My name is Ruth Glassborow and I’m the director of Improvement Support and the iHub at Healthcare Improvement Scotland.
Healthcare Improvement Scotland is a national organization in Scotland with the aim of driving improvement across health and social care services. So my role as director is really around setting the strategic direction, particularly with the increase in the elderly population, the increase in long term conditions. How do we redesign care across health and social care services that would enable people to live independently and well for as long as possible, so that it’s joined up, is integrated, it meets people’s needs and we do the right thing first time, in the right way, with the right people?
I usually start work between half six and half seven. I get in early so I can actually do my emails and get on with some of the report writing, because usually the rest of my day is spent in back to back meetings, either internally, with my own staff, or all externally, with individuals working in the service, largely at senior level, or meetings with our commissioners, who are the Scottish government, and a lot of the discussions are focused around: What’s the nature of the support we’re going to provide to the system, particularly at the moment, with the current really challenging financial context? So how are we in terms of the offerings we make, how are we going to focus them in a way that helps get cash savings out of the system but also improves outcomes for individual patients? And a lot of the discussions internally are just around providing practical coaching and support and advice to my staff, around problem solving on day to day issues. We have some of the most creative staff anywhere in the world – and I say that because people find amazingly creative ways to work in a broken system and still deliver high quality care. And that’s my frustration as a manager. The needs of our populations have changed but we haven’t redesigned those systems to meet those changing needs, and to me that’s part of what we’re about. It’s how do we make sure that everyone working in the NHS, clinicians and managers, has the skills, not just to do the job, but has the skills and ability to improve the job.
I eat my lunch at my desk which I know is not brilliant and I go home too late. So I’m often home about seven, so that can be twelve, thirteen hour days out of the house, but I love what I do, so I’m not tired. I’m told that I work at an amazing pace, but I love it, so I find what I do very energising, and I think, if I didn’t, it would be very different, but I’m very lucky to have a job I love.
I’d be lost without my PA, Rachel. She just keeps me organised and points me in the right direction as I run from the back to back meetings, and I am so fortunate with my direct reports and I rely on them enormously, and both that ability to sit down and have a chat, but also the fact that they’ll challenge me, and I really appreciate that, because it’s been a couple of times, when I’ve been going in absolutely the wrong direction, and they’ve said to me “Well, wait a minute, Ruth, is that really the right thing to be doing here?”, and I think there’s not enough of that in the NHS, there’s not enough upward challenge. Too many folk just passively go along with things, even when they know that, actually, the individual is heading for the edge of a cliff, and I think there are many reasons for that culturally, because I don’t think we tend to reward challenge, I think, people who challenge even from best intent. We tend to categorise them as these resistors to change, who are stopping things from happening, when often, I think, the challenge will come from a good place and it’s about understanding what that challenge is about. So I think we have a culture in the NHS really of suppressing challenge.
I’m lucky living in Scotland. I’m surrounded by so much beautiful countryside that, for me, actually just getting out regularly and walking and talking and spending time with close friends. I’m not somebody who’s a mad party go-er or nightclub go-er, for me there’s nothing nicer than an evening curled up, in front of a fire, with a couple of very close friends, just being together.
Where I live, I’m on the outskirts of Dunfermline and we’re, we’re quite close to a, a wood, and I love to go – particularly now that the nights are drawing out of an evening – myself and my partner will just, it’s about an hour’s stroll round, we’ll go and walk in the wood. We’ve learnt now to have the waterproof trousers and all of the waterproofs, because we were not going out if it was raining. So it doesn’t matter what the weather is, it doesn’t stop us from going out and having that walk and that talk. When you’re walking with someone, the talking just seems so much deeper. I think there’s something about the being side to side, and the walking process, that you just end up having these amazing conversations when you come back, and however much you didn’t want to go out, you, I always come back and say “I am so pleased we went for that walk, it was really worth it.” It really helps me with managing the stress and the anxiety of the job, being out with nature, walking, talking and having that sense of an expansive surrounding.
I grew up in Oxford. My mother was a mental health OT, so from a very young age I was used to hanging around occupational therapy departments on psychiatric units. It’s a great place when you’re sick as a child, because I got to do all kinds of pottery and creative artwork whilst I was off ill, but I would say the benefit of it for me was it familiarised me with that environment, and I’ve always felt incredibly comfortable being in psychiatric hospitals and being in that type of environment, because it harks back to my childhood.
I did my degree in maths and I thought my vocational calling was to teach maths. My dad was a, was a maths teacher, but I saw the pressure that he was under, I saw the pressure that all of his friends were under, a number of them had nervous breakdowns and retired from teaching early. And I decided it was too stressful a career so I decided to go into NHS management instead, which, in hindsight, I think is an interesting decision, because I think NHS management is probably as stressful, if not more so, than teaching. And then I got into mental health and that’s where I spent the next fifteen years and I loved it. I was a general manager for mental health services, for drug and alcohol services, for learning disability services, and I just loved the job and then eventually I moved up to Scotland and then made what, for me, was a very difficult choice: to come out of that mental health focus and take a role that was focused far more on health care in the, in its entirety.
I always say that if you can manage mental health, you can manage in any bit of the health care system, because of the complexities of it, and I hope I’ve proved that. But then the lovely thing for me has been with the integration of health and social care, it feels like I’ve come back home again, because I’m now sitting around again with social workers, with housing, with the third sector, and again it’s become much more important, about how we empower people to look after their own health and well being. How we make sure that everything we do is person-centred, how we move from an approach that is primarily a medical model to one that combines the medical, the psychological, and the social aspects. So everything I was doing twenty years ago in mental health has now become the thing that we’re doing across the whole health and social care system.
The thing I enjoy most about my job is that opportunity to make a difference for the people who are receiving health and social care services. I’m absolutely passionate about the NHS. I love it as a concept. I believe in it, thoroughly, health care free at the point of delivery, and I think we are so fortunate to have the system we have in Scotland, and I love having that opportunity to influence the design and delivery of care services, it’s a real privilege to be able to do that.