Major risks to 2016 health and care integration in Scotland

The ongoing integration of health and social care services in Scotland, aided by its new integration authorities (IAs), must address significant risks before major reforms are carried out, the Accounts Commission and auditor general have said.

Integration of services is one of the Scottish Government’s key policies to meet the country’s population challenges, particularly by shifting resources to community-based and preventative care home.

These reforms will be carried out by IAs, which will be responsible for planning joint health and social care services and managing budgets over £8bn by April 2016, at which point all authorities must be operational.

But a report for the Accounts Commission found that there are still substantial risks standing in the way, including difficulties with agreeing budgets, complex governance arrangements and workforce planning.

The auditor demanded that all 31 IAs must set out clear target and timescales to show how these integrated services will deliver care differently in order to meet people’s local needs.

It also suggested that IAs will be unable to make a major impact in their first year of operations.

Douglas Sinclair, chair of the Commission, said: “Integration has the potential to be a powerful instrument for change, and the Scottish Government, NHS boards and councils have done well to get management arrangements in place.

“However, there’s a real and pressing need for IAs to take the lead now and begin strategically shifting resources towards a different, more community-based approach to healthcare.”

Scotland’s auditor general, Caroline Gardner, said the creation new bodies tasked with handling £8bn of government cash is a naturally significant and complex process, meaning it is nevertheless important to recognise progress achieved to date.

But she added: “If these new bodies are to achieve the scale and pace of change that’s needed, there should be a clear understanding of who is accountable for delivering integrated services, and strategic plans that show how IAs will use resources to transform delivery of health and social care.”

Responding to the report, the Scotland’s health secretary, Shona Robison MSP, said the auditor reaffirmed the government’s views that integration is the right way forward, receiving widespread support from those implementing changes on the ground.

But she urged IAs to focus on agreeing shared budgets, saying: “I’m clear that I expect all local partnerships to be fully prepared for full integration of services from April next year. I expect partnerships who aren’t making enough progress to up the pace and urgency of change now – so that integration delivers the anticipated benefits for people in their area.”

Meanwhile, England’s timeframe for delivering integrated health and social care services is running at a different pace. As part of his Spending Review last week, chancellor George Osborne said all parts of the country must have a plan for integration by 2017.

The English plans will then be implemented by 2020, compared with operations in Scotland starting next year.

But Osborne has also given councils the power to collect ‘social care precepts’ by raising council tax by up to 2%, which the government says could add another £2bn to the social care pot by 2019-20.


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