Opportunities for change and improvement in Scotland

Our health and social care system in Scotland is facing challenges nationally and locally which open opportunities for change and improvement.

The Quality Strategy for NHS Scotland 2010 recommends putting people at the heart of the NHS. The need to save costs, the existing complexity and compartmentalisation of our healthcare system and the growing impact of long-term conditions all mean we need to rethink the ways we deliver care. The old medical model on its own can no longer address these issues sufficiently.

I work as a chest physician at Crosshouse Hospital in Ayrshire and Arran. As a clinician, like all health and social care workers, I do recognise and experience the strengths and weaknesses of our current system.

A very positive culture of encouraging staff members to make small tests of change is gradually emerging and is openly supported by national policy makers. We healthcare workers are beginning to be recognised as an asset for making improvement. The courage and encouragement to question current practice and processes of care are essential to build a service with frontline staff truly engaged.

However in my opinion, the role of the most important resource for improvement – the patient or service user – is not yet fully understood and appreciated. It’s the combination of staff ingenuity and service user experience that will be the most credible driver for authentic change going forward.

Several projects and initiatives are underway in Scotland, and in Ayrshire and Arran we are underpinning our work with this philosophy of co-production. The National Person Centred Care Collaborative, established in 2012, is aiming to lead the transformation to person-centred care and is placing patient and staff experience at the heart of changes.

Our local programme board in Ayrshire and Arran will lead the transformation from a ‘clinician and process centred service’ to a ‘person-centred service’ through a gradual process of raising awareness and testing and implementing series of small changes. We don’t yet know what the resulting model will look like, but we know that the active involvement of service users and staff in a collaborative manner is the key to progress on this journey.

Integrated into our local work on person-centred care is an initiative to implement and embed self management support. This work is funded by the Health Foundation for a period of two years. As participants in the national Co-creating Health initiative from 2007 until 2012, our team in Ayrshire and Arran has already gathered significant understanding of the concept and practice of self management support.

The development and co-delivery of patient and clinician programmes by clinician and patient tutors working together was a rewarding and eye opening experience for me. I witnessed the transformation of individual patients’ lives and clinicians’ practice. The momentum is growing and the recent introduction of a local self management network as a platform for shared learning has been met with very positive resonance.

Our challenge will now be to translate the knowledge and growing expertise in self-management support into measurable change in everyday practice on all levels of the service at all times. Such transformation will enable and empower our service users to work with us clinicians in partnership. An encouraging example of the change in mindset is a recently published leaflet for patients with the title It’s ok to ask.

Our work on person-centred care and self management support is now integrating with the Scottish Transforming Outpatients Services work stream and our local acute services review. This will result in new ways of working with an emphasis on enablement and partnership.

In the face of major challenges in health and social care in Scotland I am witnessing the start of an evolution of transformation – building on the old, keeping what is working well but challenging long-held assumptions and moving forward by using small tests of change, thereby empowering and engaging service users and staff as partners in improvement.

Hans Hartung is a Health Foundation Quality Improvement Fellow and Consultant Respiratory and General Physician at NHS Ayrshire and Arran.