Public Bodies (Joint Working) Scotland Bill: Business and Regulatory Impact Assessment

Purpose and intended effect

Background

The integration of health and social care represents the radical reform required to improve care, particularly for adults with multiple complex needs for support, many of whom are frail older people, and to make better use of the substantial resources that we commit to adult health and social care. The Bill will bring forward legislation to remove Community Health Partnerships from statute. Instead, the Bill will create an integration authority which will be the joint and equal responsibility of Health Boards and local authorities.

Objective

The Scottish Government's vision of a successfully integrated system of adult health and social care for Scotland is that it will exhibit the following characteristics:

• Consistency of outcomes across Scotland, so that people have a similar experience of services, and carers have a similar experience of support, whichever Health Board or local authority area they live within, while allowing for appropriate local approaches to deliver;
• A statutory underpinning to assure public confidence;
• An integrated budget to deliver community health and social care services and also appropriate aspects of acute health activity;
• Clear accountability for delivering agreed national outcomes;
• Professional leadership by clinicians and social workers; and
• It will be simpler rather than complicate existing bodies and structures.

The four key principles that underpin these reforms are:

• Nationally agreed outcomes to apply across adult health and social care;
• Health Boards and local authorities are to be jointly and equally accountable for the delivery of those outcomes;
• Integrated resources (budgets and human resources) will apply across the spectrum of adult health and social care provision; and
• Encouraging strong clinical and professional leadership, and the engagement of the third and independent sectors, in the commissioning of adult health and social care services.

Additional provisions within the Bill

The following additions to the Bill were not part of the consultation on the Integration of Adult Health and Social Care in Scotland. We recognise that these additions could affect businesses, particularly changes to the functions of the Common Services Agency.

(i) Joint Venture Structures

The Bill gives Health Boards the power to form and participate in forming joint ventures companies, to be extended to allow for a wider range of company structures (as currently available to local authorities) and functions that will allow for the more efficient procurement of facilities (initially via the hub initiative), promote effective joint working and support the aims of the Public Bodies (Joint Working) (Scotland) Bill.

(ii) Common Services Agency (CSA)

We are expanding the remit of the Common Services Agency (also known as NHS National Services Scotland or NSS) via a Public Services Reform Order, from a provider of shared services to NHS bodies only, to a provider of shared services to Scottish public bodies (including local authorities) where this would produce operating and cost efficiencies.

Many of the desired amendments to the remit of CSA can be made by means of a Public Services Reform Order. We consulted on the draft Public Services Reform and will continue to engage with stakeholders to monitor potential impacts on business. The Bill replicates the effect of the Public Services Reform Order through an updated approach.

(iii) CNORIS

CNORIS scheme is a self-insurance scheme operated by the NHS in Scotland for meeting losses and liabilities etc of certain health bodies. The scheme makes provision to meet expenses arising from any loss or damage to 'bodies' property and liabilities to third parties for loss, damage or injury arising out of carrying out of the functions of members of the scheme.

It is intended that the Bill will make provision to extend the CNORIS scheme to include social work functions to which the scheme applies and to include local authorities and incorporated integration joint boards amongst the bodies which can participate in the scheme.

How it fits in with Scottish policy

(i) Legislation

The Public Bodies (Joint Working) (Scotland) Bill will supersede and replace the following:

• The Community Health Partnerships (Scotland) Regulations 2004; and
• The Community Health Partnerships (Scotland) Amendment Regulations 2010.

In addition to the above, other legislation that will be directly affected by the integration agenda are legislation relating to the NHS and local authorities:

• Social Work (Scotland) Act 1968;
• National Health Service (Scotland) Act 1978;
• National Health Service Reform (Scotland) Act 2004;
• National Health Service Reform (Scotland) Act 2004;
• Local Government (Scotland) Act 1973;
• Local Government etc. (Scotland) Act 1994;
• Local Government in Scotland Act 2003; and
• Public Services Reform (Scotland) Act 2010

(ii) Policy

The integration of adult health and social care services may have implications for a number of other functions, including children and families social work services and criminal justice social work. Work has been undertaken by the Chief Social Work Adviser to ensure that the implications for other areas of service are understood and planned for. Furthermore, we have ensured there is alignment and coherence between the concurrent legislation including the Children and Young People Bill^[1] which, in part, places duties on statutory partners, with respect to planning, design and delivery of children's services. An important aspect of the integration of adult health and social care will be ensuring that, as well as bringing primary and secondary health, and health and social care, closer together, partners fully include housing and other appropriate areas of services in the integrated approach.

The Public Bodies (Joint Working) (Scotland) Bill sets out our requirements for integration. These will be applied as a minimum to adult health and social care services. Legislation will specify the minimum content of an integration plan. The integration plan will set out the functions delegated to the integration authority or to either Partner in the case of a 'delegation between partners' model. The delegation of functions to the integration authority or to either Partner will have implications for all policies linked to the delegated services.

The Bill also provides the framework to support the Scottish Government's policy of Reshaping Care for Older People^[2][3], which aims to ensure that the care people receive is more appropriate and personal to their needs. Under this policy, there is likely to be a shift from a focus on institutional forms of care, towards care in the home and community settings.

Self-directed support provides for choice and control for service users and carers about how their support is provided. The focus is on delivering better outcomes through focused assessment and review, improved information and advice, and a clear and transparent approach to support planning. The strategy is part of a wider reform agenda, and reflects the common goals of current health and social care policy including the integration agenda to deliver better outcomes for individuals and communities. The Social Care (Self Directed Support) (Scotland) Act^[4] provides a legislative framework for choice and control of provision of services by placing duties on local authorities to provide the range of options available to citizens.

How it fits in with UK policy

The Health and Social Care Act 2012 includes principles such as clinical commissioning and greater local accountability, and comes during a period when Welfare Reform by the UK Government will transform the benefits of vulnerable people in Scotland. We do not anticipate either pieces of legislation having a direct impact on the integration of adult health and social care in Scotland.

How it fits in with European policy

The Public Bodies (Joint Working) (Scotland) Bill and the broader integration policy will not have any EU or international implication.

Rationale

We know from clinicians and other professionals who provide health and social care support that, where it is appropriate and safe to do so, it is better for people's wellbeing if they are supported in their own homes or a homely setting in the community, rather than being admitted unnecessarily to hospital.

Despite a good track record of partnership working over the years, our current system of health and social care still incorporates within it barriers in terms of structures, professional territories, governance arrangements and financial management that often have no helpful bearing on the needs of the large, growing group of older service users, and in many cases work against general aspirations of efficiency and clinical/care quality. We need to reform the system to deliver care that is better joined up and as a consequence delivers better outcomes for patients, service users and carers.

Our goal for integration of health and social care is to tackle these challenges to ensure that the balance of care shifts from institutional care to services provided in the community, and that resources follow people's needs. This is in line with our commitment to a person-centred approach which builds on the principles of the Healthcare Quality Strategy for NHSScotland^[5].

This policy will contribute to delivery of several National Outcomes including:

• We live longer, healthier lives;
• We have tackled the significant inequalities in Scottish society;
• We live in well-designed, sustainable places where we are able to access the amenities and services we need;
• Our people are able to maintain their independence as they get older and are able to access appropriate support when they need it;
• We have strong, resilient and supportive communities where people take responsibility for their own actions; and
• Our public services are high quality, continually improving, efficient and responsive to local people's needs.

The challenge for health and social care services is seen in projections for demographic change in terms both of the expected growth in the older population and in terms of rising costs for health and social care for all ages. Over the next 20 years health and social care costs in Scotland are expected to rise by a total of £2.5 billion, so that by 2031 total annual costs will exceed today's by £2.5 billion, at today's prices.

The analysis that the Scottish Government published in support of our Reshaping Care for Older People programme showed that emergency admissions to hospital account, annually, for about one third of the total health and social care spend for people aged 65+; approximately £1.4 billion in 2007/08^[6].

In 2010/11, nearly two thirds of health and social care expenditure on people aged 75+ was in institutional settings (care homes and hospitals)^[6].

With a shift to community provision, there is scope to reduce these pressures and deliver better outcomes for people. The principles of the integration agenda will help to address these funding and demographic challenges over the longer term.