Experience of Scotland
Scotland (United Kingdom)
Healthcare system in Scotland
Health and social care are devolved issues in the United Kingdom. Healthcare in Scotland is mainly provided by Scotland’s public health services, NHS Scotland. It provides healthcare to all permanent residents free at the point of need and paid from general taxation.
In April 2016, Scotland’s healthcare system became an integrated service under the management of Health and Social Care Partnerships; the new joint working arrangements in place between Local Authorities and NHS Boards to improve co-ordination of health and social care in Scotland.
Integrated care in Scotland
Integrated care focuses on improving services in relation to access, quality, user satisfaction and efficiency. The aim is to enable better coordinated, joined-up and more continuous care, resulting in improved patient experience whilst achieving greater efficiency and value from health and social care delivery systems. For more information http://www.gov.scot/Topics/Health/Policy/Health-Social-Care-Integration
Self-assessment in Scotland
Reflecting the Scotland’s ambitions in integrated care, a diverse profile of stakeholders were invited to participate in the self-assessment process, ranging from the representatives of healthcare, social care, voluntary and housing sectors at national and local level. All stakeholders were invited to complete the online self-assessment survey to provide their individual perceptions on the progress of integrated care in Scotland, using SCIROCCO tool.
The outcomes of these individual surveys were captured in the form of spider diagrams, highlighting Scotland’ strengths and weaknesses in integrated care. As the spider diagrams below illustrate the involvement of the multi-disciplinary team in the assessment process implies the different views of stakeholders on the maturity of healthcare system for integrated care. Particularly striking is the difference between the perspective of policy makers and local health and social care partnerships in Scotland.
The outcomes of the self-assessment survey provided the basis for the discussion of stakeholders with an objective to reach the consensus on the current state of art in integrated care in Scotland. The spider diagrams reflect the diversity of perceptions of local stakeholder and the consensus that was reached at the workshop. The most challenging areas to reach the consensus are the Governance, Population approach and Citizen empowerment. In contrast, there is relatively common perception of Scotland’s progress in the area of eHealth services, Standardisation and Evaluation.
The outcomes of the self-assessment process also highlighted the strengths and weakness of Scotland in integrated care. The domains with the highest scoring include Readiness to change, Breadth of ambition and Innovation management. This is demonstrated by the clear strategic direction in Scotland, legal framework for integration and very extensive innovation landscape that is increasingly considering better ways of procurement and adoption.
In contrast, the areas of eHealth services, Funding and Population approach remain to be a challenge in Scotland. Although eHealth services are starting to be used in some localities, there is no overarching infrastructure for integrated care and there is lack of funding to support integration. The Population health becomes a policy priority but it is not clear yet whether this will take an integration-focused point of view.
Scotland’s experience in using SCIROCCO tool
- “The SCIROCCO tool helps with what is the reality across the piece. The tool is not an end in itself.
It’s about developing a more dynamic, learning system. You can go with naturally occurring teams, of whatever size and composition and levels and disciplines.
It’s about how does [integrated care] sit within a bigger context.
It’s about involving others whether at an oversight level or a granular level.”
- The SCIROCCO tool helps you to do your own ‘internal audit’. It enables you to think about any gaps that exist [in the system]. …
It’s not like some other standard questionnaire that you fill in, and don’t then give it another thought day-to-day.”
- “It’s good to identify some dimensions where there is some feeling that they are not as mature.
It’s about sense-checking for the health and care partnerships – which was quite a stretch. This for me is the real value!
We’ve got the legislation in Scotland, but how is it that we’re actually working?”