Background Paper 1

‘AllHandsonDeck’

Report by Frank Strang- Depute Director, Health and Social Care Directorate, Scottish Government 2013

Summary

Healthandsocialcareintegration:howeveryonecanplayanactivepartinimprovinglifeforpeopleinScotland

Thisreportsetsoutemergingconclusionsonhowbesttoinvolvethefullrangeofstakeholdersinhealthandsocialcareintegration.Itrefersinparticulartolocalities,whichmustbeupandrunningeffectivelybyApril2015,butisrelevanttoalllevels.ThisisnotformalScottishGovernmentguidance.Itis,however, likelytoinformsuchguidance overthecomingmonths.Thedifferentplayers -national butparticularlylocal-willthereforewishtotaketheseconclusionsintoaccountasthepaceofpreparationquickens.

Conclusions

The General Principles

  1. Thescale,complexityandnatureofintegrationmeanthatthechallengewillonlybemetifeveryoneplaystheirpartinfull. Theprinciplesofgoodpartnershipworkingmustapplyatalllevels.

Settingtheframework

  1. Thereisworktodotogetlocalitiesrecognisedforwhattheyare:theengine roomofintegration,centeredonpeopleandthecommunitiestheylivein.I t isnot tooearlytoplanforlocalities:iftheyaremadetoworkwell,thereiseverychancethatsuccessfulintegrationwillfollow.Astraightforwardnationalframework for localitiesprovideditissensitiveandproportionate-canunleashlocalcreativity,leadingtobetterlocalsolutions. It shouldrequiretheestablishmentofeffectivelocalities,setprinciplesandwarnofunintendedconsequences,buttounlock localpotentialtheemphasismustalwaysbeonflexibilityfor localdesignandlocaldelivery.Thecentreshouldconcernitselfwithoutcomes,notprocess.
  2. Localitiesneedclout.AkeyfactorwillbetheextenttowhichHealthandSocialCarePartnerships(HSCPs)allowforlocaldecisionmakingondeliveringoutcomes. Weshouldnotsetnationalrequirementsnordeadlinesbutsettheprincipleanddescribetheareaswhichweexpecttobedecidedlocally.WeshouldrequireHSCPstosetoutpubliclythe respectiverolesandthedialoguetheyhavehadwithlocalintereststosecureagreement.Thisneedstogohandinhandwithclearaccountability,bothtoHSCPsandcommunities.Thisshouldincludelocaloutcomes,transparency redata-andthereforevariation-and simplefinancialarrangements wherebylocalities reapsomebenefitinkindfromeasingpressureelsewhere. I t shouldbeaprioritytoworkouthowsucharrangementswouldworkinpracticeatbothpartnershipandlocalitylevel.
  1. Thisprojectneedstoleadtoimprovementswithineachofhealthcareandsocial care.Fortheformer,itmustfacilitatestrongerintegrationofhealthcareitself:allwillhavetoadjust,withamorecommunity-facingacutesector,aprimarycaresectortakingmoreresponsibilityforsystemwideissuesandanincreasingblurringoftheboundaries.Forthelatter,itmustfacilitateasocialcaresectorcombiningeffectivedeliveryofits traditional corerolewithafocusonpreventingill-health.

Preparing the way locally

(i)Short term

  1. Goodqualitydialoguelocally, especially-butnotonly-betweenprofessionals,isapre-requisite. It mustnotbeleftuntilalltheenablinglegislationisinplace.
  1. Decisionsonlocalityboundariesmustnotbeallowedtodragon.Theremaybeaneedtoagreeadeadline.Whilstthereareseveralcriteriatoconsider,theyshouldwhereverpossiblerelatetonaturalcommunities.
  1. Localitieswilltaketimetomatureandneedtokeeptheireyesonthemediumterm.Buttheyshouldthinkproactivelyaboutearlywins,startingsmallwiththingswhichareachievableanddesirableinthelocalcontext.Localexperienceofthe ChangeFundimpliesthatinmanyplacesrapidaccesstohomecaremaybeafrontrunner.

(ii)Mediumterm

  1. Professionals, communitiesandusersmustalwaysplayaprominentpart.Butaboveall,localitiesshouldbesolution-led.Theymustnotbetheservantofstructuresbutfocuscreativelyonthebalancebetweenimplementingwellthesolutionsalreadyinplaceanddevelopingnewandinnovativesolutions.Thatmindsetisasimportantasjobtitles.
  1. Embeddingtherightculturesandbehaviorsisvital.Discussionsoncultureneedtohavealocalfocusandgobeyondaspirationwords.Mutualrespectshouldincluderecognisingwhateachpartnerbringstothetableandhoweachneedstochange. Beingperson-centeredneedstoincludebeingwillingtotakerisks;andlocalitiesneedtoembraceconfidentlylocalhistoryandaspirations.
  1. HSCPsmustoperateasstrongalliesofCommunityPlanningPartnerships(CPPs)-andviceversa.Wecannotaffordduplicationofeffort,eitherforthepublicorforpublic services.Withclarityontheirroles, theycanreinforceeachother,withCPPskeytoHSCPs'delivery- andHSCPsaddingrealvaluetocommunityplanning.

Support

  1. Partnershipswillneedadequatesupportiiiftheyaretodelivertheseaspirations.Fiscalrealitiesmeanthatthiswillneedtobewelltargeted,includingthefollowing:

a.Localdesignwilloftenworkbestwithtailoredsupport. TheJointImprovementTeam,workingwithothers(seepara41), shouldbetaskedtooffereventshelpinglocalplayersto developlocal solutions.Thiswillbeaboutenergising,informingandfacilitatinglocalthinkingandculturechange.Butlocalthinkingmustnotbeleftuntilsuchanevent.

b.Whilsttheremaybeacasefortargetedtransitionalcapacity/resourcetoenablestakeholderstokick-startlocalities,all partnersneedtorecognisethatultimatelythiswillnotbesomethingtheycanchoose tooptoutofworkingwithothersinnewways todeliverwellintegratedcareissimplywhatweallnowdo.

c.Experiencepointstotheneedtokeepoureyesonoperationalissues.Moreattentionmustbegivennowontoissuesarounddata-sharingandcompatibilityofITsystems.

d.Streamlinedmechanismsareneededtoensurethatresearch,evidenceandinnovation,originatingatwhateverlevel,aremadewidelyavailabletoinformlocalchoices.Giventhefocusonprevention,thisisespeciallyrelevanttopublichealth.

e.Effectiveleadershipwillberequiredatalllevels.NHSEducationforScotlandandtheScottishSocialServicesCouncilneedtogiveearlythoughtastohowexistingresourcescanbedevelopedintoamoreintegratedresource,tobedeliveredjointly.

SH/September 2013