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Integration of health and social care


Health Secretary Nicola Sturgeon today set out the Scottish Government's plan to integrate adult health and social care.

The moves aim to improve the quality and consistency of care for older people and put an end to the 'cost-shunting' between the NHS and local authorities that too often ends up with older people being delayed in hospital longer than they should be and not getting the best standards of care.

On a visit to officially open Barrhead's Health and Care Centre, Ms Sturgeon confirmed that, following a period of engagement with stakeholders over the summer, the government had decided not to create a new statutory organisation separate from the NHS and local authorities which could create further barriers to integration.

Instead legislation will be introduced to Parliament and will herald a radical reform of Community Health Partnerships.

Key elements of the new system will be:

  • Community Health Partnerships will be replaced by Health and Social Care Partnerships, which will be the joint responsibility of the NHS and local authority, and will work in partnership with the third and independent sectors
  • Partnerships will be accountable to Ministers, leaders of local authorities and the public for delivering new nationally agreed outcomes. These will initially focus on improving older people's care and are set to include measures such as reducing delayed discharges, reducing unplanned admissions to hospital and increasing the number of older people who live in their own home rather than a care home or hospital
  • NHS Boards and local authorities will be required to produce integrated budgets for older people's services to bring an end to the 'cost-shunting' that currently exists
  • The role of clinicians and social care professionals in the planning of services for older people will be strengthened
  • A smaller proportion of resources - money and staff - will be directed towards institutional care and more resources will be invested in community provision. This will mean creating new or different job opportunities in the community. This is in line with the commitment to support people to stay at home or in another homely setting, as independent as possible, for as long as possible. The Change Fund for older people's services is already helping to deliver these improvements

Ms Sturgeon said:

"These changes represent the radical reform that is badly needed to improve care for older people, and to make better use of the substantial resources that we commit to adult health and social care.

"We are keen to avoid the pitfalls that can accompany centrally directed, large-scale structural reorganisation and staff transfer. Evidence from elsewhere is that changes in structures and staffing arrangements work best when designed and agreed locally, to suit the needs of local patients, service users and carers such as the work already underway in Highland.

"Our approach has started with the key questions about what matters most to people who use these services - what are the improvements they want to see and what are the barriers in the current system that prevent staff from using their skills and resources to best effect.

"We are trying to improve health and social care, consistently, for older people in all parts of the country. That is why a cornerstone of our reform will be nationally agreed outcomes that all local partnerships will be required to deliver.

"We will tackle the barriers that currently exist within Community Health Partnerships - division of accountability between the NHS and local authorities, insufficient and often unequal delegation of authority, budgets that are not integrated, leading to decisions about older peoples' care too often being dependent on whose budget is affected, and poor clinical engagement.

"Our reforms will deliver a system that is effectively integrated, leading to better outcomes for older people and better use of resources.

"We will now work with partners in the NHS, local government, the third and independent sectors and professional bodies to develop detailed consultation material for public discussion and scrutiny."

Cllr Douglas Yates, COSLA's spokesperson for Health and Well-being, said:

"A few months ago, COSLA prepared a manifesto on public sector reform which stressed that we had to build public services that were focused on delivering the best outcomes for people across Scotland. In the time that has past since then, we have been working closely with the Scottish Government to support this type of outcomes-based reform in respect of health and social care services.

"It is widely known that we need NHS health care to knit together more tightly with local government run social care services and the work that we have been considering with the Scottish Government attempts to achieve that. While we are still in the early stages of that discussion - with much of the detail still to be ironed out - our view on the general parameters of reform are similar. We welcome the approach taken so far and look forward to continuing to work with the Scottish Government to shape a positive agenda going forward, beginning with the Deputy First Minister's appearance at the COSLA Convention later this month."

Chair of the Expert Group on Future Options for Social Care Sir John Arbuthnott said:

"I am pleased to welcome the measures announced today by the Cabinet Secretary for Health, Wellbeing and Cities to improve the care of older people in Scotland. These lay the foundations for an integrated approach by local authorities and health boards.

"The measures that will be set in legislation will require reformed CHPs under a single accountable officer to use integrated budgets to deliver specified outcomes. The accountable Minister will be the Cabinet Secretary for Health, Wellbeing and Cities. This new approach deals with the major issues that reflect my extensive experience in the West of Scotland and the research done recently by the Expert Group."

The Health and Social Care Partnerships will be jointly accountable to the NHS and local authorities. The partnerships will also be accountable to the Cabinet Secretary for Health, the leader of the local authority and the public for the delivery of the nationally agreed outcomes which will focus initially on improving older people's care and will be included in the Single Outcome Agreements. A single, jointly appointed, senior accountable officer in each Partnership will ensure that partners' joint objectives are delivered.

Within this broad framework, local leaders can decide upon delivery mechanisms and structures that best suit local needs and priorities. Partnerships can continue to choose to delegate functions, budgets and responsibility for some aspects of service delivery if there is local agreement to do so, as in the type of lead agency arrangement being implemented in Highland.

These reforms will take place within the context of public service reform more widely, and in tandem with Ministers' commitment to the Concordat with local government and to the central role of community planning in delivering successful local services. "Integration" is about improving people's experience of the whole system of health and social care, and public services more widely. Housing services, for example, play a particularly important role in sustaining the independence and wellbeing of older people.

The Cabinet Secretary set out her plans for the future of health and social care provision on a visit to officially open Barrhead's Health and Care Centre. The facility is a partnership venture between NHS Greater Glasgow and Clyde and East Renfrewshire Council. The building is jointly owned by the two organisations. The joint building which will provide health and community services from under one roof has been developed alongside the successful Community Health and Care Partnership. The CHCP is one of only a few partnerships in Scotland which manage local authority social care services and local NHS services within a single structure.