I am pleased to open today’s debate on the integration of health and social care. It is very timely as we move towards the new world of integration from 1 April.
I was the Minister for Public Health in 2011 when we committed to introducing legislation to ensure that our system of health and social care focuses on the people who need it most. I also have experience of working in health and social care; before being elected, I was a home care organiser, so the subject is particularly important to me.
For people who have multiple complex needs, whether they be young or old, well joined-up health and social care support can be the key to living a full life, going to work, living in their own home and participating in their communities’ lives. That people are living longer in Scotland is testament in large part to great improvements in our health and care services over many years, and that is a good thing. As people live longer, integration is about adding quality of life to their years of life, particularly for those who have long-term conditions.
We know that the numbers are going up. In 2013, more than 425,000 people aged over 75 were living with a long-term condition. By 2037, we expect the number to have risen by 83 per cent, to 779,000.
Integration is also about ensuring that we bring compassion and dignity to people and their families at the end of life. It is important that we plan ahead and ensure that our systems are in good shape to make Scotland an excellent place to live, whatever someone’s age, circumstances or support needs.
I know that we all share those objectives for ourselves and our loved ones. I am grateful to Parliament for its support, across the floor, for the reform programme in the past few years. I am also grateful to colleagues in the Convention of Scottish Local Authorities, whose leadership on the agenda I greatly value.
This is a hugely ambitious national programme of reform. At its heart are people. I was reminded of that recently when I visited Clackmannanshire community healthcare centre, which provides a wide range of services to its community. The centre is home to two in-patient wards, three general practitioner practices, a day therapy unit and a local mental health resource centre. That is what integration is about—bringing together services and professionals to ensure an integrated and person-centred experience.
Nationally, we are moving into implementation. In a couple of weeks, the first of our new integrated partnerships for health and social care will go live. In one sense, years of hard work by colleagues in the national health service, local government, the third and independent sectors, the Government and Parliament are coming to fruition. In another sense, this is just one more—albeit large—stride along the path. That is why I will host a conference for leaders on integration later this month, to which I have invited some of the parliamentarians who are here today. I hope that they can attend.
The idea of integrating is not new. Community health partnerships set the baseline for today’s reforms. Under the reshaping care for older people programme, we introduced the change fund, with the principle of pooling a proportion of the money that we commit to health and social care. We are building on that by bringing together budgets, planning and provision along the whole pathway of care, involving primary healthcare, social care and aspects of hospital care that provide the best opportunities for redesign in favour of prevention.
Progress is local, too. All around Scotland, chief officers are being appointed to lead the work of the new partnerships, and consultation is under way on their integration schemes—partnership agreements—which must be submitted for approval by 1 April. A lot of work goes into writing the integration scheme in each area. Each one is unique to the partnership’s circumstances and each one depends on strong joint working between the health board and the council. It is great to see those core documents arriving now for sign-off. Just a few weeks ago, it gave me tremendous pleasure to approve the integration schemes for the three Ayrshire partnerships and lay the order in Parliament that will enable them to be established in April.
Of course, once the integration schemes are signed off, the local work to improve outcomes really begins, as partnerships get to work on their strategic plans for integrated services. Already we can see examples from around the country of local commitment to improvement through integration, such as Glasgow’s ambitious programme to reduce delayed discharge and improve intermediate care.
It is not just Glasgow. Across the country, partnerships are starting to behave as if services were already integrated. Local information tells us that delayed discharges are starting to come down. Two thirds of partnerships look well placed to deliver the two-week target in April.
Such innovation will be crucial to success at improving outcomes, and what happens in communities within partnerships—in primary and social care settings—will be as important as what happens in hospitals. That is why we have legislated for localities within partnerships. Through localities, communities, clinicians and other professionals will directly influence how services are provided and resources are used. Localities’ priorities must drive strategic planning in partnerships to enable a real shift towards supporting people in their own homes.
Of course, improving care is not a task only for the statutory partners; the third and independent sectors and the views of users and carers are important, too. Our legislative framework assures their role in strategic planning and localities.
As part of ensuring improvement in the quality of services, we are integrating and enhancing improvement support by bringing together Healthcare Improvement Scotland, the joint improvement team and the quality, efficiency and support team, and we are providing an additional £2.5 million to support improvement in the new integrated health and social care landscape.
I previously committed to refreshing our 2020 vision for health and social care. We will sharpen its focus even further on integration’s foundation—the triple aim for raising performance of improving people’s experience of care, improving the population’s wellbeing and improving the use of resources.
Integration will bring together the significant resources that we commit to health and social care. We have provided flexibility for local systems to agree the integrated arrangements that are most appropriate to local circumstances. The legislation sets out the minimum that must be integrated, which amounts to at least £7.7 billion of health and social care resource being integrated across the country to maximise people’s outcomes.
Nevertheless, we recognise that additional resource to support innovation is important. We are already providing £100 million in 2015-16 to support innovative integrated practice in partnerships under the integrated care fund. Earlier today, I announced the extension of that fund for a further two years—£100 million per year will be provided in 2016-17 and 2017-18. That £200 million is part of more than half a billion pounds of additional funding that we are providing over the next three years to support integration.