The local planning and delivery of social care is currently the responsibility of 30 Integration Joint Boards (IJBs) – partnerships between the local NHS board and council – as well as one long-standing ‘lead agency arrangement’ in Highland where the two split services.

IJBs have struggled with funding and governance since their inception in 2016, with their goal of better integrating health and care services continuing to prove too big a challenge in many areas of Scotland.

Legislation published earlier this year to establish a national care service (NCS) will see these bodies abolished in favour of new care boards, though, because of the way the enabling legislation is framed, much of the detail of what exactly these will look like, how they will operate and the way they will be funded is still to be decided.

healthandcare.scot look at what we know about care boards so far and what this could mean for social care – and even healthcare - services in the near future.

 

What are care boards?

A Bill laying down out the bones of a national care service in Scotland, published in June, introduced the concept of ‘care boards’ for the first time, described as essentially the social care counterparts of NHS boards.

Care boards will take over IJBs’ role in planning and commissioning community health and social care and take on a more direct role in procuring and delivering social care services.

The establishment of care boards also signifies a move away from the earlier concept of community health and social care boards (CHSCBs) which was laid out in the consultation. Like the proposed CHSCBs, care boards will have their own chief executive and staff, locally elected board members, and the ability to commission care services. However, earlier suggestions that primary and community NHS health services would move across to the new NCS have been dropped, while justice social work and children’s services will remain, at least for now, under the control of councils.

Scottish ministers will be in direct control and have the power to establish – and abolish – these care boards. However, ministers say MSPs would be consulted on any future creation or abolition of a care board.

Details on the number and size of care boards are also still to be established by ministers in future secondary legislation. However, the Bill says this ‘may be done by reference to another document’, which opens the possibility that the boundaries used by territorial NHS boards – rather than council areas - could be the blueprint.

Redrawing the map?

This would mean that the responsibility for care could be divided out to 14 territorial care boards coterminous with NHS boards – fewer than half as many bodies responsible for care than there is now – bolstering claims made by councillors that the NCS is a “direct attack on localism”.

Changes to funding – which has long been an issue for IJBs, due to the slightly awkward system of delegated funds from the health board and local authority – will further detach local authorities from social care.

The Scottish government will provide direct funding for care boards, and provide financial backing for them in other ways such as acting as their guarantor for loans or undertaking to indemnify them against losses. The Scottish government estimates care boards will cost between £142m and £376m by 2026/2027. However, this does not take into account two other commitments in the legislation: Anne’s Law provisions or costs associated with the right to breaks for carers, nor any anticipated future changes in fair work and ethical commissioning.

Another similarly with the NHS will be the establishment of ‘special care boards’ which suggests, rather than covering a specific geographical area, some NCS bodies will be set up to provide support for services at a national level. This can be seen within the NHS with, for example, NHS Education for Scotland – responsible for designing, commissioning and quality assuring education and training of the workforce – the Scottish Ambulance Service (SAS), and Healthcare Improvement Scotland (HIS).

Ministers will have the power to transfer both health and social care functions from the NHS and councils to the NCS. If this happens, all contracts and arrangements with external organisations that provide services will also move across 'in the first instance'. This is also true of staff working in local authority services; up to 75,000 council employees across social work and social care could be moved across into employment with the new agency under the provisions of the Bill. There also remains an option for local authorities to continue delivering care, but this will be under a procurement arrangement with the care board following an options appraisal.

Those fearful that GPs could be transferred out the NHS have not been completely reassured, with the financial memorandum saying that, though the government expects health services will continue to be delivered by the NHS, primary care and community health are still included in a costed table of services that the government considers future potential functions of care boards.

 

What about the Highlands and Islands?

The legislation follows the consultation in its assertion that care boards will be the sole model of delivery of social care. This means the previously flexible arrangement of integrated care partnerships and lead-agency agreements operating alongside each other, will no longer be an option. Highland Council, with its unique lead agency model, was clear in its response to the NCS consultation last year that arrangements must remain flexible and able to adjust to local needs and contexts.

NHS Highland currently oversees planning and delivery for all adult health and social care services in the region, so changes brought in by the NCS could have significant ramifications for the running of their – arguably most integrated and well-functioning – services.

Integration is at different stages for all local authorities, but in regions where more services have been delegated to their local IJB – most notably in Argyll and Bute IJB which has full responsibility for all children’s services, justice social work and all acute services - it is unclear whether these powers will be handed back to local authorities or passed onto care boards.

In its rural communities impact assessment, the Scottish government says its proposals for an NCS will look to ‘ensure that existing advanced areas of integration’ are supported. A key concern among island communities, in their response to the consultation, was that local accountability and flexibility will be taken away by greater centralisation. The Scottish government says local care boards will be co-designed with stakeholders, both to ensure that they are accountable to local people and have the flexibility to provide responsive services in line with local needs; an overall national framework will simply support them to improve.

The future of health and social care delivery in smaller areas like the Western Isles, Shetland and Orkney – the latter of which serves a population of just 22,000 – raises more questions. Each currently has both an NHS board and an IJB and, like Highland, have been delivered a pragmatic integrated model of health and care for many years.

Any decision to merge IJBs will have political as well as administrative implications. Perhaps, given the history of the Outer Hebrides, Shetland and Orkney’s ability to hold on to their individual identities thus far, political considerations will be particularly to the fore when it comes to Scotland’s outer islands.

 

 

Read more from our coverage on the National Care Service: National Care Service cannot be ’mini-NHS’; NCS Bill published; Islands & rural areas ‘overlooked’ in NCS

 

 

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