The way in which health and social care services are planned and delivered across Scotland was changed by the Public Bodies (Joint Working) (Scotland) Act 2014. Local Authorities and Health Boards are required by law to work together to plan and deliver adult community health and social care services, including services for older people. This new way of working is referred to as ‘Health and Social Care Integration’. The Act also permitted Local Authorities and Health Boards to integrate other services, such as Children’s Services, Homelessness and Criminal Justice, if they wished to do so.
At its heart, integration is about ensuring those who use health and social care services get the right care and support whatever their needs, at the right time and in the right setting at any point in their care journey, with a focus on community-based and preventative care.
In September 2018, the Scottish Government, NHS and COSLA published a joint statement reaffirming the shared commitment to integration as leaders in the public sector.
In total 31 health and social care partnerships have been set up across Scotland and they manage almost £9 billion of health and social care resources. Partnerships worked in shadow form in 2015/16 with the Act coming into force on 1 April 2016.
The Act required Local Authorities and Health Boards to jointly prepare an Integration Scheme. The Integration Scheme sets out the key arrangements for how integration is to be planned, delivered and monitored within their local area.
There is a choice of ways in which they may do this:
- The Health Board and Local Authority can delegate functions between each other - this is the lead agency arrangement.
- The Health Board and Local Authority can delegate to a third body called the Integration Joint Board (IJB) - this is the body corporate model.
Highland is the only area to adopt the lead agency model. In this arrangement, the Chief Executive of the lead agency has responsibility to develop the strategic plan. NHS Highland has responsibility for adult health and social care services and Highland Council has responsibility for children’s health and social care services.
30 areas have adopted the body corporate (also known as the IJB) model (Clackmannanshire and Stirling formed a joint IJB) where the planning of integrated health and social care services is led by the Integration Joint Board. The IJB membership is broad: it includes councillors and NHS non-executive directors in all cases, plus other members (who do not have voting rights) including professional representatives and community and staff stakeholders.
Each IJB receives delegated funds from the NHS board and Local Authority (there is no separate direct funding from the Scottish Government).
The IJB is required to produce a single Strategic Plan to deliver the nine National Health and Wellbeing Outcomes. The IJB then commissions (or ‘directs’) the Council and Health Board to deliver services in line with the Strategic Plan, and the IJB allocates the budget for delivery accordingly. The Council and Health Board then deliver these services within the budget and any other parameters directed by the IJB.
Each IJB has responsibility to appoint a Chief Officer to lead implementation of the strategic plan and an officer responsible for its financial administration (Section 95, Chief Finance Officer). The Chief Officer has a direct line of accountability to the Chief Executives at the Health Board and the Local Authority.
Chief Officers lead the development of integrated services and actions at a local level, so that approaches are tailored to local communities and circumstances. This localism is fundamental to integration as the Act requires Health and Social Care Partnerships to divide their area into at least two localities.
A requirement of the Act is that the IJB also produces an annual performance report outlining progress towards delivery of the nine National Health and Wellbeing Outcomes within its local area.
The shape of Scottish society and the health and care needs of our communities is changing. People are living longer, healthier lives but there are also growing numbers of people who have complex care requirements. As the needs of our society changes, so too must the nature and form of our public services. The purpose of integration is to transform people’s experience of care and the outcomes they experience. Integration is necessary because if services are planned and delivered together, this closer co-ordination will enable the fundamental changes in care models that will be needed to keep pace with people’s changing needs.
Integration is all about improving people’s lives, and the wellbeing of our system of health and social care as a whole benefits from better joined-up care, better anticipatory and preventative care and a greater emphasis on community-based care.