A Framework for Integration
Health and social care integration needs to be about significantly more than structural change within the system. To assure this the Act creates a new framework that underpins the design of the system and all integration activity.
The Scottish Government have produced guidance to ensure that Integration Authorities are clear about the ethos and purpose of the legislation. The ethos and purpose are also explicitly referred to, and embedded in all of the other guidance and advice that has been published.
National Health & Wellbeing Outcomes
This suite of outcomes provides a strategic framework for the planning and delivery of health and social care services.
They have been chosen to make sure that service planning and delivery focuses on:
- The experiences and outcomes of people who use support and services,
- Unpaid carers, and
- The quality of those services.
The Act provides Scottish Ministers with the power to create national outcomes and the secondary legislation created the nine health and wellbeing outcomes that Integration Authorities seek to achieve, or contribute to through their activities.
The nine national outcomes are: –
- People are able to look after and improve their own health and wellbeing and live in good health for longer.
- People, including those with disabilities or long term conditions or who are frail are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community.
- People who use health and social care services have positive experiences of those services, and have their dignity respected.
- Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services.
- Health and social care services contribute to reducing health inequalities.
- People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing.
- People using health and social care services are safe from harm.
- People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide.
- Resources are used effectively and efficiently in the provision of health and social care services.
The guidance relating to the health and wellbeing outcomes makes it clear that these are central to Health and Social Care Integration, and that Integration Authorities should ensure that their interpretation into the local context make them meaningful to and for people in their area.
Each Integration Authority is held to account by the nine national health and wellbeing outcomes. All Integration Authorities are required to report their progress towards achieving the national outcomes in their annual report.
To support this process NHSScotland and COSLA worked with stakeholders, including the third and independent sectors to produce a suite of twenty-three core indicators that draw together measures that are appropriate for the whole system. The ALLIANCE Policy Team briefing, produced when the indicators were first published, provides an excellent source of information that maps the indicators against their associated outcomes and explains how the indicators are defined.
The core indicators are however only part of the picture as Integration Partnerships are being encouraged to supplement the national indicators with their own local measures. All areas have undertaken work on this, many using the additional data analysis capacity offered to them through NHS National Services LIST Team Local Intelligence Support Team (LIST). Some partnerships have decided which suite of indicators they plan to use and have published information about this; however it remains a work in progress in most areas.
There has been some debate about how helpful the current national measures are for enabling system change and measuring progress in the longer term and the Scottish Government announced plans to review these earlier in the year. They recently announced that a Review of Targets and Indicators for Health and Social Care will be chaired by Sir Harry Burns and he is currently inviting interested parties to join the review group. The membership has still to be announced but it has been confirmed that there will be third sector representation. More information about the process of the review and who else is involved will be available on this site as soon as it is available.
Integration Planning and Delivery Principles
The Act is unusual in that it sets out the principles that underpin integrated health and social care. The principles explain what people using services and their carers can expect from integrated services and the behaviours and priorities expected of organisations and people planning and delivering care and support.
The principles are: –
- That the main purpose of services which are provided in pursuance of integration functions is to improve the wellbeing of service-users,
- That, in so far as consistent with the main purpose, those services should be provided in a way which, so far as possible
- Is integrated from the point of view of service-users,
- Takes account of the particular needs of different service-users,
- Takes account of the particular needs of service-users in different parts of the area in which the service is being provided,
- Takes account of the particular characteristics and circumstances of different service-users,
- Respects the rights of service-users,
- Takes account of the dignity of service-users,
- Takes account of the participation by service-users in the community in which service-users live,
- Protects and improves the safety of service-users,
- Improves the quality of the service,
- Is planned and led locally in a way which is engaged with the community (including in particular service-users, those who look after service-users and those who are involved in the provision of health or social care),
- Best anticipates needs and prevents them arising, and
- Makes the best use of the available facilities, people and other resources.
To ensure that these principles are fully embedded in the system they apply to:
- NHS Boards and Local Authorities, when drawing up their integration scheme;
- Integration Authorities, when preparing their strategic plan;
- Any organisation which carries out an integration function (i.e. delivers a service commissioned under the strategic plan);
- Healthcare Improvement Scotland and the Care Inspectorate, in carrying out scrutiny and improvement functions relating to integrated care.
More information on the Principles for Planning and Delivering Integrated Health and Social Care can be found in the Scottish Government guidance.