'Let me be clear about the objectives of this programme of reform. We want to ensure that adult health and social care services are firmly integrated around the needs of individuals, their carers and other family members; that the providers of those services are held to account jointly and effectively for improved delivery; that services are underpinned by flexible, sustainable financial mechanisms that give priority to the needs of the people they serve rather than the needs of the organisations through which they are delivered; and that those arrangements are characterised by strong and consistent clinical and professional leadership…
There is now a consensus around the contention that separate and-all too often-disjointed systems of health and social care can no longer adequately meet the needs and expectations of the increasing number of people who are living longer into old age, often with multiple, complex, long-term conditions and who, as a result, need joined-up, integrated services.'
Nicola Sturgeon MSP, Deputy First Minister and Cabinet Secretary for Health and Wellbeing, December 2011
1.1. The Scottish Government is integrating health and social care services to ensure that people get the right care in the right place at the right time. Historically, there has been a divide between "health" and "social care" services. Increasing numbers of people do not experience neatly segregated "health" and "social care" needs, so our systems to support them need to evolve to reflect complexity of needs and multimorbidity in the population.
1.2. The Act places a duty on Integration Authorities - either Integration Joint Boards or Health Boards and Local Authorities acting as lead agencies - to create a "strategic plan" for the integrated functions and budgets that they control.
1.3. The strategic plan is the output of what is more commonly referred to as the "strategic commissioning" process. Strategic commissioning is the term used for all the activities involved in assessing and forecasting needs, linking investment to agreed outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place. Within this guidance, where we refer to the strategic commissioning plan, we are referring to the strategic plan described in the Act.
1.4. The importance of effective strategic commissioning for the success of integrated health and social care provision cannot be over-stated. It is the mechanism via which the new integrated partnerships will deliver better care for people, and better use of the significant resources we invest in health and social care provision.
1.5. Integration - and therefore strategic commissioning - needs to deliver better outcomes, particularly for people with multimorbidities and in terms of improving preventative and anticipatory care, with less inappropriate use of institutional care and better support in communities. Its impact will be measured against the statutory national outcomes for health and wellbeing and the indicators that underpin them.
1.6. These are high aims. Achieving them will require partnership working - between statutory agencies and professionals and also, vitally, with the third and independent sectors, localities and communities - on a scale that we have not achieved before. This guidance sets out how strategic commissioning needs to operate in order for integration to deliver on its potential to improve people's lives.
' . . . effective services must be designed with and for people and communities - not delivered 'top down' for administrative convenience'
The Christie Commission Report
Commission on the future delivery of public services, June 2011