Health and social care integration: a radical change?

peopleSince my last blog, things have moved on across Scotland and NHS boards and councils are working with partners in the voluntary and private sectors and the public to set out how they will integrate care in their local area.

We’re now well underway with our work on this integration, speaking to a range of stakeholders and reviewing initial schemes for the new arrangements. We’re looking at what progress is being made, whether governance and financial arrangements are clear and the opportunities and risks this presents. This is our first piece of work on the new partnerships, and we’re working closely with the Care Inspectorate and Healthcare Improvement Scotland to take an early view on developments.

These are significant changes and will take time to become fully established. With this in mind, we’re planning two further audits on health and social care integration:

  • a national report after the new arrangements have been fully in place for at least a year;
  • a review of the long-term impact of the new arrangements – have the changes helped to achieve a shift towards prevention, and are we seeing improvements to outcomes for local people using health and social care services?

Inevitably, much of the difficult work hasn’t really started yet. The focus now is on building and developing trust and understanding between partners and establishing the right structures and systems. The lessons from our previous report on Community Health Partnerships are still very relevant, particularly our messages on what a good partnership looks like in terms of behaviours and leadership.

The real prize here is in developing new models of care that improve health and wellbeing, by shifting the system from picking up the pieces when things go wrong to more of a focus on supporting people to be well and healthy.

And that means this isn’t just about NHS or social care services. It’s about broader issues, the things that we know make a difference to how healthy and happy people feel – the place you live in, your environment, and the work you do. This is not something the NHS or councils can achieve on their own.

cover of Self Directed Support report

While carrying out our work on Self Directed Support last year we heard from people that giving them more choice and control over the support they needed had really started to have a positive impact. The changes were small scale at that time, but gave greater insight in to what really matters to people – that shift in focus.

Can our public sector embrace this radical new approach and learn from what works elsewhere? The true test of whether the reforms are working will take time, and it’s an ambitious agenda.

My next blog will take a further look at what’s emerging from our audits on health and social care integration, and how we plan on trying a new approach as well, to really make a difference with the work we do.

About the author


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

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