Transcript A wise man proportions his belief to the evidence”

Social care and health:
the Scottish journey towards integration.
ADASS Spring Seminar
Andrew Lowe
Immediate past president
Association of Directors of Social Work
History of social work in Scotland
• 1960’s Kilbrandon
commission
• Social Work Scotland Act
1968
• 1968 unified system which
joins children, adults and
criminal justice services
• A word about ‘Social Work’
Bob Winter, ADSW Annual
Lecture, 2009
Forty years ago, Social Work in Scotland was on the cusp of
massive change. The Social Work (Scotland) Act 1968 had
been passed and was in the process of being implemented.
The Act proved to be a landmark for Scotland.
It provided a comprehensive service, dealing with problems
affecting individuals, families and communities. It recognised
the need for a director who could advise local authorities
about social needs, and recognised that human problems
‘seldom come singly’. It swept away the segregated welfare,
children’s and probation departments.
Social work now
• 32 local authorities
• 11 Directors of Social Work who are also CSWO
• Variety of organisational models including social
work paired with housing, education, health and
corporate services
• Highland model
Change in the air
• Summer 2010 – SNP minority government
announce change funds
• Autumn 2010 – Labour party announce
proposals for a single health and care
service
• SNP up the ante...
Big change in Scotland
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1999 - parliament restored
2001 - Adults with Incapacity legislation
2002 - Free Personal and Nursing Care
2006 - Changing Lives review of social work in 21C
2009 - Megrahi released on compassionate grounds
2010 - SNP returned with an overall majority
“38,000 council
workers facing a
switch to NHS”
What is to be done?
• A research literature review
commissioned
• A position paper agreed
• An engagement commenced
ADSW position statement
• National outcomes
• National data set
• Joint strategic commissioning plans (with targets
built into SAOs)
• Joint financial governance framework
• Local/national accountability
• Leadership programme
• Public services improvement framework
Government reaction
• SNP majority government in May 2011
• December 2011, announcement to parliament to
integrate H&SC services
• Consultations issued, concluded Sept 2012
• Government response Feb 2013
• Bill due before summer recess
Key elements of integration
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2 models – Delegation between partners or body corporate
National outcomes
Joint commissioning
Joint accountability; jointly accountable officer
locality planning
Integrated budget- to cover primary care, aspects of secondary &
social provision.
• ‘Partnership Agreement’ –functions; outcomes; financial input;
accountability.
1. Scope of services included
• Expanded from older people to all adult services
• Scope of budgets and services increased
• Provision for future extension of range of services
included – children’s service could feature
• Minimum range of functions & budgets.
ADSW concerns:
• Less local discretion.
• No clarity on time frame for inclusion.
2. Jointly Accountable Officer
• Manage integrated budget- transfer of funding between partners or
to body corporate
• Statutory role of CSWO protected
ADSW questions:
• Little flexibility-implementing arrangements for post
• ‘Splitting’ of services where interface is critical
• Confusion - level of seniority & governance issues
• Strengthening the role of the CSWO
• Blurred lines of accountability
• More local accountability needed.
Questions to which the answer
is no.
• Are the proposals clear about the
problems they are trying to solve?
• Do we therefore know if we are making the
right changes?
• Will we therefore know if it’s working?
Social Work in integrated arrangements
• Need to strengthen and protect the social work
role and contribution
• Consolidate the identity of the profession
• Focus on good practice based on set of values
• Leadership and succession planning for CSWOs
• Investing in the workforce and its culture
• We need to develop a strategy