If health and care integration in Scotland is to succeed, it needs to focus more on the people who deliver care than structures.
Scottish Government plans for health and care integration are set out in the Public Bodies (Joint Working) Bill that is shortly to be considered by the Scottish Parliament. I have previously blogged about the Bill in general and our concerns about the impact on local democracy, given the massive powers given to ministers to intervene in local democratic decision making.
Today, I was speaking at the Holyrood conference on health and care integration. My key message was that health and care is delivered by people, not robots. The Bill and the prior consultation process only gives the staffing aspects of care integration a passing mention.
The success of any reform has to take account of the staffing context. Workers who have to deliver change are already operating under budget cuts with major job losses and a race to the bottom in quality, caused by outsourcing in the care sector without proper funding. Staff suffering from a real terms cut in their pay and conditions are unlikely to be highly motivated.
We also need to recognise the history of care integration. I reckon we have had on average a new care integration initiative every eighteen months to two years over the recent period. I have a slide with a long list of legislation and reports. So many in fact that the legislators are running out of names for local partnerships! In this context staff could be forgiven for saying "here we go again!"
There have been some excellent reviews of international studies into what works in care integration. Petch and SPICe are worth reading. These reviews highlight some key factors including:
Building a shared culture between organisations
Relationships between staff and a willingness to share information
Respecting professional identity
Aligning staff management and training
Investment in staff engagement
Team building and physical integration
Strong enabling (not heroic) leadership
The observant reader will note a theme here. Yes, it's all about people. Of course you have to get structures, systems and budgets right, but it's staff that deliver the service. In some parts of Scotland when the senior managers have fallen out, the service still got delivered because the staff at the sharp end got on with it. Not ideal, but it happens.
Part of the solution is to establish a national and then local workforce strategies. Let's stop trying to constantly reinvent the wheel. Let's have a national framework for staff transfer including pensions. Consistent advice on the legal issues around secondments and managing staff on different conditions. The legal consequences of some decisions that local partnerships are likely to take are very complex and my legal colleagues should be rubbing their hands with glee at fees to be earned.
There are procurement issues that may be sorted in the Procurement Bill, but I wouldn't hold your breath. Consistent equality impact assessments would be good and some common powers and duties across the public sector as highlighted by the Christie Commission report. Finally, a staff governance framework that sets out how all staff are to be treated in the new structures.
Anyone seriously wanting to improve care integration would recognise the staff context including workloads, pay cuts and the 'race to the bottom' through outsourcing. Given the history of care integration staff will be cynical, but can be won over through early engagement and seriously addressing the staffing aspects of change. Government has a role here, but so far they have not grasped the issue.