The Highland way: what can we learn from the Scottish NHS?

2016 marks 18 years for me supporting the development of leaders in the NHS. In that time I have been fortunate to learn from – and work in – a number of health care systems, including international exemplars. Notwithstanding the challenges we face in today's NHS we are still fortunate to have one of the best health care systems in the world. And as many have acknowledged before me, its people are its greatest asset.

We should also be proud of the clinical and service delivery innovation and, in parts, great leadership taking place in the NHS. Yet we tend to be reluctant to shout from the rooftops about what the NHS does well, and that means that colleagues working only a few miles away may never learn from these innovations.

The newest study tour at The King's Fund, in partnership with NHS Highland, offers an opportunity to those working in health and care around the world to learn from witnessing, first-hand, health care leadership the Highland way. This experiential tour is particularly pertinent at a time when leaders in all health and care systems are being encouraged to deliver improved work-life balance for staff in addition to enhancing patient experience, improving population health and reducing costs.

So what makes this particular part of the Scottish NHS an exemplar? One of 14 regional health boards in Scotland, NHS Highland is by its own description ‘undertaking a major transformation of health and care services within a complex and unique set of environmental factors’. The region covers 41 per cent of Scotland and has difficult terrain, many remote and rural areas, and limited transport and communications infrastructure. The leaders in this part of the world refreshingly describe themselves as a work in progress – my experience of them is that they are rather remarkable.

Returning to the Highlands last month, I was struck by the priority they give to the experience of their staff. Leaders see it as their responsibility to make NHS Highland the employer of choice in the region. A significant amount of time and resource goes into ensuring staff understand, and are proud of, their contribution to delivering safe and effective care, whether they are part of a care-at-home team or a consultant in one of the acute hospitals.

Another feature of the Highland way is the curiosity that their leaders have for what they can learn from other organisations and sectors that are held up as exemplars. You could argue that many organisations do this, but what I observe as different in the leadership team at NHS Highland is the degree of attention they give to adapting good ideas and practice to their specific patient and staff populations. I was able to accompany the chief executive Elaine Mead on a number of front-line visits, including to the employee-owned company Highland Home Carers. We met one of their care workers, Julie, who said that NHS Highland’s recognition of her potential and the time they had invested in her career development had totally transformed her life, enabling her to take up, with confidence, a role in the community delivering care to a number of older patients, who could stay in their own homes as a result. During the conversation I saw Elaine listening intently when Julie suggested that she could undertake care assessments (historically done by social workers). Later that day the suggestion was brought back to the team at NHS Highland as an idea to be adopted elsewhere in the region.

Another of my colleagues was able to witness first-hand the benefit of NHS Highland’s investment in an innovative general practice team that is seeking to respond proactively to some of the challenges of serving a rural and remote population with seasonal fluctuations. There is a care home attached to the practice and a day centre run by NHS Highland in the village. The practice employs a social worker who supports some of the most vulnerable people in the village, keeping them in their community for longer without the need for secondary care.

Looking to the future, NHS Highland has a partnership with the University of the Highlands and Islands to provide a new elective surgery care centre with general practice facilities (with expertise in sports medicine) on the new Inverness campus. The proposal includes ambitious plans for a school of health care and wellbeing to provide training for future health and care workers. So NHS Highland is leading innovation in health care in more than one way!

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Comments

#547599 Maimie Thompson
head of PR and engagement
NHS Highland

Really enjoyed your blog Vijaya. Here in Highland colleagues are really looking forward to hosting the study tour. So keen to learn and share our health and social care system, some of our culture and history. It's a stunning day today with blue skies and warm breeze but we will probably have snow by the end of the week! I do hope we can attract people north to share how we are working at transforming services and an honest discussion about why its quite a hard thing to do

#547600 Vijaya Nath
Director,Leadership Development
The King's Fund

Maimie, thank you - it's because this is so hard to achieve that your work and that of colleagues across the system in Highland stands out.
We know that putting a space between stimulus and response enables leaders to think . This tour provides stimulus, space and practical ways of leading through quality.

#547611 Cathy Balding
Director, Qualityworks PL and La Trobe University Adjunct A/Professor
Qualityworks PL

Thanks Vijaya - I have long been an admirer from afar of the Scottish NHS approach to S&Q - fits well with my philosophy and models: get the destination clear and go after it as if consumers' lives depend on it!

#547614 Badrinath
Consultant in Public Health Medicine
Suffolk County Council

Interesting initiative of learning leadership from Highlands. Although individuals are key to leadership the way systems are organised is equally relevant. I wonder how much impact the lack of purchaser provider split in Scotland helps to nurture leadership in the system where there are no organisational agendas and commissioner and provider competing with each other. In my view it is more difficult to lead the system when individual organisations have their own agendas, budgets and line of accountability!

#547625 Maimie Thompson
Head of PR and Engagement
NHS Highland

Much to discuss around leadership and systems. Sadly I doubt anyone in Scotland would claim there are no 'organisational agenda's' but there seems to be fewer with good leadership. But the move to the lead agency model in Highland was to do just than knock down barriers to drive single governance, single management and single budgets. There are still commissioning arrangements with third and independent sector where leadership across all parties is supporting positive steps. I don't think our senior leaders here would ever tell anyone anything but we are keen to share. The purchase provider model does sound incredibly challenging. Nice to have your input

#547626 Maimie Thompson
Head of PR and Engagement
NHS Highland

Much to discuss around leadership and systems. Sadly I doubt anyone in Scotland would claim there are no 'organisational agenda's' but there seems to be fewer with good leadership. But the move to the lead agency model in Highland was to do just than knock down barriers to drive single governance, single management and single budgets. There are still commissioning arrangements with third and independent sector where leadership across all parties is supporting positive steps. I don't think our senior leaders here would ever tell anyone anything but we are keen to share. The purchase provider model does sound incredibly challenging. Nice to have your input

#547629 Dr John Miller ...
Radiology
NHS H

Great work locally on the health social care dislocation. However the elephant in the room is the recruitment crisis of clinical staff due to deliberate govt policy of deafness over 20 years. Outside the bigger cities it will soon be difficult to see a GP or specialist. Scotland is not a level playing field for recruitment but according to The Times front page last week we are going to invoke emergency planning just to provide basic services. Go figure.

#547639 Debbie Sutherland
Senior Charge Nurse
NHS Highland

As a leader in NHS Highland, I see many of our staff going the extra mile, being innovative and thinking out of the box regarding the care it provides for the people it serves. Specialities are diversifying and all to the benefit of the service user. People want to be treated with care and compassion and I think we can do that.

#547665 Badrinath
Consultant in Public Health Medicine

Many thanks Maimie and I am pleased that you found my thoughts of some interest. The other issue that makes leadership challenging south of the border is the constant barrage of new initiatives which are not clearly linked either in terms of geography or what they are trying to achieve. We are likely to have combined authorities with STP boundaries at a macro level, Integrated Care System at the local level and the Government's agenda of devolution at the sub regional level. I really admire the English NHS leaders who are able to navigate the system in this myriad of initiatives some time competing ones and at the same time trying to save the NHS tens of billions of £. Good luck to them and they will need all the support they could get to maintain and improve the health service for our children and gran children.

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