Scotland: Prevention is better than cure

  • Scotland is leading the way with health and social care integration
  • From 1 April, Scotland goes live with shared health and social care responsibilities
  • We look at how health boards and local authorities north and south of the border are starting to integrate

Scotland’s 32 local authorities are leading the way in health and social care integration.

After several years of pilot schemes, Scotland begins shared responsibilities on 1 April 2016, giving health boards, joint boards and local authorities commissioning and budgetary responsibilities for patients and citizens.

The Public Bodies (Joint Working) (Scotland) Act 2014 sets out the legislative framework for integrating health and social care to support improvement of the quality and consistency of services in Scotland.

The Act allows health boards and local authorities to integrate health and social care services in two ways:

  1. The health board and local authority delegates responsibility for planning and resourcing service provision for adult health and social care services to an integration joint board (IJB).
  2. The health board or the local authority takes lead responsibility for planning, resourcing and delivering integrated adult health and social care services.

Importance of local needs

The shape of this reform differs across Scotland in response to local needs.

For example, the Highland Council and NHS Highland’s partnership agreement provides integrated services across the region. While the council has taken on children’s services, it delegates the lead responsibility for adult services to the local health board.

In other partnerships, the structure is different, with local authorities taking on health responsibilities such as primary care and dental care.

Greater Manchester health and social care integration

Still in its infancy, integration is yet to be defined in law in England.

Greater Manchester is the first English authority to trial an integration experiment, with shadow working starting in April 2016.

The groundbreaking health devolution plans give Greater Manchester and local NHS services more control over the region’s £6bn health and social care budget.

By April 2016, a Strategic Partnership Board will be responsible for the financial and clinical sustainability of Greater Manchester health and care. The Greater Manchester Joint Commissioning Board, primarily made up of 10 local authorities, 12 Clinical Commissioning Groups, and NHS England, will take regional decisions.

Principles around sharing power and making decisions were agreed in September 2015, outlining how 38 organisations will work together.

Improving communities

The fundamental principle of front-loading services to bolster health promotion, education and independence to improve outcomes within communities, is the same in Scotland and England.

In our Pioneers report, CEOs in England asserted that health and wellbeing go hand in hand. The attitude is that prevention is better than cure, with a desire for funding and planning to be invested in community and primary care solutions rather than the current emphasis on acute care.

In Scotland, the impetus is for social care and long-term, managed healthcare to be offered in the community. This enables communities to improve health and well-being outcomes for individuals and to iron out inequalities found in different areas of the country.

Ongoing programme of change

However, finding the political will to shift funding from hospitals to the community will be difficult on both sides of the border. Merging two entirely different structures and cultures – local government and the NHS – and creating new, effective and affordable bodies, will make these reforms an ongoing programme of change for years to come.

Alan Ross, Senior Strategic Risk Management Consultant, has been working with organisations in Scotland to support risk management for health and social care integration.

“Scottish integration is innovative. IJBs are trying to create better outcomes and shift resources from acute to preventative care.

“However, there is still uncertainty about how this will work in practice, such as performance management, quality and what success looks like,“ he explains.

“Integrating the work of two very different organisations can be complicated, especially when fundamental differences such as accountability structures mean there is no way to resolve disparities.”