People will always be at the heart of our health and social care system

Many challenges overcome but new ones lie ahead, writes Carole Wilkinson

Every opportunity, every challenge, every need, every complexity within our health and social care system in Scotland has one important thing in common: people. At the heart of every new advance and every solution required for every issue, people are right at the front and centre, whether they are the ones who deliver or support care, or are themselves in need of it.

I recently took on the position of chair at Healthcare Improvement Scotland and was instantly struck by the sheer breadth of work that we are involved in. One organisation with many purposes, our role is to support better quality health and social care for everyone in Scotland.

We do this in different ways: our ihub’s improvement work, our quality assurance inspections and reviews, the person-centred agenda that we promote in health and social care settings, or the evidence that we analyse and present that supports care and the development of services. But fundamentally, it’s people who make it all tick.

Having been a social worker and also held management positions within social care organisations, I’ve seen at first-hand the committed, caring and hard-working people all across the country looking to do their best for people. Within Healthcare Improvement Scotland, I can see enthusiastic, hard-working and knowledgeable people who are keen to embrace the agenda of bringing health and social care closer together for the benefit of the people of Scotland.

The opportunity that we have is not only exciting, but vitally important.

As we all live longer, the population will have more complex care needs requiring greater healthcare support to take place in the community. If hospital care is required then we need to make sure that it’s effective and efficient, that it delivers what’s needed, and that people can make a smooth transition back to their homes with the support they require in place.

But it’s not just about older people; our increasing understanding of the role of mental health in all people in our society, for example, is another area where receiving the right care in the right location at the right time can make a massive difference.

Let’s not forget that greater integration of health and social care services also makes perfect sense in terms of sharing learning from both sectors. As work forces, health and social care have similar needs and experiences. Doctors and nurses need to have very difficult conversations with patients, in the same way social workers do. A worker in a care home may have ‘end of life’ care to deliver. Both have similar challenges and pressures, whether in big and busy urban hospitals or delivering care in smaller or rural communities – so there’s a need to provide better support in all

the areas of health and social care. But we should not think that we are at the early stages of implementing these ideas. We’ve been making solid progress for some time. I’ve experienced successful integration in many areas: for example, the wellestablished close working between health and social care services in areas like child protection and mental health, and in the systems for the care of older people that were established well before current integrated systems. Challenges have already been overcome, but there are still new ones ahead.

If real change is to take place, a supportive and open culture is necessary. Our organisation brings together improvementworkalongsideinspections and reviews, and I think both areimportant. Ontheimprovement side we have opportunities to help and support people through a wide range of programmes.

In certain circumstances scrutiny has a key role where care is not being well delivered, and there’s a need to point that out as a catalyst for change. In a positive climate, people will see this as an opportunity to learn and improve, and they will listen and make the necessary changes. The desire to apportion blame to an individual or the service can get in the way of real learning and growth.

We are more likely to be successful in all our goals when we remember that at the heart of every complex system and convoluted problem are real people, both delivering care and needing care.

In my role as chair, I hope I can play a role in ensuring this is something we don’t forget. Carole Wilkinson, chair of the Healthcare Improvement Scotland