Health and social care integration slammed by public finance watchdog

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The Accounts Commission has called for improved leadership and better collaboration with the third sector to ensure health and social care integration success

15th November 2018 by Gareth Jones 0 Comments

There is little evidence that health and social care integration is working, according to Scotland's public spending watchdog. 

A report released today (15 November) by Audit Scotland and the Accounts Commission has found Scotland faces significant challenges to fully integrate health and social care.

The study finds that while some progress has been made in improving services, there is little evidence of concrete success of the Scottish Government policy.

Health and social care integration has seen NHS boards and local councils come together to form integrated joint boards. The aim is to ensure prevenative health and social care is delivered in communities, and people's own homes, reducing the need for acute and long-term care in hospitals. 

However, the 31 new integration authorities have already faced criticism from MSPs for failing to change fast enough. 

Now the Accounts Commission has said integration authorities need to make hundreds of millions of pounds of savings, and concerns have been raised about a high turnover of leadership within joint health boards.

The report says the policy's success will depend on long-term integrated financial planning and stable and effective leadership – neither of which it says are currently happening. 

It also calls for a greater commitment from integration authorities, councils and NHS boards to work with the third sector and private sector. 

The report clearly states third sector providers feel their views are not being sought or are not valued, despite often having innovative ways to improve local services. 

Anna Fowlie, chief executive of the Scottish Council for Voluntary Organisations, said the third sector's involvement in the process so far had been "tokenistic".

She said: "The Auditor General has rightly reminded us that the purpose of integrating social care and health services is to improve the outcomes and experiences of the people using those services and their families. That requires a genuine partnership of everyone involved. This report confirms what I hear on a daily basis – the third sector is seldom given anything other than tokenistic involvement in integrated joint boards’ processes and the voice of the citizen is lost in bureaucracy. While no one can argue with the good intentions behind integration, the mechanisms simply aren’t working."

Fowlie added that the report showed the value of good-quality social care, and that this can be delivered by the third sector. 

She said: “The third sector delivers the highest quality social care, and the vast majority of community activities that promote wellbeing, inclusion and social interaction. We deserve to be taken seriously and local authorities and health boards need to recognise that.”

Professor Ian Welsh, chief executive of the Health and Social Care Alliance Scotland (the Alliance), said the report noted a reduction in unplanned hospital visits and delayed dischared, but said it is: "Concerning to note the auditors view that planning is not geared towards improving outcomes."

He added: "In our view, all partners, including people who use support and services and the third sector, must be involved in setting a future agenda for integrated services across Scotland that prioritises engagement, involvement and improvement.

“To support this, we believe that chief officers from each of the integrated partnerships and the Scottish Government should urgently seek to meet with third sector leaders, to identify and fund shared learning of successful approaches to integration where prevention and partnership activity have been prioritised."

Auditor general Caroline Gardner said: "All partners, at a national and local level, need to work together to ensure the successful delivery of integrated health and social care services in Scotland. This will allow people to receive the care they need at the right time and in the right setting, with a focus on community-based, preventative care."

Graham Sharp, chair of the Accounts Commission, echoed the calls for collaboration and said there is a lot of work left to do.

He said: “There are examples of integrated health and social care services making a positive difference to people’s lives, but these tend to be local and small scale. The potential for a profound and long-term shift in the way health and social care services are delivered is clear, but there is still a long way to go.”

The report recognises that workforce pressures are a clear barrier to the implementation of integration plans, and recommends that the contribution of the third and independent sector should be part of workforce planning.

Health secretary Jeane Freeman said she recognised the government must do more.                            

She said: “We want to step up the pace and agree that further progress requires our strong, shared leadership. We are committed to working together to deliver integration successfully because we believe it is the right way to deliver better services for the people of Scotland.

“Changes this ambitious take time. With COSLA, we are reviewing progress to ensure we learn and apply lessons and continue to build the momentum for improvement.”