Single Authority Models: Publication on Progress

Draft Initial Proposals

Draft proposals reflect the unique challenges and opportunities associated with rural and islands geography and demography. Each proposal reflects local leaders’ efforts to consider simplifying and strengthening local governance of key public services as a means to more effectively and efficiently address key local priorities and delivery outcomes.

While proposed models vary, each seeks to simplify and strengthen local governance arrangements as the primary means to better enable effective local decision-making. Partners agree – as do Ministers and COSLA – that this approach can help make best possible use of the total resource available across sectors, now and for future generations. It also will lead to greater involvement of local people, building trust and giving communities real agency over those issues which they understand best.

Orkney

Orkney partners submitted ‘Orkney’s Routemap to Reform’. This represents a ‘public service reform model’ for Orkney, and partners will move away from SAMs terminology in that geography.

A set of principles will underpin consideration of options for transitioning to future governance arrangements:

• Better for communities – clear and measurable benefits
• Accountable to communities – decision-makers fully transparent and accountable
• Understanding of national situation – local models work with regional and national models
• Reducing duplication – improve efficiency, pool resources, streamline bureaucracy and improve cohesion across services

The Routemap provides a structured approach for re‑shaping support and corporate services, which is particularly important in Orkney given the small scale of health and care services and the challenges in sustaining specialist capacity.

The document sets out an iterative process which first involves identifying those areas of responsibility and activity which can be brought together to help ensure financial sustainability and protect frontline delivery. Governance arrangements will be adapted as appropriate and with support from regional and national partners. It also recognises the critical role of community involvement in developing a preventative system with a strong early intervention element to reduce pressures on statutory services.

We will support Orkney partners to develop and transition to their place-specific approach to reform. This will include joint work on how the Routemap can be implemented, both in terms of service change and support, and in terms of longer-term decisions on optimum local governance models.

Western Isles

Comhairle nan Eilean Siar (CnES) and NHS Western Isles (NHSWI) submitted a joint letter confirming a shared commitment to collaboration and transparency in the process to develop preferred models. This was accompanied by submissions from their respective organisations.

CnES has identified a ‘Single Island Authority/Partnership’ as their preferred model. A democratically elected body accountable to local communities would have oversight of budgets, strategy and direction of public services best delivered at local level to promote efficiency and effectiveness. Decision-making arrangements would comprise locally elected members supported by professional advisers, non-Executive Directors, carers, third sector representatives and others. This would involve appropriate levels of delegation for delivery of agreed policies and services, and specific remit to advise the Single Authority on strategic development. This model would maintain the NHS identity as a key delivery agency, employer and clinical network and help to ensure the experience of patients/service users is as seamless as possible.

NHSWI has identified a ’Single Health-led Care System’ as their preferred model. This would build on the successes of integration so far to further support an end-to-end patient pathway to assess and respond to care needs. As with the CnES proposal, responsibility and accountability would be vested in one organisation. Under this model, there would be direct accountability to Scottish Ministers for service planning, governance and delivery.

Further joint work will be required to explore the alignment, points of divergence and potential areas of consensus between the two preferred models, including implications for clinical governance, accountability and resource deployment.

Argyll and Bute

A joint SAM Short Life Working Group (SLWG), which includes local elected members and NHS Highland (NHSH) Non-Executive Board members is overseeing locally-led SAMs development work. An officer-led working group, including senior representatives from Argyll and Bute Council, NHSH and Argyll and Bute Integration Joint Board provides support. A range of potential benefits from SAMs have been identified including:

• Expanded democratic accountability and participation
• Place-based decision making and joined up strategic planning
• Development of clinical care pathways
• Consistency of approach, collaborative working, improved service delivery and efficiency
• Improved outcomes through wider integration beyond health and social care

Argyll and Bute partners submitted an update on work to analyse two shortlisted models: a ‘Further Empowered Local Board’ and a ‘Single Authority Partnership’. Both options would build on existing Integration Authority arrangements by identifying additional public service functions over which to have decision-making responsibility and/or agreeing a single organisation to assume the role of strategic lead for the partnership.

A locally commissioned SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis of preferred models identified potential benefits, alignment with national policy and uncertainties that required further consideration. Further evaluation of both options will include the development of a ‘hybrid’ model which might combine the benefits of both models while mitigating risks. Ongoing development work will continue to follow guiding principles agreed by local partners.