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Commissioning integrated health and social care
New integrated Health and social care boards come into operation on 1st April in Scotland. The aim is to provide preventive, joined up services centred on the needs of local people and communities.
The Government has issued guidelines on how these services should be planned and commissioned. The report calls for a fresh, clean page approach to devising the new integrated services. Contributors to the report have welcomed the partnership approach to both services and to the people receiving the services.
The aim is to start, not with services on the ground, but on what we are trying to achieve. Then the success of existing services can be gauged, and the need to do things differently, and be resourced differently, can be examined and planned.
The government's declared vision is:
'We will have a care system where we have integrated health and social care, a focus on prevention, anticipation and supported self-management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.'
The aim to minimise hospital admissions, and to restore and maintain people in their own communities is admirable. It is also of course a high priority at present, given the failure of A&E to meet Government waiting time targets, and overall pressure on hospitals which has resulted in increased stress, difficulties in recruitment and resulting short-staffing. Funding of agency staff to meet shortfalls has contributed to an ever-increasing health services budgetary deficits nationally.
The aimed for prevention, and more effective services through listening to the voices of service users locally, augur well for meeting the vision of the Government. The increasing pressure on centralised hospital facilities should also be eased. Audit Scotland in 2012 commented on the existing commissioning practices: the advocated 'better engagement with users and providers' and that 'users and carers need to be more involved in decisions about social care services, with better evidence of what differences the services make to people‘s quality of life. '
This guidance from the Government certainly promises to meet these requirements for improvement, providing that it is followed by the appropriate agencies. There are some ironing out problems: there has been some public discussions and debate about the funding of the new Integrated Boards, and whether they are completely ready to implement the changes needed by 1st April 2016. There is also a lover-term cultural change kneaded to bring about effective co-production, partnership working between very different organisations, and most importantly perhaps putting the need and the voice of the consumer at the centre of services.
Overcoming these challenges will take time and effort, and promises to have a vastly improved and more effective health and care system when this is achieved.