WE ARE fast approaching 1 April when the Public Bodies (Joint Working) (Scotland) Act 2014 will come into force, signalling a clear intent to overcome the well-versed problems caused by the split between “health” and “social care”.
This aims to address both the varying quality and level of support and the gap between health services provided by the NHS and social care. Perhaps the clearest manifestation is “delayed discharge”, when people remain in hospital longer than they need to, despite having been judged fit to return home, often because the support they need to live independently is not available.
We hear from many people who live with long-term conditions about their experiences of navigating a complex, disjointed system and having to tell their story repeatedly to different professionals. This is partly due to lack of integration between health and social care, but also silos within a health service designed around condition-specific specialities. The legislation seeks to drive services to become more efficient and able to support people to remain at home for longer and live well with long-term, often multiple and complex, conditions.
Integration requires significant organisational reforms and early energy has focused on issues such as who sits on the new integrated boards. While this is all necessary work, the Scottish Government is clear that integration must not amount simply to a structural exercise, setting out a series of principles that paint a picture of health and social care designed and delivered around people and communities. This requires people being listened to, their expertise valued and enabling them to have choice and control over their own lives. The principles also refer to people’s rights and to their human dignity. They are clear that health and social care is not simply about sustaining people, but about supporting all of us to participate equally and actively as citizens in our communities.
This reaffirms that health and social care is not the job of statutory services alone. New strategic commissioning processes must interact with natural networks of support, community activity and third-sector provision. In order to make the shift to a preventative approach, the guidance suggests the need for “a radical change in the types of support and services that will be provided” and recognises wider causes of ill health and health inequalities, such as poverty, housing and employment.
The principles sit alongside national health and wellbeing outcomes, against which health and social care partnerships will report and be held to account. These reinforce the shift towards health and social care that focuses on the outcomes that matter to people; supporting people to self manage, to remain able to live well and at home and to have positive experiences when they interact with services. The ALLIANCE and our members argued strongly for this as a robust philosophical compass for health and social care as well as a practical framework to support effective planning, design and delivery. The challenge now is to turn these principles into practice that will make a difference to all our lives, quicken the pace and scale of change and set a new path for health and social care in Scotland.
The ALLIANCE is working with health and social care partnerships to put lived experience at the heart of integration.
Our people powered health and wellbeing programme works with teams across Scotland to help enable the shift towards a focus on personal outcomes. We are working to pilot care opinion – a means of enabling people to give feedback on their experiences of services and contribute to improvement and support the development of the new stronger voice programme, aimed at amplifying voice of people and communities at a local and national level, which we look forward to helping to deliver over the coming years.
We are working to ensure the contribution of the third sector is maximised. We know that some vital, preventative third-sector work is already at risk of being lost as the reshaping care for older people change fund comes to an end. This illustrates the need for third-sector activity to be a core element of strategic commissioning and investment by the new partnerships, not a “nice to have” when additional funding is available.
Only time will tell whether we are right to be optimistic about the opportunity that integration represents. We believe transformative change is the only option and we hope the coming years will see a groundswell of movement towards health and social care that reflects the aspirations, value and contribution of those it supports.
• Shelley Gray is director of policy and communication and academy strategic lead at Health and Social Care Alliance Scotland (the ALLIANCE) www.alliance-scotland.org.uk