Setting the scene: how audit is supporting health and social care reform in Scotland

audit_scotland_blogThe integration of health and social care through the Public Bodies (Joint Working) (Scotland) Act is one of the most significant public sector reforms of recent years. Public, voluntary and private sector organisations across Scotland are now working together to change the way that these services meet people’s needs.

While speaking at a couple of recent conferences about Audit Scotland’s work in this area, I had the chance to hear about the progress people were making with integrating health and social care. What I learned is that there is a real sense of the positive impact that people hope the changes can bring, along with a lot of concerns and worries about the practical implementation.

At their heart, these reforms are about creating better outcomes for people with health and care needs in Scotland, by improving support, reducing pressure on services and making better use of resources.

The integration of health and social care could be a major turning point for Scotland, and as an auditor, I’m of course keen to see how the Act can help the public sector make better use of the £7 billion it spends each year on these services.

But it is a complex area – as everyone involved knows – and there is a lot of work to be done. We can’t underestimate the degree of change that is underway, and the impact that this will have across the public sector. I recently produced a briefing to capture the detail of this substantial programme as clearly as possible, which can be read here.

mazeHaving been involved in the audit of health and care services for many years, I have seen the major challenges that public bodies have faced in shifting resources to community-based and preventative services. I’ve also encountered many areas of good – and not so good – practice and have helped shared these examples to help support learning and improvement.

The benefits and challenges of working in partnership have been key themes in our work, including reports on the implementation of Community Health Partnerships, and Community Planning Partnerships. The lessons we’ve learned from these initiatives are very relevant to the current agenda of health and social care reform.

Locally, organisations are working together to put in place the new integrated arrangements, and consulting with the public about the planned changes. Auditors are monitoring this local progress and we’ll share more about that over the rest of the year.

In the short term, it’s important that sound governance arrangements and financial management are established. Partners need clear measures in place to know if the changes are having the desired impact on the lives of the people using their services: this may seem obvious but it is often lacking and can be lost when the focus is on establishing new arrangements.

scrubs_smallApart from putting in place the undoubtedly important systems, structures, and plans, the biggest challenges faced are about changing cultures, behaviours and leadership styles, to progress beyond some of the frustrations within the current health and social care system.

Reassuringly, I’ve come across a real appetite, particularly from health and care professionals, for an increased focus on person-centred care, more locally-based and locally planned services, and for meaningful involvement of the people using these services, carers and the people who work within them.

Colleagues and I are watching these developments with interest, and we’re committed to drawing on our own work to contribute to the significant changes on the horizon for health and social care in Scotland.

In my next blog, I’ll be exploring this commitment in more detail. In the meantime, if you’d like to share your thoughts on some of the areas I’ve touched on in this instalment, please do send your comments to blogfeedback@audit-scotland.gov.uk.

About the author

csweeney_2015Claire Sweeney is an Assistant Director in Audit Scotland, leading on health and social care integration.

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