This page has been designed to help you find the relevant legislation. We have also provided additional information about its content, where this seems helpful.
Secondary Legislation – Public Bodies (Joint Working) (Scotland) Act 2014 – The Act is supplemented by a series of statutory instruments that create its implementation context.
Public Bodies (Joint Working) (Scotland) Act 2014 Commencement Orders – There have also been a number of statutory instruments to commence the Act and deal with technical issues / definitions.
The Scottish Government have also produced a comprehensive set of guidance notes to support implementation. Links to these are available alongside other useful information on the Scottish Government’s Health and Social Care Integration webpages (This link will take you away from the website) but we have also provided links to these, and additional information about their content, within the relevant sections on this website.
The ALLIANCE briefed MSPs ahead of a Scottish Government debate on health and social care integration.
The briefing sets out a number of key points about the implementation of integration:
- This must reflect the clear vision for change in culture set out by Scottish Government guidance notes;
- The third sector has a substantial role to play and must be a key partner;
- Health and Social Care Partnerships need to become better able to shift investment to sustainably support effective, preventative approaches;
- People who use support and services must be full partners in the design, delivery and improvement of health and social care.
The debate occurred days before each of the new Health and Social Care Partnerships across Scotland had to have their integration schemes approved by the Scottish Government. A transcript of the debate can be found within the Scottish Parliament’s Official Report.
- ALLIANCE briefing – Scottish Government debate on health and social care integration, 19 March 2015 (PDF Download)
- Scottish Parliament: Official Report, 19 March 2015 (This link will take you away from our website)
A number of organisations and agencies undertake analysis of legislation and its implementation. A selection of those relating to health and social care integration are highlighted below.
- The Scottish Parliament Information Centre (SPICe) produce a range of briefings for MSPs to support them in their role. In August 2016 they published a health and social care integration briefing that describes how the legislation is being implemented and examines key issues for the integration agenda.
SPICe Briefing – SB 1670 Integration of Health and Social Care (This link will take you away from our website)
A Framework for Integration
Health and social care integration needs to be about significantly more than structural change within the system. To assure this the Act creates a new framework that underpins the design of the system and all integration activity.
The Scottish Government have produced guidance to ensure that Integration Authorities are clear about the ethos and purpose of the legislation. The ethos and purpose are also explicitly referred to, and embedded in all of the other guidance and advice that has been published.
Each Integration Authority is held to account by the nine national health and wellbeing outcomes. All Integration Authorities are required to report their progress towards achieving the national outcomes in their annual report.
To support this process NHSScotland and COSLA worked with stakeholders, including the third and independent sectors to produce a suite of twenty-three core indicators (This link will take you away from our website) that draw together measures that are appropriate for the whole system. The ALLIANCE Policy Team briefing on measuring progress against health and wellbeing outcomes (PDF Download), produced when the indicators were first published, provides an excellent source of information that maps the indicators against their associated outcomes and explains how the indicators are defined.
The core indicators are however only part of the picture as Integration Partnerships are being encouraged to supplement the national indicators with their own local measures. All areas have undertaken work on this, many using the additional data analysis capacity offered to them through NHS National Services LIST Team Local Intelligence Support Team (LIST) (This link will take you away from our website). Some partnerships have decided which suite of indicators they plan to use and have published information about this; however it remains a work in progress in most areas.
There has been some debate about how helpful the current national measures are for enabling system change and measuring progress in the longer term and the Scottish Government announced plans to review these earlier in the year. They recently announced that a Review of Targets and Indicators for Health and Social Care will be chaired by Sir Harry Burns and he is currently inviting interested parties to join the review group. The membership has still to be announced but it has been confirmed that there will be third sector representation. More information about the process of the review and who else is involved will be available on this site as soon as it is available.
Key Decisions that Underpin How Individual Integration Authorities Operate
The information below gives you an overview of some of the key decisions that underpin how individual Integration Authorities operate.
Decisions about the Model
The Act placed a duty jointly on the Local Authority and Health Board to establish an “Integration Authority” to deliver nationally agreed outcomes for health and social care (currently nine)(This link will take you away from our website).
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.
Decisions about the Delegated Functions
The Act prescribed a minimum set of services which must be delegated to the Integration Authority by both parties – adult social care, adult primary and community health care, and aspects of adult hospital care that offer the best opportunities for service redesign and better outcomes. The legislation also provided Partnerships with local discretion to allow for the inclusion of further functions, such as Criminal Justice Social Work, Housing and Children’s Health and Social Care.
The minimum requirements are:
- Social work services for adults and older people
- Services and support for adults with physical disabilities and learning disabilities
- Mental health services
- Drug and alcohol services
- Adult protection and domestic abuse
- Carers support services
- Community care assessment teams
- Support services
- Care home services
- Adult placement services
- Health improvement services
- Aspects of housing support, including aids and adaptions
- Day services
- Local area co-ordination
- Respite provision
- Occupational therapy services
- Re-ablement services, equipment and telecare
- All community health services previously managed by Community Health Partnerships (CHPs) / Community Health and Care Partnerships (CHCPs)
- Community Hospitals
- AHP outpatient clinics
- Hospital services that are most commonly associated with the emergency care pathway (i.e. areas where unplanned admissions dominate):
– A & E
– General medicine;
– Geriatric medicine;
– Rehabilitation medicine;
– Respiratory medicine; and
– Learning disability psychiatry
– Palliative care services
– Addiction services
– Mental health services (except secure forensic mental health services).
All areas have also included general health services for children and young people.
You will find information about the additional services that each area has chosen to delegate on our integration arrangements spreadsheet.