises under supervision from authorised medical practitioners, while lower risk procedures would be subject to a licensing scheme to be introduced via secondary legislation.
The Committee acknowledges concerns expressed by some of those businesses currently providing non-surgical procedures about the Scottish Government’s proposed approach to regulation. To alleviate these concerns, the Committee asks the Scottish Government to provide appropriate support and guidance to help responsible providers to make the transition successfully to the new regulatory framework.
The Committee is concerned over a lack of clarity around requirements for clinical supervision of those procedures covered by the Bill, including minimum qualification requirements for those providing supervision and the scope of their clinical and managerial responsibilities.
On enforcement, the Committee calls for a staged approach which will give responsible operators time and support to meet the requirements of the legislation, while punishing those irresponsible operators who show no interest in complying with the law.
The Committee says the current sanctions set out in the Bill are insufficient and would not deter irresponsible providers from committing repeat offences. It has therefore called on the Scottish Government to introduce stronger penalties for offences committed under the Bill.
The Committee also highlights concerns that Healthcare Improvement Scotland (HIS) may lack the capacity and resources to be able to enforce the Bill effectively. The Committee’s report seeks assurances that, in the short term, the Scottish Government will commit additional funding to enable HIS to enforce the Bill properly from the outset.
The huge variability in the quality of training and qualifications held by or available to those providing non-surgical procedures is highlighted by the Committee. It wants to see the creation of clear and appropriate standards for all practitioners.
The Health, Social Care and Sport Committee Convener, Clare Haughey MSP, said:“Our Committee believes patient safety must always come first and that’s why we are supportive of this Bill which will provide much needed regulation of the non-surgical procedures industry.
“We fully back provisions making it illegal for under 18s to access these procedures and believe the Scottish Government should work with the UK Government to improve and standardise training and qualifications so all providers meet a minimum standard.
“Healthcare Improvement Scotland must be given the resources to be able to enforce the law effectively in this area – and penalties for offences must be set at a level that creates a suitable deterrent.
“We acknowledge that there will be many practitioners who are concerned about the impact this new regulatory framework may have on their businesses. That’s why we’re calling on the Scottish Government to provide appropriate support and guidance to help responsible providers make a successful transition and continue operating in compliance with the law.
“Thanks to everyone who gave evidence to our Committee and helped inform our scrutiny of the Bill.”
On the 2nd part of the Bill, the Committee is supportive of updating the processes by which Medical Certificate of Cause of Death (MCCDs) are processed in Scotland.
This would include allowing interested persons to request a review of a MCCD even when it has already been randomly selected for review.
People in Scotland are less likely to die from cancer, with the risk falling by 12% over the past decade, according to new figures published today by Public Health Scotland (PHS).
The new report, which provides the latest insights in cancer mortality in Scotland, highlights that there was a small increase in the number of deaths due to cancer, from 16,011 in 2015 to 16,352 in 2024. This is caused by Scotland’s by Scotland’s ageing population, and older people are at higher risk of cancer.
It also shows that those who die from cancer are now older than in the past. In 2024, 70% of all cancer deaths occurred in people aged 70 and over, up from 66% in 2015. The average age at death also increased between 2000 and 2024, rising from 71 to 74 years for males, and from 72 to 74 years for females.
Lung, colorectal (bowel), prostate, and breast cancers together accounted for 46% of all cancer deaths. Lung cancer remained the leading cause, with 3,651 deaths in 2024, making up 22% of all cancer deaths. Most lung cancer deaths could be avoided by eliminating smoking.
Professor David Morrison, Consultant in Public Health, Public Health Scotland, Scotland, said:“Cancer remains the most common cause of death in Scotland, but the risk has been falling over time.
“Deaths from lung cancer have fallen by a quarter over the past 10 years, and oesophageal and bladder cancer deaths have also gone down. We can see the huge benefits of fewer people smoking and more successful treatment of cancer in these latest figures.
“Among women, the chances of dying from breast cancer have fallen by 11% over the last decade. Breast screening picks up cancers at an earlier, more treatable stage and new treatment options have become available.
“I would encourage anyone invited for cancer screening or offered HPV vaccination to take up the offers.”
Reducing harm from tobacco by creating a smoke-free generation remains a priority for PHS, particularly given lung cancer remains the leading cause of cancer death in Scotland. This, together with reducing harm from alcohol, drugs and unhealthy foods, is one of the key actions outlined in our ten-year strategy, also published today, which sets out how we will work to improve Scotland’s health outcomes.
A second cancer-focussed report published by PHS today, the Place of Death from Cancer in Scotland report, examines the place of death for people who died from cancer between 2015 and 2024.
Of the 49,474 cancer deaths in Scotland during 2015–2024, 39% occurred in NHS hospitals, 37% occurred at home or a private address and 15% occurred in hospices.
The Cancer Mortality in Scotland Annual Update 2024 report can be read here:
More information on identifying, treating and managing cancers can be found on NHS Inform: Cancer | NHS inform
Last year, we published a joint blog by Consultants in Public Health Medicine, Professor David Morrison, Director of the Scottish Cancer Registry and Dr Fatim Lakha, exploring the seemingly paradoxical good news within Scotland’s rising cancer statistics – and what it means for our future health and care system.
The work of organisations and individual campaigners, such as Beth Morrison and Kate Sanger, has been commended by the Holyrood’s Education, Children and Young People Committee as it backs proposals that would minimise the use of restraint and seclusion in Scotland’s schools.
In circumstances where restraint and seclusion must be used, schools would need to follow legal guidelines, which includes informing parents or carers if their child is subject to restraint and seclusion and this use.
The Committee unanimously supported these general principles, but in doing so, expressed its disappointment at the amount of time it had taken for changes to be made despite the tireless efforts of campaigners.
Evidence, including personal testimonies, presented to the Committee was concerning, with witnesses raising their fears that restraint and seclusion was too often seen as a first approach. The Committee was particularly concerned by the inappropriate use of the practice on children with an additional support need or disability.
The Committee’s report recommends improvements to the Bill, including refining the definitions of restraint and seclusion to avoid any ambiguity or unintended consequences and ensuring same day informing on the use of restraint and seclusion for parents or carers.
Speaking as the report was published, Committee Convener Douglas Ross MSP said:“We unanimously support the general principles of this Bill, which will be a vital tool in ensuring the safety of children and young people in Scotland’s schools.
“Our Committee heard disturbing evidence about the use of restraint and seclusion. This practice is being carried out inconsistently and, worryingly, sometimes parents are not even aware restraint and seclusion have been used. Scotland needs a consistent approach, which makes restraint and seclusion a last resort. That’s why it’s important that this Bill becomes law.
“There is still some work to be done to ensure the Bill fully achieves its aims, however we must commend the campaigners, including Beth Morrison and Kate Sanger, for raising this issue in Parliament, and Daniel Johnson MSP, who brought forward this much needed Bill.”
Increased Scottish Government investment in culture has had a “positive impact” on confidence and stability in the sector but extra funding may to some degree be being used to help meet ongoing financial pressures, rather than necessarily generating improved cultural outcomes, according to a new report from Scottish Parliament’s Constitution, Europe, External Affairs and Culture Committee.
In a report published yesterday, the Committee recognises that “despite this welcome investment” the sector continues to face significant financial pressures, including increased employment costs such as employer National Insurance contributions, the Scottish Government’s Public Sector Pay Policy and Fair Work commitments.
In its report, published ahead of the Budget announcement in January, the Committee also shares concerns raised by arts and culture organisations that the Scottish Government funding increase may be being offset by funding reductions by local government.
Reiterating concerns
Throughout its pre-budget scrutiny, the Committee has considered evidence and the response of the Scottish Government, over the whole period of this session of Parliament, in order to build a longer-term view of culture funding decisions.
In its report, MSPs ask the Scottish Government to explain why it has not delivered 3-year funding settlements for the organisations it funds directly, despite a commitment in 2021 to do so.
That is one of a number of areas where the Committee is seeking clarity from the Scottish Government on the progress made in the last five years. Others include; a lack of strategic clarity in funding decisions and progress on collaboration with other Cabinet Secretaries to move forward on cross-portfolio working on funding for culture.
It also calls for details on progress made on a recommendation first given in 2022, that the Scottish Government urgently works towards alternative funding models for the sector, as well as for an urgent update on the establishment of a ‘Percentage for the Arts’ scheme and details as to what it would look like in practice.
The initiative was confirmed to be in its “initial stages” in 2022, but despite commitments to do so, the Scottish Government has not provided any further details to the Committee on the establishment of the scheme.
“Acute” skills shortage and infrastructure challenges
Further concerns raised in the report include a lack of skilled staff to maintain Scotland’s historic environment sector, with the Committee asking the Scottish Government how it is responding to this “acute” skills shortage.
It also asks key questions about whether the upcoming Spending Review will include plans to support the refurbishment, retrofitting and upkeep of cultural assets, as well as how the “substantial capital investment” required in the culture and heritage sector will be addressed to meet climate change and net zero ambitions.
Committee convener Clare Adamson said:“The Committee acknowledges the encouraging effect of the government’s pledge to boost funding for the culture sector, which has helped foster greater confidence and stability.
“Nonetheless, persistent financial challenges continue to pose serious difficulties for heritage and cultural organisations.
“We have listened carefully to the voices of those shaping and supporting Scotland’s cultural life and are mindful of the challenging economic context in which increased support has been made available.
“Our report outlines a series of recommendations for the Scottish Government.”
More than a third of people (37%) faced issues with their most recent parcel delivery.
Royal Mail bag the top spot in the league table with 3.25 stars while Yodel trail behind in bottom place, failing to improve on last year’s score of 2 stars out of 5.
Half a decade since it first launched, Citizens Advice’s parcel league table lays bare how broken this market is.
A record 15 million people experienced a problem with their latest parcel delivery, new research by Citizens Advice has revealed.
From chasing missing parcels, battling arduous complaints systems to even having accessibility requests ignored, Citizens Advice found that more than a third of people (37%) faced issues with their most recent delivery. The research, carried out in a snapshot one month period, reveals the rate of parcel problems remains at the highest levels seen in half a decade.
Now in its fifth year, the parcel league table shows Royal Mail scored the highest this year with an overall score of 3.25 out of 5 stars, while Yodel slip to the bottom with just 2 out of 5 stars – not making any improvement since last year.
The charity’s league table looks at the top five delivery companies by parcel volume and measures their performance against criteria including customer service, delivery problems and how well they meet accessibility needs, such as people needing louder knocking or longer to answer the door.
Stuck in a rut of poor performance
While Citizens Advice’s research shows there have been marginal shifts in scores over the last five years, the overall picture is one of consumers being persistently failed by parcel companies.
The charity found:
Accessibility is the worst performing area – despite Ofcom’s new condition requiring firms to give disabled consumers the opportunity to report their accessibility needs, scores this year have actually worsened, with Yodel placing last. Citizens Advice also found that three million people who have an accessibility requirement they would like to share (37%) are still unable to share their needs. Reasons include not being aware of where to share, or their accessibility need not being given as an option when placing an order.
Complaints and customer service rankings remain stagnant – of the people who had experienced a problem with their delivery, almost half (47%) had a further issue trying to resolve the problem, such as a slow response, issues with automated systems (such as a chat bot) and having to contact a firm multiple times to get a response.
Frequent failures hitting people – the most common problems people faced with their last delivery include the driver leaving before they had time to get to the door (29%); their parcel being left in an insecure location (24%) and parcels arriving late (24%).
The overall scores
Rank
Company
Delivery
Accessibility
Customer service
Trust
Overall scores
Score change
1
Royal Mail
3.2
2.8
3.4
4
3.25 out of 5
2
Amazon Logistics
3.2
1.8
3.5
3.8
3 out of 5
3 =
DPD
2.4
2
2.1
3.4
2.25 out of 5
3 =
Evri
2.4
1.6
2.7
2
2.25 out of 5
5
Yodel
2.4
1.4
2.2
1.8
2 out of 5
“I’ve had some leave parcels in the recycling bins on recycling day” – Mike’s story
Mike, in his 70s, has muscular dystrophy and uses two walking sticks, making it difficult to move quickly or bend down. He consistently asks parcel companies not to bring deliveries to his front door as he is unable to get there in time. Instead, he asks them to deliver parcels to his back door, which is closer to his home office and easier for him to get to.
But despite repeatedly telling retailers and parcel companies about his accessibility needs, firms still ignore his requests. As a result, parcels are often misdelivered, left exposed to the weather, not put in a designated safe space or with neighbours, or delivered to entirely wrong addresses.
“The biggest problem is just getting companies to deliver according to my instructions,” Mike says.
“If nobody is in, delivery drivers are supposed to leave my parcels in a designated safe space. I chose that spot because it’s dry, out of the way, and I don’t have to bend down to pick anything up. But parcels rarely get left there. Instead, they just leave them outside, whether it’s raining, dry or otherwise. I’ve had some leave parcels in the recycling bins on recycling day.
“It makes you awfully frustrated, and it makes you really fed up, to the point that I’m beginning to stop buying from retailers that use certain delivery companies.
“I actually had one delivery agent chuck a parcel over the back gate onto the concrete floor, who said he’d handed it to the resident. I had the video showing him throwing it over the back gate then taking a picture saying he’d delivered it.”
Passing the parcel of responsibility
Ofcom introduced guidance on complaints and accessibility in 2023, but Citizens Advice says its research and Ofcom’s own findings show many parcel firms are still ignoring the rules. This isn’t a guidance problem – it’s a compliance one, and the charity is calling on Ofcom to monitor performance and fine the worst offenders.
Five years of league table analysis also shows repeated failures across the sector. Royal Mail, subject to stricter regulation, consistently performs well overall in the league table but the company offers consumers access to an independent dispute scheme (ADR) unlike other parcel providers. Citizens Advice says all consumers should have the same right to redress, no matter who delivers their parcel.
Dame Clare Moriarty, Chief Executive of Citizens Advice, said:“Ofcom has passed the parcel of responsibility for long enough.
“We’ve been doing the work of the regulator for five years now by holding parcel companies to account and speaking up for consumers who are bearing the brunt of persistently poor service.
“Our league table has tracked parcel problems from warehouse to doorstep. We continue to see millions of people chasing lost parcels, having their accessibility needs ignored and hitting a brick wall when they try to complain.
“The question now is whether the regulator will take tougher action to improve the parcel market once and for all.”
Flawed contract design and incompetent delivery left the Home Office unable to cope with the surge in demand for asylum accommodation, a report by the Home Affairs Committee has found.
Hotels went from a temporary stop-gap to the go-to solution for asylum accommodation, leading to a failed system that is expensive, unpopular with local communities and unsuitable for asylum seekers.
As the cost of asylum accommodation contracts more than tripled, inadequate oversight meant failings went unnoticed and unaddressed. The Home Office failed to keep costs down and underutilised mechanisms to penalise providers for poor performance and reclaim excess profits.
No performance penalties are applied for poor performance at Napier, Wethersfield or asylum hotels, despite hotels accounting for over 75% of spending on asylum accommodation.
Break clauses in 2026 and the end of the contracts in 2029 offer the Home Office an opportunity to end the failed system. However, without a clear long-term plan and the institutional capability to deliver a model that is more effective and offers value for money, past failures risk being repeated, the Committee warns.
The Home Office’s approach has been a series of hasty, short-term responses. It must now learn from past failures and deliver a clear long-term strategy for asylum accommodation that provides value for money, adequate standards of accommodation and takes account of the impact on local communities.
Chair of the Home Affairs Committee, Dame Karen Bradley said: “The Home Office has presided over a failing asylum accommodation system that has cost taxpayers billions of pounds.
“Its response to increasing demand has been rushed and chaotic, and the department has neglected the day-to-day management of these contracts. The Government needs to get a grip on the asylum accommodation system in order to bring costs down and hold providers to account for poor performance.
“Urgent action is needed to lower the cost of asylum accommodation and address the concerns of local communities. While reducing hotel use is rightly a Government priority, there will always be a need for flexibility within the system, and the Home Office risks boxing itself in by making undeliverable promises to appeal to popular sentiment. It shouldn’t set itself up for more failure.
“The Home Office has not proved able to develop a long term strategy for the delivery of asylum accommodation. It has instead focused on short term, reactive responses.
“There is now an opportunity to draw a line under the current failed, chaotic and expensive system, but the Home Office must finally learn from its previous mistakes or it is doomed to repeat them.”
GOVERNMENT MUST TAKE ACTION OR MISS FUEL POVERTY TARGETS
Scotland is extremely unlikely to meet its fuel poverty targets for 2030 according to a new report from the Scottish Fuel Poverty Advisory Panel.
The Panel says the Scottish Government’s first three-year update, Tackling Scottish Fuel Poverty 2021–24, shows that fuel poverty rates have risen sharply since targets were first set in 2019.
It says that greater emphasis must be placed on the monitoring and evaluation of progress towards fuel poverty targets.
The latest figures paint a stark picture: more than a third of households in Scotland (34%), approximately 861,000, are now classed as living in fuel poverty.
A household is in fuel poverty if, after housing costs have been paid for, it needs more than 10% of its remaining income to pay for its energy needs and if after paying for its energy the household is left in poverty.
It’s considered in extreme fuel poverty if they have to spend more than 20% of its remaining income. Almost one in five (19.4%) or 491,0001 households are in extreme fuel poverty, a long way from the Scottish Government’s goal of reducing the figures to 15% for fuel poverty and 5% for extreme fuel poverty by 2030.
Matthew Cole, Chair of Scottish Fuel Poverty Advisory Panel said: “We’re calling for the existing Fuel Poverty Strategy to be revised as a matter of urgency, or Scotland will not only miss its 2030 targets but is also unlikely to meet its 2035 targets.
“There is also need for a fuel poverty delivery plan that links boosting household income directly to meeting fuel poverty targets, and this delivery plan should be robustly monitored.
“While meeting the 2040 target of just 5% in fuel poverty and 1% in extreme fuel poverty is still possible, it will be a massive challenge requiring a whole new strategic approach. There are far too many people still having to choose between heating their homes and feeding their families.”
He said the Panel has heard some harrowing stories from energy advice agencies and other partners on the frontline across Scotland: “We have heard of people resorting to extremes so that they can access heat and power, with a resident in the Western Isles developing hypothermia after disconnecting the heating because they were unable to pay their bill.
“We have even heard reports of someone ripping up the floorboards in their home so that they could burn them as a heat source. These findings are shocking on their own, but are even more so when we consider the longer-term impacts living in fuel poverty can have, including on physical and mental health.”
The Panel’s new report acknowledges that the world is a very different place since the original targets were set in 2019, before the COVID-19 pandemic and cost of living crisis driven by the war in Ukraine and sanctions against Russia.
It also acknowledges that although household energy rates are not within the Scottish Government’s direct control, the escalation of fuel poverty levels in Scotland means that tackling fuel poverty should be a greater priority than ever.
The report recognises that some progress has been made by the Scottish Government over the last three years, particularly in efforts to improve the energy efficiency of housing. There has been a measurable improvement in recent years with 56% of homes rated EPC band C or better in 2023 – an increase of around 3% from 2022.
There has also been significant Scottish Government support to increase income for low-income households, with some interventions directly related to annual assistance with energy costs.
However, there is still a long way to go to achieve the targets. The Panel has made a series of recommendations to the Scottish Government urging it to:
Fulfil its commitment to revising its current Fuel Poverty Strategy by December 2026.
Accelerate the rate of improvements to make housing stock more energy efficient.
Increase awareness of how energy is used in homes to reduce waste and make costs clearer, as many households may be on unsuitable tariffs, paying more than necessary without realising it.
Set a clear vision for the GB energy market, push for reforms that take account of the needs of Scottish consumers, and protect those at risk of fuel poverty.
Target island and remote rural communities with tailored, co-ordinated action to cut fuel poverty where it hits hardest.
On behalf of the Panel, the Chair emphasised: “It is essential that the revised strategy includes a clear, credible plan to cut fuel poverty and meet statutory targets.
“That means closer monitoring, better evaluation, and flexible policies that respond quickly to stalled progress or heightened need. We look forward to seeing the Scottish Government’s response in the coming weeks.”
Gillian Campbell, Director of the Existing Homes Alliance (EHA), said: “The Scottish Fuel Poverty Advisory Panel highlights that the number of households in fuel poverty rose from 24.6% in 2019 to 34% in 2023. This rising level of fuel poverty in renewables rich Scotland is deeply concerning.
“Poor energy efficiency remains one of the main drivers of fuel poverty, yet we know Scotland already has excellent fuel poverty and energy efficiency programmes that can make homes warmer, healthier and cheaper to heat. However, the scale of existing programmes doesn’t match current levels of need.
“The Scottish Government must commit to scaling up these effective schemes and providing long-term funding certainty so local authorities and partners can maximise their impact. Without that commitment, too many people will continue to face the impossible choice between heating and eating this winter.”
Clubs, schools, day centres and other community settings could help to make health and care more accessible, new research suggests.
Familiar places like these could remove barriers to care, like not being sure if there is a health or care issue, where to go, how to get there, who to see or what to tell the health or care practitioner.
This is one of more than 20 recommendations made by people across the UK who researchers say are rarely consulted about the design of health and social care services.
A new report coins the term ‘seldom-listened-to’ to describe these people and communities. The researchers also coin the term ‘health labour’ to describe the effort needed by seldom-listened-to people to access health and care.
Participants in the research included siblings of children with life-limiting conditions; women, trans men, non-binary, and gender nonconforming people with energy limiting chronic illness, such as Long Covid and autoimmune conditions; older autistic people with learning disabilities; people living with chronic inflammatory disease, endometriosis; rural communities in the Highlands and Islands of Scotland; diverse communities in Greater Manchester; children living in areas of high deprivation in the South Tees region; African-Caribbean communities in London; mental health service users in Kent and both patients and staff who are staying or working in care units in hospitals.
“The people in our study are from communities which aren’t often listened to or included in discussions about the design of health and care services,” explained Professor Mary Stewart, academic lead for the project and Director of Social Interaction, Mental Health and Wellbeing at Heriot-Watt University.
“And yet these communities can experience profound health and care inequalities that can impact on their physical and mental health, quality of life, and the ability to live well – not only for the individual – but also their families and the wider community.
“Our research sets out the specific ways in which staff, organisations, stakeholders, and policymakers can place seldom-listened-to individuals and communities at the heart of the design of the future of health and care.
“We show not only that this is possible – but that it’s vital to co-design the future of health and care with these people and communities to improve health and care for everyone.”
The report is part of research funded by the UKRI Arts and Humanities Research Council (AHRC) – which supports arts and humanities research and study in the UK – and uses creative methods to explore how seldom-listened-to people and groups would like the future of health and social care to look.
Instead of using traditional research methods like surveys and interviews – which aren’t always accessible to seldom-listened-to people – the researchers worked with artists and creative methods to capture the views and experiences of participants. These creative methods included film, music, poetry, podcasts, comics, creative writing and folk stories.
Through a series of activities and workshops, the seldom-listened-to participants ‘reimagined’ health and social care services which could give them more say in decision-making, help them to access and engage with care – and use safer spaces to build trust and rapport.
Research co-author Bryony Nisbet, a Psychology Research Assistant at Heriot-Watt University, explained: “By safer spaces, we mean community places that are already familiar to people, and where they may already have support from trusted others.
“For example, if you’re an autistic adult with learning disabilities, accessing health and care in a day centre you already attend potentially removes the huge physical and sensory overload of trying to get to and navigate around a new place you’ve never been to before.
“For the NHS and social care, the practical change we’re proposing is moving the point of care from GP surgeries into the community. This in turn can help to tackle the growing burden on primary care in the UK.”
Other recommendations in the report include providing multidisciplinary services that span sectors including housing, employment and education – alongside health and care.
Care should also anticipate future needs, for example by developing ‘future-ready homes’ that are already adapted to meet the needs of vulnerable groups as they get older.
The report also recommends that professionals are trained to work with people with varying communication, cognitive, sensory and cultural needs.
The research aligns with the UK government’s 10-year plan to bring the NHS closer to home, including neighbourhood health centres which will house services under one roof and will be open at evenings and weekends.
The researchers have written a policy brief detailing their recommendations for policymakers. This will be shared with politicians across the UK, including Members of the Scottish Parliament and Members of Parliament at Westminster.
The ten projects in the research were all partnerships between communities, community organisations and universities. The other university partners were University of Liverpool, University of Greenwich, University of Strathclyde, Edge Hill University in Lancashire, University of Manchester, Manchester Metropolitan University, Teeside University, University of Kent and University of the Highlands and Islands Inverness.
The organisations and charities involved in the research included disability group Chronic Illness Inclusion, Manchester public arts project We Live Here; charity Endometriosis UK; Scottish Autism; educational institution Tees Valley Education Trust and arts community outreach project, Inverness Openarts.
Participants in the research included Oliver Waite, who took part in University of Manchester’s research project, called NHS 75/150 Looking Back, Looking Forwards. This engaged diverse communities in Greater Manchester in discussions around the future of health and care. Oliver’s story is captured in a comic-book style artwork that highlights the importance of seeing people as individuals.
Oliver explained: “I have schizoaffective disorder, I’m autistic and I’ve transitioned from female to male. But I’m more than just a list of medical issues.
“I’m a part-time history student with the Open University, I build models, such as Lego, and I play wheelchair rugby league.”
She said: “African-Caribbean communities are 40% more likely than white British people to come into contact with mental health services and to be detained under the Mental Health Act. “
Our project looked at a different approach, one that builds on the cultural traditions and community support that have always helped people stay mentally well. Through storytelling and folk song workshops, we created a practical toolkit to help promote good mental health in local communities”
She said: “The children and young people in our project were able to explore and express their lived experiences and perspectives on social inequality and health and wellbeing through a series of interactive and inclusive workshops, including comic-making, creative writing, dance and performance.
“We hope the artworks, creative writing and films that captured their voices will help health professionals, policy makers, researchers and the wider public to learn from the experience and insights of children and young people.”
