Committee calls for clarification on plans to integrate health and adult social care

18.11.2013

Legislation which will integrate the delivery of health and adult social care in order to improve outcomes for patients has been supported by the Health and Sport Committee. However, a number of issues have been raised by the Committee that need clarification including the reach of Ministerial powers, the role of GPs and also the extent to which the Scottish Government expects both health board and local authorities to commit towards financing the delivery of joint health and social care.

The Public Bodies (Joint Working) (Scotland) Bill creates new governance arrangements to support joint working between local authorities and the NHS. This includes the creation of nationals outcomes set by Scottish Ministers and an integration plan delivered by a joint board or lead agency model with a significant budget responsible for commissioning services.  

Convener of the Committee Duncan McNeil MSP said:

“We already know that where integrated health and social care is successful it results in better outcomes for patients. The quality of care for patients improves, people are not unnecessarily delayed in hospital and patients are supported to live a comfortable life in their own home.

“However, integrating different organisations with different cultures and principles is never going to be simple. Whilst this Committee supports the principle behind this legislation, there are clearly a number of issues that need to be addressed for this legislation to deliver the better outcomes it promises”.

Deputy Convener of the Committee Bob Doris MSP said:

“One of the successes of our National Health Service is that it has been able to deliver better outcomes for patients and more and more people are living longer, healthier lives.

“Excellent examples of integration are already happening across Scotland, and whilst this legislation is not a panacea, it will provide a focus for cementing and reinforcing progress that has already been made”.

In its stage one report, the Committee has called for clarification on a number of areas including:

• The wide-ranging powers included in section 12 (1) of the Bill for Ministers to make provision by order about the membership, proceedings and general powers of joint board, the supply of services or facilities to joint boards. The Committee calls on the Cabinet Secretary to set out in detail the kinds of circumstances in which he considers that it would be appropriate to use the powers set out in this section (p14);
• Calling on the Cabinet Secretary to consider whether there is any way of strengthening the involvement of the third and independent sectors in the integration process (p31)
• Inviting the Scottish Government to consider whether anything further can be done by way of amendment to provide carers and carers’ organisations with reassurance that their involvement in the design and production of future integrated services is guaranteed (p32)
• Calling on the Cabinet Secretary to consider what role the revised GP contract can play in encouraging or helping GPs to play a full role in the integration process (p42);
• The Committee notes the concerns about cost creep (concerns about the issues arising from integrating free universal NHS services with means tested social care that is subject to eligibility criteria) and invites the Scottish Government to indicate what measures it proposes to reassure these groups who might be most likely to be affected by cost creep (p51);
• Given the significant budget that is expected to be transferred to the joint boards, the Committee is asking to clarify the extent to which there is expected to be variation between health boards (p58);
• The need for clarity and consistency on staff issues that may be raised by integration of different staffs working for different employers and coming from different professional backgrounds (p63).