Social Care Seminar November 2018 Health and care

Social Care Seminar – November 2018 Health and care Integration: Lessons from Scotland Dave Watson Secretary Socialist Health Association Scotland www. shascotland. org

History of Care Integration 1970’s – joint finance arrangements 1999 – Local Health Care Co-operatives (LHCC) 1999 – Modernising Community Care Action Plan 2000 – Joint Futures Group (single assessment) 2002 – Community Care & Health Act (direct joint working) 2004 – NHS Reform Act – Community Health Partnerships Reshaping Care for Local People – prevention & personalisation Christie Commission – greater integration health & social care Integrated Resource Framework (IRF) Lead Agency Model – Highland, NHS adults – Council, children Public Bodies (Joint Working) Bill – Health and Social Care Partnerships

Positives Planning § National and local Engagement § Trade unions and voluntary sector Procurement § EU procurement rules – limit direct compliance § Work around: § § Procurement strategy – evaluation – contract Statutory procurement guidance: § Fair work – not just Scottish Living Wage § Better take up of UNISON Care Charter

Challenges Ageing population, chronic conditions Budget cuts, staff workload, pay and morale Financial pressure on social work & community sector Fragmentation and quality of community sector Evidence on structural integration outcomes weak Audit Scotland reports (update due Nov 18) Little ‘radical’ change High level of delayed discharge – 8% increase last year, 1500 a day Limited progress on workforce planning Weighting of Fair Work factors in procurement Delay in paying living wage and variable Fair Work progress Monitoring of contracts