Creating a healthier Scotland - What matters to you

A Responsive and Seamless Journey of Care

The need for more accessible and flexible services was raised a lot. You want to see the right person at a convenient time and place, and you would like more focus on earlier intervention and diagnosis. The length of time it can take to get appointments, and the need for a consistent service regardless of where you live were frequently mentioned. Your first point of contact does not always need to be with a GP and you recognise that other professionals can help you too. Information technology (IT) offers scope for greater flexibility although it is not for everyone.

You prefer accessing services in your local community, although you recognise this is not always possible. Accessible and affordable transport to services is important and can have a big Affect on your experience.

We heard about the need for joined up care and better partnership working, communication within and between services, and information sharing. The level of duplication you face when telling your story can be frustrating. So is trying to find out what is available in your local area and what support you are entitled to. An easier way of signposting people to relevant information and support, in an individualised way, is needed.

You told us that an important part of your care journey is getting support when you need it, but also getting access to services much earlier, before there was a crisis or an emergency. Unpaid carers in particular raised the need for earlier contact with social work staff. You also told us that people with additional support needs - including people with physical or learning disabilities and autistic spectrum disorders - would benefit from earlier diagnosis.

"One thing that was particularly important to a lot of people is the fact that the NHS is there when needed and that there are no barriers to access especially when it comes to emergency care."
NHS Borders response

"I'd like to know that wide and varied health and care systems are there when I need them - whatever it may be for."
Alliance, Citizen Wellbeing Assembly, Edinburgh

"…booking online would reduce the time and stress of having to call first thing in the morning to compete for an appointment."
Stirling Carers' Voice event

"When services offer open and flexible appointment times it can reduce the pressure on carers. This is particularly true when the carer needs an appointment for themselves."
Stirling Carers' Voice event

Whilst some people could see their GPs on the day they asked, many of you were unhappy with the length of time it took to get an appointment, particularly if you wanted to see a specific doctor. Long waiting lists to see specialists was another issue, with many comments about delays in accessing mental health support. While there was usually recognition of increasing demand for services and the impact that has on waiting lists, you also reported a lack of communication about how long you would need to wait and what other support was available in the meantime.

You told us you want more flexible services, with appointments that fit in with your lives, including work and caring commitments. Extended opening hours, including evening and weekends, would prevent you having to take time off work for your own appointments or for the people you look after. Other suggestions included booking appointments or ordering repeat prescriptions online, emailing staff, drop-in sessions allowing you to see a health professional other than your doctors, using computers or smart phones for online services such as Skype consultations. These were highlighted as ways to take the pressure off primary care, reduce physical access issues and support self-management.

While there was general support for eHealth development, some were worried that this could exacerbate inequalities, as not everyone has access to technology or the internet, or the skills to use them. We also heard that some people have a preference for face to face contact.

There was interest in a move towards more multi-disciplinary care. Although your first point of contact with health services is normally your GP, you told us that it didn't need to be, and that you had received really good care from other professionals including nurses, pharmacists, community link workers and Allied Health Professionals (AHPs). We heard from AHPs including physiotherapists and occupational therapists who talked about how they could take the pressure off GPs and prevent people from losing their independence or developing long-term conditions. Accessing support for multiple issues in one place, was suggested as a way to reduce the need for multiple appointments in different locations.

"More support is needed for co-morbidity patients who have enormous challenges trying to manage their care and treatments. We need more person-centred care and a more holistic approach."
Facebook comment

"A greater role for physiotherapy in primary care offers an immediate solution, reducing the pressure on GPs and making savings in secondary care."
The Chartered Society of Physiotherapy Scotland response

"There is a need to define the workforce and ensure sustainable services that are increasingly multi-disciplinary, evidence based and pathway led with a focus on outcomes and age appropriate care."
Children and Young People Health Support Group response

You want equal access to services no matter where you live. You complained about 'postcode lotteries' affecting standards of care, the availability of cancer drugs and portability of social care packages between local authorities.

"There was a perception that there is a difference in availability and range of social care services depending on where people live, with less choice in more rural areas."
Health Improvement Scotland staff event

"In order to ensure equal access to services provided by GPs, there needs to be a more unified approach taken. It is unfair that some patients are able to access an appointment quickly, receive a high standard of care and if necessary be referred on to further care in a timely fashion, whereas some do not have access to this level of service."
Scottish Women's Convention consultation response

"People recognise that small communities can't provide all of the services and there'll be a need to go 'off island'."
Alliance event, Stornoway

"Poor transport links make getting to the GP practice, the out-of-hours services and the hospital difficult."
Blog post about Motherwell Link up event

Many comments indicated a preference for locally-based services within the community. You acknowledged that while locally-based services were not always possible, there should be more choice and greater focus on the transport to get people to regionalised centres. In general, you said transport could be a barrier to accessing services, particularly for those living in rural or remote areas of Scotland, but also those living in urban areas who relied on public transport.

"At its heart, health and social care integration is about ensuring that those who use services get the right care and support whatever their needs, at any point in their care journey."
Caring for our carers - blog post by Carers Scotland

"…healthcare and social care need to dovetail seamlessly but that doesn't mean they are one and the same thing."
Inclusion Scotland response

Many of you suggested that services need to be more joined up and properly integrated. There was some awareness of the current integration of health and social care services in Scotland. Others who were less aware identified many issues which integration is designed to address going forward.

Common issues included the need for better partnership working, communication within and between services, information sharing (particularly the need for joined up IT systems) and tackling delays in discharging people from hospital back to their homes. The transition between child and adult services was also highlighted as an area that needs to be better supported.

Linking to the issues raised in the section on Person-Centred Care, it's important to you that everyone involved in your care is well-informed about your needs, particularly for people with more than one condition. You suggested that joined up IT systems would avoid duplication in assessment and the issue of people having to tell their story multiple times.

"We need to resolve issues of IT systems not being compatible - both health and social care need to be able to access relevant information."
Patient Focus and Public Involvement event, NHS Ayrshire and Arran

"There should be multi-disciplinary meetings in surgeries every week to share information."
Coalition of Carers in Scotland, Hawick

Some of you shared experiences of leaving hospital and other care settings, and felt that the lack of joined up care meant that some people are falling between health and social care services. You gave examples of where a lack of planning had resulted in delayed discharges or people being sent home without the appropriate package of care in place. Delays could be caused by a number of practical or administrative reasons, for example medication, transport, home adaptations and social care provision.

"Transition from hospital to home - discharge planning and integration between health and social care needs to be smoother, quicker and more resources readily available."
Milan Social Welfare Council event

"There's not enough tie-up between the ambulance service, social workers and doctors when you're leaving hospital. Cooperation could reduce costs."
Alliance event, Clackmannanshire

There were many comments about the difficulties of finding your way through the different services available across health and social care. In particular you identified a lack of awareness of what support was available in your communities. You said staff should have better knowledge about what support is available, or at least the ability to point people towards someone who does. You highlighted how a single source of information like a one stop shop or a link worker could help you find the service you needed or would benefit from. Information doesn't always have to be given in a health or social care setting, some of you would like to get information in community hubs, hairdressers, libraries, shops, supermarkets and workplaces. Pharmacies were highlighted as places where this is already happening, but needs better promotion.

"There should be automatic signposting and proactive support to help you access services."
Alliance event, Borders

"The carers' centre is a lifeline but many professionals are not making carers aware of the service."
Coalition of Carers in Scotland event, Peebles

DID YOU KNOW?

• The integration of health and social care services is the most important reform to healthcare in Scotland since the foundation of the NHS in 1948. It is about ensuring that those who use services get the right care and support whatever their needs, at any point in their care journey. It will end the distinction between health services and social care services and focus instead on planning and delivering person-centred, high quality integrated care.
• A Primary Care Digital Services Fund is in place to support wider uptake of on-line GP appointment booking.
• Care Information Scotland (CIS) is a phone, webchat and website service providing information about care services for people living in Scotland. See more at www.careinfoscotland.scot