We need to change the conversation about integration

• Written by: Theresa Shearer — Enable Scotland — Chief Executive Officer
• Published: 17th June 2018

Integration has the potential and power to lift citizens out of traditional models.

Models that no longer best support them to meet desired outcomes, either individually or collectively as a nation, and there is no doubt that this is a welcome direction.

As a sector, we have felt a little on the fringes of the integration agenda – monitoring Integration Joint Board (IJB) progress, locality planning, figuring out how the third sector voice can be more representative. We are now two years in, and the direction set by the integration opportunity is still clear – even if sometimes the processes are not. It is a unique opportunity to achieve innovative and transformational change across health and social care, driven by person-centred and rights based approaches. Great! So let’s seize it.

I would argue that those of us in the social care sector don’t have to wait to be told what to do, or to respond to the agenda set by IJBs. I would argue that we have to influence it, and that we have to influence it by offering something different into the agenda – it is designed to be the catalyst for a transformational change after all.

This is OUR challenge. And let’s be clear – a challenge it is.  In order for the integration agenda to succeed, it relies on a thriving social care sector, full of quality organisations with strong values, delivering quality support to people who are living great lives. In the current context:

• Total spend on social care in Scotland is £3.1 billion; £1.6 billion of this is spent on commissioned social care services from the third and independent sectors (this link will take you away from our website).
• ENABLE Scotland is one of over 1,000 registered providers of adult social care services in Scotland. Over 600 of these are voluntary sector (this link will take you away from our website).
• A 2016 Audit Scotland report forecasts that an additional spend of £667 million would be required by 2020 in order to deliver current services (this link will take you away from our website), against a challenging forecast of a cut of some 20% in public spending by 2020 (this link will take you away from our website).

So the challenge is how to retain that quality of provision in an era of decreasing public spend. And I do believe that the answer lies in integration, but not exclusively with health. I believe that the integration of some social care provision must be considered in order to pave the way for the integration of health and social care services.

In the sphere of learning disability, we are aware that ENABLE Scotland is one of circa 300 providers of social care for a population of 12,680 adults who have a learning disability and receive a social care budget. We are one of 600 third sector social care providers in Scotland. There are clear opportunities – and a clear impetus – for the operations which support the delivery of social care across all of these providers to be reduced through collaboration, potentially releasing millions of pounds of public funds back into the delivery of best quality frontline social care support, including helping us to fund digital transformation to enable more efficient working practice.

Beyond this, in an era where we compete with each other to recruit and retain the best staff to support people living in the same areas, now must be the time to properly consider the merit of locality/collaborative commissioning, particularly of overnight support, as opposed to (often) needs-led provider-focused commissioning. The skillset of the social care workforce is broadly transferable across different groups. Alternative commissioning models have the potential to drive sector transformation and encourage collaboration and the resulting efficiencies of public spend to be refocused on frontline service delivery. As a sector, now is the time to work together and offer these solutions to our commissioners and customers.

Even better, a focus on integrating the provision of social care services, led from within the sector, would also pave the way for smoother integration with frontline healthcare services.

This is the kind of talking about integration I would like to see more of across the third sector.

Theresa’s Opinion is part of the ALLIANCE’s ‘We Need To Talk About Integration’ anthology which is available at the link below.

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