Integrating social and health care services
Shifting the balance of care to community resources is the ultimate aim of Health and Social Care integration. The Health and Sports Committee of the Scottish Government has discussed progress made on this in the first year of operation of Integrated Joint Boards. These have been working in each area of Scotland to provide integrated services since April 2016.
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 fewer 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; consistency of quality, and effectiveness of resources in health and social care.
Progress on Integration?
The Committee considered information on how the integration of health and social care services was being progressed across the country. They considered three aspects: how the Joint Boards were operating, how budgeting was being handled, and looking at whether the balance of care was changing.
The committee acknowledged the potential for 'confusing lines of accountability and potential conflicts of interests for [integration] board members and staff', and that challenges would be faced in establishing the autonomy of the new Boards. Some Boards had indeed undergone these difficulties. However, NHS Highland submitted that ' having one management and governance system enabled them to “be very fleet of foot” in making decisions to change the staffing required to respond to local needs.'
Training and performance management were seen as key issues for the new Boards, while strong and effective leadership seems to have been the greatest factor in efficient performance and integration of services. The Government was asked to consider these factors in its oversight of the integration process.
The Committee noted that most integrated Boards had not set their budgets at the start of the year. This was thought to be an impediment to moving towards new types of services. The reason was identified as health and social care operating to different budget cycles, resulting in complex negotiations and estimates. The Government has undertaken to improve this before the next financial year begins.
Shifting the balance of care
Quite a few of the authorities pointed to efficiency savings through the new arrangements. These had been anticipated by the integration policy and should gather momentum as integration becomes more prevalent.
Specific efficiencies and improved services were reported in a separate survey. These involved hospital closures, being replaced with community services; a rapid response team to avert unnecessary crisis admissions; and modernisation of services for people with learning difficulties.
There was a general trend of an increasing shift to community care with reduced reliance on institutional care, even this early in the process.
The monitoring by this government committee shows that the integration process has shown promise in both efficiency savings and service improvement. It is hoped that this will keep pace with the pressures of demographic age increase and the apparently endless funding reductions which the services face.
It will be interesting to see if, and to what extent, the anticipated improvements occur and whether we see a real and enduring shift in the balance of care across the country.
*All information is correct at the time of publishing