By Keith Aitken in Edinburgh | 13 September 2012
Scottish ministers were told by CIPFA Scotland today that there was no need for a law to merge health and social care budgets.CIPFA was commenting on the Bill proposed by First Minister Alex Salmond last week as part of his government’s legislative programme. It will require NHS health boards and councils to integrate budgets through health and social care partnerships, which ministers hope will accelerate the minimal progress made in integrating service.
But CIPFA argues that existing legislation is sufficient to facilitate mergers, and that the financial benefits of budget integration are unproven. It says that other factors – notably the quality of leadership – are more important in improving outcomes for the public.
‘We have seen no evidence which would indicate that the existing legislative framework is in any way deficient,’ CIPFA Scotland’s submission states. ‘Any perceived failure to integrate is not as a result of a failure of legislation.’
The paper says laws passed in 2002 and 2004, to formalise a framework for merger and to establish community health partnerships, allow integration to take place but their impact has not been tested.
‘We conclude therefore that the case for new legislation has not been made and we recommend that, before there is any further legislative development, robust post-legislative scrutiny is undertaken of the existing legislation.’
CIPFA notes that several of the government’s own studies, including Sir John Arbuthnott’s report on health and social care integration in the Clyde Valley and Audit Scotland’s review of CHPs, had indicated no need for new legislation.
Instead, there is ‘a body of evidence which indicates that the need for strong leadership is greater than the need for a further legislative solution and is greater than any focus on any particular model of delivery’.
The paper is sceptical that legislation to integrate budgets would provide significant benefits. It notes an Audit Commission admission that quantifying benefits from joint financing is difficult, and a 2010 government study that found ‘no evidence that the use of joint financing was associated with improved health outcomes’.
CIPFA concluded: ‘Overall, the evidence base does not support the significant focus which is applied to budget integration within the consultation document.
‘Consequently, we remain unconvinced that financial integration is the key driver to achieving improved outcomes.’