What can England learn from Scotland?

I was in Glasgow last week speaking at the annual NHS Scotland conference. I took the opportunity to meet national and local leaders to discuss areas of common concern. Three programmes of work in Scotland hold particular interest for the NHS in England.

The first is work to improve patient safety and the quality of care. Leadership is provided by Healthcare Improvement Scotland which brings together in one organisation some of the functions that in England are dispersed between the Care Quality Commission, NHS Improvement and the National Institute for Health and Care Excellence. Healthcare Improvement Scotland also houses the Scottish Health Council and is currently placing particular emphasis on supporting person-centred care and a greater voice for citizens and communities. The impressive range of work undertaken by Healthcare Improvement Scotland is outlined on its website and it has recently hosted a visit by national leaders from England keen to learn about how it operates.

The second programme is work to improve clinical care through the national clinical strategy for Scotland and the initiative of the chief medical officer on realistic medicine. The clinical strategy encompasses all aspects of health care and outlines the need for changes in where some specialist services are provided to improve outcomes. It also makes the case for hospitals to collaborate in networks to ensure greater consistency in care and to provide more opportunities for learning. This is in recognition of variations in standards of care that need to be tackled.

Realistic medicine is a core element in the strategy and is described as ‘a new clinical paradigm’ in which fully informed patients share in decisions about treatment options. Some of the thinking behind realistic medicine echoes ideas set out in a report by Al Mulley and colleagues published by the Fund in 2012 and the initiative on prudent health care being pursued in the NHS in Wales. A common strand in all of this work is recognition that medical care is overused in some circumstances, resulting in patient outcomes that are less than optimal. Realistic medicine is in its infancy but is an initiative worth following.

The third programme is work to achieve closer integration of care, including between the NHS and local government. This is being pursued through the creation of integration authorities under legal powers introduced this year which make it a requirement for health boards to work in partnership with local authorities. These arrangements build on a history of joint working and I was told that delayed transfers of care are much less of an issue in Scotland than in England because of the work already done to build bridges between health and social care. Despite this, a recent report by the Accounts Commission and the Auditor General for Scotland challenged both the Scottish government and health boards and councils to do more to realise the benefits of integrated working.

One of the paradoxes of political devolution is that it has created greater differences in how the four countries of the United Kingdom run their health services but, with limited exceptions, appears to have reduced the appetite for countries to learn from each other. At a time when innovation in how care is provided is more necessary than ever, this is a major missed opportunity, as Nick Timmins argued in a report comparing the four UK health systems in 2013. No system has a monopoly of wisdom and learning is possible in all directions, as the OECD emphasised in its report earlier this year. Now is the time to encourage greater curiosity and exchange of ideas in a spirit of learning and humility that has been crowded out by the competitive behaviours of governments of the four countries.

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