Monitoring the progress of health and social care integration

Big changes are bringing together health and social care services in Scotland.

Traditionally, the NHS has provided health services and councils have provided social care. The new reforms will see these services planned and resourced by one local organisation, intended to create a seamless system which gives people the care they need, at the right time and place.

All adult social care and some health services including GPs, community healthcare, and certain hospital services (those which are mainly unplanned, such as A&E) are covered by the reforms. This makes the potential impact of integration wide reaching, as it involves services relied on by many. And as a country, we’re getting older, which means it’s likely the number of people needing health and social care services will increase in the years to come.

H&SCI_CoverIn early December, we published the first in a series of audits that we’ll undertake to monitor progress with the reforms. We found that the new arrangements are likely to be in place across Scotland by April 2016, but there’s more work to do to ensure that people using services feel the benefit of the changes.

We also found some evidence to suggest that local areas might not be in a position to make a huge difference in 2016/17. There are difficulties agreeing how much money councils and NHS boards will bring together to provide integrated services.  This, combined with uncertainty about much funding will be available in the longer term, means some local areas don’t have clear plans for how and when services will change.

If integration is going to make a real difference to people who use health and social care services, it’s important that all local areas make detailed plans for how they’ll make the necessary changes. It’s also important to be clear how they will measure the impact of these changes.

We found other issues that need resolved if the reforms are to be successful. For example, the new system is complicated, and it’ll be important that each local area makes clear, to both staff and the public, who is responsible for the health and social care provided.

There are also issues relating to available staff in health and social care. These include considering how this workforce can best contribute to changes to the services provided and how to recruit people into jobs where there are shortages of suitably skilled staff.

Like the different bodies involved in integration, Audit Scotland recognises the importance of getting this right and the consequences if that doesn’t happen, and we’ve made detailed recommendations to support improvement in our report to the Accounts Commission and the Auditor General. We’ll begin the next audit looking at the further progress of integration in early 2017.

In the meantime, we’re discussing our findings and recommendations with members of the Scottish Parliament’s Public Audit Committee on Wednesday (13 January). You can view the agenda, and watch the meeting live, via the Parliament’s website.

About the author

MM6A5569Rebecca Smallwood is an auditor and joined Audit Scotland in 2008.  She has worked on a number of audits with a health and social care focus, including community health partnerships, emergency departments and reshaping care for older people.