“Civil Servants could employ a greater emotional range” 
By: Scot Gov Health, Justice Collaboration
Tags: Collaboration, Justice, Government, Improvement, Health

“Civil Servants could employ a greater emotional range” 

Paul Gray has been the Scottish Government’s Director-General for Health and Social Care and Chief Executive of NHS Scotland since December 2013. Paul joined the then Scottish Office in 1979. For the last 18 months he has been joint chair of the Health and Justice Collaboration Board. He spoke to our team this week.

Paul Gray (above) retires on 15 February 2019

Paul, you have been in post for just over five years. A huge amount has been achieved and a lot has changed in that time. But do the NHS and the Scottish Government feel any different today than they did five years ago?

I think the context around our work is more complex than it was when I came into post. For instance, since the vote on EU exit, we have gone to great lengths, both at Ministerial level and across the NHS leadership, to demonstrate that we welcome the people from the EU — and beyond — who have come to Scotland to work in the NHS and in wider care provision, and that we value their contribution very highly. We have also been very forthright on how people are treated in our workplaces as individuals. We have been crystal clear that we will not tolerate any behaviour which amounts to bullying or harassment. This is also something Ministers have been very strong on. And we’ve also continued to make strides in terms of patient safety and the quality of care we provide.

We’re perhaps more aware than ever that the outcomes we are trying to achieve have many and complex causes. How does that affect how we think about these problems?

There’s no magic bullet. If you want to get to grips with inequalities from you have to be collaborative: leaders and organisations must work together more effectively. It’s also clear that you have to have communities designing the solutions to the issues they face. There is no place any more for top down solutions imposed on people and communities. If you want local change it has to be done locally.

Is there a contradiction between that approach and the stories we tell about governmental and Ministerial accountability?

I don’t think there is a contradiction there. There is still a strong role for government to take action to improve people’s health on a population level — a smoking ban in public places, minimum unit pricing, for example. That’s not in conflict with engaging local communities to design solutions to the issues faced in localities.

Much collaborative working occurs on the ground — between nurses, police officers and firefighters, doctors, social workers. What’s the role for leaders of organisations in that space?

There is a great deal we can do as leaders. We can be clear about the outcomes we want to see, we can create an authorising environment which helps them work together, we can address the barriers that prevent collaboration, we can resource, advise, support their work, and help them share best practice.

You’ve often visited frontline police officers over the last 18 months as part of the Health and Justice Collaboration work. What have you learned from those conversations?

I’ve learned a great deal. I’ve learned that the reality on the ground is often very different than you perceive it to be, and how valuable that lived experience of dealing with problems at first hand can be. I’ve learned how utterly committed police officers are to improving the well-being and outcomes of the people they serve.

I’ve also seen that police officers take data and information very seriously indeed. They’ve presented me with very thorough data analysis of how their services work and what the opportunities are to improve them. I’ve also learned that police officers can be very forthright in presenting that evidence!

Do you think we might not be forthright enough in the civil service?

I think, perhaps… perhaps civil servants could employ a greater emotional range. We say we are just “content” when we are absolutely delighted and that we are “concerned” when we mean something is just terrible. Perhaps we could be more authentic in that regard?

What’s stopping us from doing that?

There can be a tendency to behave as people expect us to as civil servants. There is obviously absolutely no place for bad behaviour, and it’s essential to understand and respect the feelings of others. But we do need to be genuine, and just be truthful. Sometimes that can mean drawing attention to good things we are doing as much as being truthful about things that are not going well. We shouldn’t feel self-conscious about just telling the truth.

For instance, if the police officers I met hadn’t presented me with their evidence, I wouldn’t know how long on average police officers spend in A&E, which is something which is informing our work around distress.

You’ve also spoken about the importance of kindness in public services. Where do very human, personal values like that fit into a policy context?

Oh, my interest in that is not based on sentimentality or emotion. There is a clear evidence base that goes back to 1964 (and probably much further) that shows that if people experience kindness and compassion in healthcare their outcomes improve.

You’re retiring at the end of this week. Do you have any personal advice for Malcolm Wright, who is stepping into your role on an interim basis?

It’s a role in public life in which you can at times feel very exposed, and where the public — quite rightly — expect a great deal from you. So it’s important to look after yourself. I don’t mean put yourself first, but to make sure you remain healthy and resilient and protect your wellbeing. Actually, I think that Malcolm’s already far better at that than I am!

And what’s next for you?

Well, I’m intending to devote more time to my family and my church, but beyond that I have no hard and fast plans. I’ll take a few weeks off. There may be some possible public service roles, but they are quite rightly offered through open competition, so I shall have to wait and see. There are also things that some individuals and organisations have asked me to help them with, so I’m not going to disappear from public service any time soon, that is unless the public decide they have had enough of me!

The Health and Justice Collaboration Improvement Board

Strong collaborative working is a key part of creating public services that are preventative and person-centred. Across health and social care and justice this can be critical in how we respond to health inequalities and reoffending.

The Health and Justice Collaboration Improvement Board, made up of senior leaders from Scottish health and justice agencies, has been established to explore how we can improve collaboration between health and justice and deliver benefits to people using services.

The Board meets quarterly and focuses on three main priorities of Distress, Forensic Services for victims of sexual offences and Health and Social Care in Prisons. If you would like to know more about the Board, visit

or get in touch with the team, ScotGovHealthJustice@gov.scot @sghealthjustice