Health and Social Care Reform in Scotland – What Next?

Health and Social Care Reform in Scotland – What Next?


A New Year is a time for reflecting on achievements, identifying new goals and making resolutions for the year ahead. This year, our resolutions are all about the 3 Rs: Recovering health, mental wellbeing, social and economic activities for people and communities; Remobilisation of our health and social care workforce to tackle the pandemic backlog; and Reform of public services to create stronger, more resilient integrated health and care systems.

At the heart of the current reform conversation in Scotland are proposals to establish a National Care Service (NCS), one of the recommendations of the Independent Review of Adult Social Care in Scotland. At the end of October 2021, IFIC Scotland convened a Round Table for partners involved in planning, delivering, enabling and assuring health and social care in Scotland. We had excellent contributions from IFICs CEO and from Prof Robin Miller, IJIC Co-editor in chief, as well as grounded insights from local government, health and care partnerships, Third sector, academics and the national TEC programme. Dr Merja Tepponen, Chief Development Officer, South Karelia Social and Health Care District, shared the inspiring transformation achieved by Eksote and outlined further health and care reform in Finland. The report of this dialogue with experts and Reference Network partners informed our response to the consultation on the National Care Service.  Our view is based on the evidence that most adults who need social care require a wide range of support and services to enable them to live their best lives. These supports are provided by family and friends, volunteers, voluntary and community partners, unpaid carers, healthcare professionals, social care providers, and housing services. Technology can enable access, personalisation, control and coordination of care across this wide range of providers, most of whom are not directly managed by statutory services.

We are pleased to see our response chimes with WHOs new Framework to support countries to achieve an integrated continuum of long term care.  Long term care is defined as a broad range of personal, social and healthcare services and support that ensure people with, or at risk of, a significant loss of intrinsic capacity can maintain a level of functional ability consistent with their basic human rights and dignity. The WHO Framework tasks national, regional and local governments to create the conditions for these services to be integrated within a system that provides a continuum of promotion, prevention, treatment, assistive care and social support, rehabilitation and palliation.  A national long term care system should enable integrated long term care and assure it is appropriate, affordable, flexible and upholds the rights of people and caregivers alike.  In December’s European Regional consultation on strengthening integrated long term care provision, WHO made clear the critical role of unpaid carers in this integrated system and their need for support. The dialogue was about creating systems that span the porous boundaries between formal health, housing and care services and unpaid carers and community supports.

So the exam question is how best to organise governance, finance and accountability across these boundaries at national, regional and local levels?  What arrangements will enable meaningful co-design of creative and sustainable solutions by local providers, partners, citizens and communities?  How can we ensure strong horizontal integration with community partners, public health and local government to improve and protect community wellbeing, particularly for populations who face socioeconomic disadvantage and inequalities, exacerbated by Covid-19.  How can we design in local flexibility for rural, remote and island communities? And how can we build on the strong local cross sectoral collaboration achieved during the pandemic and use this to strengthen population health and locality workforce planning?  For that’s where the magic of integrated care happens – at the level of place, neighbourhood, and teams.

Because it is not governance but people who change lives. At point of care, continuity and coordination, the essence of integrated care, are greatly influenced by culture, trust and relationships between practitioners and partners across different teams, care settings and sectors. It takes time to build trusting relationships, influence organisational and professional cultures, and to cede power to citizens and communities.  Real culture change can take a generation. But we know practice and behaviours can be enabled through collaborative interdisciplinary and cross sectoral learning.  So whatever the proposed reform of governance and accountability, we should invest now in developing the habits of people centred integrated care through cross-sectoral workforce development and training as in UWS Leading People Centred Integrated Care accredited postgraduate programmes and IFICs Online Certificate.

Before we embark on further reform in Scotland it’s important to reflect on what has been achieved so far and understand what got in the way of progress.  Our policy paper, recently published in IJIC, analyses the principal enablers, barriers and impacts of implementing integrated health and social care in Scotland so far. It calls for rapid, real-time and action-orientated research to understand the ‘how’ and the ‘who’ of transformation.  We offer it as  food for thought for those tasked with crafting the next phase of health and social care reform.

2022 is Scotland’s Year of Stories – watch this space as our Integration story unfolds….

Prof Anne Hendry IFIC Senior Associate,

Director IFIC Scotland