Scottish health and social care merger plans ‘hampered by lack of leadership’

29 Oct 18

Ambitious plans to merge health and social care in Scotland are being hampered by a lack of leadership within the new integrated authorities, a parliamentary committee has warned.

The Scottish Parliament’s health and sport committee found that three years into the integration process some of the 31 joint authorities were failing to deliver the transformational change required.

It was “unacceptable” that the authorities – responsible for £8bn in public funding – were taking spending decisions without any link to health and social care outcomes or assessment of the effectiveness of their expenditure, the committee said.

It also warned that budgetary control in some authorities continued to be dictated by individual partners, with senior managers still associated with either the health board or the local authority.

This could lead to conflicts of interest, the report, released today said.

Direct funding of integration authorities should be considered in order to combat the perception that resources belonged to either the health board or the local authority, it added.

Committee convener Lewis Macdonald said transformational change was required in the sector to meet long term challenges such as the aging population.

“This requires those in charge to use the powers Parliament has given them and drive change,” he said.

“It is vital that the significant budget for health and social care is spent efficiently and effectively.

“It is unacceptable that this is not happening, and the committee is calling on this to change.”

He also sought assurances in relation to the Scottish Government’s recent decision to write off around £150m in loans to struggling health boards as part of a new more flexible three-year financial framework.

The Scottish Government should spell out what was being done to reduce the need for brokerage, and what measures were in place to ensure the guarantee was not subject to abuse by health boards, he said.

“This offer should not be a blank cheque nor be open to misuse,” said Macdonald.

While there had been progress in shifting budgets towards community healthcare, this appeared to be at the expense of family health services and social care rather than hospital expenditure, which had attracted an increased proportion of expenditure, the committee found.

It also raised concerns over underspends in mental health, noting that some integration authorities had spent less than the budget allocated to mental health services, despite the Scottish Government’s plans to invest an additional £35m in the area over the next five years.

“Given concerns raised regarding mental health service provision we find it difficult to understand why this is the case,” it said.

A Scottish Government spokesperson said integration was the most significant change to health and social care services in Scotland since the NHS was established, and ensuring its success was a priority for the Scottish Government.

“That is why in 2018-19 the Scottish Government is investing almost half a billion pounds of frontline NHS spending in social care services and integration, as well as an additional £66 million to local government in support of social care,” he said.

“This is enabling local partnerships of integration authorities, health boards and councils to work together to make best use of their total resources and ensure people have access to the right care at the right time in the right place.”

He added that requests for loans represented less than 0.5% of spend and would be managed within the total health budget for each year.

A major review of the integration of health and social care is expected next month from Scotland’s Auditor General Caroline Gardner.

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