38,500 council workers facing a switch to NHS in radical new plans
TENS of thousands of council staff across Scotland will transfer to the NHS under a radical plan to look after the elderly which is being announced by Public Health Minister Shona Robison this month.
The Scottish Government is planning to shift responsibility for delivering adult community care from local authorities to health boards within two years.
Organising home care or care home places for patients who require extra support after leaving hospital will fall to the NHS rather than social work under the shake-up.
The council will merely commission the services, and some 38,500 current local authority workers will deliver it within the health service.
Public Health Minister Shona Robison said that in future councils and health boards should work more closely together under a ‘lead commissioning’ model, in order to provide better services for adults – particularly older people.
The Scottish Government’s plans are being backed by Lord Sutherland, who carried out Scotland’s review of free personal care in 2008.
Ms Robison discussed the plans with health and social care staff in West Lothian this morning, saying that how the proposals would be taken forward would be fully scrutinised and debated with stakeholders. The first step to beginning discussions is the establishment of a Lead Commissioning Group to take the integration agenda forward.
The Minister said: “Planning care for increasing numbers of older people in future is one of our biggest national challenges and doing nothing is not an option. There’s increasing recognition now that health boards and councils need to work together far more closely. The debate is about how and we believe that lead commissioning is the way forward – a view echoed by no less an expert than Lord Sutherland.
“We want to see health and social care for adults delivered in an integrated way by NHS and council social work staff working together to give a seamless service.
“Evidence from partnerships in England shows more older people can get quicker care packages, cuts in delayed discharges, reduced length of stay in acute hospitals and fewer unplanned emergency admissions to hospital. Pilot work on integration across Scotland has been making progress with this over the last eighteen months and we would now like to see this taken further nationwide.
“We will establish a Lead Commissioning Implementation Group, backed by £2 million for investment over the next financial year, to support partnerships around the country to continue to take the integration agenda forward.”
Lord Sutherland, who carried out the Scottish Government’s review of free personal care, has backed the use of lead commissioning as a way of improving social care in Scotland.
He said: “Lead commissioning provides the best and quickest way of achieving an integrated care system, and I believe the Scottish Government’s approach is the right one.
“It avoids the need for new legislation and wholesale re-organisation, which means improvements can begin to be made straight away.
“The time for talking is over. It is now time just to get on with it.”
Background
Lead commissioning would see health boards and local government contract services from one another to focus on the needs of people rather than from the basis of traditional “supply” responsibilities, i.e. what is a “health” service and what is a “social care” service, cutting through red tape and improving joined-up working. In England, lead commissioning has been used in some places to commission adult social care from the NHS, with local authorities acting as commissioners of services.
The announcement of £2 million to support integration work through the new Lead Commissioning Implementation Group is in addition to the £70 million Change Fund announced in the draft Scottish budget to support better integrated older people’s services delivered by health boards, councils, and the third and independent Sectors. Local area partnerships in Scotland will receive:
In 2008 roughly 57,000 people worked in social work services in Scotland. Were adult social care to be commissioned from the NHS by local government, approximately 38,500 adult social services staff would transfer to the NHS under lead commissioning.
The Scottish Government estimates that overall around £4.5 billion is spent every year on older people’s services across health and social care. Around a third of this – £1.4 billion – of this total goes on unplanned emergency admissions to hospital. Clinicians, care managers and older people themselves tell us this kind of admission to hospital is often distressing and results in poorer outcomes than might have been achieved by a package of primary care and social care in the community – which is what the evidence shows can be achieved via lead commissioning.
