Scottish care services, independent and Council-run, together with the local area Health boards services across the country, are working through an exciting and challenging time of change.
The integration of health and social care has been a Scottish Government policy goal for many years, being seen as providing more effective and person-centred care in the community. These plans received more impetus through the Christie Commission on Public Service Reform (June 2011) with subsequent legislation, and eventually the Public Bodies (Joint Working) Scotland Act 2014 laid the ground for mandatory change.
Integrated Authority
By April 2016 these services are expected to be integrated under single a single management board (Integrated Authority) in each Council area. The Scottish Government’s aim in this is to have services which are person- and community-centred, preventive rather than reactive in their approach, and which are accountable to specific National outcomes for the quality of care.
The national outcomes, briefly, cover:
- People have better health, with less health inequalities:
- There is greater potential for independent living;
- Improved choices and quality of life;
- Informal, unpaid carers are supported;
- Safeguarding and respect for dignity are ensured, and;
- There is better consistency of quality and value of resources in health and social care.
Audit Scotland
Audit Scotland is a statutory body set up in April 2000 to help check that organisations spending public money use it properly, efficiently and effectively. They have released a progress report on establishing the integrated system by April 2016. The report acknowledges that each area will have established its Integrated Authority, within time-scale. They also cover the areas of work which still remain outstanding to fully establish the new bodies and processes.
The Auditor General for Scotland has stated of the Integrated Authorities, responsible for £8 billion of public funds: “If these new bodies are to achieve the scale and pace of change that’s needed, there should be a clear understanding of who is accountable for delivering integrated services, and strategic plans that show how integration authorities will use resources to transform delivery of health and social care.”
The Audit Scotland report can be seen on line, and makes recommendations which need to be addressed. Importantly, they see the need for the new Integration Authorities (IAs) to agree and establish their budgets. IAs also need to develop strategic plans for several years ahead, to be able to measure progress and to plan and demonstrate the desired outcomes. Monitoring and public reporting are also issues which need to be addressed.
Most fundamentally perhaps, the IAs are said to need to provide training for the workforce, and the Board members, to move to a new community-based, preventive and person-centred approach.
It is an exciting and demanding time for care services in Scotland, as it is across the UK. Reduced funding and increasing demands on services could be answered by the more efficient services which the new Integrated Authorities promise. It is good to see that outcomes have been set and the systems will be held to account in coming years as it develops to better serve public needs.
