Consultation on the Draft Regulations relating to the Public Bodies (Joint Working) (Scotland) Act 2014 (Set 1 of 2)

ANNEX 3(A)

PROPOSALS FOR REGULATIONS PRESCRIBING FUNCTIONS THAT MAY OR THAT MUST BE DELEGATED BY A HEALTH BOARD UNDER THE PUBLIC BODIES (JOINT WORKING) (SCOTLAND) ACT 2014 (Section 1(6) & 1(8))

CONSULTATION PAPER

The proposed Regulations prescribe those functions of a Health Board that may be delegated under an Integration Scheme, and those functions of a Health Board that must be delegated under an Integration Scheme .

Schedule 1 sets out all healthcare functions that may be delegated.

The functions which must be delegated under an Integration Scheme are those functions listed in Schedule 1 but only to the extent that they are exercised in relation to healthcare services.

This approach takes account of the fact that healthcare functions are defined very broadly under legislation. By setting out which healthcare services must be included within the integrated arrangement, the regulations provide the specificity that Scottish Ministers believe is necessary to ensure that integration is delivered consistently and at appropriate scale across Scotland.

Healthcare services that must be integrated

These regulations set out that a Health Board must delegate all of its functions as they relate to adult primary and community health services, along with a proportion of hospital sector provision, to support whole system re-design in favour of preventative and anticipatory care in communities. This approach builds upon work in Community Health Partnerships (CHPs); all services already within the scope of CHP arrangements must be delegated to Integration Authorities.

A narrative description of the services listed in Schedule 2, i.e. the healthcare services that must be integrated, is provided in the table that accompanies this introduction, below.

Healthcare services that may be integrated

Healthcare functions in the "may" category include any adult services that do not fall within the "must" category, and children's healthcare services (in each case, with the proviso that the service in question is not precluded from the integrated arrangement by the regulations).

Some aspects of healthcare functions need to be included in the "must" list in order to deliver the policy intention of integration, which nonetheless cannot readily be included for practical reasons.

For example, non-cash limited expenditure on pharmaceutical services is not currently disaggregated below Health Board level. As a result, unless the Integration Authority is coterminous with the Health Board, it is not currently possible to identify the resources for these services that are used by local populations, and it would be unreasonable for these Regulations to require their delegation under an Integration Scheme. Similar challenges apply to General Dental Services and General Ophthalmic Services.

Where this is the case, we have included within the "must" list those services that can be disaggregated to individual Integration Authority areas, and which we believe should be part of the integrated arrangement. Services that cannot be disaggregated at this time are on the "may" list so that they may be included at local discretion when data allowing disaggregation becomes available in due course. In time, we anticipate that modifications to these aspects of the Regulations may be required, to keep pace with integration locally.

Healthcare services that may not be integrated

Those functions of a Health Board that are considered unsuitable for delegation under an Integration Scheme relate to matters such as the provision of regional and national health services, education and research facilities of Health Boards, and some specific duties such as the registration of health professionals.

Hospital functions and budgets, and operational delivery within hospitals

With specific reference to hospital functions and budgets that must be delegated to Integration Authorities, Scottish Ministers intend that Regulations should ensure that the following objectives are achieved:

• The emergency care pathway must be included within the scope of integrated strategic planning, as part of whole system redesign in favour of preventative and anticipatory care;

• It will be important to assure a single system vision for integrated strategic planning, built particularly around the needs of patients and service users with multimorbidity;

• It will be important to enable effective commissioning of acute services across different Integration Authorities within a single Health Board area, to facilitate effective, efficient deployment of NHS resources.

In terms of hospital provision, the focus is therefore on including unscheduled hospital care within the scope of integrated strategic planning, which is the responsibility of the Integration Authority. The approach requires that specialities that exhibit a predominance of unplanned bed day use for adults are included as a minimum.

In terms of operational management within hospitals for these services, the legislation provides flexibility for local decisions that are appropriate to local circumstances. While some aspects of hospital activity and expenditure must be included within integrated strategic planning, as noted above, it is our expectation that in many cases day-to-day operational management of hospital services will remain within Health Board hospital management arrangements, with close working arrangements in place between the Chief Officer and the hospital sector to assure congruence between operational delivery and services set out in the Strategic Plan.

Table: Health services that must be included within integration

This table lists services that must be included within the scope of integrated strategic planning, as part of whole system redesign in favour of preventative and anticipatory care in communities.

In each case, integration must include all adult provision; inclusion of children's services in integrated arrangements is left to the discretion of local partners. Additional services covered by the list of functions that may be included in integration can, of course, also be delegated locally.

Note that, where "patient's home" is referred to as a place where a service is delivered, this includes care homes.