These commentaries by John Macgill represent his opinions only and not those of any Ettrickburn client.

Medicines shortage – a new prescription for an old problem

Ettrickburn commentary - Labour's plans to radically shake-up the pharma industry (part 2)

Ettrickburn commentary - Labour's plans to radically shake-up the pharma industry (part 1)

Cost of medicines falling

Three Nations Three Practices

Community Pharmacy Eliminating Hepatitis C

Homeless People make Glasgow

Heart Failure – we can get treatment right for everyone

Bundles of Safety

Community Pharmacy’s Leader in Scotland

CPO: On the Road to Achieving Excellence

Pharmacy technicians may become prescribers

Profile: Dr Norman Lannigan OBE

Profile: Jonathan Burton MBE

Profile: Clare Morrison MBE

Deep Dive Pharmacy

Mind the Gap - Diagnostic Skills for Pharamacists

Bundles of Safety

Supporting Excellence - Alison Strath Interview

2018 Pharmacy Forum Agenda Launched

Which Referendum to Choose

Three Perspectives on Pharmacy and Mental Health

Pharmacy and the New GP Contract

Bordering on Problematic

Recognised by the Queen and her community

VACANCY Reporter/Researcher: Health and Care Policy in Scotland

Prescribing in Mental Illness – A Practice Pharmacist’s Perspective

What Matters to You? Communication in Pharmacy

Prescribing in Mental Illness – A Patient’s Perspective

Focusing the Vision: Dr Rose Marie Parr on the new strategy for Scottish pharmacy

All the things that could go wrong - looking ahead to the SNP conference

Ask Once, Get Help Fast? Pharmacy and Mental Health

Automation and Delegation in Pharmacy: Understanding the Moving Parts

Pharmacy First in Forth Valley One Year On

Initiatives Highlight Potential of Community Pharmacy

Trying to concentrate on the day job

Health and the Local Elections – a strange silence

The Pharmacist Will See You Now – The Growth of GP Pharmacy

Montgomery’s Review – Dr Brian Montgomery answers questions on access to new medicines in Scotland

An afternoon with SMC

Pharmacists at SMC

SMC – are drug firms voting with their feet?

Radical Surgery on the Horizon for Scotland’s NHS

The Future’s Bright – in General Practice

Community Pharmacy in a Changing Environment

Disclosing payments to doctors – has Sir Malcolm done the pharma industry a favour?

Health and Care in the First Minister’s Programme for Government

CMO: Scotland’s pharmacists “absolutely ideally placed” to practice Realistic Medicine

Profile: Maree Todd – MSP and Pharmacist

Scottish Parliament Health Committee Work Programme

Scotland’s new NHS – a Summer of Speculation

Scotland’s New Health Committee

Two million voices in Scotland – is integration the big opportunity to listen?

Medicines – levelling the playing field

Key appointment raises the bar for health & social care partnerships

What did our new MSPs do before?

SMC says no then NICE says yes – three times

SNP promises single formulary and a review of Scotland’s NHS

More Generous than the CDF – but less transparent

Comparison of Funds: New Medicines v Cancer Drugs

Bonfire of the Boards? SNP signals NHS Review

A tribute to five retiring MSPs

New Medicines Review - Health Committee sends findings to Government

Medicines New & Old in the Scottish Cancer Strategy

Great Ambitions, Slow Progress – New Models of Care in Scotland

Scottish Minsters Demand Up-Front Medicine Price Negotiation

Opportunity and Disappointment: MSPs Investigate New Medicines Access

Scottish NHS Strategy calls for 'Realistic Medicine'

The Scottish Model of Value for Medicines: Taking Everything into Consideration

When SMC Says No: An Access to Medicines Lottery

Reviewing the Review: Access to New Medicines in Scotland

A day of psephology and kidology

Insulting the Lifesavers

Worthy of Mention – Health and Science in the Honours List

News Silence from North of the Border

A Christmas PPRS Present from Pharma

Tuesday, June 7, 2016: Two million voices in Scotland – is integration the big opportunity to listen?

Has Scotland missed an enormous opportunity to have the expertise of some of the 2 million voices of users feed into the DNA of the new Health and Social Care Integrated Joint Boards?

In common, it appears, with most of Scotland’s national and local politicians, I had accepted that the obligation to have one Third Sector member, one carer member and one service user member on each of the new boards ensures the voice of the ‘customer’ is built into the new structure.

That was until I listened to Dr Oliver Escobar at the 2016 ALLIANCE conference, talking about two of the ALLIANCE’s five ’Provocations for the Future of Health and Social Care’: courageous leadership and ceding power.

Oliver Escobar is Co-Director of What Works Scotland, an ESRC and Scottish Government-funded programme that works alongside fellow academics, government, the NHS and the third sector to use research and evidence better when decisions are made about public services and policy.

As already touched upon by Oliver’s colleague, Claire Bynner, in her blog on the event[i], there is a real opportunity to democratize health and social care through the involvement of citizens in the governance of Integrated Joint Boards.

Through their consultations to help inform their strategic plans, the new organisations have taken care to listen to the views of citizens. But has the template they have been given, by the legislation, allowed them the opportunity to enjoy the full insight of Scotland’s 2 Million Experts when deciding how to spend their £8 billion of resources?

Oliver Escobar warned the conference that too many decisions seem already to have been made; that the framework of people and assumptions that is already in place will mean the new landscape will actually be very similar to that which has gone before.

He suggests that courageous leadership and ceding power are about trusting people in the design of services.

“Instead of an individualist take on leadership, we need to look at leaders as facilitators to make difficult conversations happen. Leadership is about following the experience of people using services. It is very dangerous to have heroic individuals as leaders. Courageous leadership is about collaboration.”

Oliver warns that each manager in the new integrated health and social care landscape is inheriting groups of staff and resources. As a result, decisions will be driven – perfectly legitimately – by the interests of these people. Can you really expect, he says, the head of a service to cut their staff and move towards a new social economic model or social enterprise model to deliver their work?

“The question,” says Oliver, “is how to help these decision makers and the answer is to give the 2 million experts a permanent platform. Difficult decisions need to be made and those making the decisions are currently trapped in a system that prevents them using evidence better and hearing the voices of the users.”

Oliver says ceding and sharing power beyond just consulting people has been done elsewhere. He cited the experience of Australia’s second biggest city in answer to the question from a delegate: ‘how can people be listened to when the government say it has no money?’

“We need to rethink how we make decisions. In Melbourne, faced with a whole range of local challenges, the way they made their decisions was to delegate the work of redesigning to a randomly selected group of citizens set up to reflect the population mix of the city.

“This was no small consultation. This was about redesigned for the future: drawing up a five-billion-dollar plan for the next ten years.

“The group put forward 21 recommendations of which 19 were accepted. It worked because the group started without preconceived ideas.”[ii]

And Oliver Escobar says the way we move into the integrated world of health and social care here needs to be invigorated by more of Scotland’s 2 Million Expert Voices:

“We have a lack of local democracy that is slowing progress. We need to focus on making sure we reach the citizens who are seldom involved in the decision making. We need a radical change in our approach.

“Ceding power means sharing power and creating new sources of power.”


[i] Claire Bynner blog:

[ii] For more on the Melbourne People’s Panel read The Age newspaper commentary at: