Health and social care integration a year on: Shona Robison 'extremely proud'

Shona Robison - David Anderson/Holyrood

It’s no secret that the integration of health and social care was, and continues to be, one of the most ambitious programmes of work this government has ever undertaken. But we know that it will deliver health and social care services that work more efficiently around the needs of patients.

So, a year on from the implementation of the legislation, I think it’s a good moment to reflect on our commitment to ensuring that our health and social care services are both prepared for and anticipating people’s needs as the population changes.  

I’ve been involved in the health portfolio since 2007 and I’ve seen first-hand the advances in care and the changing environment within which our health and social care professionals work. I’ve also listened to people and learned about their current needs as well as the ones they anticipate in the future. 

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When we looked at integration, a key aspect was creating the right environment to bring about further improvement and giving people access to the right care, in the right place, at the right time. And we have enabled this by introducing changes to help ensure the links between care provided in communities, hospitals and care homes are seamless, and by responding to people’s priorities. 

The 31 integrated authorities that we have across Scotland now manage over £8bn of health and social care budgets that were previously managed separately by the NHS and local government, covering unplanned hospital care, primary care and social care for adults as a minimum.

And that allows those authorities to work with communities and stakeholders to design and commission services and new models of care that reflect the needs of the people they serve – effectively creating local answers to local needs, building on local assets and priorities.

Importantly, these boards are formed of some of Scotland’s leading figures from health, local authorities and the third sector, so we have a breadth of knowledge and experience coming together to deliver the majority of health and social care services across the country.

Of course, one of the main care changes we need to look at across health and social care is the fact that people are generally living longer and our health is better – and I’ve seen that for myself. 

My mum lived until the age of 91 and she needed, and received, excellent care at the Royal Victoria in Dundee. I witnessed the exceptional dedication and commitment of people working in health and care, and they were extremely professional in dealing with what was clearly a very difficult time for my family. I will always be grateful to them for that.

But what that highlighted to me was the fact that the improvements we have seen in standards of living and healthcare support are leading to longer, healthier lives – and we need to plan for that.
If every one of us can look forward to a fulfilling old age, then we must design and deliver services that work well together for people who are living with multiple conditions and complex needs.

Now, I want to stress that integration is not about taking people out of hospital when they need hospital care – if people need the medical care that can’t be provided anywhere else then of course, hospital is the best place for them. However, as we get older, most of us will need care that can be provided in settings more appropriate to our individual needs and better placed to support our health and wellbeing.  

I think it’s entirely reasonable to think that most of us would rather receive support and care at home or in a homely setting when we need it. Too often, frail older people in particular are admitted to hospital as an emergency when earlier provision of a package of care in their own home or community would have been better. 

I’ve heard from people who have said they would have felt more comfortable in their own home rather than an unfamiliar hospital ward. We want to do all we can to ensure that care and recovery takes those feelings into account, which is what integration is all about.

It’s built around the needs of the individual, and it’s often not about medical needs –  it can be about providing support to people to remain part of and connected to their families and communities, allowing people to carry on doing the things they love with some additional help.

For example, let’s look at what’s going on in Ayrshire. I recently visited the North West Kilmarnock Area Centre which houses GPs, dentists, community midwives, social work services, the community learning disability service, physiotherapists and housing services.

And when I was there, I met a woman who told her story of recovery from drug addiction – she lost her home and was sleeping rough but has turned her life around with the help of addiction services and is now employed as a key worker, helping others who have addiction and mental health issues.

There’s also the Red Cross Home from Hospital Service which aims to reduce admissions to hospital, facilitate discharge, provide resettlement support and follow-up reassurance – the service has supported more than 1,600 people across the three Ayrshire partnerships since it was commissioned. 

These are strong examples of three health and social care partnerships in Ayrshire working closely with a range of sectors, including the third sector, to support people with multiple conditions live well in their communities.

This is hugely encouraging and demonstrates the type of cross-boundary working that is improving lives at a local level. And there’s more work going on across the country.

In Aberdeen City, an area which has traditionally faced challenges recruiting and retaining social care staff, the partnership works with Cornerstone Community Care and the Aberdeen & Grampian Chamber of Commerce to develop a social care campus to provide a training and accommodation package designed to raise the profile of social care work. 

A result from this? Bed days lost to people being inappropriately delayed in hospital – when clinical staff have decided they’re ready to go home – have reduced by around 27 per cent since the start of this year, and that’s down to improved local leadership and the culture change in taking an integrated approach.

There have also been impressive results in Glasgow where the Glasgow City Health and Social Care Partnership has introduced discharge to assess, which aims to ensure patients are discharged within 72 hours of being medically fit. 

This, alongside the increase in step-down intermediate care beds commissioned from private sector care homes, has resulted in a reduction in the number of bed days lost to delay by over 42 per cent between April 2015 and June 2016.  

So what we’re doing is working and in a way that suits the needs of local areas – that’s a key plank of integration. 

The importance of GPs and the primary care sector more widely remains vital and we are doing all we can to support our GPs. We’re working closely with BMA Scotland and have signed a joint agreement to work with the profession to redesign services so GPs have that wider team of health professionals in the community to support them, allowing them to spend more time on consultations with patients.

And, of course, these changes and innovations must be backed financially – and we’re doing that. 

We’ll increase the NHS revenue budget by almost £2bn by the end of this parliament, and will continue to shift the balance of care by increasing the share of the NHS budget dedicated to mental health and to primary, community, and social care. 

Annual spending on primary care will go up by £500m by 2021/22, and in 2017/18 we will invest an additional £107m in integration authorities, to support the delivery of improved outcomes in social care and to deliver the Living Wage for social care workers.

We know that planned hospital care is also essential for people’s wellbeing, so we’re putting aside £200m to support the creation of additional capacity to meet the rising demand for elective procedures such as hip and knee replacements and cataracts. This includes the development of a network of new and expanded NHS elective centres across Scotland to enable people to receive their planned surgery more quickly and reduce cancellations by easing the competing pressure of unplanned and emergency treatment.

There is so much work going on across health and social care that it’s sometimes hard for things like integration to come to the fore and be recognised for what it is. However, these changes are happening now, we’re committed to seeing them through successfully, and they are already delivering positive results across the country, proving we were absolutely right to press ahead with our plans.

Changes in health and social care is an issue being faced throughout the developed world – we’re all looking at how we can provide the care that is needed for ageing populations and reduce unnecessary hospital stays. 

And although there might be different approaches, what we can say, justifiably, is that Scotland’s approach is recognised as leading the way. And the credit must go to a dedicated and committed workforce across health and social care that continually goes beyond the call of duty to care for the people of Scotland. 

I am extremely proud that our model is looked upon as a world leader and it’s just one of the reasons that makes me proud to be Scotland’s Health Secretary.