There is concern about a lack of identifiable progress on integrating health and social care services in Scotland. This was discussed in the Scottish Parliament Committee of Health and Sport. Despite a spend of £8bn, the Committee found that no means of setting and monitoring outcomes were in place. This meant that progress by the Integration Authorities towards integration could not be properly assessed.
Background
Shifting the balance of care to community resources is the ultimate aim of Health and Social Care integration.
The Scottish Government’s aim in this is to have services which are person-and community-centred. They should be preventive rather than reactive, and accountable to specific national outcomes for the quality of care.
The stated national outcomes, briefly, are:
- 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 effectiveness of resources in health and social care
The Committee previously surveyed progress made on services integration in the first year of operation of the Integrated Joint Boards. These had been working in each area of Scotland to develop and to provide integrated services since April 2016. There were many positive results given at that time in the responses, including greater flexibility and financial savings.
However, a closer look has been taken to evaluate progress toward the intended outcomes of integration. As noted, there now appears to be little evaluation by the Boards themselves on their progress, and a lack of clarity about outcomes. There seems to be no evidence on how the £8bn funding has been spent, still less on whether this has been done effectively.
The Committee also made other criticisms. A ministerial response referred to the complexity of the change process. It also agreed that there was a need for greater transparency and more active public involvement. The minister promised further work on removing barriers to equal participation by service users and carers. It was also agreed that better liaison with the third sector in commissioning and planning would be of help. However, the minister gave several examples of good practice on this already in place.
Lastly, the need for guidance and monitoring of the shift in the balance of care was acknowledged. The need to accelerate progress was agreed. A culture of openness and transparency was aimed for, with genuine good practice in the engagement of all stakeholders.
The Future
It is good to see that this monitoring of the move to integration is taking place. However, it is largely critical and calls for major change and improvement. One has to agree on the massive complexity and intricate details of changing our care systems, and hope that the Government will act upon promised improvements. We need assurance that better quality and increasingly effective services are available to everyone across Scotland.
