“Major challenges” to Scottish health and care integration

3 Dec 15

Plans to integrate health and social care provision in Scotland face significant risks that must be addressed if the reform is to improve how services are delivered, a report has found.

Examining plans to create partnerships known as integration authorities, which are set to bring together over £8bn of health and care spending by April 2016, the Accounts Commission and auditor general for Scotland said challenges include budgeting, governance arrangements and workforce planning. The report called on the authorities to set clear timescales for integration to be delivered, as there is evidence to suggest they would not be able to make a major impact until after their first year of operation.

Around two million people in Scotland have at least one long-term condition, and almost two-thirds of the population will have developed a long-term condition by the age of 75. As a result, the Scottish Government estimates the need for health and social care services will rise by between 18% and 29% between 2010 and 2030.

Accounts Commission chair Douglas Sinclair said integration has the potential to be a powerful instrument to address these pressures, and the Scottish Government, NHS boards and councils have done well to get management arrangements in place.

“However, there’s a real and pressing need for integration authorities to take the lead now and begin strategically shifting resources towards a different, more community-based approach to healthcare,” Sinclair added.

Auditor general for Scotland Caroline Gardner stated the creation of new bodies responsible for £8bn of public money would be a significant and complex process. “If these new bodies are to achieve the scale and pace of change that's needed, there should be a clear understanding of who is accountable for delivering integrated services, and strategic plans that show how integration authorities will use resources to transform delivery of health and social care,” she added.

Responding to the report, Scottish health secretary Shona Robison said integration would put individuals at the centre of how their care is delivered.

“Audit Scotland’s report reaffirms our view that the integration of health and social care is the right way forward. Indeed, Audit Scotland found widespread support for the principles of integration from those who are implementing the changes on the ground,” she added.

“They also recognise the significant financial contribution that the Scottish Government has made to support the implementation of integration – over half a billion pounds has been committed over three years to support new ways of working at a local level to help NHS and council partnerships deliver better integrated care.”

Robison urged the integration authorities to focus on agreeing shared budgets. “I’m clear that I expect all local partnerships to be fully prepared for the full integration of services from April next year. I expect partnerships who aren’t making enough progress to up the pace and urgency of change now – so that integration delivers the anticipated benefits for people in their area.”

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