Have you ever wondered what healthcare leadership and management was like in another country? As medical leaders we can learn plenty from the established healthcare models in Australia, Singapore, Sweden, the United States and Scotland. Hold on just a minute; did I say Scotland? Yes indeed. Contrary to the prevailing hysteria in London, Scotland is still actually attached to England, and you don’t even need a visa to visit (just a warm coat). Working on the principle of “who dares, wins”, three of the National Medical Director’s Clinical Fellows set off on the red-eye to Edinburgh to find out how things are done “Up North”.
To understand any healthcare system, it’s important to have a bit of context. The NHS in Scotland is completely devolved, with responsibility for financing and running services residing within the Scottish Government. The budget assigned to the NHS in Scotland is in the order of £12 billion, for a population of 5.3 million (which is comparatively more generous than the £96 billion allocated to the populous of 53 million in England).
During our two-day visit we were hosted by Dr Mike Winter, Medical Director of Procurement, Commissioning and Facilities at NHS National Services Scotland (NSS). We were also joined by the two inaugural Scottish Clinical Leadership Fellows, who have been in post since January 2014. A packed agenda gave us insights into commissioning, public health, adverse incident management and procurement (this session should receive special mention for actually being incredibly interesting, which apparently is not an oxymoron).
On reflection, we were totally abashed at our lack of knowledge of a healthcare system that exists a stones throw across an imaginary border (unless, unlike the Barbarians, you count Hadrian’s wall). This was especially startling to our group of clinical fellows, some of whom have made great efforts to understand the nuances of healthcare systems on the other side of the Atlantic.
What really struck us during our visit was how integrated the system was. The delivery of healthcare in Scotland has been the responsibility of the 14 territorial and 7 special NHS boards since 2004, and the turmoil of the Health and Social Care Act in England has left Scottish healthcare waters untroubled. Granted, the population is smaller, and the supporting structures and organisations are smaller as a result (it certainly appeared to help that a number of different healthcare organisation teams were based on an integrated site in Gyle). However, what made the organisations we met seem nimble and forward facing was the networks of people they had established. Members of the team from commissioning, procurement and public health knew each other’s roles, their limitations, and how they could support each other to see the bigger picture.
This focus on the importance of working together extends to patients and their families too: the “Future for NHS Scotland – 2020 Vision” aims to deliver “fully integrated health and social care with a focus of keeping people out of hospital and in their own home or community as much as possible.”
As we approach the first anniversary of the Health and Social Care Act in England, and the creation of NHS England and Clinical Commissioning Groups, we can learn a lot from Scotland’s focus on integration for the benefit of patients. Breaking down organisational barriers can be challenging, but the rewards are well worth the effort.
Links: www.nhsnss.org
