1. Integration of Adult Health and Social Care

2. What is the problem we are trying to solve? Too much variability of health and social care in different parts of Scotland, particularly for older people. No incentive to help get people out of hospital quickly and back into a homely setting. Much easier to get an older person admitted to hospital than to arrange services that would keep them at home.

3. Projected Demand for Health and Social Care, All Ages, 2008/09 prices.

5. Vision Older people are supported to live well at home or in the community for as much time as they can They have a positive experience of health and social care when they need it

6. Framework for improvement Consistency of approach across Scotland; Applies in every council and health board area; Statutory underpinning; Integrated budget to deliver some acute, community and social care services; Someone clearly accountable for delivering agreed outcomes; Professionally led by clinicians and social workers; Simplifies rather than complicates existing bodies and structures; and Wherever possible, it should be achieved with minimal disruption to staff and services.

7. What does the evidence tell us? Planning for populations, not delivery structures Pooling resources – money and people Embedding GPs, other clinicians and care professionals in the processes of service planning, investment and provision Very strong local leadership

8. Principles of reform Nationally agreed outcomes across health and social care, focussing in the first instance on older people’s services Joint accountability via the Chief Executives of the Health Board and Local Authority to Ministers, Council Leaders and the public for delivery of those outcomes Integrated budgets Strong clinical and professional leadership, and engagement of the third sector, in commissioning and planning of services

9. Framework for integration – slide 1 Legislation: –nationally agreed outcomes –joint accountability –integrated budgets across primary care, community health and social care, and some of acute care –locality planning

10. Framework for integration – slide 2 CHP committees will be taken off the statute book and replaced by Health and Social Care Partnerships – joint and equal responsibility of the NHS and Local Authority Jointly appointed senior accountable officer will report to the Chief Executives of the NHS and Local Authority Annual accountability meetings will enable accountability to Ministers and Leaders

11. Framework for integration – slide 3 Locality service planning groups will strengthen the role of clinicians and social care professionals Fewer resources will in future be directed towards institutional care and more resources will be directed towards community provision

12. Next steps Formal consultation Detailed work now underway to consider practicalities: –Outcomes –Joint governance and accountability –Integrated financial management –Impact on other areas of service –Workforce and HR issues –Locality planning –Improving commissioning skills –Requirements for OD and leadership development work –Ensuring meaningful engagement of the third and independent sectors