Experiences of Integration in Scotland

ADASS Spring Conference

Peter McLeodVice President

Association of Directors of Social Work

Social Work Services in Scotland

SW (Scot) Act 1968• Kilbrandon and ‘integrated ‘ care

• The promotion of ‘social welfare’

• The Children’s Hearing

• The Chief Social Work Officer

• 32 local authorities

“38,000 council workers facing a switch to NHS”

2nd February 2011

ADSW’s perspective• Achieving the best outcomes for the people who use our services

• Early intervention

• Personalised care, power, choice and control for individuals

• Supporting and empowering communities and carers

• Seamless pathways of care

• Equitable access

• Local democratic control

• Evidence based decision making

• Cost neutral / cost saving, transparent and multi-sectoral reform

• Promotion of social welfare

ADSW’s contribution• A research literature

review commissioned

• A position paper agreed

• An engagement

commenced

ADSW’s proposal – 9 point plan

1. 7-10 outcomes

2. A nationally agreed dataset

3. Joint strategic commissioning plans

4. Joint commissioning plans based on total LA and NHS adult care spending

5. Joint financial governance

6. Targets for joint commissioning within single outcome agreements

7. Accountability meetings

8. Annual leadership event

9. PSIF self-evaluation to be undertaken by partners

Scottish Government’s response

“Another key message that emerged from work over the summer was that wholesale, nationally driven, structural reorganisation of current statutory bodies was not the best way to address the challenges. Evidence shows that that is not the way to achieve better outcomes for people, and it is therefore not the route that we are choosing.” Nicola Sturgeon, Cabinet Secretary

Current configurationsSocial Work Services

• 11 'Stand Alone‘ departments• 5 Social Work and Education• 4 Social Work and Housing• 2 Social Work, Education and Housing• 6 Children's Services• 3 Adult social work services, Housing and Community Services• 6 Community Health and Care Partnerships• 1 Shared Service model

What is the problem we are trying to solve?

• Too much variability of health and social care in different parts of Scotland, particularly for older people.

• No incentive to help get people out of hospital quickly and back into a homely setting.

• Much easier to get an older person admitted to hospital than to arrange services that would keep them at home.

Projected Demand for Health and Social Care, All Ages, 2008/09 prices.

Health and Social Care Demand Projections, £ mn, 2008/09 prices

5,000

6,000

7,000

8,000

9,000

10,000

11,000

12,000

13,000

14,000

15,000

2010 2015 2020 2025 2030

Year

Co

st

£m

n

HLE constant

Change HLE = 0.5 change LE

Change HLE = Change LE

NHS Delayed DischargesScotland; September 2000 to April 2011.

0

500

1000

1500

2000

2500

3000

Sep2000

Apr2001

Oct2001

Apr2002

Oct2002

Apr2003

Oct2003

Apr2004

Oct2004

Apr2005

Oct2005

Apr2006

Oct2006

Apr2007

Oct2007

Apr2008

Oct2008

Apr2009

Oct2009

Apr2010

Oct2010

Apr2011

Census

Nu

mb

er

of

pa

tie

nts

Over 6 weeks

Under 6 weeks

Framework for integration

• Legislation:– nationally agreed outcomes– joint accountability– integrated budgets across primary care,

community health and social care, and some of acute care

– locality planning

Next steps• Formal consultation

• Detailed work now underway to consider practicalities:– Joint governance and accountability– Integrated financial management– Impact on other areas of service– Locality planning– Improving commissioning skills– Requirements for OD and leadership development work– Ensuring meaningful engagement of the third and

independent sectors

Chief Social Work Adviser workstream

• Impact on other social work functions• Transitions• Child, adult and public protection• Cross cutting services and support• Scoping workforce implications for professional leadership and

support• Opportunities for improvement to current service delivery

Timetable

• Local elections 3 May

• Consultation paper launched end of May

• Bill to parliament in session 2012/13

• Implementation 2014

Context we are operating in• A vacuum of information from now until the consultation document is

published after the local government elections in May

• Congruence with developments in England: The Future Forum

• Learning from the integrated care pilots

• Importance of community planning and the single outcome agreement

• The current agenda and work in this area: Change Fund; joint initiatives we have already established

Issues we are concerned about• We need to maintain pressure to ensure services are delivered and

outcomes determined at a local level

• We need to understand more about what a single accountable officer is and how that role will play out

• We need to understand more about what a Health and Social Care Partnership is

• We need others to realise the importance of any impact of change on other services within social work and within the wider community planning framework

• We need to know about the number of partnerships and how they will be governed

• We will continue to emphasise the crucial role of the CSWO

Influencing the debate• Meaningful and comprehensive engagement in the consultation

– Engagement with our own members

– Engagement with partners in local authorities, NHS, third and independent sectors

• Parliamentary engagement

• Useful and insightful comment on the conclusion drawn from the consultation

• Dedicated involvement in the drafting of legislation– Professional advice

– Work to limit unintended consequences

The future

“If you don’t know where you are going, any road will get you there”

Lewis Carroll