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

Chapter 6 Jointly Accountable Officer

What do we want to achieve?

6.1. In order for each Health and Social Care Partnership's integrated budget to work properly - so that it is managed without reference to whether it is "health" or "social care" money, but instead only in terms of its best use for the patient or service user or carer - it will be important for a senior Jointly Accountable Officer to manage the budget and oversee delivery of outcomes. Options for financial integration are explored in Chapter 5.

6.2. In order to ensure the level of authority and autonomy envisaged for the post, the Jointly Accountable Officer will be a senior appointment, at senior executive level or equivalent, and will report directly to the Chief Executives of the Health Board and Local Authority.

6.3. As previously discussed, the role of the Jointly Accountable Officer is central to the potential success of the approach laid out in these proposals. The post-holder must carry sufficient authority to make decisions about resource prioritisation without needing to refer back up the line within either the Health Board or the Local Authority. The effectiveness with which this aspect of delegated financial authority is achieved will be key to ensuring that resources lose their "health" or "social care" identity in the integrated budget.

How will this approach be different from current arrangements?

6.4. There are already some examples of senior joint appointments managing services across health and social care in Community Health Partnerships.

6.5. The new arrangements will be different because they will make it obligatory for every Health and Social Care Partnership to establish such a role, at a senior level, and because they will assure the financial authority of the Jointly Accountable Officer for health and social care budgets, including some acute budgets, managed as a single envelope of resources.

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

6.6. We will place a duty on Health and Social Care Partnerships to jointly appoint a senior Jointly Accountable Officer, at Executive level, reporting to the Chief Executives of the Health Board and Local Authority, to manage the integrated budget for adult health and social care and service provision to achieve the outcomes specified in the Partnership Agreement between partners.

6.7. The mechanism via which the Jointly Accountable Officer is assured the financial authority described here will depend upon the model for financial integration between the Health Board and the Local Authority that is used. Models for financial integration are discussed in Chapter 5.

6.8. If functions are delegated to the Health and Social Care Partnership, established as a corporate body, the financial authority of the Jointly Accountable Officer to manage budgets from both organisations could be established via a service level agreement between the organisations.

6.9. If functions and resources were delegated between the Health Board and Local Authority, with one partner delegating functions and resources to the other, the Jointly Accountable Officer will be employed by the host partner to account for the functions which that partner hosts. He or she will then be accountable to the Chief Executive of the host partner for use of the integrated budget and delivery of the outcomes specified by the Health and Social Care Partnership in their Partnership Agreement. Both Chief Executives will be accountable for the performance of the Health and Social Care Partnership.

What do we want to know from you?

Question 13: Do you think that the proposals described here for the financial authority of the Jointly Accountable Officer will be sufficient to enable the shift in investment that is required to achieve the shift in the balance of care?

Question 14: Have we described an appropriate level of seniority for the Jointly Accountable Officer?