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November 18, 2015

Look to Alaska

Ever since the Christie Commission reported its findings in 2011, those responsible for our public services have had a common purpose – to rethink and reshape a system of public services that is fit for purpose, affordable and capable of delivering better outcomes. Easy enough to say, but clearly, judging by results, much harder to achieve. Which is why, when we see real-life examples of transformational change in a public service, we should do more than show a passing interest.


Dr Margaret Hannah


To see full report by Dr Margaret Hannah click here

This is a note of my six day visit to Southcentral Foundation (SCF) healthcare system in Alaska. SCF is a remarkable healthcare organisation. It operates within the US healthcare system, with federal government financing, to meet the health needs of Alaskan Natives – a group with high levels of drug and alcohol dependency, high rates of depression and suicide, domestic and other abuse compared to the US average. Yet over 15 years it has achieved remarkable improvements in population health at significantly lower cost for similar populations elsewhere – and is attracting international attention for its success.

I was one of a small team of four health practitioners from Fife, Scotland introduced to SCF last summer and invited to Alaska to experience SCF in practice, to attend and present at a two day conference exploring and developing their model of care, and to undertake the three day Core Concepts training given to all SCF staff embodying the core competencies that underpin their model of care.


The “Nuka System of Care” is the name given to the whole healthcare system created, managed and owned by Alaska Native people to achieve physical, mental, emotional and spiritual wellness. Nuka is an Alaska Native word used for strong, giant structures and living things. The bare bones of the model, its structures and underlying principles can be gleaned from the SCF website at and are reproduced in the appendix at the back of this report. It reads like a vision statement, a utopian ideal that we have often conjured with in our ‘blue skies’ moments but rejected as wildly idealistic and impossible to achieve.

But in Alaska we experienced the system as reality and were given every support to realise it now in our own context, here in Scotland. I can say that for the four of us who went, the experience was transformative. We discovered that it is indeed possible to manage a healthcare system to promote the physical, mental, emotional and spiritual wellness of the population; to do so by combining western medical expertise with the wisdom of our common humanity; to provide such a service at less cost and with far better outcomes than our existing model; and to start – even now, within ourexisting organisations and structures – from Nuka’s simply stated truth that “good quality relationships equal healthy people”.

What follows is a brief and inevitably partial record of my time in Alaska – written in order to encourage others to explore this model in more detail. If anyone is interested to learn more, please get in touch: my colleagues and I would be very happy to talk to you. We also want to broaden and strengthen the web of relationships between health services in Scotland and SCF. And we are committed to one day being able to invite visitors to our own part of the world – to see Fife Nuka in action, inspired by the model the following pages describe.