Social care and health: the Scottish journey towards integration.

ADASS Spring Seminar

Andrew Lowe

Immediate past president

Association of Directors of Social Work

History of social work in Scotland

• 1960’s Kilbrandon commission

• Social Work Scotland Act 1968

• 1968 unified system which joins children, adults and criminal justice services

• A word about ‘Social Work’

Forty years ago, Social Work in Scotland was on the cusp of massive change. The Social Work (Scotland) Act 1968 had been passed and was in the process of being implemented. The Act proved to be a landmark for Scotland.

It provided a comprehensive service, dealing with problems affecting individuals, families and communities. It recognised the need for a director who could advise local authorities about social needs, and recognised that human problems ‘seldom come singly’. It swept away the segregated welfare, children’s and probation departments.

Bob Winter, ADSW Annual Lecture, 2009

Social work now

• 32 local authorities• 11 Directors of Social Work who are also CSWO• Variety of organisational models including social

work paired with housing, education, health and corporate services

• Highland model

Change in the air

• Summer 2010 – SNP minority government announce change funds

• Autumn 2010 – Labour party announce proposals for a single health and care service

• SNP up the ante...

Big change in Scotland• 1999 - parliament restored• 2001 - Adults with Incapacity legislation• 2002 - Free Personal and Nursing Care• 2006 - Changing Lives review of social work in 21C• 2009 - Megrahi released on compassionate grounds• 2010 - SNP returned with an overall majority

“38,000 council workers facing a switch to NHS”

What is to be done?• A research literature review

commissioned• A position paper agreed• An engagement commenced

ADSW position statement• National outcomes• National data set• Joint strategic commissioning plans (with targets

built into SAOs)• Joint financial governance framework• Local/national accountability• Leadership programme• Public services improvement framework

Government reaction

• SNP majority government in May 2011• December 2011, announcement to parliament to

integrate H&SC services• Consultations issued, concluded Sept 2012• Government response Feb 2013• Bill due before summer recess

Key elements of integration

• 2 models – Delegation between partners or body corporate• National outcomes• Joint commissioning• Joint accountability; jointly accountable officer• locality planning• Integrated budget- to cover primary care, aspects of secondary &

social provision.• ‘Partnership Agreement’ –functions; outcomes; financial input;

accountability.

1. Scope of services included• Expanded from older people to all adult services• Scope of budgets and services increased• Provision for future extension of range of services

included – children’s service could feature• Minimum range of functions & budgets.

ADSW concerns:• Less local discretion.• No clarity on time frame for inclusion.

2. Jointly Accountable Officer

• Manage integrated budget- transfer of funding between partners or to body corporate

• Statutory role of CSWO protected

ADSW questions:• Little flexibility-implementing arrangements for post• ‘Splitting’ of services where interface is critical• Confusion - level of seniority & governance issues• Strengthening the role of the CSWO• Blurred lines of accountability• More local accountability needed.

Questions to which the answer is no.

• Are the proposals clear about the problems they are trying to solve?

• Do we therefore know if we are making the right changes?

• Will we therefore know if it’s working?

Social Work in integrated arrangements

• Need to strengthen and protect the social work role and contribution

• Consolidate the identity of the profession• Focus on good practice based on set of values• Leadership and succession planning for CSWOs• Investing in the workforce and its culture• We need to develop a strategy