Annex A: Detailed requirements
The Act places a number of duties on Integration Authorities in relation to strategic commissioning. These are summarised below, along with further detail on how these requirements should be taken forward by Integration Authorities.
a) Requirement to prepare strategic plans (section 29)
The Integration Authority can include such material as it thinks fit in the strategic commissioning plan. There are nonetheless two matters that must be covered:
- A strategic commissioning plan must set out the arrangements for carrying out the integration functions in the Local Authority area over the period of the plan. The area must be divided into a minimum of two localities for this purpose, and the arrangements for each locality must be set out separately.
- A strategic commissioning plan must also set out the way in which the arrangements for carrying out the functions are intended to achieve or contribute towards achieving the national health and wellbeing outcomes.
The first strategic commissioning plan of an Integration Authority must be prepared before the integration start date, which is the date on which the Health Board and the Local Authority delegate functions to the Integration Authority. The strategic commissioning plan must be prepared before this date so that the Integration Authority can function immediately.
Scottish Ministers have prescribed in Regulations that functions must be delegated on 1 April 2016, if not before. The strategic commissioning plan must, at the latest, be prepared in time to allow delegation of functions on this date. The Health Board and Local Authority may choose to delegate the functions on a day that is earlier than the day prescribed by the Scottish Ministers. Where this occurs, the Integration Authority must make clear in its first strategic commissioning plan the date on which functions are to be delegated.
b) Considerations in preparing strategic plans (section 30)
The Integration Authority is required to take into account the integration planning and delivery principles set out in the Act, and the national health and wellbeing outcomes set out in Regulations, in preparing a strategic commissioning plan. This is to ensure the principles and national outcomes are at the heart of planning for the population and to embed a person centred approach, alongside anticipatory and preventative care planning.
Each Integration Authority, when preparing a strategic commissioning plan which sets out, or proposes to set out, arrangements for the use of services, facilities or resources used by another Integration Authority, must take account of any other strategic commissioning plan that has been, or is being, prepared which also sets out arrangements for the use of those services, facilities, or resources. Essentially, areas that share resources or services must take account of this in their respective strategic plans. Many local areas will plan hospital usage in a neighbouring area so close communication and co-operation will be needed.
The strategic commissioning plan should ensure correlation with other local policy directions as outlines in, for instance, Single Outcome Agreements, NHS Local Delivery Plans, Housing Strategies, NHS Clinical Strategies, community plans and other local corporate plans.
Under the terms of the Local Government in Scotland Act 2003 or, where applicable, the Public Finance and Accountability (Scotland) Act 2000, the implementation of the duty of Best Value will apply to the Integration Authority. That duty is:
- To make arrangements to secure continuous improvement in performance whilst maintaining an appropriate balance between quality and cost; and in making those arrangements and securing that balance.
- To have regard to economy, efficiency, effectiveness, the equal opportunities requirements, and to contribute to the achievement of sustainable development.
c) Integration delivery principles (section 31)
The integration delivery principles are:
- that the main purpose of services which are provided to meet integration functions is to improve the wellbeing of service-users,
- that, in so far as consistent with the main purpose, those services should be provided in a way which, so far as possible:
- is integrated from the point of view of service-users
- takes account of the particular needs of different service-users
- takes account of the particular needs of service-users in different parts of the area in which the service is being provided
- takes account of the particular characteristics and circumstances of different service-users
- respects the rights of service-users
- takes account of the dignity of service-users
- takes account of the participation by service-users in the community in which service-users live
- protects and improves the safety of service-users
- improves the quality of the service
- is planned and led locally in a way which is engaged with the community (including in particular service-users, those who look after service-users and those who are involved in the provision of health or social care)
- best anticipates needs and prevents them arising
- makes the best use of the available facilities, people and other resources
These integration delivery principles must be taken into account in the preparation of the strategic commissioning plan and in the actual carrying out of functions included in integration arrangements. The effect is to ensure a focus on integrated delivery, including consideration of the needs of different service users and different areas, the dignity of service users, the participation by service users in the community in which they live, protecting and improving the safety of service users, improving the quality of services local planning and leadership, the anticipation and prevention of need, and the effective use of resources. Consideration should be given to how adherence to these principles will be given effect in order to demonstrate effective implementation. It will require clinical and care professionals to apply the principles in all that they do in delivering integrated health and social care services.
d) Establishment of Strategic Planning Group (section 32)
Integration Authorities are obliged to establish a Strategic Planning Group for the area covered by their Integration Scheme for the purposes of preparing the strategic commissioning plan for that area. Depending on the model of integration chosen, the group must involve members nominated by the Local Authority or the Health Board, or both. In effect, this provides for the partners who prepared the Integration Scheme, and are party to the integrated arrangements, to be involved in the development of the strategic commissioning plan.
In addition, the Integration Authority is required to involve a range of relevant stakeholders. These groups must include representatives of groups prescribed by the Scottish Ministers in regulations as having an interest. These are:
- Users of health care
- Carers of users of health care
- Commercial providers of health care
- Non-commercial providers of health care
- Health professionals
- Social care professionals
- Users of social care
- Carers of users of social care
- Commercial providers of social care
- Non-commercial providers of social care
- Non-commercial providers of social housing
- Third sector bodies carrying out activities related to health or social care
The Integration Authority can include other persons it considers appropriate. The Integration Authority is to determine the number of members in its Strategic Planning Group and the process for the appointment, replacement and removal of members.
The Act allows the Integration Authority to:
- appoint members of the Strategic Planning Group from persons nominated;
- remove persons from membership of the group; and
- appoint members in place of members who resign or are removed from membership of the group.
It also provides for members nominated by the Local Authority and/or Health Board to be removed from the Strategic Planning Group by the body which nominated them, and replaced with a different nominee. Furthermore, a member of the Strategic Planning Group can resign at any time.
The views of localities must be taken into account with the Integration Authority required to identify the most appropriate person to represent each locality on the Strategic Planning Group. Local flexibility is allowed, so that an individual can represent more than one locality. The Strategic Planning Group's ability to make decisions should not be undermined by any vacancy in its membership.
The Integration Authority is to determine the procedure of the group, and may pay members of the group expenses and allowances. It will be up to each Integration Authority to decide how the group should operate.
While Integration Authorities will be expected to make best use of established local user, carer and advocacy groups, they should not be constrained by a traditional working group approach. Rather, they may wish to introduce innovation in respect of networks and in-roads to community engagement.
Strategic commissioning is crucially about establishing a mature relationship between different partners from across the public, third and independent sectors in a way which will help to achieve the best services for the population. Providers themselves will bring knowledge and experience of their services and the outcomes they are delivering. Every partner has a role to play in strategic commissioning, and that is why it is important that local arrangements promote mature relationships and constructive dialogue. Those involved in the strategic commissioning process need to develop their skills in working with a range of partners including the independent and third sector, along with service users and their carers to build and implement commissioning priorities. Clinicians and care professionals in localities also play a key role in ensuring that local needs are understood, and that they inform the overall priorities. They will be key to the delivery of improvements in services and support, and in ways of working on the scale of what is envisaged in strategic commissioning plans.
It is vital that the full extent of the third sector's knowledge, expertise, and information, both in relation to communities and the sector itself, is brought to bear upon strategic commissioning and locality planning in order to achieve the outcomes of health and social care integration. This will require all parties to work with trust and mutual respect.
The role of Third Sector Interfaces (TSIs), established in 2011, provide a strong, coherent and cohesive voice for local organisations in each of Scotland's 32 Local Authority areas - seeking to influence the architecture of community planning structures in the interests of the community. Evidence from the Reshaping Care for Older People (RCOP) programme has shown that a relatively small amount of additional support for the third sector can result in more co-ordinated and innovative responses to the challenges facing the sector and communities. This helps to harness the assets to deliver locally and ensure the voices of local people are connected to the local and national agenda.
The housing sector already makes a very significant contribution to national outcomes on health and social well-being by:
- providing information and advice on housing options;
- facilitating, or directly providing 'fit for purpose' housing that gives people choice and a suitable home environment;
- providing low level, preventative services which can obviate the need for more expensive interventions at a later stage;
- building capacity in local communities; and
- undertaking effective strategic housing planning.
The integration of adult health and social care is recognised as bringing opportunities to strengthen the connections between housing and health and social care, to improve alignment of strategic commissioning, to support the shift to prevention, and to incorporate (and if necessary review) current arrangements for housing support and homelessness services.
The Scottish Government engaged with the Institute of Public Care (IPC) to produce a Learning Development Framework, to assist all those involved in the strategic commissioning process. IPC, along with the Joint Improvement Team (JIT) has also provided a learning and development programme across all partnerships, for those people involved in commissioning. Further development and support continues to be available from the JIT. Integration Authorities will need to ensure that members of the Strategic Planning Group are fully supported to be able to carry out their functions in a meaningful and effective way.
It will be important that the workforce is supported so that people who work in health and social care services are supported to continuously improve the information, support, care and treatment they provide, and feel engaged with the work they do.
An advice note will be developed that sets out the policy context within which the workforce is operating. It will set out who is included in the workforce and the national learning frameworks available to individuals and employers and the wider public.
e) Preparation of strategic plan (section 33)
The Strategic Planning Group is required under the Act to be involved in the development of the strategic commissioning plan, assuring the group's engagement in the process from the start.
The Integration Authority is required to prepare proposals about matters the strategic commissioning plan should contain, and consult the Strategic Planning Group on the proposals and then to prepare a first draft of the strategic commissioning plan, reflecting the views of the group expressed during the consultation. The Integration Authority must then consult the Strategic Planning Group on the draft.
Taking into consideration the views in response to the consultation on the first draft, the Integration Authority is required to prepare a second draft of the strategic commissioning plan and send a copy of it for comment to all interested stakeholders. This must include the Local Authority and the Health Board, or both (depending on the model of integration chosen), as well as representatives of any groups prescribed by the Scottish Ministers.
It is essential that the Integration Authority shares the draft strategic commissioning plan widely with those who have an interest in the delivery or receipt of health and social care within the geographic boundaries of the proposed Integration Authority. The integration planning principles state that services should be "planned and led locally in a way which is engaged with the community (including those who look after service-users and those who are involved in the provision of health and social care)". A wide and diverse engagement will ensure that the strategic commissioning plan is not simply controlled by the small number of people on the Strategic Planning Group but rather the population that will be affected by its findings. For example, this would include the involvement and engagement of existing representative fora, such as joint planning groups, advocacy organisations, locality planning groups and those involved in local community planning.
It is important that the Integration Authority develops an agreed communication and engagement plan at an early stage. In line with Scottish Government policy, such consultation can take place in a variety of ways - written information, public meetings, focus groups, questionnaires and on-line and interactive discussion forums. Integration Authorities should make best efforts to allow groups of people with an interest to participate in a consultation process in order to express an opinion on the draft strategic commissioning plan.
This will ensure that any other parties with an interest will have an opportunity to fully understand the direction of travel and to comment on the draft plan. The Integration Authority is duty bound to take into account the views obtained through consultation on the second draft of the strategic commissioning plan when finalising the strategic commissioning plan.
To ensure proper proportionality in the potential communication exercise that consulting with the above might entail, the Integration Authority should consult with people that they can reasonably expect to recognise as representatives of these groups. Integration Authorities should consider various methods to engage their target audience.
f) Provision of information for purpose of preparing strategic plan (section 34)
Health Boards, Local Authorities and Integration Joint Boards have duties to share information with each other for the purpose of preparing the strategic commissioning plan. Information must be shared if it is information which may be reasonably required for the purpose of preparing a strategic commissioning plan.
The Scottish Government recognise the importance of developing and supporting strategic planning and locality planning capabilities in partnership, so that leaders of integration - and particularly Chief Officers and their senior teams - are equipped with the skills and information necessary to improve care and outcomes for people.
Integration Authorities will require robust information and intelligence if the potential benefits of strategic planning are to be realised. In order to support this, the Scottish Government has commissioned NHS National Services Scotland (NSS) to develop linked individual level longitudinal health and social care datasets for all Integration Authorities. These datasets will be provided via a secure storage solution.
The Integration Authority should oversee the production of Joint Strategic Needs Assessments (JSNAs) to analyse the needs of local populations and to inform and guide the commissioning of health, wellbeing and social care services within their area. As indicated above, the main goal of a JSNA is to accurately assess the care needs of a local population in order to improve the physical and mental health and wellbeing of individuals and communities.
As stated previously, public support will be vital in taking any redesign forward. It is important that stakeholders have been fully involved in the process, from the start, and not presented with a conclusion. Integration Authorities will want to have an agreed and transparent option appraisal process in place, especially to underpin major investment and disinvestment decisions. The Scottish Government has been testing one such approach - Programme Budgeting & Marginal Analysis - and will provide detail in the accompanying advice notes.
An advice note will be produced to provide further details on JSNA and the data store being developed by NSS. This will also provide a single reference point for information that is available to help prepare a strategic commissioning plan.
g) Publication of strategic plans (section 35)
Integration Authorities have a duty to publish strategic commissioning plans. This can be done in a variety of formats but it will be expected as a minimum that these would be made available on the internet. These must be published as soon as practicable after the plan has been finalised. The Integration Authority must also publish a statement at the same time it publishes its strategic commissioning plan, which describes the consultation it undertook.
In addition to the publication of the strategic commissioning plan, the financial statement (see below) and the description of the consultation, Integration Authorities should also consider an implementation plan or set of implementation plans outlining how the strategic commissioning plan will be delivered. This could include a procurement plan providing specific detail to direct those responsible for contracting services. In line with the recommendations of the task force for the future of residential care, a Market Facilitation Plan, which is a summary of the key requirements to meet current and future demand, should be incorporated within the strategic commissioning plan, clearly stating the level and type of services required. Although this recommendation came from the task force market facilitation should not be confined to residential care or older people. Based on a good understanding of need and demand, market facilitation is the process by which strategic commissioners ensure there is sufficient, appropriate range of provision, available at the right price to meet needs and deliver effective outcomes.
An advice note will be prepared on Market Facilitation Plans, self-directed support and issues around the links with procurement.
h) Significant decisions outside strategic commissioning plan: public involvement (section 36)
Where an Integration Authority, which is a Health Board, Local Authority or Integration Joint Board plans on making a decision that would have a significant effect on the provision of an integrated service, outwith the context of the strategic planning cycle, then the Integration Authority must involve and consult its Strategic Planning Group, along with users, or potential users, of the service.
i) Review of strategic commissioning plan (section 37)
An Integration Authority is required to review its strategic commissioning plan at least every three years, and may carry out additional reviews from time to time. In carrying out a review of the strategic commissioning plan, Integration Authorities must consider:
- the national health and wellbeing outcomes
- the indicators associated with the national outcomes
- the integration delivery principles
- the views of the Strategic Planning Group
There should be a clear recording and measurement framework so that there is an ongoing process to assess whether aims are being achieved. Arrangements should also be put in place so that any information relating to risks or significant changes in trends that emerge from the ongoing JSNA process can be considered and responded to timeously by the Integration Authority, at any time during the strategic planning cycle.
The Health Board and Local Authority are required to provide the Integration Authority with the information that is reasonably required to carry out the review of the strategic commissioning plan. A review may result in the integration authority making any necessary changes by replacing its strategic commissioning plan. Flexibility is provided for Integration Authorities to determine the details of the review process they use.
A strategic commissioning plan which is prepared following a review must specify the date on which it takes effect.
j) Requirements on Integration Joint Boards to prepare replacement strategic plan (section 38)
The Act provides for the Local Authority and the Health Board, acting jointly, to direct the IJB to prepare a replacement strategic commissioning plan where they both agree the strategic commissioning plan prohibits them from carrying out any of their functions. A direction from both the Local Authority and the Health Board requiring the replacement of the strategic commissioning plan is binding on the Integration Authority.
k) Strategic plan: annual financial statement (section 39)
The Integration Authority must publish an annual financial statement upon publication of its first strategic commissioning plan, and every year after that. The financial statement must set out the total resources that the Integration Authority intends to allocate under the provisions of the strategic commissioning plan.
An advice note will be prepared on the financial aspects involved in strategic commissioning.
l) Scrutiny (sections 54 to 56)
Sections 54 to 56 of the Public Bodies (Joint Working) (Scotland) Act 2014 amend the Public Services Reform (Scotland) Act 2010 and The National Health Services (Scotland) Act 1978 to extend the remit of the Social Care and Social Work Improvement Scotland and Healthcare Improvement Scotland (HIS) to inspect the planning, organisation or co-ordination of the services that Health Boards and Local Authorities delegate, as set out within their Integration Schemes, to Integration Authorities.
These amendments set out the purpose of these inspections that can include:
- reviewing and evaluating the extent to which integrated services are complying with the integration planning and delivery principles and contributing to achieving the national health and wellbeing outcomes.
- reviewing and evaluating the extent to which the planning, organisation or co-ordination of integrated services are complying with the integration delivery principles and contributing to achieving the national health and wellbeing outcomes.
- reviewing and evaluating the effectiveness of a strategic commissioning plan prepared under section 29 of the 2014 Act in complying with the integration delivery principles and contributing to achieving the national health and wellbeing outcomes.
- encouraging improvement in the extent to which implementation of a strategic commissioning plan prepared under section 29 of the 2014 Act complies with the integration delivery principles and contributes to achieving the national health and wellbeing outcomes.
- enabling consideration of the need for any recommendations to be prepared as to any such improvement to be included in the inspection report.
Healthcare Improvement Scotland and Social Care and Social Work Improvement Scotland are able to inspect health and social care services for the purpose of reviewing and evaluating how the planning and provision of services is contributing to the achievement of the outcomes. Alongside this they are able to encourage improvements and make recommendations in relation to the implementation of strategic commissioning plans in order to contribute to achieving the outcomes (sections 54 and 55 of the 2014 Act).
The outcomes apply to all Integration Authorities, and to all persons carrying out integration functions. By reference to the outcomes, the effect of integrated health and care services on the health and wellbeing of individuals can be measured. As the outcomes apply nationally, their application will provide for the reduction of unwarranted variation in the quality of health and care services between geographical areas.
Section 56 of the Act states that Healthcare Improvement Scotland and Social Care and Social Work Improvement Scotland may jointly conduct an investigation into a service provided by an Integration Scheme and also a Local Authority, Health Board or Integration Joint Board in relation to a strategic commissioning plan.