After the publication of reports on the integration of health and social care services by Audit Scotland and the Health & Sport Committee, the consensus seems to be that all stakeholders, particularly Integrated Joint Boards (IJBs), must collaborate more to integrate better…

Within Audit Scotland’s Health and social care integration: Update on Progress, published this week, better joint working between IJBs, councils and NHS boards was recommended and the remaining challenges to integration were described as significant, despite some progress by stakeholders. During the Public Audit & Post-legislative Scrutiny Committee's evidence session with Auditor General, Caronline Gardner, last week, she described the investments announced in the UK Budget as helpful in providing "breathing space" but cautioned that health care costs were rising fatser than funding and Government must make use of this time to urgently implement policy focused on delivery of care in the community and other aspects of integration. Liberal Democrat health spokesperson, Alex Cole-Hamilton, condemned the “failing” integration authorities for not having the ground-breaking impact the Scottish Government promised they would have.

Chair of the Accounts Commission, Graham Sharp, said:

“There are examples of integrated health and social care services making a positive difference to people’s lives, but these tend to be local and small scale. The potential for a profound and long-term shift in the way health and social care services are delivered is clear, but there is still a long way to go.

A collective effort from the Scottish Government, COSLA, NHS Boards, councils and the Integration Authorities is needed for health and social integration to make a more meaningful difference to the people of Scotland.”

Earlier in October, Audit Scotland published The NHS in Scotland 2018. The report stated urgent action was needed to move the NHS away from “short-term firefighting” and to bring about essential long-term and fundamental change. The Health & Sport Committee published Looking ahead to the Scottish government - health budget 2019-20: is the budget delivering the desired outcomes for health and social care in scotland? The report calls for greater transparency from IJBs over their spending and concluded that transformational change in health and social care was not being achieved, in part due to the leadership in the organisations set up to deliver integration not exercising the powers given to them. Convener, Lewis Macdonald, said it was unacceptable that the significant budget set aside for integration was not being spent effectively or efficiently. He also highlighted the Committee’s call for “significantly better data”, with an increased focus on outcomes, to enable proper scrutiny of budget spending.

Relatedly, Scottish Labour used their time in the chamber on Wednesday to debate some of the challenges faced by health and social care providers. The motion lodged by Alex Rowley, investing in social care for Scotland’s future, asserted there was a disparity between the value of social care to society and the pay and working conditions of those employed in the sector. Labour sought support for its view that greater funding was needed for social care services and that it was not sustainable, in an era of integration, to protect health budgets at the expense of local authorities’ budgets. Alex Rowley cited a statement from Fife Council’s David Ross, in which he asserted that expecting the NHS to transfer adequate funding into social care from acute care not only lacked transparency but was unrealistic, noting concerns that social care funding channelled through the NHS had, in the past, had a proportion siphoned off before reaching social care services. Cabinet Secretary for Health and Sport, Jeane Freeman, highlighted the current jointly run review undertaken by COSLA and Government on progress within integration included strands around governance and finance. She said the clarity the review would provide would address the issues brought up by David Ross.