Integration of Adult Health and Social Care Consultation Analysis Report

CHAPTER 4: DISCUSSION OF THE CONSULTATION EVENTS

4.1 A series of public and practitioner events took place between May and August 2012 in Edinburgh^[13], Glasgow^[14], Dumfries^[15], Perth^[16] and Elgin^[17]. The target audience included health and social care professionals from statutory and non-statutory organisations; carers; user of health and social care services; and members of the public more widely. The rest of this chapter provides a summary of the key themes discussed.

Public Events

Streamline services

4.2 Participants expressed the view that Health Boards and Local Authorities need to work with the third sector in sharing information, avoiding duplication and delay in user access to services. The idea of a 'one stop shop' with good signposting to refer people to the appropriate services was mentioned several times as a positive way forward.

4.3 Many participants commented on the possible benefits of integration. Some felt that an integrated service may provide greater consistency of services and improve accountability. A joint service could provide more opportunity for patients and service users to be involved in decisions relating to their own care. Participants hoped that by working in partnership, integration may lead to changes in attitude of NHS sector, third sector and Local Authorities and eliminate the "blame culture".

Overcoming barriers

4.4 Most of the participants supported a move towards integrated adult health and social care services but thought there were a number of barriers to overcome. Discussions included reference to a lack of resources, different organisational cultures and staffing issues. Some participants felt that the impact of welfare reform could put additional pressure on services with the potential of funding being withdrawn from one area of health and social care to fund another area. Different organisational cultures would need to be overcome. There was recognition that there are existing different staff terms and conditions. Participants expressed the view that these barriers could be overcome by including staff training and the introduction of robust and meaningful processes for dealing with disagreements and disputes. There was also reference made to the importance of learning from integration projects that have been set up in other parts of the country.

4.5 Participants at the practitioner events also discussed the different cultures of the NHS sector and Local Authorities. There was recognition that a culture change and desire for integration needs to happen. Good leadership was mentioned as essential to the success of managing the change process. Staff will need to be supported.

4.6 Training and development of staff was highlighted many times. Participants expressed the view that training should be high priority, particularly if there is less emphasis on acute services and more on community based care in the future. If staff resources are to be reapportioned from acute to community care services, then there will be a need for refresher training.

Information technology

4.7 Participants expressed the view that current information technology systems, which are not currently designed to support integration, could act as a barrier. Information technology needs to be joined up for single shared assessments to take place.

4.8 Information technology was also discussed at the practitioner events. The current systems were viewed as obstructing clear patient pathways due to difficulties in the sharing of information and data governance. Participants expressed a desire for a single patient record and an improved ability to share information between professionals.

Public involvement

4.9 A recurring view at all the events was the importance of public involvement. There was recognition that Public Partnership Forums (PPF) had played an important role in representing the views of the public and were an excellent source of local expertise and knowledge. Many agreed that it would be important for PPFs to plan how best to support health and social care integration. Participants also expressed the view that meaningful engagement means involving service users and carers throughout the process of planning and developing services.

4.10 Among those who attended the practitioner events, there was also the view that robust public involvement is required.

Practitioner Events

Scope

4.11 Participants recognised the demographic pressures that we are experiencing and the need to improve outcomes for older people. However, some participants expressed the view that there is a need to look to the wider society and include children. Participants asked for clarity regarding the initial focus on 'older people'. Specifically what is meant by 'older people' and whether this means there will be an 'age criteria' attached.

4.12 There was differing opinion about the level of prescription that should be written into the legislation. Some argued that the Scottish Government should provide central focus, whereas others favoured local solutions.

Governance

4.13 Participants expressed the view that the consultation proposals require more detail regarding who will be in charge and who will be held accountable. There was reference made to the need for a balance between delivering on outcomes for both Ministers and Local Councillors and for the outcomes themselves to still be tangible.

4.14 Human Resource issues were seen as a barrier to working in joint teams. This creates a need to streamline the governance to counteract this. The specific barriers mentioned were: two sets of terms and conditions; two salary scales; issues over information technology and information governance; and external scrutiny arrangements.

Locality planning

4.15 Participants expressed the view that this should be left to local determination. Reference was made to the need for communities to be in charge of their own services and localities of different geographies, and structures need to have flexibility to request services which best meet their demand.