Integration of Adult Health and Social Care Consultation Analysis Report

CHAPTER 1: INTRODUCTION

1.1 The Scottish Government launched a public consultation to inform recommendations for legislation to support integration of adult health and social care in Scotland. This report presents the views expressed by respondents to the consultation proposals.

Background to the consultation

1.2 The Healthcare Quality Strategy for NHS Scotland^[2], published in May 2010, underpins our commitment to deliver the highest quality healthcare services to people in Scotland and, in recent years, we have seen significant improvements in terms of standards and outcomes, with improvements in waiting times, patient safety and delayed discharges from hospital. Our introduction of Scotland's National Dementia Strategy^[3], our continuing commitment to Free Personal and Nursing Care^[4] and our Reshaping Care for Older People^[5] programme, all demonstrate our determination to assure innovative, high quality care and support services that improve people's lives. Caring Together: The Carers Strategy for Scotland^[6] supports unpaid carers, who are themselves essential providers of health and social care, and the Social Care (Self Directed) (Scotland) Bill^[7] seeks to put greater control into the hands of individuals using care and support services.

1.3 The recent review of Community Planning undertaken by the Scottish Government and the Convention of Scottish Local Authorities identified that effective Community Planning arrangements should be at the core of public service reform to achieve better outcomes for communities. Realising this will require community planning partners and communities to work together to understand local needs and aspirations, and to design and deliver services that meet these needs and aspirations.

1.4 There is recognition, however, across Scotland that we need to go further. Separate - and sometimes disjointed - systems of health and social care can no longer adequately meet the needs and expectations of increasing numbers of people who are living into older age, often with multiple, complex, long-term conditions, and who need joined up, integrated services. Addressing these challenges will demand commitment, innovation, and collaboration from everyone involved in planning, managing, delivering, using and supporting health and social care services.

1.5 The Scottish Government, statutory partners in local government and NHS Scotland, and non-statutory partners in the third and independent sectors, agree that better integration is required if we are to ensure the ongoing provision of high quality, appropriate, sustainable services. Integration is not an end in itself - it will only improve the experience of people using services when we all work together to ensure that we are integrating services as an effective means for achieving better outcomes.

1.6 The Scottish Government launched a public consultation on 8 May 2012, to inform recommendations for legislation to support the integration of adult health and social care services in Scotland. The consultation paper was entitled Integration of Adult Health and Social Care in Scotland: Consultation on Proposals^[8] and stated that the aim of the proposed legislation is to improve people's experience of health and social care services and the outcomes that services achieve, and to ensure that the substantial proportion of Scottish public services spending, that supports these services, is used to the very best effect.

1.7 Four key objectives for integration:

• Health and social care services are firmly integrated around the needs of individuals, their carers and other family members;
• There should be strong and consistent clinical and care professional leadership in the planning and provision of services;
• The providers of services should be held to account jointly and effectively for delivering improved outcomes; and
• Services should be underpinned by flexible, sustainable financial mechanisms that give priority to the needs of the people they serve, rather than the organisations through which they are delivered.

1.8 The consultation set out six key features of the proposals:

• Community Health Partnerships will be replaced by Health and Social Care Partnerships which will be the joint and equal responsibility of Health Boards and Local Authorities, and which will work in close partnership with the third and independent sectors and with carer representation. The focus will be on making sure that people have access to the right kind of care, at the right time and in the right place.
• Nationally agreed outcomes will apply across adult health and social care. Health and Social Care Partnerships will be accountable, via the Chief Executives of the Health Board and Local Authority, to Ministers, Local Authority Leaders and Health Board Chairs for the delivery of those outcomes. These outcome measures will focus, at first, on improving older people's care and will be included in all Community Planning Partnerships' Single Outcome Agreements.
• Health and Social Care Partnerships will be required to integrate budgets for joint strategic commissioning and delivery of services to support the national outcomes for adult health and social care. Integrated budgets will include, as a minimum, expenditure on community health and adult social care services, and, importantly, expenditure on the use of some acute hospital services. Where money comes from - health or social care, or indeed, housing - will no longer be of consequence to the patient or service user. What will matter instead will be the extent to which partnerships achieve the maximum possible benefit for service users and patients together, against the backdrop of shared outcomes and integrated budgets.
• A jointly appointed, senior Jointly Accountable Officer in each Health and Social Care Partnership will ensure that partners' joint objectives, including nationally agreed outcomes, are delivered within the integrated budget by the Partnerships.
• The role of clinicians, social care professionals and the third and independent sectors in the strategic commissioning of services for adults will be strengthened. Health and Social Care Partnerships will ensure that effective processes are in place for locality service planning led by clinicians and care professionals, with appropriate devolved decision-making and budgetary responsibilities.
• Proportionally, fewer resources - money and staff - will be directed in future towards institutional care, and more resources will be directed towards community provision and capacity building. This will mean creating new and potentially different job opportunities in the community.

Purpose of the consultation

1.9 The purpose of the consultation was to seek people's views about the legislative proposals for the integration of adult health and social care. The consultation included twenty questions covering seven key themes: the case for change; outline of proposed reforms; national outcomes; governance and joint accountability; integrated budgets and resourcing; jointly accountable officer; and professionally led locality planning and commissioning of services.

This report

1.10 The rest of this report sets out to explore responses received to these questions. Chapter 2 describes the method used to capture views to the consultation proposals. Chapter 3 focuses on the views expressed in the written responses and Chapter 4 provides a summary of the discussion at the public and practitioner consultation events.