Integration of health and social care
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.
Public Bodies (Joint Working) (Scotland) Act 2014
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.
- 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.
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.
A full list of guidance and advice is available here.
Review of Integration Authorities
In May 2018 a debate took place in the Scottish Parliament on financial accountability in the NHS, prompted by concerns over financial management at NHS Tayside. The Health Secretary Shona Robison agreed to establish such a review and announced the Ministerial Strategic Group would carry out this work.
In February 2019, the Scottish Government published the final report of the Ministerial Strategic Group for Health and Community Care’s progress review on the integration of health and social care. The report sets out a range of proposals to be carried forward on the basis of “joint and mutual responsibility to improve outcomes for people using health and social care services in Scotland”.
The Scottish Government has since announced a joint programme of work with COSLA following the progress review, including:
- developing new statutory guidance for community engagement and participation in the design and
delivery of health and social care services
- developing a framework for community-based health and social care integrated services to help ensure that what works to improve outcomes in local community settings is shared and promoted across the whole system
- carrying out an audit of existing national leadership programmes and improving collaborative working with all health and social care partners, including the third and independent sectors
- improving strategic inspection by making sure it better reflects how different bodies need to work together to improve outcomes
Also see the following Audit Scotland reports:
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 were published by the Scottish Government in November 2017. 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.
A selection of resources that explain what SDS is, people’s stories, assessment and support planning tools as well as resources to influence commissioning and procurement practice to make SDS truly mainstream across Scotland
Good practice examples to give care services ideas on how to bring generations together in a variety of care settings in a way that improves the quality of their lives
The Health and Social Care Standards set out what we should expect when using health, social care or social work services in Scotland
Latest Adult and Health Bulletin
A weekly bulletin produced by our policy team providing an update on the key developments in adult social care and health
Adult and Health Bulletin - 12-16 October 2019Adult and Health Bulletin - 12-16 October 2019
Latest Children and Young People Bulletin
A weekly bulletin produced by our policy team providing an update on the key developments concerning children and young people