Public Bodies (Joint Working) Scotland Bill

Shifting the balance of the bill

The need to radically rethink how public services operate and the outcomes they achieve is part of the rationale behind the Bill.  There are significant challenges ahead in this regard, not least of these being the need to shift power and resources to people who use health and social care services; ensuring that family and community capacity is supported and that the right infrastructure is in place which enables people who have disabilities, illnesses or long term conditions to participate in society and the economy on an equal basis.  To this end, it is vital that the bill’s provisions reflect a clear commitment to wellbeing, personal outcomes and independent living. We welcome the commitment within the Stage 1 report and from the Cabinet Secretary for Health at a recent engagement event with the third sector (20 November) to revisit the Bill to ensure that there are clear commitments to a human rights perspective within its provisions.  We feel this is an important move which will help to swing the balance of debate about the Bill away from technicalities, processes and budgets back towards people and towards the kinds of outcomes envisaged in the Policy Memorandum, the Christie Commission report and the Scottish Government’s Route Map to the 2020 Vision for Health and Social Care. Further redressing the existing imbalance in the Bill can be achieved through:

• an ongoing commitment to co-produce the national health and wellbeing outcomes and
• by placing a refreshed set of integration principles at the front of the Bill setting the tone of the Bill and direction of travel in no uncertain terms.

How this might look is laid out in document produced jointly by a range of organisations from the sector in a shared document, also included in an appendix to this briefing. [i] We believe that this focus on individuals, their families and their assets and aspirations is key to erasing boundaries between services/budgets.

The third sector as equal partners

As outlined in the Bill Policy Memorandum, one of the key outcomes for seeking to integrate health and social care should be about encouraging “the utilisation of the talents, capacities and potential of all of Scotland‘s people and communities in designing and delivering health and social services”.[ii] This key outcome is a central reason for seeking clarity around the role and contribution of the third sector in commissioning and planning of care and support and in integration planning and service delivery. We believe that the diversity and reach of the third sector is a real strength within the context of reshaping health and social care in Scotland. From food and shopping services, community transport, day care services, support for unpaid carers and more widely in giving a voice to people who are disconnected from policy making, over 20,000 organisations work in the field of health and social care[iii]. They bring intelligence, expertise and reach which will be critical in planning and shaping services within the new partnerships and at local level.  The kinds of services outlined in the links below are part of a critical community infrastructure which must be enhanced. http://www.gdaonline.co.uk/pathways/index.php http://www.thefoodtrain.co.uk/our-services http://www.borderscarerscentre.co.uk/hospital-discharge--liaison.html We welcome the Committee’s restatement of the commitment within the Policy Memorandum to ensure mandatory involvement of the third sector, and linked to this, disabled people, carers and their representative organisations, in strategic planning (joint strategic commissioning and in localities (p43). We remain concerned that any progress in recognising the role of the sector in commissioning health and social care services gained within Reshaping Care activity may still be lost. However, we also welcome the Cabinet Secretary’s commitment at a third sector event on 20/11/13 to consider amendments which might recognise the role that the sector can play strategically within commissioning and planning of services – this must be at all key levels and structures.  We offer our support to the Scottish Government to make this happen either in the current bill, in secondary legislation as well as in supporting guidance. Issues around conflict of interest were discussed as sector representatives gave evidence to the Health and Sport Committee.  We contest any assertion that this issue applies only to the sector – given that councils who provide social care services and health boards are represented in budget decision making processes which impact on the services they deliver, one might argue that this conflict of interest applies equally to statutory providers. Through third sector interfaces and existing structures arising through Reshaping Care activity, processes for dealing with conflict of interest will be in place. This does not mean that there won’t necessarily be difficult discussions for the sector as the operational and funding environment in which they operate may well change.

Capacity of third sector to engage in integration

The Stage 1 report from the Health and Sport Committee makes a strong case for supporting the capacity of GPs and other professions to fully take part in new arrangements (e.g. BMA evidence) as well as adding to their responsibilities in this context (p40).  The Committee accepted the importance of GPs involvement being critical to success of integration, (para 204 and para 230). As outlined above, we welcome and support moves to given the third sector a key role in making change happen however, the capacity challenge outlined above for health and local authority professionals applies equally to professionals and frontline staff within the third sector.  The integrated care fund and/or financial memorandum must recognise significant capacity challenges for the sector as integration takes hold not least of these bring engagement with consultations, contributing to commissioning and locality planning whilst continuing to deliver services on a day to day basis – the very services which enable connections to community, reduced isolation, self-management and support for informal care. We welcome the Cabinet Secretary’s commitment to considering these capacity issues at the above mentioned event on 20/11/13 – including the need to identify and support the capacity of people with disabilities, informal carers and their representative organisations to fully participate in integrated service planning, delivery and evaluation.

Third sector strategic involvement and locality planning

The issue of locality planning seems to have caused real concern amongst statutory agencies as outlined in the Stage 1 Report from the Committee. To look at how locality planning might work, SCVO’s health and social care pathfinder in East Dunbartonshire may provide a steer. Funded by the Scottish Government the pathfinder will consider how “a strategic investment in the capacity of the third sector can prevent need for mainstream (statutory) health and care services arising, and improve quality of life for people within their own communities.”[iv] The investment would be designed to map out, join up, enhance and replicate approaches which support people with care needs, especially older people, to live as independently as possible, without becoming isolated. Critically the investment made in the pathfinder will help enhance third sector activities that involve| supporting wider wellbeing outcomes, mobility, physical activity, and connectedness, whether or not these interventions have traditionally been seen as ‘care’ or ‘health’ services. Close working with statutory partners to share this intelligence and shape local services will be a key aspect. We believe that this shift to investing directly in community and personal capacity is preventative in nature and can help reduce demand for statutory health and social care – a key element of Christie’s vision for public services.

Other issues

Community Planning: SCVO notes that the Committee calls for greater clarity on the relationship between Community Planning Partnerships and the new Health and Social Care Partnerships – we welcome this and would urge the link between the two to be made more explicit as well as giving consideration as to how this might impact on third sector interfaces and the sector more generally in terms of capacity to engage with both partnerships.

Links between this and other legislation must be more specific

If the Bill can specify that the HBs and LAs must be involved in this, then surely it can specify other relevant partners ? (which is basis for amendments suggested in joint sector paper)  Can we look to Local Govt Act 2003 which specifies partners who have a duty to participate in Community Planning and allows ministers to specify others who may also be involved (specifically section 16)

Conclusion

A shared suite of amendments on this and others issues has also been pulled together by a range Its important to highlight that some of the challenges outlined in the Health and Sport Committee’s stage 1 report are with us now. SCVO members and other third sector colleagues highlight what might be described as a potential crisis in social care with cuts to existing packages and services which may breach rather than fulfil the rights of disabled people and their families. The Bill and work towards more integrated services lets us draw a line in the sand and provides an opportunity to revisit issues around charging and accessibility in social care, the parity of esteem of the sector in health and social care and the issue of universalism in services which clearly have a signigicant role in achieving community cohesion, independent living and indeed have wider economic impact e.g helping people to access or remain in work. More widely, the impact of the Coalition Government’s welfare reform agenda – the uncertainly over the independent living fund, the potential loss of care and mobility support in the transfer to Personal Independence Payments place a cloud over the bill and all work linked to it.