Scotland’s ambition to deliver fully integrated health and social care services is at risk due to leadership gaps, cultural misalignment, and a failure to scale successful innovations, a new report from UWS warns.

The Cultures and Leadership for Integration (CLI) in Health and Social Care: Navigating to Successful Change report, led by Professor Stephen Gibb, highlights the challenges that are stopping Scotland from delivering better health and wellbeing.

The findings call for urgent leadership reform, a shift in organisational cultures, and a more outcomes-driven approach.

 Key Findings:

·      A lack of distributed leadership, particularly in middle management, is hindering effective integration.

·      Cultural barriers between NHS, local authorities, and third-sector organisations continue to block meaningful collaboration.

·      Performance measures are overly focused on immediate outputs instead of sustained improvements in health and wellbeing.

·      While successful local integration projects exist, there is little infrastructure to expand them nationwide.

·      The report introduces eight key ‘navigators’ to guide integration: Cultures, Belonging, Headspace, Mindsets, Outcomes, Leadership, Learning & Development, and X Factors.

Professor Stephen Gibb, lead author of the report, stresses that without immediate action, Scotland’s integrated care ambitions risk stagnation:

Scotland’s health and social care system has the potential to be a world leader in integration, but leadership challenges and cultural barriers are holding us back. We need to move beyond policies and strategies that talk about integration and instead build the structures, leadership, and cultural conditions that make it a reality.

 

The report also proposes the establishment of a National Advisory Board to drive systemwide improvements and ensure consistent, high-quality care across Scotland. 

Previous efforts to navigate change through a National Care Service faltered, leaving Scotland at a crossroads. Rather than revisiting past approaches, this report shifts the focus to what can be done now - building on the current landscape to implement practical, achievable reforms. The newly established National Advisory Board is positioned to play a crucial role in overcoming leadership and cultural barriers, turning ambition into action.

“We believe that fostering the right cultures and leadership at every level of the system is key to achieving truly integrated health and social care,” said Professor Gibb. 

“This report provides a clear direction for policymakers, healthcare leaders, and frontline staff to create sustainable, people centred change, but only if we take decisive action now.”

The Cultures and Leadership for Integration in Health and Social Care: Navigating to Successful Change report is now available here.

 

Professor Gibb's report aligns with several United Nations Sustainable Development Goals (UNSDGs), particularly Goal 3: Good Health and Well-being, by advocating for a more effective, integrated health and social care system that improves long-term outcomes. It also connects with Goal 10: Reduced Inequalities, as the report highlights disparities in access to quality care and the need for leadership and cultural shifts to ensure equitable services. Additionally, Goal 16: Peace, Justice, and Strong Institutions is relevant, given the emphasis on governance, leadership reform, and systemwide accountability to drive meaningful change.