Merging – or integrating – health and social care

A recent Localis report ‘Rebooting Health and Social Care Integration: An agenda for more person centred care’ includes the following insight from a former Department of Health adviser:

“If you’re flying to Singapore, but have to change airlines en route, at no point does anyone suggest the airlines merge. We put the passenger in charge and the airlines build it around them.”

The report’s author acknowledges what is clearly true: ‘a patient, service user (or passenger) doesn’t care how it all works, as long it works.’

Similarly, when people expect newcomers to ‘integrate’ into a community they join, they don’t expect them to somehow combine with existing community members. Instead, they use integration to refer to people following common norms or systems.

These analogies raise an important question for health and social care integration in Scotland. Is the best approach to ‘merge’ NHS and local authority functions, or to ensure they operate in such a way that users see a seamless service?

Above all, our focus should be on ensuring health and social care integration gives the person receiving care or treatment greater independence and control.

You can read the Localis report ‘Rebooting Health and Social Care Integration: An agenda for more person centred care’ here.

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Contributing to national discussion and debate

We’ve been asked by Andrea Pearson, a freelance journalist, to contribute to a series of articles reflecting on ‘big ideas’ in the news. The first one was published a couple of weeks ago in the Herald Business magazine. In it, Animate partner Jo adds her reflections on the idea of a Universal Basic Income to those of business leaders from across sectors. 

The concept of a Universal Basic Income is currently attracting attention. As automation concentrates wealth into smaller groups, this proposal would see taxes pay for every adult to receive an income.
On the one hand it simplifies the welfare system, frees people to work hours that suit them and
enables them to care for others. On the other hand it would cost a fortune and make work
less attractive. The Business HQ panel puts Universal Basic Income under the spotlight.

Read more…Herald Business HQ-Universal Basic Income

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Animating assets

Animating Assets was a research and learning project that explored what difference working in asset-based way made in communities and services. We were involved as part of a team brought together by the Scottish Community Development Centre and Glasgow Centre for Population Health. The project explored what being assets-based means in practice in two locations in Edinburgh and two in Glasgow. It also developed tools and frameworks to help people evaluate their practice.

As part of What Works Scotland’s series on asset-based community development, Dr Jennifer McLean, Public Health Programme Manager at the Glasgow Centre for Population Health, discusses the work further on the What Works Scotland website.

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Our role in improving health and social care

Animate partners Joette and Jo became Improvement Associates with Health Improvement Scotland last year. Here they reflect on their experiences and learning.

Health Improvement Scotland is the agency tasked with driving improvements that support the highest possible quality of care for the people of Scotland. Their Improvement Associates support local and national projects identified by HIS which help partners to achieve the nine national health and wellbeing outcomes.

The application process to become an Improvement Associate was onerous, but it really got us thinking. Not only did we have to detail our experience but we had to describe our approach to improvement, how we defined the effectiveness of our practice and what we had learned.

We are now part of a team of around 30 practitioners with various skills who are supporting health and social care integration in one way or another.  We get together every few months to hear from Health Improvement Scotland about their priorities and to share our sense of what is happening around integration across the whole which gives us an interesting oversight.

Jo is facilitating the What Matters to You Social Movement gatherings, for all those involved in person centred working and co-production, which culminate in an event for up to 250 people at the end of February. For more information go to

We are also working on a couple of projects in collaboration with Cathy Sharp. The first one is an evaluation of the Real Time/Right Time initiative which involves a few health boards in Scotland experimenting with getting and acting on feedback from patients about the care they are receiving immediately or very soon after treatment. Patients are asked directly about their care, either by a nurse on the ward or by another practitioner. We are visiting hospitals in Glasgow and Lanarkshire to find out more about how they are getting on.

The second project, which kicks off shortly, is taking us into new territory…looking at what care homes have been doing to  reduce pressure ulcers.



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Animating in Brazil: Concluding thoughts

Jo & Joette BrazilWe’re sitting in the airport having a glass of wine before getting on the plane. We said goodbye to the sisters this afternoon during a beautiful closing ritual. It is great to go home, but it is hard to leave a community we have become part of over the last 3 weeks.

New Leadership

In our last installment week we told you about how the sisters had started work on their strategic directions. Three quarters of that work had been done before they went into the election process for their new leadership team, so they had a rough idea of where they wanted to go before they decided who might lead them there. It is an unusual recruitment process. The sisters surface names themselves through a combination of prayer and discussion. All those who receive more than 5 votes get to ‘speak to their names’. Some of what we heard was sisters asking to be taken off the list – the role requires relocation and considerable international travel. It sounds glamorous but is hard, and sometimes isolating, work. After 2.5 days, a leadership team was elected through a secret ballot.

It is not an easy process; nuns are just as human as the rest of us, and it is easy for people to feel exposed or excluded. There is both anticipation and disappointment, but in the end a celebration of a team of 4 who come from 4 different countries and have 3 different first languages.

The handover ritual took place at the end of the Chapter. It was preceded by a week in which the old leadership began to step back and the new team moved into the space, gradually and in their own way.

The ritual itself symbolised the importance of the transition. It was physical as well as a mental experience including singing and dancing, and it culminated in the old leadership team putting their prayer-shawls round the shoulders of the new leadership team. It enabled the sisters both to honour and thank the old team, and to welcome the new. Nobody can deny the change has happened, as it has been made so visceral for everyone.

New structures

In religious life, strategic directions are referred to as mandates. The outgoing leadership team had a mandate to restructure the congregation, encouraging more collaboration on an international level, more decision-making at local level and ultimately a greater sense of being part of one body as opposed to being ‘siloed’ in geographical regions.

During their 6 years they have made a strong start, creating international teams and pooling finances so that they are held by and available to the whole congregation, as we described in our last blog.

The new leadership team has a mandate to develop these new structures and to strengthen a sense of responsibility and authority at all levels. There are 9 regions, each containing between 6 and 40 sisters. While each region has a leadership team, the real decision making is supposed to happen at Regional Assemblies to which all sisters are invited and which normally take place once a year. The Assemblies have a responsibility to operationalise the Chapter mandates at a regional level in a way that suits the local context. They, in turn, delegate responsibility to teams and local communities. Every 2 or 3 years Congregational Assemblies meet to take decisions about life and priorities for all sisters in the region.

Self-managing teams

In the new model, where leadership is held at many levels, the Congregation could be seen as one large self-managing team with a number of smaller self-managing teams in local areas. Leadership is dispersed across the whole system as is the aspiration in many of the organisations we are currently working with in Scotland and England.

Although this has huge potential, particularly for collaborating in the best use of resources, it also brings challenges. It makes it imperative that each sister uses the authority she is given by the Assembly to take her part in delivering on the shared purpose. In the old model everyone knew who was in charge and waited to be told what to do; now it is not always clear, and sisters need to take the initiative, and decide together on the best way forward. It requires more communication across and throughout the congregation, and ultimately greater insight into their own strengths and weaknesses.

We noticed a pattern that was familiar from other work and indeed from our own team, which was how much easier it is to think about and agree on how to act in the interests of those we serve; and how much more challenging it is to reflect on ourselves.

This is exacerbated in a group where there are such differences; of age, of nationality, appetite for change, and in priorities. Being able to truly listen to each other’s pain as well as each other’s passion was difficult at times and we struggled to support them to stay with uncertainty in the large group. As a consequence, the tension and conflict surfaced in smaller groups. It slowly became clear that their struggle was the struggle of the whole Chapter, and needed to be addressed by all, and not just a few.

Final thoughts

Spending 3 weeks working with nuns in Brazil sounded like it was going to provide a stark contrast to our normal work, and in many ways it did. Perhaps unsurprisingly, we found familiar patterns – people aren’t short on commitment and big ideas, particularly when it is about what they do for others; significant diversity means that it takes a lot of time and a deeper level of listening to define our common ground and find the best way forward; effective leadership enables others to offer their leadership, thus increasing the resources available for both thinking, and doing.

It was a luxury to have had considerable time in which to accompany them in their explorations and take their first steps into the next 6 years.  We learned a lot, both about them and about ourselves, and how we might improve our practice.

We were sure to thank them.