Is a sustainable health and social care system in Dumfries and Galloway possible? by Viv Gration

We’ve all seen and heard the stories on the news and are experiencing first hand for ourselves that health and social care services are under pressure. The whole health and care system is struggling to cope with increasing demand and stretched resources. So what can we do to try and help this situation? How can we find sustainability within health and social care services in Dumfries and Galloway?

At the moment when I think about the health and social care system I see a beat up old 1940s car that has been overloaded, it has been patched up and repaired, a roof rack has been added (for extra capacity) and it is limping along trying hard to keep up with the modern world. When things reach this stage it’s surely time to re-evaluate what is needed and consider changing our mode of transport to a modern, efficient and reliable car that has the technology to make our journey easier. Or perhaps re-evaluation will lead us to a different way to travel altogether – a train, an aeroplane, a bicycle, on foot, or even stop travelling at all – it’s important that we are open to all potential alternative options.


This year, we will celebrate 70 years of the NHS (established in post war Britain 1948). The primary model of care is the same today as it was in 1948 remaining relatively unchanged through the decades. The King’s Fund’s video ‘Sam’s Story’ describes this ‘old’ model of care well .

Reviewing what we do, working together with partners and stakeholders to find new ways to deliver care and support will help us to adapt to the current and future demands on services. The single fact that applies to all organisations is their ability to survive depends on their ability to change and adapt to the environment in which they operate. For example:

Shopping –

There has been a major shift, even in the last 5 years, in the way that people shop. Shopping habits have been influenced greatly by the internet and the most successful organisations have responded to the change in how people want to shop.

Most of the major supermarkets have recognised the preferences of a large number of people to order food online and have it delivered. In September 2017 it was reported that 35% of UK shoppers now use the internet for their grocery shopping. But there is also change in the way people do their grocery shopping in store. Just last month Amazon opened their first grocery store Amazon Go, but it is not at all a traditional store –there are no checkouts, no queues and no people to take payment from you, just use the app to enter the store and pick up what you need, and go!

Banking –

Technology is also playing a major role in changing the banking sector. From 2007 to 2017 the number of people regularly accessing online banking services doubled. The banks with branches still on the high street have also changed to have more technology within the branch and there are even examples of banks promoting training in technology for their customers – we’re sure many of you have seen the adverts on TV for Barclays Digital Eagles.

Considering new technology is just one way to affect change and it is important. But there are a range of things we can think about and do to progress towards sustainability. Let’s understand what people need and want from the health and social care system, what good outcomes are, what we do well, what practice we should expand and promote, what we should stop doing and what we should do differently. By having conversations like this within teams, with the people who use services and with partners across the whole system we will be able to find new ways of working that will take us closer to an adaptable and sustainable system.

The new Service Planning Framework has been developed to help us have a consistent approach to these conversations and approaches. It sets out six essential planning principles and suggests a range of potential actions to help teams to do this.

Viv 1

Using the Service Planning Framework will help us to have a consistent approach to:
Understanding the balance of resource and capacity, anticipate future requirements and plan for this
Ensuring that service delivery is up to date and in line with evidence of effectiveness and best practice guidance
Ensuring that service is comparable with other areas in terms of quality, activity, outcomes, costs etc
Identifying actual or potential gaps in need, service delivery
Generating alternative options/ service models (eg. partnerships with other providers, third sector, independent sector)


So we’re suggesting that we all invest time to think about what we can do to change/transform our models of delivery to become an adaptable, more efficient, modern and ultimately sustainable system.

Service Planning Framework


To answer our initial question about whether sustainable services are possible in Dumfries and Galloway, we suggest they are. But it is going to take some time and effort, working together across the whole system to adapt to the environment we are working in. No doubt services will look and feel different and that is what is needed to become sustainable.

“No transformation of great scale occurs without innovation, hard work and significant change – or disrupting the norm” Chief Executive of General Motor, Canada.

Viv Gration, Strategic Planning & Commissioning Manager
Linda Owen, Strategic Planning & Commissioning Manager
Chris Fyles, TEC Project Team Lead

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