Highland staff transfers mark start of care integration

More than 1,400 adult care staff at The Highland Council have today been transferred to the NHS as part of Scottish Government plans to integrate social and health care provision.

At the same time, around 250 NHS health visitors, school nurses and similar staff have moved in the other direction, joining the council payroll.

In an agreement sealed less than two weeks ago, the council and NHS Highland settled on a ‘lead agency’ model, saying that previous attempts to work in closer partnership had foundered on each partner effectively wielding a veto. The new relationship, called the Highland Health & Social Care Partnership, follows 15 months of preparatory work.

The arrangement formally designates NHS Highland as lead agency for delivering adult services and the council as lead agency for services to children, with an undertaking that managers and staff will work together as single entities in the respective organisations to redesign services and improve delivery.

Don Peebles, CIPFA in Scotland’s policy and technical manager, said the Highland approach was only one possible integration model and that others were likely. ‘There is a consultation paper coming out in May which will suggest a number of models but it is not expected at this time that there will be any single prescribed way,’ he said.

Peebles said that one brake on more efficient joint working was that central funds continued to be allocated in traditional institutional silos, so that deals like the Highlands one relied on a subsequent local financial readjustment.

In Highland’s case, indicative figures for the first financial year envisage a transfer of almost £88.3m from the council to the NHS for adult care, with £8.1m flowing in the other direction for children’s services.

Peebles told Public Finance that CIPFA is about to embark on a major inquiry, the first of its kind in Scotland, which would take a critical look at the current approach to public sector funding distribution. Implications for partnership working and shared services will be an important part of the inquiry.

The Scottish Government has indicated that it would prefer to see a ground-up approach to merged provision of health and social care, which it believes can both improve service quality and save money. But the forthcoming consultation paper also reflects an impatience for faster progress.

Enabling legislation preparing the way for health and social care partnerships has been on the statute book for several years. Although several local initiatives have been attempted, the outcomes have fallen short of government ambitions.