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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.