Auditor calls for reform of Scottish community health partnerships

Organisations which join up healthcare and social care need reviewing and improving, according to Audit Scotland

Scotland’s 36 community health partnerships, which manage £3.2bn of the country’s £13bn health and social care spending, need a “fundamental review” according to its auditor general.

A report published by Audit Scotland criticises the partnerships between health boards and local authorities, pointing out that some health trends that might be improved by better co-operation have in fact worsened. These include more older patients and those with chronic respiratory illnesses being admitted to hospitals as emergency cases, and a rising number of patients being delayed in leaving hospital.

Legislation in 2004 required health boards to link up services by setting up partnerships. Scotland has at least one partnership in each health board area, but the models vary: in some areas they link both health and social care, in others they only link primary and acute healthcare.

The report found that they have faced problems with councils and health boards separately managing budgets and staff, and in sharing information. In its recommendations, it said that the partnerships need to become more efficient, particularly at the ‘integrated’ partnerships that join up health and social care, which face specific problems from differences in organisational culture, planning and performance and financial management.

In its recommendations, the report says that the Scottish government should find ways to help health boards and councils measure partnerships’ performance and advance the ‘eCare’ agenda, to aid the sharing of data across organisational boundaries. Boards and councils should improve transparency of the partnerships, clearly define their objectives and involve local GPs in planning services.

“Stronger shared leadership is needed from all partners, with good engagement from GPs and other care professionals, to ensure services meet the needs of local people and are efficiently delivered,” said Robert Black, Scotland’s auditor general. “There should also be a fundamental review of the various partnership arrangements.”

“In order for partnerships to deliver high quality services to people in their communities, there needs to be leadership and a shared vision at a local level,” added John Baillie, chair of the Accounts Commission for Scotland. “For a decade there has been a focus on improving partnership work between councils and NHS boards, however the added value of these partnerships is not clear.

“The report makes strong recommendations for all partners to address this together. Greater clarity is needed from councils and NHS boards about how money is currently spent and where this could be better targeted to make a positive difference to people’s lives,” he added.

Dr Dean Marshall, chairman of the British Medical Association’s Scottish general practitioners committee, said the report shows the need for “a complete review of the structure and function” of the partnerships. “In order to be successful at improving joint working between primary and secondary care, and between health and social care, these organisations must be clinically-led and management supported,” he added. “They cannot continue as they are.”