HSCI Guidance: Facilitating the Journey of Integration

1. Introduction

1.1 The public sector reform agenda

In 2011, Campbell Christie produced a report, commissioned by the Scottish Government on the future delivery of public services. The Christie Commission, called for organisations delivering public services to work together and integrate in order to provide a more efficient and effective service to people. Amongst his key recommendations he urged that "public service providers must be required to work much more closely in partnership, to integrate service provision and thus improve the outcomes they achieve"; and that "our whole system of public services - public, third and private sectors - must become more efficient by reducing duplication and sharing services wherever possible".

1.2 Health and social care integration

The integration of health and social care is part of the Scottish Government's ambitious programme of public sector reform. It embodies the recommendations of the Christie Commission in that it aims to improve outcomes for those who use health and social care services by requiring those services to integrate.

The Public Bodies (Joint Working) (Scotland) Act 2014 came into force on 1 April 2014. It provides the legislative framework for the integration of health and social care in Scotland. It requires local integration of adult health and social care services, with Health Boards and Local Authority partnerships deciding whether to include other services in their integrated arrangements.

The vision for Health and Social Care Integration in Scotland

Ensuring better outcomes for people where users of health and social care services can expect, for themselves and those that they care for, to be listened to; to be involved in not just in deciding upon the care they receive, but to be an active participant in how it is delivered; and to enjoy better health and wellbeing within their homes and communities as a result.

Shona Robison, Cabinet Secretary for Health and Wellbeing and Sport has stated that:

"We want those who use health and social care services to have integrated care - services that work together to give the best outcomes based on that person's personal circumstances."

1.3 The wider context

It is important to remember that health and social care integration is part of a wider agenda of public sector reform. These reforms are vital to ensure the sustainability of our public services and to deliver better outcomes for those that use them.

The reforms are focused on joining up public services, organisations working together and improving outcomes for the most vulnerable people in our society. Success will ensure the sustainability of health and social services and wider public services not just for now, but also for years to come.

Integration Joint Boards need to pursue the principles of reform as a fundamental part of their role. They must work closely with other public services and also the third, independent and private sectors, to integrate service provision, use resources effectively and direct spend towards prevention and early intervention.

In this context community planning partnerships provides a pivotal vehicle for achieving effective public service reform at local level. By working with partner bodies in Community Planning Partnerships, Integration Joint Boards (IJBs) can build close connections with local communities, and shape and target the collective use of local public service resources towards integrated and efficient approaches.

This change and will require clear and cohesive leadership across all levels of the partnerships involved and confident and focused governance arrangements will be critical to getting this right.

1.4 Who is this guide for?

This guide is designed for use by a broad audience of those helping to support Integration Joint Boards as they establish themselves and begin to formulate their shared strategic vision for the partnership.

In considering the unique support requirements of Integration Joint Boards and their members, it is important to recognise that individual members will bring a variety of different skills, knowledge and understanding of particular issues to the Board. As a result, some material within the guide may be of more use to some members than others.

It is recommended that to support development approaches, IJBs start to collect data and insights that allow for the establishment of individual and collective development programmes. This will help to ensure that IJB members have the skills, knowledge and support to carry out their roles and ensure that they effectively scrutinize the governance arrangements which are in place.

The approaches detailed in this document are suggestions that can be used to begin the process of data collection, however, there is no requirement to undertake the activities outlined and those providing support to Boards are free to pursue alternative approaches should they wish.

The majority of partnerships have implemented the 'body corporate' model of integration and therefore have an Integration Joint Board, but this resource could equally be of use for those in a governance role in partnerships based on the 'lead agency' model. However, for ease of use, the resource will refer to the Integration Joint Board throughout.

1.5 The aim of this guide

The resource highlights the important roles that are required to make the integration of health and social care a success. It is structured around providing key pieces of information followed by 'development exercises' that can be used to support the effective development of an Integration Joint Board, either individually or collectively. .

This guide focuses on three main areas:

1. How can an Integration Joint Board make a difference to people's lives in delivering integrated health and social care services through the principles of integration?

2. What may be different about being a member of an Integration Joint Board?

3. How can members make a difference on an Integration Joint Board? What skills and experience do members bring from their respective backgrounds?

1.6 How to use this guide?

This resource works at an individual and collective level and can be used to stimulate discussion, affirm purpose and create conditions for effective team working. It can be used to help create a development plan for the Integration Joint Board or as an on-going reflective resource to support the strategic vision.

It aims to help develop reflective thinking in order to support:

• Identification of the collective and individual roles required to carry out the responsibilities of an Integrated Joint Board;
• Reflection on how an Integration Joint Boards will exercise collaborative leadership to achieve the outcomes for integration;
• The principles of integration being visible throughout all Integration Joint Board work;
• Discussion on how Integration Joint Boards can make a difference;
• Acknowledgment that all Integration Joint Board members come with rich but sometimes differing experience and perspectives; and
• The development of a shared understanding and appreciation of integration and how collective thinking can contribute to improving outcomes for people.
  

There may be times where the responses to some of the questions and development exercises create a range of different and opposing thoughts from board members. Acknowledging and working through these areas of difference will be important and could provide the greatest opportunities for learning for an Integration Joint Board as it navigates its way through new ways of working.

It is important to recognise that things will change as integration progresses. Using this guide at different points along the path of integration may illicit different responses to areas. Integration Joint Board may therefore want to revisit discussions over time to assess where members are at with their thinking.