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

Chapter 3 National outcomes for adult health and social care

What do we want to achieve?

3.1. Our priority is to improve people's experience of health and 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. We believe that it is important to focus squarely on that priority, and on overcoming the barriers that exist in current systems - and not to take centrally directed structural change as a starting point for the transformation that is required. The many professionals who work in health and social care in Scotland must be well-placed to focus their attention fully on the shift in outcomes that is needed, and our programme of proposed reforms is designed to support that.

3.2. The underlying principle of these proposals is to provide national leadership in relation to what is required - the outcomes that must be delivered - and to leave to local determination how best to achieve those outcomes - the delivery mechanisms that will best suit different local needs.

3.3. For these reasons, we are proposing a programme of reform that takes as its starting point the introduction of a new set of nationally agreed outcome measures and standards for adult health and social care, with a particular focus initially on services for older people. From this starting point, we will work with partners to develop outcome measures covering all of adult health and social care.

3.4. The nationally agreed outcomes will apply across adult health and social care; will be transparent and accountable locally and to the Scottish Parliament via Ministers; and will provide assurance that local variation is appropriate to local needs. Providing information and evidence from across health and social care will be critical to demonstrating progress, and external scrutiny processes will be appropriately aligned to support integration of adult health and social care.

3.5. This is an ambitious and challenging approach. Success will depend in no small part on a step change in the relationship between the NHS and local government, and between both statutory partners and central government. By focussing on outcomes, we will be leaving no hiding place in which to conceal, or explain away, lack of progress. In a complicated delivery landscape like health and social care, and when tackling the very significant challenges that we face, it is important that our proposals for improvement are sufficiently ambitious to address the priorities we must tackle. We believe that an outcomes-led approach to reform is the right way to put in train the improvements we must now realise.

How will this approach be different from current arrangements?

3.6. Currently, performance management and reporting frameworks for NHS Scotland and Local Authorities are considerably different from one another.

3.7. The introduction of the Concordat between the Scottish Government and COSLA in November 2007 brought with it the end of ring fencing of local government funding and associated scrutiny by the Scottish Government of Local Authority spending. Single Outcome Agreements are now agreed between each Community Planning Partnership (CPP) and the Scottish Government.

3.8. Single Outcome Agreements provide the mechanism via which CPPs agree local strategic priorities, and demonstrate how those outcomes contribute to the National Outcomes that are part of the Scottish Government's National Performance Framework. Each Single Outcome Agreement is specific to local priorities, with performance management and continuous improvement arrangements that are unique to individual Local Authorities, although with some common characteristics between Local Authorities.

3.9. In contrast, within NHS Scotland, management plans and decisions for the delivery of nationally applied targets are scrutinised and agreed with the Health and Social Care Directorates within the Scottish Government, with decisions for major service change ultimately sitting with Scottish Ministers.

3.10. By introducing nationally agreed outcomes that apply across adult health and social care, we will for the first time introduce a mechanism for ensuring that Health Boards and Local Authorities are jointly and equally clear about their priorities for integrated working, and can be jointly and effectively held to account for delivery. Health Boards and Local Authorities will be free to choose locally to agree joint outcomes for other areas of service.

3.11. The specific outcomes themselves will not be written into legislation as they will be expected to change and develop over the years to come. Draft outcomes, focussing for now, as explained above, on older people's services, are currently under development and are provided at Annex A of this consultation.

How will we go about achieving this change - what will change in legislation?

3.12. Legislation will put in place a duty on statutory partners to deliver nationally agreed outcome measures for adult health and social care. The nationally agreed outcomes will apply across Health Boards and Local Authorities, which will be jointly and equally accountable to Scottish Ministers, Local Authority Leaders and Health Board Chairs for the delivery of those outcomes.

3.13. Further details on proposed governance and accountability arrangements for Health Boards and Local Authorities under these new arrangements are provided in Chapter 4.

What do we want to know from you?

Question 3: This proposal will establish in law a requirement for statutory partners - Health Boards and Local Authorities - to deliver, and to be held jointly and equally accountable for, nationally agreed outcomes for adult health and social care and for support to carers. This is a significant departure from the current, separate performance management mechanisms that apply to Health Boards and Local Authorities. Does this approach provide a sufficiently strong mechanism to achieve the extent of change that is required?

Question 4: Do you agree that nationally agreed outcomes for adult health and social care should be included within all local Single Outcome Agreements?