Delivering health and care integration is proving every bit as a complex as we anticipated.
I was at a seminar in Ayrshire today that brought together our council, health and community sector activists to discuss the implementation of the health and care integration plans in the Public Bodies (Joint Bodies) Act. Ayrshire has three Shadow Integration Boards but are planning to adopt a pragmatic local approach by sharing lead roles and manage some services on a pan-Ayrshire basis. None the less it will be a complex matrix structure, on top of what is already a complex array of services.
More clarity is needed on how the new organisations work with NHS, councils and partners in the third sector. Wherever you draw boundaries there will always be a need to work in a connected way with other services outwith the new structures. Front line social workers in Ayrshire very clearly highlighted the problems the private sector in particular is having in delivering the home care hours they have been contracted to deliver.
In my overview, I drew attention to international evidence of what works in care integration. It's a long list on the slide, but the common feature is that it's about people. Sadly, in this whole process that's the bit that has been given the least attention. Most workforce issues have not been resolved, like different procedures; disciplinary, grievance etc. Different salaries and conditions also apply for workers doing similar jobs. There is a national group working on these issues but it is making very slow progress.
There are also different industrial relations models and cultures. However, the positive news is that there is a willingness to adopt a positive best practice and employee reps on the integration boards will help that.
There is a risk that as we focus on the mechanisms of integration boards, we lose focus on the wider changes that are impacting on this sector. Issues like self directed support and budget cuts are happening at the same time. There are also different views on the role of third and private sector in service delivery and different approaches between councils in Ayrshire. Some understand ethical care issues better than others and procurement strategy is an important issue for everyone involved.
There is also demographic change with growing numbers of older people. How this is addressed is not consistent across Scotland. The common picture is the reduction in residential care beds and increasing demand for more intensive home care. However, there are very different patterns of unscheduled admissions to hospitals, and delayed discharges. That is a big cost that was always intended to fund social care. I remain sceptical that much of this revenue cost will actually be released.
Integrating and connecting services remains a desirable objective. However, the challenges colleagues flagged up in Ayrshire today are reflected across Scotland. Structures are of course important, but it's people that deliver quality care services.
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