Integration with Councils and Health and Social Care Partnerships is not working, says Auditor General

Beth Culshaw of the West Dunbartonshire HSCP; Jeane Freeman, Health Secretay and Caroline Gardner, Auditor General.

By Bill Heaney

The Scottish Government’s flagship policy of health and social care integration faces ‘significant’ challenges or vital services could become unsustainable; a new report has warned.

The Audit Scotland and Accounts Commission report on health and social care integration says there is little evidence that the policy of bringing together council and health board budgets to provide more care in the community is working.

While there have been successes, they have been small scale and slow, the financial watchdog said, according to a report in the Sunday Herald.

Meanwhile barriers to progress include a high turnover of leadership and the need for integration authorities to make hundreds of millions of pounds of savings every year.

More than half of the authorities – joint boards set up by councils and health boards – have changed their leadership teams and seven out of 30 have had a new chief officer in the last two years.

The relatively new leader of West Dunbartonshire’s Health and Social Care Partnership is Beth Culshaw, who was appointed from Greater Glasgow and Clyde Health Board.

She arrived amidst a controversy over a Dumbarton GP having his contract ended despite widespread public concern in the midst of a recruitment crisis for GPs, taking over as chief officer of the HSCP from Keith Redpath, a social worker.

By law, they are meant to take over control of elements of hospital budgets, relating to areas such as care of the elderly. But this is not happening in most areas, the report says, starving IAs of £809.3 million, around nine per cent of their budgets.

Meanwhile a lack of financial planning is limiting the ability of integration authorities to improve health and social care in Scotland.

The report calls on the Scottish Government to spend more to maintain progress and said it should take urgent action to resolve the problem of budget transfer. So-called ‘set aside’ funding is hard to calculate as some health boards may be working with several IAs, and trying to calculate what share of resources each is entitled to.

Last year, 16 of Scotland’s 30 Integration Joint Boards sought a total of £32.8 million in additional funding from NHS boards to balance their books, while 10 sought an extra £18.6m from councils.

Last year 12 had to put in place recovery plans because of projected overspends, but only two achieved them in full.

Politicians, health chiefs and social care leaders are also urged to be more honest and open about the changes needed to “sustain” health and care services in Scotland.

While there is a consensus that much health and social care support is better to be provided in the community rather than in large hospitals, more needs to be done to take the public along, Audit Scotland said.

Auditor General Caroline Gardner said: “All partners, at a national and local level, need to work together to ensure the successful delivery of integrated health and social care services in Scotland.

“This will allow people to receive the care they need at the right time and in the right setting, with a focus on community-based, preventative care.’

Meanwhile Graham Sharp, Chair, of the Accounts Commission said: “There are examples of integrated health and social care services making a positive difference to people’s lives, but these tend to be local and small scale.

“The potential for a profound and long-term shift in the way health and social care services are delivered is clear, but there is still a long way to go.”

Cllr Stuart Currie, COSLA Spokesperson for Health and Social Care said councils were fully committed to making integration work:  “As today’s report clearly states, integration is beginning to make a demonstrable improvement to the health and social care system but more needs to be done to realise its full potential,” he said.

“While Audit Scotland raise a number of issues with integration so far, we absolutely recognise these and the report is welcome in highlighting the challenges that lie ahead.”

Professor Ian Welsh OBE, Chief Executive of the Health and Social Care Alliance Scotland, said integration must deliver better outcomes for the public and this was not happening.

“We welcome reductions in unplanned hospital activity and delayed discharges which have occurred as a direct result of integration, but it is concerning to note the auditors view that planning is not geared towards improving outcomes,” he said.

Theresa Fyffe, Director of the Royal College of Nursing Scotland said integration was the right thing to do, but called for nurse leaders to be listened to.

“We have raised concerns around the need to improve strategic and financial planning and to strengthen clinical and care governance for some time now,” she said.

Health Secretary Jeane Freeman said she accepted the Government had more to do. “We want to step up the pace and agree that further progress requires our strong, shared leadership. We are committed to working together to deliver integration successfully because we believe it is the right way to deliver better services for the people of Scotland.

“Changes this ambitious take time. With COSLA, we are reviewing progress to ensure we learn and apply lessons and continue to build the momentum for improvement.”

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