Providing care in the most appropriate setting

Managing patients with long-term or chronic conditions is one of the biggest challenges facing the NHS and collaboration between health and social care has great potential in this regard. The College supports the ‘Should you go to A&E?’ campaign and calls for this to go further by promoting co-production (equal participation in deciding on treatment options between clinician and patient), as meeting patient preferences and delivering care in the most appropriate setting improves patient outcomes.

It is important that, where appropriate, patients are treated in a community setting and are empowered to be active participants in their own care where possible, and that patients fit for hospital discharge can do so safely without delay. It is essential to ensure that consultants and other members of multidisciplinary teams (MDT) have adequate time for patients with long-term or chronic conditions to promote patients’ understanding of their own care, and for patients to have improved access to specialist nursing care. It is important to ensure that people are able to access the most appropriate care for their needs. For example, mental health crises are better dealt with by mental health services and not A&E and it is important that people are directed to the most appropriate service. Although dealing with a single disease, COVID-19 hubs have performed well in keeping patients out of A&E and should be reviewed to ascertain what can be learned from these.

An important part of providing high quality patient care is ensuring that patients are well informed and have accurate expectations of their treatment and care: effective and compassionate communication with patients will remain a key priority for the College. We work closely with our Lay Advisory Committee, which is a valued and highly respected part of the College governance framework, in developing our policy positions at all levels. 

Integration Joint Boards (IJBs)

IJBs are a key part of the framework to integrate health and social care in Scotland. The College has called for health and social care integration in Scotland to be made simpler in order to avoid confusion around roles and responsibilities, and to make accountability clearer, particularly when there is service failure. The College asks the Scottish Government to implement the recommendations of the report Integration in a diverse health and social care system: how effective are Integration Joint Boards? to ensure that IJBs are operating efficiently and effectively.

The College’s Quality Governance Collaborative is an independent, neutral, non-governmental body which brings together multi-professional groups and develops national and international collaborations which aim to highlight issues and improve the practice of quality governance. The Collaborative would welcome the opportunity to work further with the Scottish Government and NHS Scotland to explore leadership and governance issues and how to address them.

We welcome ambitions to improve how the NHS and the care sector operate, however it is essential that this is delivered in a person-centred and integrated way, while recognising the distinct and sometimes separate challenges within the NHS and the care sector. The creation of a National Care Service, we believe, will provide new challenges as to how – and what type of – care is delivered, and it is vital that people can continue to have choice over the type of care they receive in Scotland, as opposed to a ‘one size fits all’ approach. We are interested to understand how this will affect the work of IJBs, and are calling for clarity around this.