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

Jointly Accountable Officer

83. We asked whether you thought that our proposals for appointing a Jointly Accountable Officer in each Health and Social Care Partnership would enable the shift in outcomes we seek, and whether we had described an appropriate level of seniority and financial authority for the Jointly Accountable Officer.

What we heard

84. Respondents expressed a range of views regarding the appointment of Jointly Accountable Officers, and asked for further information on the role and remit of the post.

85. Some respondents thought that responsibility for planning and delivery of integrated services should sit with the Chief Executives of Health Boards and Local Authorities, and existing Community Health Partnership General Managers.

86. Some respondents agreed with the responsibilities of the role but questioned whether it was necessary to establish the position as a post in every Partnership. Along similar lines, we have been asked by a number of stakeholders whether the position of the Jointly Accountable Officer is to be a post, or whether it might be a role fulfilled in various ways according to different local circumstances.

87. Some respondents felt that such a role would be necessary in order to manage the integrated budget effectively.

88. There was general agreement that if Jointly Accountable Officers are appointed they need to be multi-skilled, experienced, knowledgeable and expert leaders and managers, able to operate with autonomy, wield influence and exercise authority within both statutory structures, as well as within the Health and Social Care Partnership. Many respondents expressed the view that the Jointly Accountable Officer post must be senior enough to reflect these requirements.

89. A few people have suggested to us that it is in practical terms impossible for a jointly appointed senior post to be held accountable by two different public bodies.

90. We were also asked about the impact of the Jointly Accountable Officer position on other statutory officer roles, and particularly on the role of the Chief Social Work Officer.

The Scottish Government Response

91. In the earlier consideration of governance and accountability arrangements, we reflected on the need to balance two aims: achieving real change, and a real shift in the balance of care, with the importance of assuring proper governance of the new Health and Social Care Partnership arrangements via Local Authorities and Health Boards.

92. We are committed to the principle of integrating budgets to reflect population needs. A single budget, delegated from two partner organisations, can only be managed effectively via a single point of senior oversight and accountability.

93. In the integrated adult health and social care environment for which we plan to legislate, joint accountability at senior level is required, in simple terms, to achieve two objectives:

• To provide a point of joint accountability upwards, from the Health and Social Care Partnership, to the Partnership Committee, via which there is accountability to the full Council and Health Board; and
• To provide a single, senior point of joint and integrated management down through the delivery mechanisms in each partner organisation.

94. These arrangements work differently in the two different models of financial integration for which we plan to legislate.

95. In the delegation to a body corporate model, a single post of Jointly Accountable Officer will be required in order to fulfil both functions. We are not satisfied that the responsibilities we envisage for such a post can be effectively shared between different individuals employed by the partner organisations. That is a common situation now; its perpetuation would in all likelihood simply achieve a continuation of the status quo.

96. In the delegation between partners model, the first objective - accountability upwards, to the committee and thence to the full Council and Health Board - is provided via the Chief Executive of the host partner. So, for example, if, as in Highland, adult social care is delegated to the Health Board and children's community health services are delegated to the Local Authority, the Chief Executive of the Health Board is accountable to the Council and Health Board for delivery of adult services, and the Chief Executive of the Local Authority is accountable for delivery of children's services. Other arrangements would also be possible under this model, of course: the key point is that the Chief Executive of the 'host' partner in any such arrangement would be accountable to the Council and Health Board for delivery of the delegated services.

97. In the delegation between partners model, the second objective - joint and integrated management downwards through the delivery mechanisms of each partner organisation - is achieved via delegation of delivery of integrated outcomes from the Chief Executive to other senior staff in the host partner organisation.

98. In the delegation between partners model, therefore, joint accountability is a role fulfilled according to the delegation arrangements agreed locally.

99. We already know that it is practically possible for a jointly appointed senior post to be held accountable by two different public bodies. This kind of model is already in operation in a number of partnership areas in Scotland, albeit not yet with the full range of authority invested in the post that we envisage. In particular, we envisage greater authority and influence with respect to planning for provision of hospital services in the new arrangements.

100. Questions about the impact of the Jointly Accountable Officer position on other statutory officer roles, particularly the role of the Chief Social Work Officer, are important. We recognise the key importance of statutory roles as currently defined in legislation and have no intention of changing these.

101. This should provide firm reassurance of the Scottish Government's commitment to the Chief Social Work Officer role and to professional leadership in general. We are strongly of the view that the influence of high quality professional leaders in Health and Social Care Partnerships is central to the effectiveness of the new arrangements.

102. We are already working closely with professional leaders on this agenda, for example in revising the Scottish Government guidance on the role of the Chief Social Work Officer.