by Steven McGinty

Last month, on April 1^st, the Public Bodies (Joint Working) Scotland Act 2014 was given its royal assent. According to Alex Neil, Cabinet Secretary for Health and Wellbeing, this new addition to the statute book signifies a ‘landmark’ change for the provision of healthcare in Scotland. The Act will be introduced in stages, with the full integration of health and social care expected by April 2016. The principal aim is to provide better patient outcomes through the integration of health and social care services. There has been broad support for the new legislation, but some say the Act has not gone far enough.

The integration model has been seen as a significant step in meeting the needs of patients. Health and social care organisations believe that integration is necessary to provide a more patient centred service. They have suggested that a more integrated approach would be better at preventing illness, as well as supporting those with long term conditions. The Welsh Government has recently argued that integration better meets the needs of older people. Similarly, the London Health Commission has highlighted that the fragmentation of health and social care is a major barrier to providing quality care. There have also been calls for the housing sector to play a role in providing integrated services.

The Public Bodies (Joint Working) Scotland Act 2014 includes many aspects of what organisations have been looking for. The Act introduces several important changes:

• Local authorities and Health Boards will be required to jointly prepare an integration scheme for the area of the local authority.
• Local authorities and Health Boards will have integrated budgets for health and social care.
• Local authorities and Health Boards will be required to jointly produce strategic plans.
• Local authorities and Health Boards will be required to establish local integrated partnerships and governance arrangements.
• Local authorities and Health Boards will be required to consider national health and wellbeing outcomes in their integrated plans.

So, will these changes lead to better outcomes for patients?  The intentions of the Act are hard to argue with. Most practitioners and academics support integration and will be pleased with many of the reforms. Nevertheless, issues did arise during the consultation stages. In particular, the Alliance, a national third sector intermediary, expressed concerns over the lack of clarity for the role of the third sector. They also make it clear that they would have preferred principles explicitly based on human rights, instead of the delivery principles that the Act currently has.  They suggest that principles based on human rights are more powerful and can be a ‘practical driver of change and improvement’.

Further, Labour Health Spokesman Neil Findlay voiced the disappointment of the Labour Party at the failure to ensure a ‘living wage’ for care workers. They suggest that the Act fails to address the recruitment crisis and low morale amongst staff. A recent report by the International Longevity Centre entitled ‘The Future Care Workforce’ echoes Findlay’s sentiment.

Despite these concerns there are still plenty of changes that could make a difference to patients. It is however important that the changes brought into law are implemented properly. Recently, the Institute for Research and Innovation in Social Services published a report entitled ‘Delivering Integrated Care and Support’. This report outlines the factors needed for effective integration, highlighting the important role leadership and vision play. For the Act to be successful, those involved in integrating services, as well as the Scottish Government, must show strong leadership and a clear vision throughout the integration process and beyond.

So, to answer the main question, have these changes gone far enough? In short, it is difficult to assess whether any particular policy has gone far enough. However, the Act will be judged on whether it improves the quality of care, and improves outcomes for patients. If progress is made, then the Act has at the very least taken a step in the right direction. Here, at the Knowledge Exchange, we’ll be monitoring the debate closely and making sure the Information Service keeps its members up to date. If you want further information on the integration of health and social care or some background information on how the Act was passed, feel free to browse our Information Service.

Articles referred to in this blog (please note you must be a member to access articles):

• Public Bodies (Joint Working) (Scotland) Act 2014
• MSPs unanimously pass the Public Bodies Bill: http://www.bbc.co.uk/democracylive/scotland-26340505
• Health and care integration: making the case from a public health perspective
• A framework for delivering integrated health and social care for older people with complex needs
• London Health Commission: summary of call for evidence
• Housing’s contribution to the health and social care integration agenda, IN Spotlight, No 99 Mar 2014, pp1-15 (whole issue)
• Briefing paper: Public Bodies (Joint Working) (Scotland) Bill, May 2013
• The future Care workforce
• Delivering integrated care and support