Budget control hinders social and health integration in Scotland

5 Feb 19

The unwillingness of public bodies to relinquish control of budgets is hindering the integration of health and social care in Scotland.

This is according to a review of progress carried out by the Scottish Government and the Convention of Scottish Local Authorities, released yesterday

Councils and health boards must treat the funds held by the new integration joint boards as a collective resource for health and social care, the report also found.

“We should be focused on outcomes, not which public body put in which pound to the pot,” it said.

It was critical that the resources of the integration boards “lose” their original identity as belonging to either health or social care and became a single budget - although this did not prevent the board from being accountable for the use of these resources, the review said.

“Services should be underpinned by flexible, sustainable financial mechanisms that give priority to the needs of the people they serve, rather than the organisations through which they are delivered,” it said.

It also called for the delegated budgets for integration boards to be agreed by the end of March each year, and for each board to develop a “transparent and prudent” reserves policy. Measures should also be put in place to avoid conflicts of interest for boards’ chief finance officers, it said.  

The review found that although good practice was developing, this was not yet the case in all areas.  The pace and effectiveness of integration had to increase, it concluded.

“We know there are challenges we must address and want to make use of good practice to drive forward change and reform to truly deliver integration for the people of Scotland,” it said.

Local partners must have the necessary “tough conversations” to make integration work and to be clear about the risks being taken, and ensure mitigation of those risks was in place.

The review follows a critical report by Audit Scotland in November, which found that integration was being undermined by budgetary pressures and a lack of long-term financial planning.

Health secretary Jeane Freeman said the Scottish Government and COSLA had to act together and in their individual roles to accelerate progress.

“Truly integrated services, focused on the needs of citizens, require our leadership and personal commitment,” she said.

“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.”

Stuart Currie, COSLA spokesperson for health and social care, said that good progress had been made under integration to date but, as Audit Scotland had highlighted, there was always more that could be done.

“We welcome the [review’s] proposals and their broad endorsement across the system sends a strong message of commitment to the health and social care integration agenda,” he said.

There are 31 integration boards, with a combined budget of almost £9bn, across Scotland, each responsible for the strategic planning and commissioning of health and social care services in their area.

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