Connected Communities shares examples of good practice within integration in health and social care across Scotland. The case studies come from the perspectives of those delivering integrated support and services, as well as from those accessing these services.

We are looking for examples of integration and are actively researching the landscape across the country by making contact with voluntary organisations and statutory bodies to identify areas where we can highlight.

We would be keen to gain your input in this project and welcome any suggestions and examples you may have that exemplify integrated ways of working within health and social care.

Examples of integrated ways of working may include themes such as:

• Collaborative working
• Fostering authentic relationships
• Strong and compassionate leadership
• Innovation and transformation
• Overcoming barriers
• Community and lived experience involvement
• Culture shift(s)
• Shared decision-making

Connected Communities case studies are published on the ALLIANCE website and shared across social media. They are also shared through our e-bulletins which feed into our wider Integration work to further establish the ALLIANCE as an authority committed to integration. The learning from the case studies will then be drawn out and shared with our stakeholders, which may include the Scottish Government.

Most importantly, Connected Communities will show how integrated services help improve the quality of people’s lives.

The case studies:

• Identify areas of good practice within integration
• Showcase the third sector’s role as a key partner in integration
• Demonstrate the progress of integration
• Highlight the challenges and barriers to achieving integration

Inspiring and impactful work is taking place throughout Scotland’s communities and we aim to be a driving force in raising awareness of this work.

To participate in Connected Communities, or to suggest great examples that you think we should cover, the integration team can be contacted directly at integration@alliance-scotland.org.uk

To read all Connected Communities, please follow this link.

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Human Rights

The Scottish Human Rights Commission (this link will take you away from our website) takes a human rights based approach, promoting international human rights standards to ensure that people’s human rights are put at the very centre of policy and practice.

A human rights based approach empowers people to know and claim their rights. It increases the ability of organisations, public bodies and businesses to fulfil their human rights obligations. It also creates solid accountability so people can seek remedies when their rights are violated. The PANEL principles are one way of breaking down what a human rights based approach means in practice.

PANEL stands for:

• Participation
• Accountability
• Non-Discrimination and Equality
• Empowerment
• Legality

Cathy Asante Presentation on Human Rights Based Approach (this link will take you away from our website).

Human Rights in Health and Social Care

Human rights can help to bridge the cultural divide between health and social care. Embedding human rights within the Public Bodies (Joint Working) (Scotland) Bill, and the wider agenda, provides a shared foundation, not owned by ‘health’ or ‘social care’ and focused on people, not structures or systems.

Human rights underpin a range of ideas currently prevalent across health and social care, including: personalisation, person-centredness, recovery, coproduction and self management. All of these involve the person being at the centre and having choice and control over their own lives.

A human rights based approach can help us to deliver the public service reform agenda.

Scotland’s National Action Plan for Human Rights

SNAP – Scotland’s National Action Plan for Human Rights (this link will take you away from our website) aims to build a better human rights culture, help improve people’s lives through human rights and contribute to a better world by giving effect to Scotland’s international human rights obligations.

SNAP is the first National Action Plan for human rights in any part of the UK. It is based on experience from other European and Commonwealth countries, as well as guidance from the United Nations and the Council of Europe.

Prevention

The Christie Commission (this link will take you away from our website) recommended that Public Service Reform prioritised prevention (along with reducing inequality, and promoting equality) to tackle root causes of problems and negative outcomes, and thereby reduce demand in public services, which is essential in a time of reduced public spending and changing demographics.

‘Preventative spend’ in Scottish Government terms is characterised as spending in the current period that is expected to reduce public spending demands in the future by reducing avoidable health and social problems. This definition differs from wider public health definitions of ‘prevention’, where the focus on prevention can be seen to take 3 distinct forms:

• Primary prevention: Activities designed to reduce the incidence of health problems – involves measures to reduce the risk of health issues arising and to reduce their duration.
• Secondary prevention: Activities aimed at detecting and treating health problems – this covers almost all of health care activity.
• Tertiary prevention: Activities aimed at reducing the impact of health problems to ensure people engage fully in educational, family, professional, social and cultural life – this covers almost all of social care activity.

When the Integration Authority has been formed using the Body Corporate model, the Integration Joint Board (IJB) has overall governance responsibility for the Integration Authority.

The membership of the IJB is made up of voting and non-voting members. The formal arrangements for voting members are set out in the Integration Scheme and all voting members are either Local Councillors from the associated Local Authority or Non-Executive Directors from the associated Health Board.

The non-voting members that are required to be involved in IJBs include :

• The Chief Officer of the Integration Authority
• The Chief Finance Officer (or person who carries Section 95 responsibility for the IJB)
• The Chief Social Work Officer of the Local Authority
• A GP representative, appointed by the Health Board
• A secondary care medical practitioner, appointed by the Health Board
• A nursing representative, employed by the Health Board
• A staff-side representative that can represent the interests of Integration Authority staff employed by both the NHS and Local Authority
• A third sector representative
• A carer representative
• A service user representative

The IJB can also widen its membership to include others at its discretion.

When the Integration Authority has been formed using the Lead Agency model (only Highland have chosen to adopt this model), the Integration Joint Monitoring Committee has overall governance responsibility for the Integration Authority. Although the membership structure and Chair arrangements are slightly different the Joint Monitoring Committee fulfils the same functions as the IJB and has the same requirement to include stakeholders as non-voting members.

Further reading:

Integration Joint Board guidance (this link will take you away from our website)

Strategic Planning Groups

The Public Bodies (Joint Working) (Scotland) Act 2014 requires each Integration Authority to establish a Strategic Planning Group to support it to develop its strategic commissioning plan and requires it to:

• Seek the views of the Group on the proposed content of the plan
• Take account of these views when drafting the plan
• Seek the views of the Group on the draft plan
• Re-draft the plan, taking account of these views

The Strategic Planning Group plays a key role in developing and finalising the strategic commissioning plan and also in reviewing and measuring progress. This is highlighted in the Strategic Commissioning Plans Guidance.

The group also needs to include locality planning groups in shaping their strategic plan, however as people may fulfil more than one role within the group this might not mean additional members.

Locality Planning Groups

The main purpose of the Locality Planning Group is to provide an organisational mechanism for local leadership of service planning, to be fed upwards into the Integration Authority’s strategic plan.

The Scottish Government has produced localities guidance that sets out what localities are for, the principles upon which they should be established, and some of the practicalities that Integration Authorities should take into account when establishing and supporting localities. It also makes it clear that localities must have real influence on how resources are spent in their area.

Locality arrangements are not defined in the legislation and Integration Authorities have the freedom to design their locality arrangements around local need. However, they must have input from:

• Health and social care professionals who are involved in the care of people who use services
• Representatives of the housing sector
• Representatives of the third and independent sectors
• Carers’ and patients’ representatives
• People managing services in the area of the Integration Authority

Further Reading:

• Localities Guidance (this link will take you away from our website)
• Strategic Commissioning Plans Guidance (this link will take you away from our website)

The Integration Planning and Delivery Principles help inform integration activity that should be delivered to achieve the nine national health and wellbeing outcomes. They set a tone for both the national guidance and local implementation of the Public Bodies (Joint Working) (Scotland) Act 2014.

The Integration Planning and Delivery Principles aim to build a system that complements and builds on people’s natural assets, supports them to live well, is joined-up from the perspective of people who access services and is built around the needs and aspirations of people who access services. They also aim to enable investment to be targeted where it is most needed, by making it easier for money to flow between the different parts of the system.

Further Reading:

• Integration Planning and Delivery Principles (this link will take you away from our website)
• Nine National Health and Wellbeing Outcomes (this link will take you away from our website)
• Guidance for Health and Wellbeing Outcomes (this link will take you away from our website)

Key Documents:

The key documents that explain the role, remit and purpose of the new Integration Authorities include:

• Integration Scheme
• Strategic Plan
• Locality Plan

The Integration Scheme contains operational arrangements that ensure effective planning and delivery of the functions of the Integration Authority. Take a look at the guidance on what must be included in an Integration Scheme (this link will take you away from our website).

The Strategic Plan sets out the Integration Authority’s longer term vision for what services should look like, the challenges to achieving this vision and provide some level of needs analysis. Stakeholders must be fully engaged in the preparation, publication and review of the strategic commissioning plan in a co-productive approach. Guidance on strategic plans can be found on the Scottish Government website (this link will take you away from our website).

Every Integration Authority has to be divided into two or more localities and each locality needs to have its own Locality Plan. The guidance on strategic plans above includes some useful information about locality plans, as does the localities guidance (this link will take you away from our website).

The Public Bodies (Joint Working) (Scotland) Act 2014 was given Royal Assent on 1st April 2014. This Act provides the legal framework to enable Health & Social Care integration and is the largest piece of public service reform ever undertaken in Scotland.

The aim of health and social care integration is to help address the three main challenges facing health and social care:

• Shifting demography
• An increasing number of people living with multiple, complex, long-term conditions
• Ever reducing public funding.

The Public Bodies (Joint Working) (Scotland) Act 2014 placed a joint duty on the Local Authority and Health Board to establish an “Integration Authority” to deliver the nine nationally agreed health and wellbeing outcomes for health and social care.

The parties had the option to choose between two models for their Integration Authority:

• A ‘Lead Agency’, where one of the authorities (NHS or Local Authority) would be responsible for delivering specified integrated functions; or
• A ‘Body Corporate’, whereby a new legal entity would be created to take responsibility for the delivery of the integrated functions, under the direction of a jointly appointed Chief Officer.

All areas except Highland elected to adopt the Body Corporate model and Clackmannanshire and Stirling decided to form a single Body Corporate to service the needs of both areas. This means that there are 30 Integration Joint Boards (IJBs) and 1 Joint Monitoring Committee (Highland) across the 32 Local Authority areas in Scotland.

More information:

• Primary Legislation
• Secondary Legislation
• Scottish Government Health and Social Care Integration pages

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Our programme uses a variety of methods to support the third sector’s ability to influence the direction of health and social care integration in Scotland. As a team, we use our platform to promote and champion the role of the third sector. We also play a role in ensuring that the voice of lived experience is able to influence the design and delivery of integrated services.

As well as this, we collate intelligence around the successful implementation of integration in Scotland, identifying and sharing examples of good practice.

Some recent highlights of the Integration Support team’s activities include our partnership work in the Scottish Borders in which we have supported the third sector to engage with their statutory partners within the local Health and Social Care Partnership and our Engagement Insights report which highlights the key aspects of meaningful engagement.

If you would like to read more about the work that we are doing have a look at our news section and Twitter page. If you have any questions about any of our work, you can get in touch with the Integration Support team at integration@alliance-scotland.org.uk

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