What is transformation in health and social care?


What is transformation in health and social care?

A good question to reflect on at the start of a new year. The word ‘transformation’ is at risk of becoming another well used but ever more elusive concept as it becomes part of our everyday language in the world of health and social care.  Somehow despite our best efforts the thing we seek to develop becomes harder to pin down.

This past year saw some of the pieces of the transformation jigsaw come a bit more into focus as I’ve grown in to my role within the Health and Social Care ALLIANCE and the House of Care programme in Scotland.

 In the House of Care programme, we use the T word a lot as well as coherence, person centredness, self management and sometimes even compassion. It’s a funny word – sometimes people move towards it in conversation and sometimes not. For me it’s a very important and fundamental jigsaw piece and I like the definition of compassion from Dr John Gillies, co-director of the Global Compassion Initiative and former chair of the Royal College of General Practitioners,

“an acknowledgement that a person or individual is suffering or unhappy and having the intention to take action to address that”.

Sometimes compassion gets a bad press as soft and fluffy – a luxury if you like in the real world of health and care but I don’t agree. It’s at the heart of the care and support planning conversations in the House of Care adopter sites across Scotland where prepared people and prepared staff develop a different kind of conversation.

It works best when there is a shift of intention towards sharing the power in the relationship and really supporting the person to be in the driving seat of their care and support.

It was heartening to read the recent social work report ‘It’s no longer them and us –it’s just us’, which also echoes the importance of co-production within a good conversation:

‘The relationship between the assessor and the assessed person is the foundations – it’s so important. It needs good communication – especially good listening – and honesty. Processes and systems should be built around this and enable it, rather than getting in the way.’

Hopeful signs perhaps that policy and practice in health and social care integration really are beginning to converge with the person at the centre.

We say we want a more human compassionate approach but when budgets are perceived as tight, services like this, which have high levels of support and satisfaction from people and their families are often cut; struggle to survive on short term funding; or are perhaps not even funded in the first place. Those services and staff are often judged against a reductionist effectiveness model, leaving the third sector to be the fertile ground for more person centred approaches and services that are informed by the voice of lived experience. We need a third sector that is truly an equal partner in health and social care.

But how can this shift in relational care be more clearly measured and evidenced? Sir Harry Burns is chairing a national review of indicators and targets. We must measure the process and the day to day business of the effectiveness of the systems but we need to include the voice of lived experience if we really want to understand what good care and support means. I hope that what emerges will also include the language of human, relational care in support of transformational  change.

There’s a growing body of evidence to show that compassion is good for us all. Whether you’re a person living with a long term condition, an unpaid carer or a staff member, I’m hoping that in 2017 we openly move towards a kinder, more compassionate approach in support of transformation in health and social care.

There was an excellent piece in a recent Sunday newspaper where Professor John Gillies spoke bravely and clearly about the need for compassion and Dr James Doty, the neurosurgeon who founded the Centre for Compassion and Altruism Research at Stanford University, quoted the Dalai Llama:

“If we say the practice of compassion is something holy, nobody will listen. If we say, warm-heartedness really reduces your blood pressure, your anxiety, your stress and improves your health, then people pay attention.”

I’d vote for that kind of prescription.


Cath Cooney

First Published for the Health and Social Care Academy at the ALLIANCE 10th January 2017


A Flourishing Scotland – What kind of leadership do we want to see emerge in Scotland?



Recently asked to reflect on ´the asks´in the Manifesto of the Health and Social Care Alliance in the run up to the Scottish Government elections in May of this year. Here´s what I said…

“The ask that resonates most for me is the creation of a Ministerial position for championing disability, long term conditions and carers. A Minister should model the values of courageous leadership; emphasising humanity and core values; actively nurture transformation in self management and care, working with people of lived experience and support the population to flourish in a fairer, healthier Scotland – that would get my vote”
Cath, Glasgow, Health and Social Care Academy Ambassador


See more at HAVE YOUR SAY






Five Provocations for the Future of Health and Social Care


Five Provocations for the Future of Health and Social Care

Here is a link to the summary of the Five Provocations for the Future of Health and Social Care session held by The Academy of the Health and Social Care Alliance in Scotland:


Here also is a short film from the session:



Think Tank on Creating Wellbeing in Scotland

Here is a link to a podcast from the Health and Social Care ALLIANCE Academy Think Tank that was held in October 2015 in Edinburgh.


The latest Academy podcast features Dr David Reilly, Director of the WEL Programme, Professor Alan Miller, Chair of the Scottish Human Rights Commission, and Cath Cooney, Citizen blogger for the Academy who each contributed to the Academy’s Think Tank event, held in Edinburgh’s Assembly Rooms on Tuesday 27 October 2015.

The event brought together a collection of leaders from across Scottish society to discuss transformative ideas on the question “What is needed to transform Scottish society so that all citizens are able to thrive?”

In this podcast, David, Alan, and Cath reflect on this issue from the perspective of different elements of the Academy’s PATH Principles.

  • Person centred
  • Asset-based
  • Transformative change
  • Human rights and equality
Extract from Academy update Nov 2015

Springtime and hope for change…


So much was happening this spring… as the General Election was coming up we were offered promises that change is on the agenda and will happen if only you vote for me… On a personal level, a few things have come up for me these past few months that have made me think about the likelihood of achieving change – is it possible no matter what your life experience has been and how old you are, and how might health and social care services play a role in supporting transformational change?

We know so much now about the functioning of the brain and how we can actively work to build new brain cells and build new, neurological pathways, which is encouraging, even as we age. As part of the Glasgow Centre for Population Health Seminar Series Prof Bruce McEwen, an eminent neuroendocrinology researcher from Rockefeller University in New York, recently spoke to a packed audience in Glasgow. The focus of his life´s work has been to research the effects of stress on health over the life course and to better understand why the burden of stress related health is greater for some, particularly people who have experienced socio economic disadvantage. I was at the lecture and then also lucky enough to be at a later round table discussion, chaired by Andrew Lyon, with Bruce and his colleague Karen (who specialised in inflammation) and folks from research and practice around Glasgow – stimulating conversation and so much covered…

We talked about finding windows of plasticity, the toxic effect of shame, the impact of adverse childhood experiences (ACE), the greater burden of stress alongside widening health inequalities, placing love and compassion at the heart of policy and practice, agreed that inflammation is understudied, pondered if mindfulness has become the new religion, agreed that there is no magic bullet for non communicable diseases/long term conditions, and acknowledged the centrality of connection and good early attachment (serve and return) and so on.
So what’s my take home on all of this?

I´ve mentioned before in my blogs the work lead and developed by Dr David Reilly that supports people to learn to spark and maintain a more compassionate, self care approach to their health and wellness –it´s called TheWEL (Wellness Enhanced Learning). TheWEL is an example of an intervention that is working with people who are experiencing the negative effects of chronic stress, and often early life trauma, on their health. The WEL has demonstrated that by activating a shift – a sense that change can and is waiting to happen – is the first step in going some way to take back control and so reverse the damage done by the burden of toxic stress response (Prof McEwen calls this the alostatic load). In other words, what we often describe as an asset-based approach. We know that the use and presentation of the science and evidence base relating to neuroplasticity, neuroendocrinology etc. in TheWEL chimes with people and the idea of creating new pathways that can be myelinated, as well as demyelinating old and damaging habits, seems to work as a catalyst in visualising the benefits of daily wellness enhancing practices.

Folks round the table with Prof McEwen agreed that using recognisable language is an important key – using images and simple metaphors (the prefrontal cortex described as the air traffic controller) helps people to understand and internalise the scientific effects of stress and seems to help build motivation to action. In TheWEL such images are used to good effect: the plant, road to Dublin, the Gardner, the child, dog, 3d model etc.

Bruce emphasised that prevention is key and that…

The plasticity of the brain gives hope for therapies that make positive use of brain-body interactions…

The WEL is such an intervention and it is showing good, replicable and hopeful results in Scotland and internationally.
It was a privilege to hear first-hand from such experienced and renowned scientists – but who also showed up as human beings. Bruce and Karen summed up at the end by saying how they had been struck by the willingness to have these kinds of conversations in Scotland – scientists in the US are perhaps not so keen to engage in such an open way.
The lecture was filmed and is now be on GCPH website. http://www.gcph.co.uk/events/155e

Cath Cooney May 2015


A dignified approach

What is the true value of caring and supporting others? Of late I’ve realised more and more that our society tends to assign a monetary value to everything – including the role of carers of disabled people and people who live with long term conditions.

But that doesn’t need to be the case.

I was recently at an event organised by the Glasgow Centre for Population Health, on “the economics of dignity”. The seminar was addressed by Dr Marilyn Waring, a feminist academic from New Zealand who has spent the last 25 years working to empower woman and men to challenge the priorities that are imposed upon them by economists.

She told of her own experiences as an author, an academic, and crucially as a carer for her father, and how they all led her to believe that dignity (a basic human right) is missing from the systems set up to support us all. How we tend to think about outputs from services as being most important – not the outcomes for the people we love.

She designed research which took in evidence from across the world of human rights violations related to carers and young carers, which meant missing school, less food to eat, constant loan repayments, domestic violence, a lack of clean water and wives and daughters sent to care away from home. In response, a capability approach was used– one which argued support for carers should be drawn on the human rights which apply to us all and affect our everyday lives.

I didn’t know much about Dr Waring’s work before the event but she gave a fantastic analysis of the situation as she sees it affecting Scotland, and impressed upon the audience that people from across the world are watching what we do next for carers, and for young carers in particular.

I spoke to friends and colleagues afterwards and looked through the body of evidence that has been developed around this type of work. It made me reflect again on the importance of initiatives, like the Health and Social Care Academy, which seek to listen to the voice of people and their lived experiences.

She made me think more about the upcoming carers legislation in Scotland – and the opportunity it offers us to think differently about assessing carers needs. We should be asking questions such as:

• “How is your own health?”
• “Are you able to do any work outside of the home?”
• “Can you go to any community or political meetings?”

We need to ask these questions so that we know what needs to change – and backing that up with real action, or else we run the risk of raising expectations with little end product.

Rather than asking what do carers offer to society in a financial sense, we need to turn the question on its head and ask “what is the state doing to ensure carers´ human rights are respected?”
Originally posted in February 2015 through The Health and Social Care Academy blog

Interested in finding out more?
Dr Marilyn Waring´s lecture is available to watch on the Glasgow Centre for Population Health website

The Carers Bill, that Dr Waring refers to was introduced to the Scottish Parliament on Tuesday 10th March 2015

See Professor Waring´s own web-site


Looking ahead for 2015

Looking back as 2015 begins the issue of human rights and health is much in my mind. I´ve been in Sweden over new year, the birthplace of the founder of the Nobel prize, and the 2014 Nobel Laureates for Peace Malala and Kailash have been recognised for their courageous human rights work with children and received much coverage in closing year reviews here. Over the last few years I´ve followed the career of Margot Wallström, the newly appointed Swedish Foreign Minister, and former UN Special Representative on Sexual Violence in Conflict who has long spoken up in support of worldwide human rights issues. In Scotland the ALLIANCE Academy Masterclass on Human Rights and Health – delivered by Jonathan Cohen and chaired by Audrey Birt was powerful and the take home message for me was that Communities claiming health as a human right…creates change´.   All this has caused me to question the visibility of human rights language in the context of wellness. As a person of lived experience, where severe loss of healthy functioning came as a shock, resulting in a disconnect from my sense of self worth in society – a sense of shame that simply being ill can bring, the loss of a sense of value in society and yes the loss of the sense of entitlement to the basic human rights in society. Having to navigate punitive and inhuman benefit and employment services where, even when staff are trying to retain and support a sense of dignity, a blame culture all too often exists. So I´m wondering if there is the potential to make human rights language a stronger part of the conversation in health and social care for both service users and those who do their best to deliver those same services? Two areas that I´m involved in come to mind. TheWEL programme in Scotland, is doing great work in helping people to develop and foster their own wellness and self care through a compassionate approach. The consistent findings in TheWEL show the same levels of poor health and wellness in both staff and service users and yet that is not so often acknowledged. As a member of The Programme Board of the ALLIANCE Academy, I know that there is great work being done by The ALLIANCE and its partners in raising issues of human rights in Scotland through the development of the National Action Plan and sessions such as the Jonathan Cohen Masterclass. A human rights approach to health and wellness – are we seeing this being modelled in Scotland? Yes I think we are, but how to foster ways of leading and developing transformational models rather than simply focussing on managing existing services faster and harder. Back to Margot Wallström who recently reflected that Knowing your own strengths and weaknesses…being a manager is a position: being a leader is a relationship. And that’s the knack – making the distinction´. Cath Cooney, Citizen Blogger January 2015

Originally posted through the Health and Social Care Academy citizen blog in January 2015