CommonSpace journalist David Thomson takes a look at big changes due to come into force in social care in Scotland from this April
ON 15 December 2015, Jane was admitted to the Royal Infirmary in Edinburgh by her GP because she was suffering from a urinary tract infection (UTI) and confusion. After an initial consultation, her GP was not made aware of any other medical issues.
Two days later, Jane was assessed by the Edinburgh South East (SE) Recovery Hub, which is a one-stop shop offering a wide range of services for people who have drug and alcohol problems.
The SE Recovery Hub discharged her on 18 December to be assessed by an occupational therapist and physiotherapist the following morning at Jane’s home. During the visit, the occupational therapist made a full assessment of her home situation and Jane’s mobility, and she was provided with a walking aid and offered advice.
Nearly all parts of the country have set up integrated joint boards: a partnership between all 32 local NHS authorities and local councils to manage combined care services.
The occupational therapist evaluated whether using different resources in a variety of ways would enable Jane to have a care plan tailored to her, and provide her with the necessary support.
With the aim of establishing a more cohesive, integrated service and finding new ways of working in health and social care teams, this is the type of integrated service set to begin rolling out across Scotland this April as part of a major change in the delivery of care services.
Nearly all parts of the country have set up integrated joint boards: a partnership between all 32 local NHS authorities and local councils to manage combined care services. The joint boards will handle an PS8bn budget to provide resources for health and social care in a move aimed at joining up services.
It is hoped the changes will tackle some of the problems facing local areas across Scotland, such as 96 per cent of patients blocking beds in their local hospitals and 83 per cent of unplanned hospital admissions for those people who are aged over 75.
The Scottish health secretary, Shona Robison, says that the integration of health and social care will “fundamentally change the way parts of the healthcare system operates, helping to shift the focus away from acute care towards a model of care that looks after the person at home or in a homely setting”.
“People are living longer,” she says. “This is a good thing and a testament to the advances in our NHS and the medical care we now provide. However, this means that we have an increasingly elderly population with more complex and long-term conditions than ever before.
The joint boards will handle an PS8bn budget to provide resources for health and social care in a move aimed at joining up services.
“It is predicted that by 2037 the number of people with a long-term condition will rise by 83 per cent and what is clear is that the traditional models of care, where the NHS and the social care sector work independently of each other, are no longer suitable to care adequately for these people.
“Integration is one of the most ambitious programmes of work this government has undertaken and one which we believe will deliver sustainable health and social care services for the future that are centred on the needs of patients.”
Former chief nursing officer for Scotland Professor Paul Martin says that the integration of health and social care has been “long overdue”.
“It would mean that the new boards would be able to provide services to people with a single controlled journey,” he explains.
“That means that from the start of their care, there would be a seamless transition from assessing what is wrong with the patient, right through to providing the care necessary through one contact.”
The Public Bodies (Joint Working) (Scotland) Act 2014 became law in April 2014 and, coming into force from April this year, will provide the legal framework for integrating both health and social care across the country.
The legislation requires local integration of adult health and social care services, with health boards and local councils deciding on whether to include children’s health and social care services.
“Integration is one of the most ambitious programmes of work this government has undertaken and one which we believe will deliver sustainable health and social care services for the future that are centred on the needs of patients.” Shona Robison
For 31 out of the 32 health and social care partnerships, the joint boards will be set up in time for 1 April. There is a separate arrangement in place in the Highland Council area, where either the NHS Highland or the local authority will take a lead in providing certain services.
In what is called the ‘lead agency’ model, NHS Highland will take the lead in providing adult services while the local authority will take the lead in providing children’s services.
With this setup, unlike the joint boards which will eventually employ all staff from the local health board and the local authority, staff will be either working for NHS Highland or Highland Council.
Around 1,500 social care staff will be transferred to NHS Highland at a cost of PS90m to help redesign adult services. To the tune of PS8m, 250 staff will be transferred to Highland Council to assist with the reorganisation of social care, education and health.
The new health and social care partnerships will offer people support through the self-directed care model, a fresh approach which began implementation throughout Scotland last year. Self-directed support offers service users a number of options on how their care is organised and delivered, and the focus of the scheme is to give people a more central role in deciding the best personalised option for them.
The four methods of care delivery people can choose from are:
* Option 1: Direct payment between the health and social partnership and the healthcare provider with existing care services
* Option 2: the person directs the available support
* Option 3: the local authority arranges the support
* Option 4: a mix of the above
So far in Scotland, not every region has offered the full range of four options, but the roll-out is ongoing.
However, while the move to integration has been welcomed by some, the transition will place pressure on local authorities already battling cuts to services. The combined changes amount to a substantial new approach and are part of a broader plan aimed at restructuring care delivery in Scotland.
As agreed recently as part of the Scottish Government’s PS10.3bn package to local government for 2016-17, PS250m will be invested in integrated health and social care services.
However, while the move to integration has been welcomed by some, the transition will place pressure on local authorities already battling cuts to services.
The investment will help to iron out some of the problems found in an Audit Scotland report in December 2015, which warned that significant risks would need to be addressed if integration had any hope of providing the changes required in health and social care. Those risks included difficulties in agreeing on budgets, complex governance structures and workforce planning.
However, Caroline Gardner, Auditor General for Scotland, says it is important to recognise the early progress that is achieved to date given how complex the changes are.
“If these new bodies are to make the scale and pace of change that’s needed, there should be a clear understanding of who is accountable for delivering integrated services, and strategic plans that show how authorities will use resources to transform the delivery of health and social care,” she says.
Other pressures on local authorities include the commissioning of services and housing provision for those people who are in care.
Dave Watson, Unison Scotland head of policy and public affairs, takes issue with the “top-down approach” to the commissioning of services and instead emphasises “getting locality planning right; building on the knowledge and capacity of local people about their wellbeing”.
“If these new bodies are to make the scale and pace of change that’s needed, there should be a clear understanding of who is accountable, and strategic plans that show how authorities will use resources to transform the delivery of health and social care.” Caroline Gardner, Auditor General
Watson says that work will need to be done with poor performance teams to improve outcomes, and that “housing provision also needs to change if we are to address the needs of an ageing population”.
“All too often, a person will move from their family home into a care home via a period in hospital,” he says.
“This is partly because of the lack of suitable alternatives at a local level. We need to build new, affordable and sustainable housing, with a range of house types and sizes that encourage mobility in the housing system and enable downsizing for those that wish it.
“Housing support services currently play a small, but significant, role in helping older people to remain living at home and need to be expanded.”
Elsewhere in the Scottish Government budget to local government is a pledge to facilitate a Living Wage for every social care worker across Scotland after pressure from both trade unions and Scottish Labour. Around 39,000 care workers will benefit.
“It is the right thing for workers, and it will raise standards across the service, ensuring that those who receive care get a better quality of care,” says Scottish Labour equality spokesperson Jenny Marra.
“Our NHS will feel the benefit, too. A motivated workforce supported by more investment will keep more patients out of hospital, giving them the dignity of care in their home and relieving the pressure on our hospitals.
“It is time to end the sticking plaster approach to our health service and get serious about social care as a vital part of a sustainable NHS for the long term.”
With this being the biggest change in health and social care for a generation, a primary aim is to give patients the ability to take charge of the type of care they want.
Professor Paul Martin says that paying the Living Wage will make the care industry “a valuable career option for a person to enter as a profession”.
“If the individual member of staff can see that there is a career path for them to their place of employment, whether that is support for them to do an HND or degree or move into more senior roles, they should be given the opportunity,” he says.
With this being the biggest change in health and social care for a generation, a primary aim is to give patients the ability to take charge of the type of care they want.
Delivering it effectively will require long-term thinking and planning for those involved at every level of the delivery of care, but crucially, the changes will elevate the role of service users such as Jane at the heart of the care model.
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Picture courtesy of WorldSkills UK