Integration of Adult Health and Social Care in Scotland: Consultation on Proposals

Introduction

We have a great deal to be proud of in terms of health and social care provision in Scotland. The Healthcare Quality Strategy¹ 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 a Dementia Strategy², our continuing commitment to Free Personal and Nursing Care³ and our Reshaping Care for Older People⁴ programme, which is supported by the significant Change Fund⁵ for older people's services, all demonstrate our determination to assure innovative, high quality care and support services that improve people's lives. Our Carers' Strategy supports unpaid carers, who are themselves essential providers of health and social care, and our Self Directed Support Bill⁶ seeks to put greater control into the hands of individuals using care and support services.

Nevertheless, there is widespread recognition 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, stamina and collaboration from all of us who are involved, in different ways, in planning, managing, delivering, using and supporting health and social care services.

The Scottish Government, our statutory partners in local government and NHS Scotland, and our 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.

When we refer to "integrated health and social care", we mean services that are planned and delivered seamlessly from the perspective of the patient, service user or carer, and systems for managing those services that actively support such seamlessness. We have laid out our proposals for delivery of better outcomes for people via integration in this consultation to reflect what we believe are the key features of effective integration.

This consultation follows on from an announcement made by the Cabinet Secretary for Health, Wellbeing and Cities Strategy on 12 December 2011, which outlined the Scottish Government's proposals for integration of adult health and social care. You can read the text of that announcement here: http://www.scotland.gov.uk/News/Releases/2011/12/12111418

A debate was held in the Scottish Parliament on 15 December 2011, which confirmed broad cross-party support for Scottish Ministers' proposals. You can read the official report of that debate here: http://www.scottish.parliament.uk/parliamentarybusiness/28862.aspx?r=6627

The process of developing these proposals has included the direct involvement of the Scottish Government's partners in NHS Scotland and COSLA, and input also from many stakeholders, including representatives of professional groups and the third and independent sectors. The Scottish Government acknowledges and is grateful for the contributions made already to this important process by everyone involved so far.

What is the purpose of this consultation?

The Cabinet Secretary for Health, Wellbeing and Cities Strategy noted in her opening speech to Parliament in the debate on 15 December 2011 that, "there should be no mistake about the extent and ambition of the changes that we seek."

This consultation paper provides an opportunity for you to offer your views on new legislation that will be introduced in order to enable the changes that Ministers propose.

New legislation will not on its own achieve the improvements that Ministers are looking for. There will also be important work to carry out in terms of developing professional skills and leadership, for example. Legislation nonetheless has an important role to play - it will help to create the type of working environment that professionals and staff within the current health and social care system, and users of it, tell us is needed, and it will be used to change some arrangements that are no longer in step with society's needs. It will seek to address a number of difficulties currently faced by partners in pursuit of better outcomes for individuals and communities.

Within this consultation document, we have sought to describe the proposed new legislation in enough context to inform your answers to the questions we have asked. It is important to note, though, that this consultation does not - indeed, could not - provide a comprehensive description of every aspect of policy development, clinical improvement and practical implementation that will be part of the long-term story of effective integration of adult health and social care services in Scotland. Many of those changes and improvements will be developed locally and will build upon good practice developed over recent years.

Should the legislation proposed here pass through the Scottish Parliament, the Scottish Government will, with input from stakeholders, patients and service users, develop regulations and statutory guidance to support the changes that will be enabled by the new legislation described here. Such regulations and guidance will provide important further detail to the provisions of the Bill. There will be an ongoing, short to medium term process to give real effect to the ambitions expressed here, which will include consideration of what is required in terms of workforce development. There will of course be opportunities to contribute to that broader, ongoing process of development and improvement, which will be set within the wider context of public service reform.

Who should respond to this consultation?

Planning for, and providing, good quality health and social care services is a marker of a civilised society, and the challenges that accompany that aim affect us all, directly or indirectly. We expect that this consultation will be of interest to a wide range of people - patients, service users, carers, clinicians and other professionals working in the NHS and social care and beyond, and in the third and independent sectors, and members of the public more widely.

Equality Impact Assessment

The public sector equality duties require the Scottish Government to pay "due regard" to the need to:

• Eliminate discrimination, victimisation, harassment or other unlawful conduct that is prohibited under the Equality Act 2010;
• Advance equality of opportunity between people who share a protected characteristic and those who do not; and
• Foster good relations between people who share a relevant protected characteristic.

These three requirements apply across the "protected characteristics" of age; disability; gender reassignment; pregnancy and maternity; race; religion and belief; sex and sexual orientation.

In effect, this means that equality considerations are integrated into all functions and policies of Scottish Government Directorates and Agencies.

A key part of these duties is to assess the impact of all of our policies to ensure that we do not inadvertently create a negative impact for equality groups, and also to ensure that we actively seek the opportunity to promote equality of opportunity and to foster good relations.

In March 2012, the Scottish Government ran a scoping workshop to identify potential impacts that may or may not arise as a result of the policies described in this consultation. This workshop provided the first stage of an Equalities Impact Assessment (EQIA). A report of the findings from the workshop has been used to develop a partial EQIA, which is attached at Annex D.

We welcome your feedback regarding the equalities impact of the proposals presented in this paper, and the effect they may have on different sectors of the population.

Business Regulatory Impact Assessment

The Scottish Government is committed to consulting with all parties potentially affected by proposals for new legislation, or where any regulation is being changed significantly. All policy changes, whether European or domestic, which may have an impact upon business or the third sector should be accompanied by a Business Regulatory Impact Assessment (BRIA).

The BRIA helps policy makers to use available evidence to find proposals that best achieve the policy objectives, whilst minimising costs and burdens. Through consultation and engagement with business, the costs and benefits of the proposed legislation can be analysed. It also ensures that any impact on business, particularly small enterprises, is fully considered before regulations are made.

A partial BRIA is attached at Annex E. We welcome your views regarding the impact that the proposals presented in this paper may have on businesses, and your comments and feedback on the partial BRIA.

Structure of this consultation paper

This consultation paper is organised into chapters, as follows:

Background

Chapter 1 The case for change
Chapter 2 Outline of proposed reforms

Detailed proposals

Chapter 3 National outcomes for adult health and social care
Chapter 4 Governance and accountability
Chapter 5 Integrated budgets and resourcing
Chapter 6 Jointly Accountable Officer
Chapter 7 Professionally led locality planning and commissioning of services

Supporting information

Annex A Draft national outcomes for adult health and social care
Annex B Impact on other areas of service - beyond adult health and social care
Annex C Workforce implications

Equality Impact Assessment and Business Regulatory Impact Assessment

Annex D Partial Equality Impact Assessment
Annex E Partial Business Regulatory Impact Assessment

Responding to this consultation

Annex F Respondent Information Form
Annex G Consultation Questionnaire
Annex H How to respond

Please ensure that your response is sent to:

adulthealthandsocialcareintegration@scotland.gsi.gov.uk

Or

By: 11 September 2012