Given the history of health and care integration, we should be wary of raising expectations over what the new bodies will be able to achieve
All Health Boards and Local Authorities in Scotland are required to submit their Integration Schemes for Ministerial approval by today. The new Health and Social Care Partnerships across Scotland will be up and running by April 1, 2016.
The BBC is running a good feature across the UK today, on how the different administrations are tackling integration. The Scottish Government’s standard response to all questions on bed blocking and social care is that the new joint bodies will sort out all the problems. A response that should send a shudder down the spine of those appointed to lead them!
In my BBC interview I welcomed the broad approach, but urged some caution. Simply moving the managerial deck chairs around will not solve some of the big challenges facing the sector.
There is strong international evidence of what works in care integration and the common feature is that it's about people. Sadly, in this whole process that's the bit that has been given the least attention. The focus has been on structures and budgets rather than workforce issues.
The biggest challenge facing the new organisations is social care. The number of patients in hospital who shouldn’t be, is now the equivalent of the number of beds in Scotland’s newest and biggest hospital - South Glasgow. Setting new targets for delayed discharge is all well and good, but councils need to be funded to deliver the quality and capacity of social care to get these patients into community settings.
Local authorities have taken the brunt of austerity cuts in Scotland while the NHS has had a degree of protection. Demand for social care has also been rising and as a consequence most councils have commissioned a race to the bottom in outsourced home and residential care. Wages and conditions have been cut as well as the time allocated to care properly. UNISON’s Time to Care report and the subsequent survey of staff involved in care integration makes this very clear. We have now reached a position where many providers are unable to recruit and retain the quality or quantity of staff needed to deliver even a basic service.
To address this we urgently need a new procurement framework that addresses how care services are commissioned including a common workforce framework. The workforce element should include the Scottish Living Wage, ending the reliance on nominal and zero-hour contracts, proper training and most importantly, time to care. All of this requires the Scottish Government to resource the changes needed and for the rest of us to give them some political space by recognising that the NHS is only part of the care system in Scotland.
Health and care integration is right in principle, but the practice is more challenging and the first priority is to tackle our crumbling social care services.