Integration Governance Structures
This page provides information about the different governance structures that underpin integration
Integration Joint Board
When the Integration Authority has been formed using the Body Corporate model, the Integration Joint Board (IJB) has overall governance responsibility for the Integration Authority. Given that governance relates to the systems and processes concerned with ensuring and assuring the overall direction, effectiveness, supervision and accountability of the organisation, the primary responsibilities of the IJB include providing strategic leadership, robust management oversight, effective risk management and ensuring effective stakeholder engagement.
The membership of the IJB is made up of voting and non-voting members. The formal arrangements for voting members are set out in the Integration Scheme and all voting members are either Local Councillors from the associated Local Authority or Non-Executive Directors from the associated Health Board.
Although the number of voting members varies by Integration Authority, the legislation stipulates that there must always be an equal number of Councillors and Non-Executive Directors and sets the minimum number from each group at three. The voting members also hold the Chair and Vice Chair roles and these are normally shared across both organisations (i.e. if a Local Councillor Chairs the IJB a Non-Executive Director will be the Vice Chair, and vice versa).
The non-voting members that require to be involved in IJBs are clearly set out in the legislation. These are:-
- The Chief Officer of the Integration Authority
- The Chief Finance Officer (or person who carries Section 95 responsibility for the IJB)
- The Chief Social Work Officer of the Local Authority
- A GP representative, appointed by the Health Board
- A secondary care medical practitioner, appointed by the Health Board
- A nursing representative, employed by the Health Board
- A staff-side representative that can represent the interests of Integration Authority staff employed by both the NHS and Local Authority
- A third sector representative
- A carer representative
- A service user representative
The IJB can also widen its membership to include others at its discretion.
The Scottish Government have produced guidance that focuses on the roles, responsibilities and membership of the Integration Joint Boards to support their successful implementation.
Like most governance groups, IJBs have a number of sub-committees to enable them to meaningfully fulfill their responsibilities. The number of sub-committees and the role, remit and membership of each varies by IJB. Not all IJBs have chosen to involve the third sector on their sub-committees but the sector also chair sub-committees in some areas. The Team are currently mapping this across Scotland and will provide more information on this shortly.
Joint Monitoring Committee
When the Integration Authority has been formed using the Lead Agency model (only Highland have chosen to adopt this model), the Integration Joint Monitoring Committee has overall governance responsibility for the Integration Authority. Although the membership structure and Chair arrangements are slightly different the Joint Monitoring Committee fulfills the same functions as the IJB and has the same requirement to include stakeholders as non-voting members.
Strategic Planning Group
Although Integration Authorities are responsible for preparing proposals for what a strategic plan should contain, the Act requires each Integration Authority to establish a Strategic Planning Group to support it to develop its strategic plan and requires it to: –
- Seek the views of the Group on the proposed content of the plan
- Take account of these views when drafting the plan
- Seek the views of the Group on the draft plan
- Re-draft the plan, taking account of these views
Although this is a relatively narrow prescribed role, the strategic planning guidance makes it clear that the Strategic Planning Group is a core part of the strategic planning process and that this “does not start or end with the publication of the strategic commissioning plan”. Further stating that the involvement of the Strategic Planning Group is part of a continual, iterative cycle. According to the guidance, the role of the Strategic Planning Group therefore goes beyond developing and finalising the strategic commissioning plan as it is also integral to reviewing and measuring progress. The guidance also creates a context for this involvement by making it clear that the focus of the group should be less about how things are done now and more about how it should be done in the future.
These are some key questions that the Scottish Government expects Strategic Planning Groups to explore:-
- How many people need services and what type do they need
- What is currently provided, is it at the right level, quality and cost
- How can services improve people’s lives
- Which services will best achieve this
- How can these services be developed within budgets
- How can these services be commissioned and delivered to the best effect
- How will this provision be monitored and reviewed
You may find our briefing that summarises the content of the guidance useful in developing your understanding of strategic commissioning and the role of the Strategic Planning Group.
Although the Integration Authority determines the number of members and the process for the appointment, replacement and removal of members, the group must include members to represent the following interests:
- People who use the health care services provided by the Integration Authority
- People who use the social care services provided by the Integration Authority
- Unpaid carers who care for people who use the health care services provided by the Integration Authority
- Unpaid carers who care for people who use the social care services provided by the Integration Authority
- Non-commercial providers of health care
- Non-commercial providers of social care
- Non-commercial providers of social housing
- Third sector bodies carrying out activities related to health or social care
- Commercial providers of health care
- Commercial providers of social care
- Health professionals
- Social care professionals
- Any other person or person that the Integration Authority considers appropriate
The group also needs to have a mechanism to embed the voice of the locality planning groups in their thinking however, people may fulfil more than one role so this might not mean additional members.
Locality Planning Group
Integration seeks to drive decision-making closer to people and communities and Locality Planning Groups are one of the primary mechanisms for achieving this vision. The Scottish Government have produced guidance that sets out what localities are for, the principles upon which they should be established, and the ethos under which they should operate to support the successful implementation of Locality Planning Groups. The guidance also gives detailed advice about how Integration Authorities can assure that the expertise and views of different stakeholders inform Locality Planning Group discussions, including how this can be achieved without direct membership of the Group. According to the guidance, the primary purpose of the Locality Planning Group is to provide an organisational mechanism for local leadership of service planning, to be fed upwards into the Integration Authority’s strategic plan, it also makes it clear that localities must have real influence on how resources are spent in their area.
The guidance states that localities must:
- Support the principles that underpin collaborative working to ensure a strong vision for service delivery is achieved (further stating that robust communication and engagement methods will be required to assure their effectiveness)
- Support GPs to play a central role in providing and coordinating care to local communities, and, by working more closely with a range of others (including the wider primary care team, secondary care and social care colleagues, and third sector providers) help improve outcomes for local people.
- Support a proactive approach to capacity building in communities, by forging the connections necessary for participation, and help to foster better integrated working between primary and secondary care
Locality arrangements are not defined in the legislation and Integration Authorities have the freedom to design their locality arrangements around local need (including the structure and process used and who is involved). However, the guidance clearly states that to ensure the quality of localities’ input to strategic planning, they must function with the direct involvement and leadership of:
- Health and social care professionals who are involved in the care of people who use services.
- Representatives of the housing sector.
- Representatives of the third and independent sectors.
- Carers’ and patients’ representatives.
- People managing services in the area of the Integration Authority.
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