Leaders of the bodies responsible for the planning and delivery of community health and social care across Scotland have told MSPs that the establishment of a National Care Service could provide a solution to current governance and scrutiny challenges, but that progress in delivering integration could also be lost.

Giving evidence to this week’s meeting of the Scottish parliament’s Health, Social Care and Sport Committee, the Chief Officer of Dundee Integration Joint Board (IJB) said that structural changes to be brought in by the NCS will do little to tackle the fundamental challenges holding back integration in some parts of Scotland.

Vicky Irons told MSPs: “Health and social care integration has worked phenomenally well in areas where there has been a will to make it work, but it hasn’t necessarily thrived in other areas where there hasn’t been that level of support and development.

“I think it’s really those things we need to focus our efforts on rather than expecting another significant organisational change to fix those things. I think they’re much more about the culture and the will to make things a success, rather than significant organisational change.”

IJBs are set to be replaced in Scotland’s new National Care Service (NCS) in favour of new care boards, which will take on the same commissioning and planning role as their predecessors with additional responsibility in procurement and service delivery.

Funding – which has long been an issue for IJBs which receive delegated funds from their local health board and council – for these new bodies will come directly from the Scottish government according to the bill.

Ms Irons voiced concerns about whether this will further stretch limited health and social care budgets:

“I do still have some concerns about the fit of that and whether there is enough financial resource to support essentially three public authorities in [a country] the size of Scotland, but also just exactly how that will work out.”

Work has been underway across Scotland to integrate health and social care services since the partnerships came into being in 2016, but some areas – especially across the Highlands and Islands – had seen closer working long before this.

The Chief Officer of Orkney Health and Social Care Partnership, Stephen Brown, said that the early days of integration saw lots of progress, due to excitement about what bringing together community-based health and care services could mean for people.

However, he told MSPs that “significant barriers” to full integration remain, including a lack of joined-up information systems and different terms and conditions for staff across health and care.

Ms Irons said this initial excitement has been replaced by a fear of the unknown:

“I think this [excitement] has been dampened down recently and I think some of that is because of the fear of change ahead, to a certain extent wondering if we go from really significant, strategic shifts in care and whether there might be a point in time in the next couple of years where the rug might be pulled from underneath that.”

MSPs heard there are also difficulties within the scrutiny and governance of IJBs, which the Chair of the Chief Officer Group, Judith Proctor, said has become a “cluttered landscape”.

IJBs are accountable to local authorities and the NHS board which Ms Proctor – who is also Chief Officer of Edinburgh IJB – said can lead to confusion and wasted time when providing assurance.

“Streamlining, duplication, being able to ensure chief officers can represent the change they are trying to deliver and represent their organisations clearly are going to be really important in the new arrangement so that voices aren’t compromised by any of the tension inherent in the current model.”

However, Ms Proctor said there is a risk that work to create an NCS could become a distraction for IJBs:

“As more of the detail around the NCS becomes available, I think there is a real risk that we begin to feel a real tension in terms of the current direction of travel, planning, relationships, allocation of budget. I think there’s a real issue here and what we’re required to do around the NCS.”

The Scottish government has committed to fully co-develop the NCS and the Interim Chief Officer of Inverclyde Health and Social Care Partnership said IJB leaders have been assured they will be included in shaping the new service.

Allen Stevenson told MSPs: “We look forward to being at the centre of discussions moving forward. We are committed to making this work. I think the challenge is there in front of us now to be fully involved in this moving forward.”

 

Read more: Integration ‘underpinned’ rapid virus response; Integration "inconsistent & fragile" five years on; Editorial: Care changes must be explained

 

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