College publishes report on health and social integration

The College has launched a new report, which calls for health and social care integration in Scotland to be made simpler. Overall, the report welcomes deeper integration as a means to deliver a more focused health and social care system.

The report, Integration in a diverse health and social care system: how effective are Integration Joint Boards?, highlights that the authorities responsible for integration, Integration Joint Boards (IJB), are complex. This can sometimes lead to confusion around roles and responsibilities, and even make accountability unclear, particularly when there is service failure. This may prevent care being delivered in a timely and efficient manner.

The report also says that IJBs must understand the needs of their local population for integration to work, and that “staff on the ground” require more support to deliver health and care objectives. This should be underpinned by integrated financial planning and stable and effective leadership.

IJBs were established by the Scottish Government to integrate health and care systems across the country. Currently, local authorities and health boards jointly delegate certain responsibilities to IJBs, to be delivered through a local strategic plan. This includes planning and resourcing community service provision.

A number of recommendations on IJBs are put forward in the College’s report, including:

• IJB governance must be made simpler, and leadership must focus on strategic goals.
• Clear guidelines must be in place to clarify the roles and responsibilities of IJB board members, and their relationship with the public.
• The purpose and focus of IJBs must be regularly reviewed.
• A common language is required to ensure that all staff understand the rationale for health and social care integration, and their role within that process.
• A model to develop quality and good practice is essential, as a tool to improve quality standards in health and social care.

The College has agreed to begin “governance surgeries” on IJBs, free and available to health and social care leaders, which will advise on a range of matters.

Professor Michael Deighan chaired an event led by the College on the effectiveness of IJBs, on 7 September 2018. He said:

The Royal College of Physicians of Edinburgh has been greatly interested in the progress of IJBs. This year, the College’s Quality Governance Collaborative (QGC) has hosted the first in a series of detailed conversations on IJB quality governance and performance. I commend this report as it examines the key issues around IJBs, including their effectiveness to date. The report also examines performance and governance arrangements for IJBs, and makes important recommendations for improving governance arrangements, to ensure quality, safe, effective care for patients.

Professor Derek Bell OBE, President of the Royal College of Physicians of Edinburgh, said:

IJBs are very early in their journey, and there are many miles left to go. Although we would not recommend hardwiring the system and then drastically changing it, because this can be disruptive, many opportunities exist to tweak health and social care in order to improve service delivery. Flexibility is important here. Any changes to the current system must be based on what local data tells us, to make sure that we know our population and can reflect their needs. There is potential in future to share learning and best practice, and to work together to develop a shared learning and problem-solving approach.