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New health and social care plans for Scotland

Doctors call for ‘clinically driven’ reforms

Jo Carlowe

Tuesday, 13 December 2011

The Scottish Government has announced plans to integrate adult health and social care.

The overhaul will see new legislation introduced to reform Community Health Partnerships.

Under the proposals, CHPs will be replaced by Health and Social Care Partnerships, which will be the joint responsibility of the NHS and local authority, and will work in partnership with the third and independent sectors.

Partnerships will be accountable to Ministers, leaders of local authorities and the public for delivering new nationally agreed outcomes. These will initially focus on improving older people's care and are set to include measures such as reducing delayed discharges, reducing unplanned admissions to hospital and increasing the number of older people who live in their own home rather than a care home or hospital.

NHS Boards and local authorities will be required to produce integrated budgets for older people's services to bring an end to the 'cost-shunting' that currently exists.

The role of clinicians and social care professionals in the planning of services for older people will be strengthened, a smaller proportion of resources - money and staff - will be directed towards institutional care and more resources will be invested in community provision.

In announcing the proposals, Health Secretary Nicola Sturgeon said: "These changes represent the radical reform that is badly needed to improve care for older people, and to make better use of the substantial resources that we commit to adult health and social care.

"We are keen to avoid the pitfalls that can accompany centrally directed, large-scale structural reorganisation and staff transfer. Evidence from elsewhere is that changes in structures and staffing arrangements work best when designed and agreed locally, to suit the needs of local patients, service users and carers.

"We will tackle the barriers that currently exist within Community Health Partnerships - division of accountability between the NHS and local authorities, insufficient and often unequal delegation of authority, budgets that are not integrated, leading to decisions about older peoples' care too often being dependent on whose budget is affected, and poor clinical engagement.Our reforms will deliver a system that is effectively integrated, leading to better outcomes for older people and better use of resources.”

Dr Brian Keighley, Chairman of the British Medical Association in Scotland, said the overhaul was long overdue but warned that the reform must be more than ‘a superficial re-branding exercise’.

“The failure of CHPs has been highlighted by GPs since their introduction in 2004 and more recently, by Audit Scotland,” he said.

“They have become bureaucratic structures, caught up in their own internal processes rather than influencing planning, funding and development of local services to meet patient needs. It has been widely accepted that they have failed to bridge the gap between health and social care.”

For the shake-up to succeed, Dr Keighley said it was essential to involve clinicians from secondary and primary care.

“If these new ‘partnership’ organisations are to succeed, they must engage and involve GPs representing practices in the local area. And while it is important to provide much greater integration with social care services, it is essential that these new organisations endeavour to engage doctors from secondary care to ensure that there is greater integration of community and hospital based services.

“These new ‘partnerships’ must not be about saving money, but should focus on providing the right balance of care available to local communities. In order to succeed, they must be clinically driven and supported by management to avoid falling into the pitfalls of the predecessor organisations and I hope that legislation will reflect this.”

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