Scotland leading way in integration

Managing services under the same roof may not be new but budget cuts and an ageing population could mean its time has come

Barrhead’s Health and Care centre is relatively unusual. It is one of only a few partnerships in Scotland that manages local NHS and local authority social care services under a single structure and – in this case – the same roof.

Jointly owned by NHS Greater Glasgow & Clyde and East Renfrewshire council, proposals recently announced by the Scottish government mean Barrhead could soon become the norm.

Integrating adult health and social care in Scotland is not a new idea, but in the context of budgetary pressures and an aging population, its time has come. Having consulted with stakeholders last summer, ministers have ruled out establishing a new statutory organisation (as proposed by Labour during the recent Scottish election) but will instead legislate to reform radically existing Community Health Partnerships (CHP).

CHPs will be replaced by new Health and Social Care Partnerships (HSCP), which will be jointly run – as in the case of Barrhead’s Health and Care centre – by the NHS and local authority in each locality. Initially, each HSCP will focus on improving care for older people by cutting delayed discharges, reducing unplanned admissions to hospital and increasing the number of older people who are cared for in their own home rather than in a care home or hospital.

Central government spending will also reflect this shift from institutional to community-based care, with fewer resources (cash and staff) being directed towards hospitals and more to local facilities. NHS boards and local authorities will be required to produce integrated budgets for older people’s services, which the Scottish government believes will end “cost-shunting”, under which older people often end up remaining in hospital for longer than necessary.

The new HSCPs will be jointly accountable to the NHS and local authorities, as well as the health secretary, but the Scottish government stresses that within this “broad framework”, it will be local health and community care professionals who decide upon the delivery mechanisms and structures that best suit local needs and priorities.

Health secretary Nicola Sturgeon said: “These changes represent the radical reform that is badly needed to improve care for older people, and to make better use of the substantial resources that we commit to adult health and social care.

Evidence from elsewhere is that changes in structures and staffing arrangements work best when designed and agreed locally, to suit the needs of local patients, service users and carers such as the work already underway in Highland.

“We will tackle the barriers that currently exist within Community Health Partnerships – division of accountability between the NHS and local authorities, insufficient and often unequal delegation of authority, budgets that are not integrated, leading to decisions about older peoples’ care too often being dependent on whose budget is affected, and poor clinical engagement.

“Our reforms will deliver a system that is effectively integrated, leading to better outcomes for older people and better use of resources. We will now work with partners in the NHS, local government, the third and independent sectors and professional bodies to develop detailed consultation material for public discussion and scrutiny.”

Councillor Douglas Yates, the Convention of Scottish Local Authorities’ spokesman for health and wellbeing, said: “It is widely known that we need NHS healthcare to knit together more tightly with local government-run social care services and the work that we have been considering with the Scottish government attempts to achieve that.

“While we are still in the early stages of that discussion – with much of the detail still to be ironed out – our view on the general parameters of reform are similar.”

Dr Brian Keighley, chair of the BMA in Scotland, said: “An overhaul of CHPs is long overdue. If these new ‘partnership’ organisations are to succeed, they must engage and involve GPs representing practices in the local area.

“And while it is important to provide much greater integration with social care services, it is essential that these new organisations endeavour to engage doctors from secondary care to ensure that there is greater integration of community and hospital based services.

He added: “These partnerships must not be about saving money, but should focus on providing the right balance of care available to local communities. In order to succeed, they must be clinically driven and supported by management to avoid falling into the pitfalls of the predecessor organisations. I hope that legislation will reflect this.”

Integration of health and social care is, to varying degrees, happening across the UK. Northern Ireland has done it since the 1970s; in Wales a recent strategy paper recommended moving care “closer to home”; while in England the controversial health and social care bill envisages clinical commissioning groups (CCGs) overseeing greater integration.

A pilot scheme in the London borough of Sutton, for example, resulted in substantial savings. But on the mainland at least, Scotland appears to be leading the way.