Integration of Adult Health and Social Care in Scotland Consultation: Scottish Government Response

The case for change - whom to legislate for?

7. The consultation proposed that legislation should apply to adult health and social care services, with a particular focus at first, via performance management, on improving outcomes for older people.

What we heard

8. In general terms, respondents agreed that there is variation in the quality of service for people and their support networks across Scotland.

9. Respondents observed, clearly and consistently, that it would not be a good idea to restrict integration to services for older people as defined by age. While acknowledging that there is a strong correlation between long-term conditions and age, respondents felt that it would be better if approaches to integration were considered in terms of people's wellbeing and state of health, and the complexity of their needs, rather than in terms of chronological age.

10. Many respondents also said that it would be better to consider taking a whole system approach to integration, and therefore including children's and young people's services, rather than solely focussing on integration of older people or adult services.

The Scottish Government Response

11. We recognise that there is variation in terms of support provided to people, as noted by respondents. This programme of change seeks to address those concerns and challenges by reinforcing the importance of effective partnership working within a statutory context. By making these proposed changes, we are looking to remove the bureaucratic and financial barriers that exist within the current system for delivering adult health and social care services, and to ensure clear accountability for the delivery of national outcomes, providing transparent performance information for different areas in Scotland.

12. Whilst legislation cannot address all the organisational and cultural issues that currently challenge delivery of these services it can ensure that all communities in Scotland are set within a single outcomes framework. Improvement, performance and scrutiny mechanisms will also play an important role in enabling the public sector and its partners to judge progress, share best practice and address poor performance.

13. We recognise that the point about focussing on people's wellbeing and state of health is well made, and provides a stronger approach than one that depends on groupings defined by chronological age.

14. There is nevertheless an important early priority for us to address in terms of improving outcomes for adults with multiple long-term conditions and complex support needs. Many of those people are older. It is important that we improve outcomes for people with such needs, for their wellbeing and also to ensure that the whole health and social care system works effectively for everyone who needs support. That is why our proposals put the person at the centre of service planning and delivery, and will look to ensure that health and social care support is integrated around their needs.

15. Current arrangements around Scotland provide a range of examples of models of children's services, some standalone, some successfully integrated with adult health and social care services, and others where links are closer with education services.

16. The Scottish Government believes that local partners (Health Boards and Local Authorities) will be best placed to decide whether children's services should fall within the scope of these new arrangements. It is therefore our intention to legislate to require Health Boards and Local Authorities to integrate health and social care services for all adults. We believe that integration of service planning and delivery is the most effective way to support person-centred care. We intend to legislate so that, in future, the Scottish Government can extend the range of areas of service provision that must be included in the integrated arrangement.

17. Whichever approach is taken to integration in different areas - to integrate only adult services, or adult and children's services at the same time, or in sequence - we will look for focussed improvement in outcomes, and a shift in provision of care from institutions to communities, for adults with multiple support needs. This is not to diminish our focus on assuring good outcomes for other groups of people as well, but to achieve parity of focus on the needs of frail older people and other adults with multiple complex needs for care and support. This outcomes-focused approach will be applied to children's services through provisions in the Children and Young People Bill on the joint planning of services to support children's well-being by local authorities and health boards.

18. Criminal justice social work has important relationships with both adult and children's services. Community Justice Authorities have responsibility for reducing reoffending, but criminal justice also features in the work of other partnerships including the small number of Community Health and Care Partnerships that currently exist. The Scottish Government is currently consulting on the future of community justice structures and a consultation paper was published on 20 December 2012 which sets out possible options for change. The consultation period will last until 30 April 2013 with a view to the Scottish Government making an announcement on the way forward in late 2013, and subject to Parliamentary approval, implementation from 2016 onwards. Local partners will need to take into account developments in criminal justice, as it progresses, when determining the scope of services to be included in their local arrangements.