Integration of Adult Health and Social Care

What is the problem we are trying to solve?

• Too much variability of health and social care in different parts of Scotland, particularly for older people.

• No incentive to help get people out of hospital quickly and back into a homely setting.

• Much easier to get an older person admitted to hospital than to arrange services that would keep them at home.

Projected Demand for Health and Social Care, All Ages, 2008/09 prices.

Health and Social Care Demand Projections, £ mn, 2008/09 prices

5,000

6,000

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8,000

9,000

10,000

11,000

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13,000

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15,000

2010 2015 2020 2025 2030

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t £m

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HLE constant

Change HLE = 0.5 change LE

Change HLE = Change LE

NHS Delayed DischargesScotland; September 2000 to April 2011.

0

500

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2000

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Sep2000

Apr2001

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Apr2009

Oct2009

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Apr2011

Census

Nu

mb

er o

f pat

ien

ts

Over 6 weeks

Under 6 weeks

Vision

• Older people are supported to live well at home or in the community for as much time as they can

• They have a positive experience of health and social care when they need it

Framework for improvement

• Consistency of approach across Scotland;• Applies in every council and health board area;• Statutory underpinning;• Integrated budget to deliver some acute, community and

social care services;• Someone clearly accountable for delivering agreed

outcomes;• Professionally led by clinicians and social workers;• Simplifies rather than complicates existing bodies and

structures; and• Wherever possible, it should be achieved with minimal

disruption to staff and services.

What does the evidence tell us?

• Planning for populations, not delivery structures

• Pooling resources – money and people• Embedding GPs, other clinicians and care

professionals in the processes of service planning, investment and provision

• Very strong local leadership

Principles of reform

• Nationally agreed outcomes across health and social care, focussing in the first instance on older people’s services

• Joint accountability via the Chief Executives of the Health Board and Local Authority to Ministers, Council Leaders and the public for delivery of those outcomes

• Integrated budgets• Strong clinical and professional leadership, and

engagement of the third sector, in commissioning and planning of services

Framework for integration – slide 1

• Legislation:– nationally agreed outcomes– joint accountability– integrated budgets across primary care,

community health and social care, and some of acute care

– locality planning

Framework for integration – slide 2

• CHP committees will be taken off the statute book and replaced by Health and Social Care Partnerships – joint and equal responsibility of the NHS and Local Authority

• Jointly appointed senior accountable officer will report to the Chief Executives of the NHS and Local Authority

• Annual accountability meetings will enable accountability to Ministers and Leaders

Framework for integration – slide 3

• Locality service planning groups will strengthen the role of clinicians and social care professionals

• Fewer resources will in future be directed towards institutional care and more resources will be directed towards community provision

Next steps

• Formal consultation

• Detailed work now underway to consider practicalities:– Outcomes– Joint governance and accountability– Integrated financial management– Impact on other areas of service– Workforce and HR issues– Locality planning– Improving commissioning skills

– Requirements for OD and leadership development work– Ensuring meaningful engagement of the third and independent

sectors