Integrating health and social care
Health and social care integration is resulting in radical changes to how acute and community health services, as well as social care services, are planned, funded and delivered. Integration means that the expertise and resources of adult health and social care services are combined and plans made jointly, from the perspective of the service-user. As such, councils and NHS boards have a major opportunity to add value to people’s lives through improved, coordinated services. The legislation came into force on April 1, 2016.
What does integration mean?
The Public Bodies (Joint Working) (Scotland) Act sets out how health and social care services for adults are integrated across Scotland. This means changes to the law which require health boards and local authorities to integrate their health and social care services.
Councils and health boards are mandated to set up a new 'integration authority' in every area, which manages an integrated budget and plan for integrated care. They also need to appoint a chief officer, jointly accountable to both partners, to ensure new national outcomes are met. A list of chief officers can be found here.
Integration authorities plan across the entire pathway of care to enable the delivery of health and social care services which are seamless and joined up. They decide which integrated services will be provided, how they will be funded and what they should look like. They then direct the NHS board and local authority to deliver those services.
Models for integration
Besides these requirements, there is flexibility, meaning the implications for social care professionals depends on where they work. There are two models of integration which can be chosen by the integration authorities.
In the first option, the ‘Body Corporate’ model, responsibility for service planning and the integrated budget could be vested in an “Integration Joint Board”, a new corporate body that would allocate sums to councils and NHS boards to deliver on joint objectives. In the second option, the ‘Lead Agency’ model, the health board and local authority can delegate responsibilities for services and budgets to each other, meaning that council social workers could find themselves working for the NHS, as has already happened in the Highlands (see below).
In the model currently being implemented in the Highland partnership, the Local Authority is delegating adult social care services to the Health Board, and the Health Board is delegating children’s community health services to the Local Authority.
NHS Highland “hosts” the budget for adult social care, which is delegated to it by the Highland Council, and the financial governance system of NHS Highland applies to the adult health and social care budget.
Highland Council “hosts” the budget for children’s community health services, which is delegated to it by NHS Highland, and the financial governance system of the Highland Council applies to the children’s community health and social care budget.
What services are affected?
The types of services which fall within the scope of integration are broad. Each health board must integrate all of its functions as they relate to adult primary and community health services, along with a proportion of acute services. This includes services such as: health promotion; district nursing; health visiting; addiction services; women’s health and family planning services; and general medical services.
Similarly, local authorities must integrate their functions in relation to a broad range of social services, including: social work services for adults; services for adults with physical disabilities; drug and alcohol services; community care assessment teams; care home services; mental health services; health improvement services; and aspects of housing support.
Opportunities and challenges
Other key features of the Act include that new national outcomes for health and wellbeing apply equally to health boards, local authorities and integration authorities. Integration authorities have also replaced community health partnerships since April 2015.
It is still too early to tell what exactly what the integration of health and social care may mean in practice for HIV related services. In research conducted in producing the report 'Making the vision a reality' (HIV Scotland, 2015), local authority staff highlighted uncertainty over how the changes may affect them. Some did also see potential for a greater focus on HIV prevention work.