Reflecting on our learning and developing the ihub’s offering

Over 46,000 more Anticipatory Care Plans available for staff to view electronically when someone is admitted to hospital which is an increase from 4.5% to 5.3% of population covered - Read more


Even in the first year of integration, progress has already been seen in changing the shape of frontline health and social care services. However, at the heart of continuous quality improvement is a philosophy of acting, reflecting, learning and then adjusting our actions in response to that learning. Therefore, during 2016–2017, we worked closely with a range of stakeholders to better understand their key needs for improvement support and from this identified a number of additional offerings under each of our four core aims which we will develop over 2017–2018.

To support services to better understand their local opportunities for improvement, the ihub will:

  • work in partnership with NSS’ Information Services Division (ISD) to support our delivery partners to access and use comparative data to better understand their key opportunities for improvement.
  • work with the Improvement Service to jointly develop the Public Services Improvement Framework self-assessment tool for application across Integration Authorities. As part of this, we will develop a self-assessment tool that enables organisations to evaluate their current capacity and capability to carry out quality improvement work.
  • work in partnership with ISD to develop simulation modelling tools to support health and social care partners to assess the potential impact of system redesign changes.

To assist in the design of better processes, services and systems of care, the ihub will:

  • develop our website as a “one stop shop” providing an easily accessible source of information to support the work of redesigning models and pathways of care.
  • work with national and delivery partners to design and deliver a range of resources that support delivery partners to apply design and improvement methodologies to the work of redesigning services.
  • develop a co-production toolkit for workforce, communities, people accessing services, clinicians and social work leaders, establishing strong links with co-production agendas, the Alliance and the Scottish Health Council.

In providing practical support for implementing improvements, the ihub will:

  • support delivery partners to develop systematic approaches to developing theknowledge, skills, capacity and cultures that enable sustainable improvement.
  • work with other national improvement organisations to further develop our approaches to identifying and scaling up improvement.
  • work with partners to maximise new approaches to market facilitation and procurement in supporting improvement.

To support services and systems to evaluate the impact of their changes and spread the learning, the ihub will:

  • test approaches to using clinical, care and personal outcomes data to better understand the impact of services and changes.
  • work with the Scottish Health Council to ensure the experiences of individuals accessing care is embedded into approaches to evaluating impact.
  • support work to develop a better understanding of the financial benefits of improving quality.
  • undertake work to develop a systematic approach in Scotland to sharing learning about what works in delivering improvement and applying or adapting that learning into different contexts. In doing this, we will draw on our learning from the last 9 years leading the Scottish Patient Safety Programme. To ensure this is both accessible and meaningful, we will test approaches to producing topic-specific evidence and learning summaries which combine the learning from doing the work in Scotland within diverse local contexts with the wider evidence internationally.

Constantly learning and adapting the ihub’s offerings to a fast changing context

The above set of priorities for development were agreed in March 2017. However, the current pace of change means we need to be responsive to emerging issues and constantly reviewing the relevance and focus of our offerings. To inform our thinking we recently commissioned a survey of the experiences of those leading integration at a local level with the aim of understanding the factors that have enabled and hindered the work of integrating health and social care over the last year. The full report of the findings from the survey is included as an addendum to this report: The Challenges and Learning in Transforming Health and Social Care during 2016–2017. There may be value going forward in repeating this type of exercise with the leaders of NHS boards and Local Authorities.

As part of this survey we asked about their experience of the ihub. Twelve Chief Officers responded to the question on their experience of the ihub. Eight (66%) rated their experience as either ‘satisfied’ or ‘very satisfied’ and four gave a non-committal response suggesting they had had less contact with the ihub. None rated any overall dissatisfaction. There were some positive messages and also some suggestions for how the ihub could strengthen its approach, such as in cultivating a more universal language of improvement.

In exploring the priority in relation to support from the ihub going forward, Chief Officers are clear that this must be practical in nature. They need ‘on the ground’ support and extra capacity in improvement and redesign. Intelligence about what works was also seen to be a priority. Moreover, in creating a new health and social care landscape, Chief Officers and their teams are keen to share and learn from others who have already addressed these issues.

This survey also highlights a number of areas where further work is needed nationally, including the following.

  • There is a clear need for systems level organisational development support that is able to bridge the IJB, the NHS board and the Local Authority and address the systemic and relational issues that can create barriers to collaboration. At present, a number of national organisations are providing aspects of this, including some limited support available from the ihub. Some systems are appropriately contracting directly for this input, although the risk is that those most in need of it are the least likely to bring it in. There is a need for a more co-ordinated national support offering focused on addressing the systemic and relational issues that can create barriers to collaboration.
  • Systems need support to better understand their current capacity for improvement, make an assessment of what they need and then develop plans to bridge any gaps. The ihub is progressing work in 2017–2018 to develop an approach to assessing quality improvement infrastructures. However, whilst quality improvement capacity is a necessary part of the conditions for system wide improvement, there are a wider range of factors that also need to be in place including leadership capacity and capability.
  • Health and Social Care Partnerships, NHS boards and Local Authorities are all experiencing significant challenges to focusing on longer term outcomes and costs due to the pressing financial issues. This is creating a situation where there are significant risks that short term actions to balance budgets in one year will build increasing financial pressures in the future.

Whilst the ihub has a role in supporting the health and social care system on aspects of the above challenges, they all require a wider system response. With this in mind, we will continue to deliver interventions in a manner that ‘works with’ rather than ‘does to’ with the aim of building local improvement capacity. Over time, this will become more self-sustaining and achieve all our collective goals of better quality health and social care for everyone in Scotland. We will also continue to work with other national organisations to ensure a co-ordinated national improvement support offering that is focused on the priority issues for delivering better health and wellbeing outcomes for people in Scotland.