How Scotland can foster an integrated health and social care system – Commentary by Justene Ewing

We have seen the bravery of doctors, nurses and caregivers as they work on the frontline of a pandemic that has claimed the lives of over 150,000 people in the UK.

However, Covid has also revealed the desperate need for a restart in a system that is feeling the strain and a depleted workforce. This reboot must be centered on a people-centred approach to system redesign, enabled by technology and spanning across health care and social services.

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I have worked in healthcare in both the public and private sectors for a decade. I was responsible for digital transformation at NHS24, where I implemented new strategies, including new clinical and digital services for patients, clinicians and healthcare providers.

Health and care systems need to tap into our ever-expanding gold mine of data, says Ms Ewing (file image). Photo: Getty Images/iStockphoto.

I created the Scottish Government’s innovation hub, the Digital Health and Care Institute, which sought to develop partnerships in areas where collaboration could be challenging.

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As Managing Director, I led as a facilitator to understand the issues, enabling partnership working, testing and implementing digital solutions in a thoughtful way. Health innovations introduced by the organization included avoiding unnecessary colonoscopies by using a pillcam to take images as it moved through the digestive system.

Above all, I learned that Scotland has enormous capacity in the public, private and academic sectors. Combined, they can be a powerful force for change by focusing on outcomes for the patient or service user, the workforce, the system, and the economy.

Four years ago, I joined CGI, a values-driven, global IT, systems integration and business consulting firm. We are trusted to deliver ambitious, complex and sensitive transformation programs in 40 countries.

I have seen financial services, retail, education, transport, cybersecurity and energy transform significantly to meet changing needs, address important challenges and enshrine innovation and sustainability at the heart of organizations.

We can do the same for health and care. But this challenge is not new. In 2006, Sir David Varney set up a review looking at how government used technology to deliver services to the public. She drew two main conclusions: IT services need to be designed around the “citizen”, and there needs to be an increased culture of shared services. Service transformation and value for the public purse were at the heart of the report.

In 2011, the Christie Commission reported on the future delivery of Scottish public services. Among its findings were recommendations to build services around people and communities, and that organizations should work together more effectively, including by providing integrated services to ensure improved well-being and reduced inequities in health.


Yet here we are in 2021 with the same problems, now exacerbated by Covid-19. Yes, it is vital to “keep the lights on”. But it’s also essential that we build a system fit for purpose and create the time and space to ensure that transformation happens.

The top priority is to end the current system of working in silos. Patients and service users have to tell their story several times to several people. An integrated and comprehensive approach to service redesign, starting with the person in their own home and activating in the community, offers the possibility for meaningful improvement.

Health and care systems must also tap into our ever-expanding data goldmine. The use of health apps is booming. People are downloading them on Apple Watches and iPads, and Fitbits have been introduced to young and old alike.

Homes are smarter – smart meters are provided free of charge and establish connectivity regardless of financial status. They support the ability to determine home lifestyles and whether someone is living in fuel poverty.

Yet health, care, unpaid, voluntary and third sector professionals have an active role in supporting vulnerable people, but no way to share data. Similarly, wellness, primary care, acute care, dentistry, and pharmacy cannot easily share full visibility of a person’s data and information so that we can make better decisions and improve outcomes.


We are losing a golden opportunity to do things differently at a time when the need for change has never been greater.

I saw this first hand. My 18-year-old son Kieran’s first job was as a home health aide. He came home fully recovered in his first week after learning how to safely remove and clean catheters and reinsert new ones. He oversaw medication adherence, personal hygiene, and food consumption.

But he wouldn’t be allowed to do a routine blood pressure check using a digital cuff, take a blood prick to check diabetic sugars, or check a wet wound for tears. A community nurse or GP should come out, often requiring no intervention.

Unlike the health profession, there is no career path for caregivers. We do not have nursing practitioners (although speaking to a colleague at National Education Scotland I am delighted to hear this is now being considered). We need to understand the role data and technology play to enable them properly while reducing the administrative burden on our staff to allow more hands-on time to deliver better clinical and care outcomes.

Private companies like CGI can be part of it. We can help and strengthen the public sector rather than take away services and responsibilities. We are ready to answer a call to arms.

Scotland has one of the most innovative digital economies, top universities and a talented health and care workforce. Let’s start working together now for a better tomorrow.

Justene Ewing, Vice President, Health and Care for CGI UK

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About Shirley L. Kreger

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