Associate feature: Working together

As the country’s scrutiny and improvement body for health and social care, Healthcare Improvement Scotland (HIS) could not have sent a clearer signal about its commitment to the integration agenda than by appointing a social worker as its new chair.

Former Scottish Social Services Council (SSSC) chief executive Carole Wilkinson was appointed to the role in October, after a career which saw her lift the recognition of the professionalism and standards of social work as an educator, director of Housing and Social Work for Falkirk Council and implementing the regulation and registration of social services workers at SSC.

If there were any concerns that staff at Healthcare Improvement Scotland would be resistant to the appointment of such a prominent social worker, rather than someone with a healthcare background, they were quickly allayed.

Wilkinson tells Holyrood: “People have been really positive, really open. To me it said something about where HIS is in the integration agenda. That it would be good to have someone from social work.”

She describes being instantly “bowled over by the enthusiasm and commitment of the staff. And the quality of the staff” at the agency.

Wilkinson is no stranger to integration herself, describing the experience of well-established close working between health and social care services in areas like child protection, mental health and the care of older people well before current integrated systems were in place.

But social workers were not formally qualified in those early years, and Wilkinson’s career has since been one of pushing workforce development and improvement, in an attempt to get the professionalism and status of the job recognised.

When she moved into a teaching role at a college, she realised this also applied to staff right across social care.

“There were a whole load of people in social care doing very important jobs who were being neglected – home helps, people in older people’s homes, residential childcare workers, all sorts of people doing difficult, quite demanding jobs.

“Everyone was thinking, frankly, ‘it’s women’s work, it’s low paid, women can do it because women care...’ All of that I found quite difficult to tolerate.”

At SSSC Wilkinson succeeded in working with colleagues in Northern Ireland and Wales to regulate the register to include “a whole range of social care staff” which in Scotland includes the need to be qualified.

When Wilkinson retired from SSSC, her interest in workforce development was continued at NHS Scotland’s training body NHS Education for Scotland (NES), where she joined the board as a non-executive member.

“I was interested, I think, in trying to get the NHS to understand the social work and social care perspective,” she remembers. “When I applied for the board my punt in the interview was, I think the board could benefit from having people from my sort of background.”

This was helped by the appointment of another board member with a social care background, Susan-Douglas Scott, with whom Wilkinson formed an unconscious “double act” to push for greater recognition of the wider NHS workforce, not just nurses and doctors. NES now has an annual conference and training programmes for healthcare support workers.

The prevailing narrative is that integration of health and social care can be tricky because of established working cultures, but Wilkinson argues that good joint working is happening on the ground.

“Sometimes because of support and leadership, and sometimes despite it,” she adds. “Because I think if the professionals see the person in the middle, see the need, they don’t necessarily spend a lot of time arguing about ‘is it my job, is it your job’.”

Healthcare Improvement Scotland is well placed to make an impact on integration, according to Wilkinson, given its many functions including providing health and social care improvement support, inspections and reviews of hospitals and services, writing clinical guidelines, approving medicines, listening to patients and communities, and spreading innovation and improvement through its ihub service.

“I do think scrutiny and improvement sit nicely together,” she says.

“One of the exciting things about HIS is that on the improvement side we have opportunities to help and support people, through a whole range of things we do.

“We provide evidence, we provide information, all the work we do around quality improvement, it can help people see what needs to be done and they can make the improvements themselves.

“That’s not to say that in certain circumstances scrutiny doesn’t have a role where people aren’t doing things well and you need to look at that and point out to them that they are not doing the right things. You make the recommendations and you expect them to change. In a good climate people see that as an opportunity to learn and improve, and they listen to you and make the changes.”

This goes back to Wilkinson’s lifelong interest in workforce development.

“The important thing in the middle of all this is that people working in health and social care are doing very demanding and challenging jobs that are very stressful and have significant workloads.

“As workforces, they have similar needs. Doctors and nurses have to have very difficult conversations with patients, in the same way social workers have to. If you are a worker in an old people’s home you have to deal with people dying. You are working with people at the end of life. There are similar challenges and pressures.”

There is a “shared agenda” with NES, she adds, “helping to support managers and leaders to do the job that needs to be done. We need to be creating workplaces where people feel safe, where people feel wanted, where the culture is right. Because that will attract people and will encourage people to stay.”

Wilkinson recently attended the Quality Improvement Awards, organised between HIS, government and the Children and Young People Improvement Collaborative. She describes being struck by the “sensitive and caring work” done by maternity services in Tayside and the intergenerational work done where nurseries combine with old people’s homes.

“It is brilliant and it is very, very simple. It’s a good example of bringing education, social care and the NHS together,” she tells Holyrood.

“For us to be around celebrating good practice sends a message that we’re not just there to tell you when you aren’t doing it right, we’re also there to tell you when you are doing something very well.”

In her role as chair, it is clearly important to Wilkinson that the HIS board leads by example. There is an impression she has already been hands-on, working among staff in the open plan office and listening to concerns.

“People come up and chat. There’s no standing on ceremony, which I like,” she says.

“There is incredible expertise and knowledge, which is very impressive, a real commitment to developing themselves. I think that is a very good message to the outside world, you know?

“If you are going out and telling other people how to do it, there is a message in being seen to be able to do it yourself. The workforce here is a very good example of that, and that’s where I’d like the board to be.”

Indeed, improvements in board-level leadership is something Health Secretary Jeane Freeman has called for across NHS Scotland.

Healthcare Improvement Scotland’s new board members will be expected to use the same quality improvement methodology the organisation applies to those it scrutinises, which uses intelligence to build a culture of self-improvement.

“We need to be a board that people look at and say they are doing their job well,” says Wilkinson.

“Again, the message is you don’t ask your workforce, you don’t ask the NHS people you inspect or scrutinise to do things without demonstrating you are doing it yourself.”

Clearly Wilkinson feels engaging with staff has helped.

“You learn a lot from talking and listening to people, and I have to say this organisation has been very open and willing to make sure I go to meetings and things, give me the scope to do that.

“I have to say that’s not always the case. Some organisations try to reign in their chairs and non-execs. But I like to learn a lot. It makes for more informed board discussions. You get one perspective in a paper, but you may well have spoken to a group of staff who have talked to you about that piece of work and you have a much broader feel for it.”

Holyrood points out she sounds like a social worker, learning from the people she is working with to inform her decisions.

“I went to the new members of staff induction day. It was great. I’ve now decided all new board members will go to that,” she smiles.

Healthcare Improvement Scotland “still has some work to do” to be recognised in social care circles, says Wilkinson, but the approach of putting the person in the centre and humanising them can be the key to integration, she suggests.

“Both sides need to find more ways to come together and recognise their strengths. If you put people in the middle, they are not healthcare people or social care people. They are people. People who need services.”