The Public Bodies (Joint Working) (Scotland) Act 2014 creates a new framework for health and social care integration that underpins the design of the system and all integration activity.
Secondary Legislation – Public Bodies (Joint Working) (Scotland) Act 2014 – The Act is supplemented by a series of statutory instruments that create its implementation context.
There have been a number of Commencement Orders and associated Commencement Orders related to the Public Bodies (Joint Working) (Scotland) Act 2014. The Scottish Government have also produced a comprehensive set of guidance notes to support implementation of the Act. Further information and links to these are available on the Resources section at the bottom of this page.
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)
The Scottish Parliament Information Centre (SPICe) published a health and social care integration briefing in August 2016 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)
Each Integration Authority is held to account by the nine national health and wellbeing outcomes (this link will take you away from our website). 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, helps to map the indicators against their associated outcomes and explains how the indicators are defined.
Integration Partnerships are 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. A review group, chaired by Sir Harry Burns was established to review targets and indicators for health and social care, and a final independent report (this link will take you away from our website) was published in November 2017.
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 the nine nationally agreed 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.
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.
You will find information about the additional services that each area has chosen to delegate on our integration arrangements spreadsheet.