Scotland speeds plans to pool health and social care

Recommendations from a recent report on public services will accelerate Scotland’s plans to join up health and social care

The central focus of the Christie Commission on the Future Delivery of Public Services, which reported at the end of June, was prevention. Former trade unionist Campbell Christie and his team concluded that around 40% of public service spending in Scotland goes on tackling social problems that could have been prevented. And, they warned, those services may “buckle” in the absence of more preventative measures to tackle inequality.

“Unless Scotland embraces a radical, new, collaborative culture throughout our public services,” concluded the report, “both budgets and provision will buckle under the strain.” Although the commission was criticised by some for being short on recommendations to tackle imminent budget cuts, it did suggest pooling the health and social care budgets to improve services and reduce financial pressures.

The idea is not new. Last October, the then leader of Scottish Labour Iain Gray pledged to do precisely that, establishing a ‘National Care Service’ within the lifetime of the next Scottish Parliament. Indeed, the Scottish Conservatives also support such a move, saying that “as a means of delivering a faster response time to those in most need of care… care is a health benefit and it is right that it should be part of the health budget”.

Most significantly, SNP health secretary Nicola Sturgeon also agrees. “We are committed to the integration of health and social care and will introduce proposals to advance this early in this Parliament,” the health secretary told Guardian Healthcare Network. “We have already started the process of integration with our £70m change fund.”

Meanwhile, the Scottish local authority umbrella group Cosla says it will be moving immediately to implement the Christie Commission’s recommendations, regardless of the timescale of the SNP, which won an outright majority in the Scottish Parliament in May’s general election.

Cautious on collaboration

The British Medical Association (BMA) in Scotland is also on side, but sounds a note of caution in light of past efforts to more closely integrate health and social care delivery in Scotland. “The complexities of the provision of health and social care in local communities has been an issue that the NHS has grappled with for decades,” says Dr Brian Keighley, chairman of the BMA in Scotland, “but the changing demographic of the country means that this is now more important than ever before.
“The BMA is clear that the barriers that exist within and between health and social care need to be broken down and replaced with greater collaboration – whether that is through shared budgets, lead commissioning or the creation of an entirely new structure. There have been financial, cultural and structural reasons why joint working has failed in the past. Community Health Partnerships (CHPs) have failed to bridge the divide between health and social care and primary and secondary care services.
“The BMA believes that medical leadership can help to resolve many of the problems that have led to the failure of CHPs. By working with social care, doctors can identify and plan the services needed to prevent patients being unnecessarily admitted to hospital. This is a huge challenge that must be addressed and in order for it to be successful, the way forward must be decided by the health and social care staff who are providing the services.”
Social worker Ruth Stark, manager of the Scottish Association for Social Work, also emphasises the back-story, pointing to the 2006 Changing Lives review of social work delivery in Scotland. “A lot of whether this will work relies on local community building,” she says. “The Changing Lives review said it would only happen when there was more ownership, particularly in terms of preventative strategies; so front-line staff need more power in order to take this forward.

“That said, what works in a rural community will be different to what works in an urban setting, so we also need flexible arrangements that allow frontline staff to find solutions to these issues – that’s going to be absolutely key. I think that’s less about budgets and more about there being a big cultural change. There’s a line in the Christie Commission report about the need to ’empower front-line staff and allow them to give of their best’; if they can do that, then they’ll be able to implement its recommendations.”

“The process of reform must begin now,” commented Campbell Christie upon the publication of his report, “and I would urge the Scottish Government to act quickly and decisively and to use our recommendations as a route map for the difficult journey ahead.” With Scotland’s block grant due to decline in real terms for several years in a row, it will indeed be a difficult journey, although it is one most stakeholders seem prepared to take.