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What is planning for integration?

On 16 December 2024, the Board of NHS Highland and The Highland Council agreed in principle to commit to planning for the integration of health, education and social care services. They asked for a formal implementation plan to be developed and brought back to The Highland Council and NHS Highland Board on 12 May 2024. At this meeting a decision will be made on whether to proceed with the planning for implementation.

Why should services be integrated?

Demographic changes in the Highland area mean that we have an increasingly ageing population to care for. As a result, we have to change the way we deliver our services and make our processes as efficient as possible if we are to care adequately for the people living in this area. We also have to recognise the impact this may have on children’s services.

Separately, the Scottish Government is currently exploring ways to drive integration of services forward, meaning that it is no longer optional. However, by beginning the process now, Highland has an opportunity to influence the national situation.

What progress has been made to date?

The planning for integration project began with the agreement between NHS Highland and The Highland Council in December 2024. A report outlining the preferred method of implementation, and identifying the the benefits and risks, will be presented to the joint meeting of the NHS Highland Board and The Highland Council on 12 May 2024.

The detail of the changes required to achieve integration will be decided by everyone involved in health, education and social work services – both people using the services and those working within the services.

As part of this process, consultations have already begun with people who currently use the services. At the same time, workshops and meetings with staff, trades unions, user groups, as well as independent and voluntary sector organisations, are discussing how integration might be practically implemented.

What are the timescales for integration?

If the joint meeting of the NHS Highland Board and The Highland Council on 12 May 2024 agree to progress to planning for integration, a full high level plan for integration will be prepared for presentation to them in April 2024.

The detail of this plan and the changes required to achieve integration, will be decided by and in consultation with everyone living in Highland, and everyone involved in delivering these services in the area.

Would the Highland model be based on another tried and/or implemented elsewhere?

The Highland approach will not be a replication of any other model. However, NHS Highland and The Highland Council will examine what has happened in other areas take on board and learn from their experiences where appropriate.

How would the new responsibilities be allocated?

Where they have a shared responsibility for delivering services, The Highland Council and NHS Highland will explore whether one of them could take the lead role in delivery of these services.

The NHS Highland Board and The Highland Council have agreed to develop the proposals on the basis that the most appropriate single lead agency for the delivery of Adult Care is NHS Highland and that the most appropriate single lead agency for Children’s Services is The Highland Council.

What would integrated service delivery look like?

The Highland Council and NHS Highland have agreed to explore changes that would “improve the quality of education, health and social care services, ensuring they are effective and efficient.”

Most importantly the changes should enable public sector organisations to meet the needs of the people of Highland.

The statement of intent by The Highland Council and NHS Highland is: “The Highland Partnership is committed to achieving the best possible outcomes for our population and service users. We believe that services should be person-centred and enabling, should anticipate and prevent need as well as react to it, should be evidence based and acknowledge risk. We will improve the quality and reduce the cost of services through the creation of new, simpler, organisational arrangements that are designed to maximise outcomes and through the streamlining of service delivery to ensure it is faster, more efficient and more effective.”

The solution for Highland would be designed specifically for this area and will take into account the variety of integration models tried and tested by other areas of the country.

Is this just for health and social work services?

The integration proposed for children’s services includes aspects of education, as well as some health and social work services.

Have some services of NHS Highland and The Highland Council already been integrated?

The Highland Council and NHS Highland believe that integrating the delivery of services for children and adults in Highland will improve the experience for everyone. Through The Highland Partnership, The Highland Council and NHS Highland have made considerable progress towards integration of services for adults and children.

  • Joint Future was launched around 2024 and has evolved to focus on improving services for older people and those in need of community care services. As part of this, community planning has grown at local and Highland level with a wide range of stakeholders now regularly involved in planning and delivering services.
  • Steps to integrate children’s services have begun, first through the integrated plans developed as part of For Highland’s Children, and then through GIRFEC. This has moved services into a more streamlined and child-centred focus, reducing bureaucracy, simplifying process especially for families and reducing duplication for staff across agencies.

Why does it need to be taken further?

Changes already carried out have already improved services for people living in Highland. However, some barriers still remain and The Highland Council and NHS Highland believe that full integration would further improve services by offering more responsive and flexible approaches to service delivery.

Evaluation of GIRFEC (Getting It Right For Every Child) confirmed a need to make integrated practice the norm, with associated developments in quality assurance and access to services.

For adult services, it is anticipated that integration will help to achieve sustained reductions in delayed discharge, as well as a shift in care delivery from institutions to community based care, and the sustained shift from re-active to pro-active care.

By integrating services, the organisational and structural constraints that impact on our ability to modernise will be reduced.

What are the kinds of changes likely to be made in practice if further integration takes place?

The Better Health Better Care project has outlined the following descriptions of how the changes will affect services in health, education and social work:

Current Post integration

Geared towards acute conditions → Geared towards long-term conditions

Hospital centred → Embedded in communities

Doctor dependent → Team based

Episodic care → Continuous care

Disjointed care → Integrated care

Reactive care → Preventative care

Patient as passive recipient → Patient as partner

Self care infrequent → Self-care encouraged and facilitated

Carers undervalues → Carers supported as partners

Low tech → High tech

What principles will guide progress to integration?

  1. Improvements to patients, families, and carers must be central to change.
  2. A new solution must address the majority of current issues.
  3. If/when challenges and complications arise, they must pose less of a risk to the quality of services than the current position.
  4. Governance must be explicit and assured.
  5. New arrangements must be worked through with staff and trade unions across organisations.
  6. Costs must be the same or less than under the present set-up.

Is NHS Highland taking over The Highland Council responsibilities? Or is The Highland Council taking over NHS Highland?

Neither. This is not a take-over by either agency. Lead agency arrangements will be governed by commissioning plans which will spell out accountabilities, responsibilities and jointly agreed outcomes for the services provided to patients. The organisations will retain their accountability but the responsibility for delivery of the service will be with the lead agency.

Has a plan already been designed for the integration of services?

The plan for integration will be designed by people who use education, health and social work services in Highland, in partnership with the people currently working in the services. At present, although management of both organisations have committed to integration if it is practically possible, no decisions have been made about what the final solution might look like.

What values will underpin the model for integration?

  • Services should be person centred, respecting individual need and circumstance; users must be involved as partners in the design and delivery of care.
  • Services should be enabling; designed and delivered to support people to achieve their own maximum potential, independence and attainment
  • Improvements in service quality (user experience, effectiveness and efficacy) should be the priority, and achieving this will in turn improve efficiency and reduce cost.
  • Services need to be preventative and anticipatory, as well as reactive and responsive.
  • Those who deliver services, service users and their carers need to acknowledge that risks cannot be eliminated and that approaches to maximise a user’s potential may require the acceptance of a higher level of risk.
  • The intention of a service intervention needs to be clear and understood; services need to be effective and deliver the outcomes intended.

Who should I contact if I have a query about integration?

To contact the project team with a query, you should email p4i@highlandlife.net.

For employees of NHS Highland and The Highland Council, an issues log has been set up to record all queries and to ensure that they are addressed through the process of integration.

The human resources and finance departments of both organisations are contributing to the development of the initial plan. The Scottish Government are also providing support, including through the funding for the national “Change Fund”.

I have raised an issue already. What has happened to that?

All issues have been collated into an issues log which has been shared with the Programme Board and the Staff Partnership Forum. These issues will contribute to further informing the queries presented here as answers develop and will be considered as the issues of employment, leadership and management structures are addressed through the project development.

© 2024 Highland Public Services Partnership.
Project part-financed by the European Union (European Regional Development Fund) within the INTERREG IIIB Northern Periphery Programme