Briefing: Scotland’s health & care intelligence

An expert group reports on the use of data to drive forward improved patient care

Wednesday 28th August 2019

Often cited as an example of a country where various health inequalities that other small nations have managed to reduce persist, Scotland has, in recent years, received high praise for its health and care data – where patients can be tracked from cradle to grave through globally significant projects like the Aberdeen children of the 50s.

Despite being ‘awash’ with data, an expert group’s report suggests there are in fact data ‘blind spots’, particularly on care in community settings.

The Scottish Government’s preferred direction of travel is for care to be increasingly delivered in home and community settings, rather than in hospitals, and to achieve this the Sharing Intelligence for Health & Care Group recommends new nation-wide datasets be developed.

Echoing the sentiments of previous reports from organisations including Audit Scotland, the group states:

‘We believe that a greater scale and pace of change is required to ensure that people’s health and care needs are met in future.

‘There needs to be open and honest debate, locally and nationally, about the changes that are needed to sustainably deliver health and care services in Scotland that are of high quality and value, and also to more fully integrate health and social care services.’

Despite a ‘highly pressured health and care system’, recent positive hospital standardised mortality ratio statistics and reduced infant deaths are given as examples of care services that are improving in Scotland.

Co-chaired by Professor Stewart Irvine and Ann Gow, members include the Mental Welfare Commission for Scotland, NHS Education for Scotland, NHS National Services, the Scottish Public Services Ombudsman, Healthcare Improvement Scotland, the Care Inspectorate, and Audit Scotland.

‘Significant workforce challenges’ faced throughout Scotland are also touched upon, particularly consultant vacancy rates in radiology and psychiatry.

Authors say these vacancies lead to ‘fragmentation of care and frustration for patients’.

Enhanced monitoring cases refer to instances where special measures are taken to address concerns about medical education and training environments. That no new cases were initiated in 2018-19 is given as evidence in the report of the ‘positive training environments’ in operation across Scotland, in the face of the ‘very challenging issues that NHS boards are trying to address’.

Despite governance issues permeating through NHS boards and Integration Joint Boards (IJBs) – the organisations established to oversee the delivery of integrated services – the report concludes there is evidence of ‘increasingly integrated governance of health and social care services’.

An ‘unsustainable’ ‘heavy reliance’ on one-off savings is a cause for concern however:

‘They also reflect a focus on short-term actions rather than transformational change and long-term financial planning,’ the report states.

‘The financial pressures facing the NHS continue to intensify. Pressures such as drug costs, a backlog of maintenance, and the use of temporary staff are predicted to continue in future years.’

Frequent changes in senior roles are reported as another problem that services have faced in recent years. Similar to the high turnover of IJB chief executives since their inception, experts voice concerns about ‘churn’ among NHS leadership.

‘As a group we agree that building collaborative leadership and strategic capacity, while minimising the ‘churn’ in leadership teams across the health and care system, are key factors for making good progress with integrating health and social care services.’