Are integrated health and social care boards stuck in silos already?

This week Scottish Labour seized on the recent Audit Scotland report which revealed progress towards health and social care integration was not gathering pace.

In a debate in the chamber, Shadow Health Minister Jenny Marra said her party would give all extra health funding via Barnett consequentials to the new integrated boards to facilitate change.

“The case that I am making today is for spending the health consequentials that are coming to Scotland from the comprehensive spending review on health and social care integration. That is preventative spend, absolutely, and allocating Barnett consequentials—the health funds that are coming to Scotland from the chancellor’s statement—in that way is the only, and the right, thing to do with them,” she said.

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Marra is right to criticise, but the basis of the argument is that the Auditor General’s concerns over governance refers to the governance of the Scottish Government. However, I rather think the report refers to the governance of the Integrated Joint Boards (IJBs) themselves.

Would throwing money at them help? The Audit Scotland report suggests the IJBs have done inadequate workforce planning, with a lack of evidence as to how third sector or independent services would be involved.

Made up of councillors and existing health board members, these IJBs are people who are used to fighting for their own piece of a shrinking budget. By definition, they are already in silos, sitting in a structure designed to break down silos.

John Mason MSP pointed out Glasgow City Council’s executive had, under plans for procurement, said: “The Integration Joint Board will in future commission the Council to deliver social care services and the Health Board to deliver health services.”

Hardly silo-breaking stuff.

Sitting through the committee meetings two years ago as the integration legislation passed through parliament, what we heard from professional bodies and the third sector time and time again was that cultural change cannot happen from the top down, and that the new roles of practitioners and volunteers alike should be shaped by the people on the ground and patients themselves.

Patients, the third sector and professionals should have been placed on the boards themselves, they argued.

Faced with an April deadline, it seems whether the partnerships deliver a strategic plan on time or not is secondary to any progress made on the ground, which will require professionals easily and quickly sharing information and patients being informed and in control.

All the focus seems to be on doing the former first, in which case this saga looks to run and run.