Tony Duncan

Change of Direction – from Military to Health and Social Care Strategy

Tony Duncan (a Class of 1983 FP) enjoyed his time in the school cadet contingent and went on to join the army in October 1985. In a military career that spanned 33 years, he served in many locations across the world including Hong Kong, Germany, Cyprus, France as well as in the UK. Operational service took him to Northern Ireland, Bosnia, Kosovo, Iraq, Cyprus (with the United Nations) and routine visits to Afghanistan. Tony retired as a Brigadier and among many highlights, he identifies serving as Commanding Officer of the Queen’s Own Gurkha Logistic Regiment as his finest achievement.

Leaving his regiment in 2008, Tony joined the General Staff and developed his military career further with roles in Headquarters Army and the Army Personnel Centre. Following attendance at the Royal College of Defence Studies in London, he served as the UK 1* senior national representative in the French NATO Rapid Reaction Corps in Lille before starting his final role in the military, as Head of Strategy at the Directorate of Defence Communications based in the Ministry of Defence, London. It was during this time that Tony decided to leave the service early, change career and return home to Scotland. He looked for a role that would allow him to utilise the skills and experience that he had gained from his time in the military. In January 2019, he was appointed Interim Head of Strategic Planning for Edinburgh’s Health and Social Care Partnership and soon afterwards accepted a permanent contract.

His first task on joining the Partnership was to assess the Integration Joint Board’s strategic priorities and produce a new strategy working towards the delivery of a sustainable and trusted health and social care system for the City of Edinburgh. Tony designed this new strategy around ENDS, WAYS and MEANS and at the heart of this new strategy is an ambitious and wide-ranging transformation programme, built on three key elements. Defining a new Edinburgh Health and Social Care Offer (The Pact), which seeks to optimise alignment between public expectation and realistic delivery of health and social care services in Edinburgh. It aims to form a modern pact between care providers and people in receipt of care, by working alongside formal health and social care agencies, as well as other partners within communities, to build genuine collaborations which support people and communities through co-production.

The Three Conversations approach is a model that is gaining traction in several local authorities across the UK. It seeks to move away from the conventional approach to care which triages people, requires completion of unwieldy documents, involves hand offs and presumes the need for formal services. This approach provides three clear and precise ways of interacting with people that focus on what matters to them: Conversation 1: Listen and Connect, Conversation 2: Work intensively with people in crisis and Conversation 3: Build a good life. And, Home First Edinburgh, a model which seeks to embrace the national strategy of shifting the balance of care from acute hospital settings to home or a homely setting within the community. Delivered through prevention of admission or early supported discharge from hospital, which includes improved collaboration between social care and hospital staffs.

In the first year of implementing the new strategy, Tony and his team have made good progress despite the significant impact of the Covid-19 pandemic. As lockdown began his team redeployed to support the Covid-19 response. In the early stages Tony recalls that “the pressure was on to increase flow in the system to create space in hospitals and to source appropriate Personal Protection Equipment – it was full on, requiring long hours and commitment from all staff”. He further reflected “reacting to the pandemic and navigating through these unchartered waters has tested everyone. At a time when so much activity was forced to stop in society, within the health and social care sector, activity increased markedly. Those on the new front line deserve our utmost respect – and with this I must include my youngest daughter who is an NHS midwife”.

In early April, Tony established a ‘lessons learned’ exercise to capture the thoughts and experiences of staff and managers. Several themes emerged, not least the importance, flexibility and reliability of technology. The exercise concluded in July and Tony provided some initial thoughts in his video blog (bit.ly/34z7DG3) released at that time. Lessons continue to be captured at local and national level and post Covid-19, whenever that comes, things will certainly not all return to where they were.

Tony, like so many others, has been working from home since the initial lockdown at the end of March and the signs are this will continue for some time yet. He draws some similarities from previous operational tours in the military in terms of being confined and the importance of setting routine “establishing a work rhythm is essential, particularly when in this case your home becomes your office. The risk is that you are tied to your desk, with minimal downtime, there isn’t the normal time associated with travel to and from the office, movement between meetings and locations and of course interaction with colleagues in passing”.

Looking forward, Tony expects that “the use of technology in the provision of health and social care, and in general ways of working, will accelerate and become common place. Managing the effects of Covid-19 will most likely be part of our day to day lives for some time to come and with it, managing the inevitable mid to longer term consequences. It is a unique and challenging time to be involved in the development of health and social care strategy”.