Health and social care integration is “progressing well but needs to happen faster”, according to a joint report from the Scottish Government and the Convention of Scottish Local Authorities (COSLA).

The report has been produced by a ministerial strategic group chaired by director general of health and social care, Paul Gray, and chief executive of COSLA, Sally Loudon.

Highlighting a need for COSLA and her administration to collaborate as well as advance in their individual roles, Cabinet Secretary for Health & Sport, Jeane Freeman, said:

“Truly integrated services, focused on the needs of citizens, require our leadership and personal commitment…

“There are challenges we must address and we recognise that we need to adapt, compromise and support one another to deliver integration for the people of Scotland.”

Key findings include that good practice is developing across Scotland, both in terms of how Integration Joint Boards (IJBs) are operating and in the planning and delivery of services.

However, it notes some local partnerships are making less progress despite evidence of improvement in some local areas.

Background

Work to integrate health and social care in Scotland has been underway since 2016 and in November 2018, Audit Scotland published the second of three planned reports on progress.

The health & social care integration: update on progress report identified significant challenges for integration and concluded success would be dependent on long term integrated financial planning and stable and effective leadership.

Action to tackle these issues was called for “as a matter of urgency” in order to transform the way services are delivered in Scotland, particularly in order to meet the needs of an ageing population.

Difficulties were identified in the implementation of set-aside budgets, with the report noting ‘If IJBs are to use resources more strategically to prioritise prevention and care in a community setting, this issue needs to be resolved’.

The report

The Scottish Government and COSLA report focuses on six areas of integration set out by Audit Scotland, namely:

• collaborative leadership and building relationships
• integrated finances and financial planning
• effective strategic planning for improvement
• agreed governance and accountability arrangements
• ability and willingness to share information
• meaningful and sustained engagement

Proposals to progress integration focus on effective strategic planning, clearer governance and accountability arrangements, and sustained engagement with local communities.

An audit of existing national leadership programmes is to be undertaken over the next six months to ‘identify gaps and areas of synergy to support integration’.

In order to have a joint understanding of the respective financial positions as they relate to integration, the report concludes health boards, local authorities and IJBs will be expected to jointly request consolidated advice on their financial positions from the NHS director of finance and relevant local authority and IJB officers by 1 April 2019 and each year thereafter.

Within three months, each IJB will also be expected to ‘develop a transparent and prudent reserves policy’, where reserves are identified for a purpose or held as a general reserve to cushion the impact of unexpected events or emergencies.

Next steps

The findings of the report will be considered at the next meeting of COSLA’s health and social care board, on Wednesday 6^th February.

The board’s self-directed support implementation plan with also be considered alongside the Scottish Government’s social isolation and loneliness strategy, and an alcohol and drug partnerships MOU review.

Commenting on the report, COSLA spokesperson for health and social care, Councillor Stuart Currie, said:

“Good progress has been made under integration to date but, as highlighted by Audit Scotland last year, there is always more we can do to achieve improved outcomes for our communities.

“COSLA welcomes the proposals and their broad endorsement across the system sends a strong message of commitment to the health and social care integration agenda.”

The full report is available here.

The Health Secretary and COSLA will also be questioned on the review by the Health Committee on Tuesday 19^th February.