Health and social care - strategic plans: statutory guidance

2. Introduction

The aim of the integration of health and social care services is to ensure that people receive the right care, in the right place, at the right time. Integration seeks to mitigate the historic divide in the delivery of ‘health’ and ‘social care’ services.

The 2014 Act places a duty on integration authorities – either IJBs or health boards and local authorities acting as lead agencies – to create a strategic plan for the integrated functions that they control.

The strategic plan should draw upon the ‘commissioning’ process. Commissioning is the term used for all the activities involved in assessing and forecasting needs. It links investment to agreed outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place^[1].

The impact of integration is measured by the statutory national health and wellbeing outcomes and the indicators that underpin them^[2], as well as consideration of other relevant national outcomes frameworks and data sets. Achieving these ambitions requires partnership working between statutory agencies and professionals, the third and independent sectors, and local communities.

Recognising that integration has developed significantly since 2015, when this guidance was originally published, a working group of key partners was convened to refresh the guidance. The intention in revising the guidance was to bring it up to date, draw upon wider good practice, and further support integration authorities to meet the range of statutory requirements. This version of the guidance seeks to establish a solid foundation on which to take forward future developments in the integrated planning of health and social care, including through the development of the National Care Service, while also reflecting the Scottish Government’s commitment to support improvement now.

A further overarching ambition of the working group was for the guidance to support and encourage holistic local planning as a mechanism in upholding rights, tackling inequalities, and safeguarding, supporting and promoting wellbeing. This guidance therefore aims to support local, cross-sector links between health, social care, housing, children’s social work, and wider areas where integration authorities may have a significant role or impact.

This guidance sets out how strategic planning and commissioning needs to operate in order for integration to deliver better outcomes and improve people's lives. As planning requirements have now been in place for a number of years, integration authorities may wish to use this guidance to assess the effectiveness of their established processes collaboratively with wider partners. This will provide an opportunity to support greater cohesion between IJB decision-making and other local governance and decision-making forums

‘Strategic commissioning’ and producing a strategic plan

Recognising that integration represented a new, collaborative way of developing health and social care services, the previous version of this guidance placed an emphasis on ‘strategic commissioning’, and the activities set out in the 2014 Act were developed based on the Institute of Public Care’s commissioning cycle^[3]. Throughout this guidance, the language has been amended to align closer with what is used in practice, while seeking to maintain the policy intent underpinning the 2014 Act, which put commissioning in a strategic, collaborative way at the centre of how integration authorities should operate.

Commissioning ‘includes identifying the needs of individuals and communities, enabling people to decide what will best address those needs and working together with agencies to put the right services and support in place’^[4]. Models of commissioning tend to emphasise its cyclical nature, with commissioning providing the context for procurement and contracting. The commissioning process should be equitable and transparent, and therefore open to influence from all partners and stakeholders through an ongoing dialogue with people who use services, carers, and service providers. It should take account of any other local commissioning activity to avoid duplication or gaps.

The previous version of this guidance referred to the ‘strategic plan’ in the 2014 Act as the ‘strategic commissioning plan’. In this revised version of the guidance, ‘strategic plan’ is used for clarity and consistency with the 2014 Act. This change also reflects the language used by integration authorities, with most producing a ‘strategic plan’.

The function of the strategic plan, as defined in the 2014 Act, is to set out arrangements for carrying out integrated functions and outline how these will achieve, or contribute to achieving, the national health and wellbeing outcomes. Through determining needs and developing services to meet these needs, commissioning is a key process in achieving this objective and therefore strategic plans should draw upon output from the commissioning process.

The Coalition of Care and Support Providers in Scotland (CCPS) has produced a guide on commissioning for outcomes and the different terminology.