Stepping up the pace on care integration

The Scottish Parliament’s Health and Sport Committee has published a report on the forthcoming budget. UNISON Scotland gave written and verbal evidence to the inquiry.

The report highlights their ongoing concern over the absence of budget transparency, with specific reference to the new health and care integration authorities. There is no real breakdown of the £8.9bn spent by the IAs overall and they will not set their individual budgets until July next year, well into the financial year. The report gives several examples of how it is impossible to identify spending plans for specific services, with organisations forced to resort to freedom of information requests.

The committee also highlighted one of UNISON’s concerns over the budget, the double counting of social care funding in both NHS Scotland and local government. There also remains a misalignment of budget timescales between councils and health boards.

The lack of transparency means it is also difficult to see how integration funds are contributing to the nine national health and wellbeing outcomes. In evidence to the committee most IAs emphasised the difficulty in achieving linkages with expenditure. This is supposed to be a statutory duty!

There has been an informal push by some IAs towards direct funding. We set out UNISON’s objections to this in an earlier blog post.

The report welcomes the announcement about ending the 1% pay cap and rightly seeks assurances on funding the increase. They also highlight the cost of extending the living wage to sleepover provision. 

The report also calls for long-term budget planning, recognising that the short-term nature of the UK budget setting process hinders this approach. Delivering transformational change by shifting resources to care in the community will not be achieved in the current time frames. Support for investment in preventative spending also requires a longer time frame. Audit Scotland have produced a useful video clip that illustrates the challenges.

The report also highlights UNISON Scotland’s concerns over the potential cut to sports and leisure facilities if the Barclay Review is implemented without additional funding to councils.

Overall the committee is disappointed over the slow progress in integrating health and care services and the lack of transparency in budget allocations. They believe key outcomes such as shifting resources have been allowed to drift and clear leadership is required to deliver this.