Integration of Health & Social Care

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Overview

The Public Bodies (Joint Working) (Scotland) Bill received Royal Assent on 1 April 2014. The Public Bodies (Joint Working) (Scotland) Act will support improvement of the quality and consistency of health and social care services through the integration of health and social care in Scotland.

The Public Bodies (Joint Working) (Scotland) Act 2014 is designed to:

  • Improve the quality and consistency of services for patients, carers, service users and their families.
  • Provide seamless, joined up quality health and social care services in order to care for people in their homes or a homely setting where it is safe to do so.
  • Ensure resources are used effectively and efficiently to deliver services that meet the increasing number of people with longer term and often complex needs, many of whom are older.

The legislation came into effect in April 2016 and new Integration Authorities now have responsibility for over £8 billion of funding for local services  which was previously managed separately by NHS boards and local authorities.  

The Scottish Government has published a map of integration joint boards.

In December 2016 the Health and Social Care Delivery Plan was published. The Plans sets out a programme to “further enhance health and social care services” so people can live “live longer, healthier lives at home or in a homely setting” with a health and social care system that is integrated; focuses on prevention, anticipation and supported self-management; will make day-case treatment the norm, where hospital treatment is required and cannot be provided in a community setting; focuses on care being provided to the highest standards of quality and safety, whatever the setting, with the person at the centre of all decisions; and ensures people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

Key provisions

The Act:

  • Removes community health partnerships from statute and provides two broad models for integration: the ‘body corporate’ or ‘lead agency’.
  • Requires health board and local authority partners to arrange an ‘integration scheme’ for their area, setting out which integration model is to be used and how functions are to be delegated.
  • Provides for national outcomes for health and wellbeing which health boards and local authorities will be accountable to. These will be prescribed by the Scottish Government in consultation with a wide range of stakeholders.
  • Sets out integration planning and delivery principles which integration partners must have regard to.
  • Requires integration partners to prepare a strategic plan for their area, setting out arrangements for the delivery of integration functions and how the national health and wellbeing outcomes will be met.
  • Establishes the role of the Care Inspectorate and Healthcare Improvement Scotland in working together to evaluate the effectiveness of the new integrated landscape and support improvement. 

Regulations

Over the summer of 2014, the Scottish Government consulted on a number of regulations relating to the Act. The following draft Affirmative Regulations to support the integration of health and social care are among those that have been approved in the Scottish Parliament:

National Outcomes and Guidance

The Scottish Government has published National Health and Wellbeing Outcomes: A framework for improving the planning and delivery of integrated health and social care services. The outcomes, to apply across all integrated health and social care services, provide a strategic framework for the planning and delivery of health and social care services.

The framework should be read alongside Guidance on the Principles for Planning and Delivering Integrated Health and Social Care.

Other guidance documents:

National Review of Indicators in Health and Social Care 

The findings of an independent national review into targets and indicators for health and social care have been published by the Scottish Government. The review, led by former Chief Medical Officer Sir Harry Burns, considered how targets and performance indicators align with the Government’s strategy for the future of NHS and social care services and identifies some key principles and recommendations for using and developing targets and indicators in the future. The report makes a number of overarching conclusions, including that the present system is fragmented and many of the indicators do not lend themselves to effective improvement interventions. Specific recommendations around a different approach are made in relation to indicators in a range of areas, including children’s wellbeing, opinions of supported people, place of care and independent living, and end of life care.

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