Integration of Adult Health and Social Care

VHS Member event, Monday 1 JulyGrant Hughes, Scottish Governmentgrant.hughes@scotland.gsi.gov.uk

Vision

• People are supported to live well at home or in the community for as much time as they can

• They have a positive experience of health and social care when they need it

Why integrate?

• To address variability of health and social care outcomes in different parts of Scotland, particularly for frail, older people.

• To make it easier to provide services to help people stay at home, rather than being admitted to hospital.

• To make it easier to get people out of hospital quickly and back into a homely setting.

What are Ministers looking for?

• Consistency of outcomes

• Applies in every council and health board

• Statutory underpinning

• Integrated budget

• Someone clearly accountable for delivering agreed outcomes

What are Ministers looking for? Cont.

• Professionally led

• Simplifies existing bodies and structures

• Minimal disruption to staff and services

• Robust public involvement

What does the evidence tell us?

• Planning for populations, not delivery structures

• Pooling resources – money and people• Embedding GPs, other clinicians and care

professionals in the processes of service planning, investment and provision

• Very strong local leadership

• Consultation - May to Sept 2012

• Analysis report - 19 Dec 2012

• Scottish Government response - 13 Feb 2013

• Bill introduced to Parliament - 28 May 2013

Progress

Key points from consultation

• Scope: adults• Local flexibility• Importance of a “minimum position”• Access to robust, shared data• Importance of ensuring a strong role for local

professionals

Key features of legislation

• Nationally agreed outcomes

• Integration plan

• Strategic Plans

• Locality planning

• Integrated budgets

Principles of IntegrationServices should be planned so that they:•Are integrated from the point of view of recipients•Take account of the particular needs of different recipients•Take account of the particular needs of recipients in different parts of the area in which the service is being provided•Are planned and led locally in a way which is engaged with the community and local professionals•Best anticipate needs and prevent them arising, and•Make the best use of the available facilities, people and other resources

National Outcomes for adult health and social care and scope

• Focus on a needs based approach

• Do not want to undermine the importance of local understanding of need, and local agreement of appropriate local outcomes and measures

Governance and Joint Accountability

• Need to ensure that statutory partners are jointly and equally responsible for the delivery of outcomes

• Need to overcome differing organizational and political priorities

• These have the potential to disrupt and lead to the breakdown of services

Integrated budgets and resourcing

• Budgets and resources will be integrated to focus attention on the outcome for individual

• A more integrated approach to sharing information

• Two models for financial integration:– The Body Corporate – Delegation between partners

Jointly Accountable Officer (chief officer) & Workforce

• Two workstreams developing proposals: Short Life Working Group and Strategic Workforce Development Group

• The SLWG is developing the post of the JAO• The SWDG is looking at the longer term issues

of training and organisational development

Locality planning

• Locality arrangements must reflect local needs and priorities

• Professionals must be involved in determining locality arrangements, not just consulted

• Must enable real traction on change and improvement

• Importance of wider community – third sector, patients, service users and carers

What next?

• Bill Advisory Group• Working groups:

– Outcomes and measurement– Governance and accountability– Integrated resources– Joint strategic commissioning– Workforce development and HR

• + further work on locality planning

“Public service providers must be required to work much more closely in partnership, to integrate service provision and thus improve the outcomes they achieve. . .

Experience tells us that all institutions and structures resist change, especially radical change. However, the scale of the challenge ahead is such that a comprehensive public service reform process must now be initiated, involving all stakeholders.”

The Christie Commission Report

Commission on the future delivery of public services, June 2011