Transcript A wise man proportions his belief to the evidence”

Experiences of Integration in
Scotland
ADASS Spring Conference
Peter McLeod
Vice President
Association of Directors of Social Work
Social Work Services in Scotland
SW (Scot) Act 1968
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Kilbrandon and ‘integrated ‘ care
The promotion of ‘social welfare’
The Children’s Hearing
The Chief Social Work Officer
32 local authorities
“38,000 council workers
facing a switch to NHS”
2nd February 2011
ADSW’s perspective
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Achieving the best outcomes for the people who use our services
Early intervention
Personalised care, power, choice and control for individuals
Supporting and empowering communities and carers
Seamless pathways of care
Equitable access
Local democratic control
Evidence based decision making
Cost neutral / cost saving, transparent and multi-sectoral reform
Promotion of social welfare
ADSW’s contribution
• A research literature
review commissioned
• A position paper agreed
• An engagement
commenced
ADSW’s proposal – 9 point plan
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7-10 outcomes
A nationally agreed dataset
Joint strategic commissioning plans
Joint commissioning plans based on total LA and NHS adult care
spending
Joint financial governance
Targets for joint commissioning within single outcome agreements
Accountability meetings
Annual leadership event
9. PSIF self-evaluation to be undertaken by partners
Scottish Government’s
response
“Another key message that emerged from work
over the summer was that wholesale, nationally
driven, structural reorganisation of current
statutory bodies was not the best way to address
the challenges. Evidence shows that that is not
the way to achieve better outcomes for people,
and it is therefore not the route that we are
choosing.” Nicola Sturgeon, Cabinet Secretary
Current configurations
Social Work Services
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11 'Stand Alone‘ departments
5 Social Work and Education
4 Social Work and Housing
2 Social Work, Education and Housing
6 Children's Services
3 Adult social work services, Housing and Community Services
6 Community Health and Care Partnerships
1 Shared Service model
What is the problem we are
trying to solve?
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Too much variability of health and social care in different parts of Scotland,
particularly for older people.
No incentive to help get people out of hospital quickly and back into a
homely setting.
Much easier to get an older person admitted to hospital than to arrange
services that would keep them at home.
Projected Demand for Health and
Social Care, All Ages, 2008/09 prices.
Health and Social Care Demand Projections, £ mn, 2008/09 prices
15,000
14,000
13,000
Cost £mn
12,000
11,000
10,000
9,000
HLE constant
8,000
Change HLE = 0.5 change LE
7,000
Change HLE = Change LE
6,000
5,000
2010
2015
2020
Year
2025
2030
NHS Delayed Discharges
Scotland; September 2000 to April 2011.
3000
Number of patients
2500
Over 6 weeks
Under 6 weeks
2000
1500
1000
500
0
Sep
2000
Apr
2001
Oct
2001
Apr
2002
Oct
2002
Apr
2003
Oct
2003
Apr
2004
Oct
2004
Apr
2005
Oct
2005
Apr
2006
Census
Oct
2006
Apr
2007
Oct
2007
Apr
2008
Oct
2008
Apr
2009
Oct
2009
Apr
2010
Oct
2010
Apr
2011
Framework for integration
• Legislation:
– nationally agreed outcomes
– joint accountability
– integrated budgets across primary care,
community health and social care, and some of
acute care
– locality planning
Next steps
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Formal consultation
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Detailed work now underway to consider practicalities:
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Joint governance and accountability
Integrated financial management
Impact on other areas of service
Locality planning
Improving commissioning skills
Requirements for OD and leadership development work
Ensuring meaningful engagement of the third and
independent sectors
Chief Social Work Adviser
workstream
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Impact on other social work functions
Transitions
Child, adult and public protection
Cross cutting services and support
Scoping workforce implications for professional leadership and
support
Opportunities for improvement to current service delivery
Timetable
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Local elections 3 May
Consultation paper launched end of May
Bill to parliament in session 2012/13
Implementation 2014
Context we are operating in
• A vacuum of information from now until the consultation document is
published after the local government elections in May
• Congruence with developments in England: The Future Forum
• Learning from the integrated care pilots
• Importance of community planning and the single outcome agreement
• The current agenda and work in this area: Change Fund; joint
initiatives we have already established
Issues we are concerned about
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We need to maintain pressure to ensure services are delivered and
outcomes determined at a local level
We need to understand more about what a single accountable officer is and
how that role will play out
We need to understand more about what a Health and Social Care
Partnership is
We need others to realise the importance of any impact of change on other
services within social work and within the wider community planning
framework
We need to know about the number of partnerships and how they will be
governed
We will continue to emphasise the crucial role of the CSWO
Influencing the debate
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Meaningful and comprehensive engagement in the consultation
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Engagement with our own members
Engagement with partners in local authorities, NHS, third and independent sectors
Parliamentary engagement
Useful and insightful comment on the conclusion drawn from the
consultation
Dedicated involvement in the drafting of legislation
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Professional advice
Work to limit unintended consequences
The future
“If you don’t know where you are going,
any road will get you there”
Lewis Carroll