The integration of health and social care is the Scottish Government’s ambitious programme of reform to improve services for individuals who use adult health and social care services.
It will result in radical changes to how acute and community health care services, as well as social care services, are planned, funded and delivered in the future. Integration means that the expertise and resources of adult health and social care services will be combined, shared and coordinated and plans made jointly, from the perspective of the service-user.
The principal ambitions of health and social care integration are to:
• Support the improvement of 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.
The Public Bodies (Joint Working) (Scotland) Act 2014 was granted Royal Assent on 1 April 2014. The legislation sets out how health and social care services for adults will be integrated across Scotland. This means changes to the law which requires Health Boards and Local Authorities to integrate their health and social care services.
There are two models of integration. In the first option, the ‘Body Corporate’ model, the Health Board and Local Authority can delegate the responsibility for planning and resourcing service provision for adult health and social care services to an Integration Joint Board.
In the second option, the ‘Lead Agency’ model, the Health Board or Local Authority takes the lead responsibility for planning, resourcing and delivering integrated health and social care services. The intended result of both models is to provide seamless, joined up, quality health and social care services across Scotland.
In Dumfries and Galloway we have adopted the ‘Body Corporate’ model.
The Act enables a whole system redesign of health and social care planning and provision, around a system centred on anticipatory and preventative care. It also empowers the Integration Joint Board to plan across the entire pathway of care to enable the delivery of health and social care services which are seamless and joined up, from the perspective of the service-user.
Integration places a greater focus on prevention and anticipatory care in the community – GPs, social workers, district nurses, etc working together to support people in their own homes
There are many inefficiencies in how we currently allocate and use health and social care resources. These inefficiencies can adversely affect outcomes for people with multiple long-term and complex conditions and are often characterised by disconnects in services provided by Health Boards and Local Authorities. Delayed discharges are a key indicator of this.
While scrutinising the legislation, the Scottish Parliament’s Finance Committee noted that expenditure on health and social care services is projected to increase. This is because of demographic change – more people living for longer – and because more people are living with multiple conditions. The Act removes the barriers that cause these inefficiencies and enables Integration Authorities to maximise the value of their integrated resources in addressing demographic and locality specific challenges over the longer term.
The Scottish Government recognises the valuable role that is played by the third and independent sectors in providing good quality support to people, working in partnership with other partners.
The Act sets out that strategic planning must be developed with, and take full account of, the views of the third and independent sectors, as well as the statutory partners.
All care services are required to meet the National Care Standards. Health and social care integration aims to improve the quality of services across Scotland. Disinvestment and reinvestment will be required to ensure services meet the increasing complex needs of the population.
The main aim of integration is to provide a seamless response to everyone who uses adult health and social care services, putting the person at the heart of all decisions made. Integration is about understanding different professional perspectives, sharing existing expertise and coordinating resources. It’s about making the delivery of health and social care better.
Integrating health and social care will see services more joined up. It aims to provide seamless care and improve outcomes for people who have a range of complex support needs, and for their carers and families as well. Too often, in these circumstances, people are admitted to hospital, or to a care home, when a package of care and support in the community could deliver better outcomes for them. When this happens, the consequences are felt across the whole system, by the individual and by services, as resources are tied up inappropriately in care that is not best suited for the individual.
Services will still be provided via the Local Authority and there is no reason that this means a different carer. It will be for the Local Authority to arrange appropriate care provision in collaboration with the individual.
Integration isn’t just about focusing on older people. The aim of integration is to make Scotland a great place to be born, grow up in and grow old in, where people of all ages are supported to live well at home or in the community, for as much time as they can, ensuring that they have a positive experience of health and social care services when they need it.
While there is lots of excellent work taking place already, the existing way of working can be improved to produce a more seamless approach to meeting an individual’s care needs. This will include reducing duplication of effort across a range of functions and professional boundaries that can result in delays and frustrations for people who use health and social care services. Integration can help reduce inefficiencies and ensure that we are spending the funding that we have in the most productive and efficient way by combining and directing resources appropriately.
Participation and Engagement
Good participation and engagement are key to the successful planning and delivery of integrated health and social care and support. It ensures that decisions are informed by harnessing the knowledge and expertise of people in our communities.
Our Partnership is committed to ensuring local people and partner organisations are involved in the planning, design and development of services through participation and engagement.
We recognises that our communities are diverse. To be inclusive, and to engage with members of our communities, the Partnership recognises the need for sufficient time, focus and effort to be given to engagement activities. This will enable the use of, new and flexible approaches to reach those groups who may not traditionally readily engage but who have an important, valid and valued contribution to make.
Our Partnership has adopted the National Standards for Community Engagement and we are clear when we say we are informing, consulting or engaging with the public.
The definitions we use for informing, consulting or engaging are;
- information – providing information to people, communities, staff, groups and other key stakeholders
- consultation – consulting people in relation to specified options or
- engagement – a more open and equal relationship with key stakeholders which involves shared decision making and/or action.
Useful Documents and Links
IJB Participation and Engagement Strategy