One of the two people who heads up Highland’s unique integrated community health and care system has told MSPs her team supports plans which will end their current way of working and align Highland with the rest of Scotland – but warned the path ahead is ‘fraught with risk and uncertainty’.

In their response to the parliament’s health and care committee call for views, leaders from Highland said, despite foreseeing challenges, they are supportive of the proposal to bring an end to its lead agency arrangement.

NHS Highland and Highland Council were allowed to retain their existing joint working arrangement when 30 integration joint boards were introduced in 2016.

NHS Highland chief executive Fiona Davies explained to the health and care committee at an evidence session earlier this week that being an outlier has caused challenges in Highland.  

Ms Davies told MSPs:

“It is a complex picture, but perhaps the main factor in our taking that view is that not having peers impedes the process of improvement and learning that we have been talking about throughout the session. We have no other body whose homework we can look at to see how it has gone about things or how it has utilised the structures in the lead agency model to maximise benefit and outcomes for people.

“On balance, then, we are supportive of moving to a single model of integration as NHS Highland, although it will come with significant challenges.”

Local community health and care in most of Scotland has since 2016 been delivered and planned by integration joint boards – partnerships between the NHS board and council.

Highland instead opted for a lead agency arrangement, where the council retained responsibility for children’s services and the NHS responsibility for adult services.

The revised National Care Service Bill will remove this option and instead require Highland to organise services within an integration authority, or care board, like everywhere else.

While supportive overall, NHS Highland said in its submission to the committee’s earlier call for views that it expects the transition to be ‘fraught with risk and uncertainty’.

Cost and the length of time it will take to make the change were raised as key concerns.

NHS Highland said the Bill is unclear as to whether additional funding will be provided to support the board during this period.

The situation is further complicated by the as-yet-undecided future of children’s services.

NHS Highland said that children’s services, which are currently sole responsibility of the council, will have to undergo an ‘entire remodel’ within a new local care board.

There is no mention of children’s services in the revised Bill, but social care minister Maree Todd has confirmed it is her intention that they will ultimately be included in the National Care Service.

 

Read more: New chief executive for NHS Highland; Millions less needed to deliver NCS; NHS Highland: ‘worst funding gap seen’; A timeline of Scotland’s National Care Service

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