The key to effective services is involving those that use them

Adrian Mackenzie is the Pharmacy Clinical Lead for MAT standards at Healthcare Improvement Scotland. Before joining Healthcare Improvement Scotland, Adrian worked as a Pharmacist in Substance Use and Lead Pharmacist for Community Pharmacy in an NHS Board. Adrian now helps support the health, social care, third sector, voluntary, and justice systems implement the Medication Assisted Treatment (MAT) standards through Improvement and Implementation Support.

Reflections

Substance use related harm is closely linked to deprivation. Possilpark, Glasgow, one of the most acutely deprived areas in Scotland, is where my parent was born and the data around the prevalence of harm is a stark reminder of how different my life could have been had they not moved away. Thus, my connection to a community with the worst SIMD* 2020 health rank in Scotland provides a personal drive to ensure that all communities receive equitable care around drug related harm.
*SIMD – Scottish Index of Multiple Deprivation; a tool for identifying the places in Scotland where people are experiencing disadvantage across different aspects of their lives.

I have worked in and around community pharmacies for over 20 years, both as a pharmacy contractor representative and a service commissioner. My biggest reflection after one year in my current post is that the population’s needs are often not prioritised over service needs.

When we design services without including those who will access them, we often don't get the outcomes we hope for. It's critical to involve users, to listen to them and understand their needs, if we hope to deliver the anticipated outcomes.
Over the last year it has become clear to me that there is a need to include those with living and lived experience (LLE) into improvements in delivering community pharmacy service. This community knows first-hand about the challenges and needs of people accessing services. To come up with better solutions, we should think about different viewpoints and be aware of things like experiences of trauma and stigma.

Health and social care services are facing many challenges. There has never been a more important time to ensure we deliver our services in the most efficient way, given resource pressures around staff recruitment, budgetary pressures, and increasing demand. Designing services right the first time enables better outcomes for everybody involved.
Any engagement must be both meaningful and safe for individuals. Meaningful engagement goes beyond mere interaction and allows those with Living experience to feel that they have been heard and their views taken into account.

Safe and meaningful engagement

Safe engagement ensures that when we engage with people we consider the risk of trauma to anyone involved in the process. Safe engagement builds on existing trusted relationships and people are engaged in a way they are comfortable, with in a safe, supported and familiar environment,
My colleagues in the Community Engagement teams at Healthcare Improvement Scotland have produced some very useful guidance to support safe and meaningful engagement. Which can be found at the links below:

Why engage people in health and care?
Involving people with lived and living experience of alcohol, drug and homelessness services.

Summary and challenge

The importance of including those with living and lived experience in service improvements cannot be overstated All of us who receive care from community pharmacies each provide unique perspectives, empathy, and understanding which serve as the foundation for developing patient-focused and impactful services. By involving us throughout the design process, service commissioners can create solutions that address real needs, build trust, and reduce stigma.
Ultimately, this inclusive approach leads to better service outcomes, fosters collaboration, and enables continuous improvement in the field of service development. In doing so in our programme, we aim to contribute to reducing drug related deaths and harm.

So my challenge to you all is: How are you going to ensure that those with living and lived experience are meaningfully and safely involved in your next service improvement or review session?

Adrian MacKenzie, Healthcare Improvement Scotland