Comment / Scotland needs faster pace on whole system working

The NHS in Scotland needs whole system collaborative working to manage demographically driven demand increases. In recent reports, both the Scottish Government and Audit Scotland have highlighted that integration between health and social care services must advance at a faster rate.

The Scottish government’s response includes the proposals set out in the Review of progress with integration of health and social care, which are designed to bring forward further integration. Each of the 31 integration joint boards in Scotland (along with council and health board partners) have completed a self-evaluation against the criteria listed in the bullet points below.

A recent briefing from HFMA – Planning for health in Scotland - a regional approach – addresses the challenges by building on two topics from the Scotland branch annual conference in October last year – integration and regional planning (see presentations from the event here).

At the conference, Steve Wilson, the executive lead for finance and investment in Greater Manchester and Sue Jacques, chief executive of County Durham and Darlington NHS Foundation Trust, shared their experiences of integration and transformation. The HFMA briefing includes further valuable lessons from the NHS in England’s development of sustainability and transformation plans and its move to a more collaborative approach to planning and delivering health and social care through integrated care systems.

The HFMA briefing provides an insight into the findings from the association’s close working with English health and social care organisations over the last three years and the transformation challenges facing the Scottish health system. In terms of structure, it adopts the headings used in both the Audit Scotland progress update on Health and social care integration and the Scottish government report.

• Collaborative leadership
• Integrated finances
• Strategic planning for improvement
• Governance and accountability arrangements
• Sharing of information
• Meaningful and sustained engagement

The briefing also covers another area discussed at the conference – regional planning. At the conference Tim Davison, chief executive at NHS Lothian, shared the regional vision for the East of Scotland. The need to reconcile financial and workforce resources with rising demand and deteriorating access performance is common across all three Scottish regions and poses the question – are improvements possible if some elements of care are planned and delivered on a regional basis?

To increase members’ awareness and understanding of the draft regional plans, the briefing outlines the objectives and specific areas of focus of the plans for North, West and East Scotland individually.

The Scottish government’s commitment to develop regional plans was founded by the Health and social care delivery plan in December 2016, and subsequent draft plans were developed in 2018. These plans have not been published and the impetus behind regional transformation seems to have markedly slowed. Questions around regional governance and accountability arise due to the informal collaborative nature of regional arrangements.

Separately, the recently launched Parliamentary inquiry into the future of primary care services is designed to allow the Health and Sport Committee to hear the public’s views on What does primary care look like for the next generation?

In line with its 2020 vision set in 2011, the Scottish government is endeavouring to adapt the delivery of primary care services and use the advances in technology to meet the evolving needs of a growing population, now and for future generations.

Transforming health and social care was never expected to be an overnight process. But with Scottish population demands continuing to rise, it is essential that finance teams rise to the challenge of supporting whole system collaborative working with good underpinning governance.

The 2019 Scottish HFMA conference takes place on 24/25 October 2019 and will focus on the theme of collaboration – between health and social care, between finance and clinicians, and between the government and the service.