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

Integrated budgets and resourcing

70. We asked whether you thought the models for financial integration proposed in the consultation could deliver the objectives described, whether Ministers should prescribe minimum budgets to be included in the integrated arrangements, and whether you had other suggestions for integrating resources.

What we heard

71. There was a general view that the two models could deliver the objectives described, allowing for previous comments regarding local challenges and competing priorities, and the need to overcome historic barriers to effective integrated working.

72. Of the two models for financial integration that were described in the consultation - delegation between partners and delegation to a body corporate - most respondents indicated a preference for the body corporate model.

73. A number of respondents, particularly from Local Authorities, noted that more than two models should be offered. No alternatives were proposed, however.

74. A consistent message came through that the choice of which model to use should be left to local determination.

75. There was a general view that Ministerial direction on budgets to be included in the integrated budget should be kept to a minimum, to allow for maximum local flexibility and decision-making. A few respondents noted a concern that, if Ministers prescribe a minimum, only that minimum would be included in the integrated budget.

76. At the same time, a strong view was reported on the importance of ensuring that sufficient and appropriate parts of hospital budgets were included in the integrated budget.

The Scottish Government Response

77. Ministers have invited COSLA to give further consideration to the question of whether further alternative models for integrating budgets are available and should be offered via legislation. We will consider suggestions in due course.

78. It is our intention to legislate so that it is necessary for all local partnerships to reach agreement on integrated arrangements to be implemented locally, subject to the specifications described in legislation. It is our intention to make provision for arrangements to be put in place where there is local failure to agree.

79. We are committed to including within the integrated budget resources used for the delivery of adult health and social care services, covering primary care and aspects of secondary health care and social care provision. Further work is underway to articulate services that should be included within this scope. In order to make sure that the resources allocated by the partners to the integrated budget are of sufficient scope, we intend to legislate for a minimum range of functions and associated budgets that must be included. It will be left to local determination to decide the scope of any other budgets for inclusion, potentially covering, for example, children's and housing services, as described previously.

80. Where partners agree to use the delegation to a body corporate model, the integrated budget will be formed by transfer of funding from each partner to the body corporate. Decisions on its use will rest with the Health and Social Care Partnership, within the context of the delegated arrangements defined in the Partnership Agreement. The Health and Social Care Partnership will allocate the integrated budget to the Health Board and Local Authority and, as appropriate, to third and independent sector partners, to deliver the services agreed in its joint strategic commissioning plan.

81. Where partners agree to use the delegation between partners model, the integrated budget will be formed by the transfer of funding from one partner to the other, combined with the lead partners own resource.

82. Work is ongoing with partners across health and social care to agree the detail of which categories of spend should be included within the minimum range, and to agree practical aspects of implementing integrated budget arrangements, which will be provided in guidance.