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by David McColgan, BHF Scotland
18 June 2024
Associate Feature: Taking heart

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Associate Feature: Taking heart

How might the Scottish Parliament help your organisation accomplish your aims in the coming years?
The face of heart disease is changing in Scotland, with projections showing that there will be a growing number of people living longer with life-limiting conditions such as heart failure. There needs to be a renewed focus on tackling heart disease and recognising it is a significantly more complex condition than just heart attack survival. 

As we move forward we won’t be able to avoid a serious conversation about how our health service is structured and delivered and as part of that we need to ensure that disease burden is factored into service design and delivery.

We also need a greater focus on the patient and patient outcomes ensuring that best practice and care is delivered the length and breadth of the country. This will require brave decisions and bold action but more importantly it will require everyone to be judged on harder targets or metrics and not simplistic measures, this will undoubtedly be an uncomfortable departure from the norm, but one that will revolutionise the way we judge success.

Looking more broadly at the public health space – a space the Scottish Parliament has used so well in areas such as the smoking ban and minimum unit pricing for alcohol – we’d like to see the parliament find the bravery it had in tackling the commercial determinants of health. Our parliamentarians hold the power to change so many lives by shaping and influencing the world we live in. Our environments are overrun by commercial interests profiting from the sale of health-harming products – alcohol, high fat, salt and sugar food and drink, tobacco and related products – and the Scottish Parliament has the power to challenge these industries to ensure we live in a health promoting environment and ensure that they are held accountable for the ill-health they profit so greatly from. 

What has been the greatest highlight for your organisation during the past 25 years? 
Whilst there have been many significant moments in the public health and health space in Scotland one of the biggest highlights was the 2019 change to the organ donation laws in Scotland. 

The landmark piece of legislation saw Scotland move from an opt-in to a soft opt-out system after six years of campaigning. The campaign had cross-party support and was rooted in the very early years of the parliament, when Kenneth Gibson MSP led the call for the change in the first session of the Scottish Parliament. 

How has your organisation changed since 1999?
At the British Heart Foundation we’ve seen the investment in teams based in the devolved nations grow, the autonomy to drive change to help achieve our mission, and the relationships with key figures increasingly held outside of London. 

Devolution, especially in the health space, was a challenge for many UK charities. Whilst it opened up new channels for influencing and advancing our mission it also required a change in mindset. 

It often saw change across the UK taking different routes and speeds and as such the centralised view of advocating in the health space had to be radically changed.

I think to operate effectively in the devolved context, UK-wide charities – especially in the health space – have had to get very comfortable with ambiguity. The strength of devolution is that institutions in different parts of the UK have been able to define local priorities that might differ from one nation to the next. 

I have had the privilege of working across Wales, Northern Ireland, and Scotland in a public affairs role and that ambiguity was something I had to deal with every day, organisational priorities might be clearly defined but the drum beat of change is different all over and where one parliament is focused on waiting times for heart disease, another might be focused on out of hospital cardiac arrest and the other might be looking at public health prevention. 

This has resulted in a real need to be able to speak locally, not just about Scotland but at a health board, constituency and even city and town level – and when you look across the sector organisations that can achieve that always have the greatest impact. 

How do you think your sector will evolve in the next 25 years? 
The pace of change in healthcare and medical research is incredible and to think where we’ve come in the last 25 years and where we’ll be after the next is hard to comprehend. 

We’ve got tough questions to answer as a nation when it comes to the health and care of the people of Scotland, but the biggest evolution that can occur over the next 25 years is in how we go about finding those solutions. The NHS, Scottish Government, local government, third sector cannot do it alone, it will require a mindset that sees everyone as equal partners and a clear vision we collectively want to work towards. 

  A move away from siloed visions and objectives and a coming together of joint aims would revolutionise how we delivery change in Scotland. Organisations like the British Heart Foundation can play such a powerful role in convening government, health professionals and politicians together to share a collective challenge and define the collective solution and we are increasingly supporting such work and hope to continue to do so in the years to come. 

We also need a greater focus on the patient and patient outcomes ensuring that best practice and care is delivered the length and breadth of the country

How has devolution managed to find (in the words of Donald Dewar) ‘Scottish solutions to Scottish problems’?
In the world of heart disease it has definitely created a space where we can look at the unique challenges Scotland faces, be that high rates of disease or urban/rural divides and ensure that relevant voices are around the table helping identify the solutions and driving change. 

Looking more broadly at public health, the parliament has definitely lived up to the ambitions of Donald Dewar. We led the way with the smoking ban and with minimum unit pricing, forcing the world to look to Scotland and play catch-up. 

It would be great to find that spirit again, and remember those words as we embark on the next 25 years as Scotland today faces challenges that we have the power to tackle, so let’s not wait for permission, or wait to see what everyone else is doing, let’s get out front and lead the way again. 

What policy/bill/law from the past 25 years has had the most profound effect (either positive or negative) on your organisation? 
It is still hailed as one of the biggest achievements of the Scottish Parliament but the smoking ban in public places saw a reduction in heart attacks by 17 per cent in the first year of the ban alone. 

The legislation really showed the power of the Scottish Parliament, the power to be bold and take steps to support the health of the nation. 

We’d do well to remember that ambition, remember that boldness and remember how the parliament can have a truly life-changing effect on the people of Scotland. 

What’s your earliest memory of devolution? 
I have to admit I was still in high school in 1999 when the parliament first sat again in Edinburgh. But my earliest memory was probably leading the campaign for the Red Party (read into that what you will) when our school held mock elections as part of modern studies class to mark the first elections. 

  After that I also remember sitting in the gallery of the General Assembly Hall on the Mound with my modern studies class as guests of Scott Barrie, the MSP for Dunfermline West at the time. 

This article is sponsored by British Heart Foundation Scotland

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