A fresh perspective on Scotland’s progress in improving and redesigning health and social care

Ruth-3711-EditWe know the challenges facing our health and social care system are, and will continue to be, significant. They are well understood; increasing demand, ongoing difficulties recruiting to a range of posts, and an ever more challenging financial context.

When helping providers improve care it can be easy to feel daunted by the challenges as they can seem so difficult to address. So recently I was fascinated to see our context through others’ eyes.

Over the last year, through the support of the Health Foundation, I’ve been privileged to participate in Sciana, a new European network of Healthcare Leaders.

To say I was surprised when some colleagues from another European country described their main challenge as too much money in their system is an understatement. And the reason why they described it as a challenge: they have no incentive to change and they know that the current system is not fit for purpose for today’s health and care needs.

It gave me a new perspective on our financial challenges as they are enabling a much needed redesign of our health and social care system. It reminded me of a quote from an Integration Joint Board (IJB) Chief Officer (CO) “Crises and challenges have created the sense of urgency and the willingness to think the unthinkable that allows us to tackle the wicked issues”.

“We have proved that we can do change at scale in Scotland”

This rings very true to me as, in the midst of our challenges, we also have so much to celebrate.  The improvement and redesign work happening across Scotland every single day is really impressive. Healthcare Improvement Scotland’s ihub has just published our latest Impact Report which details just some of the fantastic success stories taking place across health and social care in Scotland.


Through the Scottish Patient Safety Programme (SPSP), we have proved that we can do change at scale in Scotland. This year we are celebrating 10 successful years of SPSP and the data around safety work speaks for itself.

But it is worth pointing out what we have learned about how that success has been created:

  • Relentless focus on skilling up those who deliver care in quality improvement techniques
  • The development of national learning systems which bring those working on common improvement challenges together to share learning and problem solve
  • Person-centred, evidence and data informed improvement work.
  • The political support for an approach which takes time initially, but delivers sustainable results at scale in the longer term.

Yet, when we set up the ihub at Healthcare Improvement Scotland, we were clear that the nature of the challenges meant that we needed to go even further. In addition to our continuous improvement approach we needed to also focus on system and service redesign. We believe that both are vital if we are to deliver the transformation of health and social care that we all aspire to and so desperately need.

Relationships are the glue that holds our system together. So all our work is co-designed, co-owned and co-delivered with partners – with the aim of building local improvement capacity to meet local need. A recent count of organisations we actively worked in partnership with during 2017-18 highlighted an incredible 117 separate organisations. And thanks to the work of programmes such as the Children and Young People Improvement Collaborative and NHS Education for Scotland’s Quality Improvement training programmes we now have quality improvement expertise that has been built up not just in health but also in the wider social care and educational environments.

“We actively worked in partnership with an incredible 117 separate organisations during 2017-18”

Our collective response in challenging conditions is aided by the fact that we all share the same simple goal – better health and wellbeing outcomes for people in Scotland.

One look at the stories in the Impact Report and we can see what is possible. There are amazing people in every service in Scotland working tirelessly every day to deliver and improve our health and social care services; sometimes in very challenging circumstances.  I often hear comments highlighting that we are delivering improvement in Scotland despite the challenging context; hearing from colleagues in other countries has got me wondering if maybe we are delivering such exciting innovations precisely because of the challenging context.

What for me is unquestionable is that we wouldn’t be achieving any of this without the dedication and commitment of those involved in supporting and delivering health and social care across Scotland. It leaves me confident that whether it is because of, or despite of, our circumstances, by working together we will continue to find solutions that deliver better outcomes for people in Scotland.

Ruth Glassborow is Director of Improvement with Healthcare Improvement Scotland.

Click here to access the The ihub Impact Report.

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