I was giving evidence at the Scottish Parliament's Health Committee today on the Public Bodies (Joint Working) Bill that aims to improve health and care integration. I covered three broad areas of the Bill.
Firstly, the governance arrangements in the corporate body option are confused, particularly for staffing issues. As staff won't, in the main, be employed by the new organisations, it is unclear how major staffing decisions will be addressed. There are statutory and non-statutory procedures that need to be accommodated. This reminds me of the similar shambles in the recent Police Bill!
Ministers have many powers of direction in the Bill and there is a legitimate concern that these will be used to impose a top down model of care integration. All the international studies show that this won't work.
Secondly, the financial provisions are inadequate for the scale of the challenge ahead. The big goal of integration is to release cash from avoidable admissions to hospital, estimated at £1.5bn. I have always been sceptical about this figure, but now that health boards are demanding extra beds to cope with demand, supported by the Health Secretary, it is difficult to see where the extra funding is coming from.
The key issue is how we fund social care. It is a national disgrace at present with a race to the bottom in quality and quantity. The service is increasingly being delivered by staff, barely above the minimum wage, on zero or nominal hour contracts. As one care worker put it to me recently, the shocking 15 minute visit is becoming the best that elderly people can expect.
Thirdly, the Bill largely ignores staffing issues, a point I have covered in previous posts. Care is delivered by people not robots, but reading the Bill you wouldn't recognise that fact. There appears to be more concern about who sits on boards than the quality of care.
The Committee Convenor reasonably posed the question, will this Bill make any difference? Sadly, I remain sceptical that it will. The success of care integration requires local design and a number of people actions, none of which are addressed in the Bill so far.