Health and social care integration
Will transforming health and social care in Scotland be an £8 billion challenge for public money?
The Public Bodies (joint working) (Scotland) Act was passed in 2014. The Act brings real opportunities to address some of the longstanding challenges facing health and social care services in Scotland, but the reforms are complex and inevitably bring risks.
Why integrate health and social care services?
The aim is to ensure health and social care services are more integrated so that people receive the care they need at the right time and in the right setting, with a focus on community-based and preventative care.
Many public services will be affected, including most health and social care services (and over £8 billion of public money) and wider services such as housing and education.
How will it work?
To achieve this change, the 2014 Public Bodies (Joint Working) (Scotland) Act required councils and health boards to form new partnerships, known as ‘Integration Authorities’ (IAs).
All areas of Scotland opted to establish Integration Joint Boards (IJBs), except NHS Highland and Highland Council, where a Lead Agency model has already in operation for several years.
As a minimum, IAs are responsible for the governance, planning and resourcing of social care, primary and community healthcare and unscheduled hospital care for adults. Some areas have also integrated children’s services and social work criminal justice services. In one area all acute services have been integrated.
IAs became operational at different times, but they were all established by April 2016 and are now in at least their second year of operation.
As with any reform, the integration of health and social care brings with it great opportunities but also risks and has implications for many areas of our audit work.
These audits have led to the identification of a number of common areas for auditors to consider in future financial statement reviews. These include accounting issues, but also issues of a non-technical nature, including those relating to leadership, behaviours, governance, accountability and risk management.
Our future audit work will focus on a wide range of issues, include accounting for reserves, management of over/underspend and agreement of the IJB budget between the NHS board and council.
Auditing and reporting
In addition to the annual financial audits of IJBs, Audit Scotland have committed to three performance audits assessing and reporting on national progress of integration in Scotland. You can find out more on our dedicated health and social care ehub.
We published the first report in December 2015, at a time when IAs were being established. This audit highlighted emerging significant risks to the success of health and social care integration, including complex governance arrangements, difficulties in budget-setting and consequent delays in strategic planning.
In our second audit, due for publication in late 2018, we expect to review progress in addressing the issues raised in the first audit report and assess, for example, the effectiveness of strategic planning. The audit will also look for emerging evidence of more integrated working, changes in service delivery and impact on the public.
The third planned audit will focus on the impact of the policy of integration, assessing the extent to which integration has led to a significant shift from acute and reactive services towards more community-based, preventative and sustainable services. This audit will seek evidence of the impact of these changes on improving people’s lives and outcomes.
Audit Scotland has reported through a number of national audits that the pressures facing the health and care system are significant. IAs have a central role in working with their partner organisations to help to address these pressures.
Through our local and national audit work and stakeholder engagement we have seen evidence of positive change through the integration agenda, but we have also identified many issues which will need to be addressed if this reform is to succeed and deliver the intended transformation.