As the Bill to take forward health and social care integration moves to its final stages, please find below a short briefing from SCVO.

Summary

  • The third sector has a vital and full role to play in both strategic and locality planning to achieve the outcomes envisaged for the Bill – yet it is still not recognised on the face of the Bill.  Without this, will statutory regulations and guidance be able to ensure the sector plays its part?
  • We support the briefing being sent by the Health and Social Care Alliance – including the amendments outlined.  These include 117 and others which aim to increase involvement of third sector and ensure a strong voice in planning for service users and carers.
  • The third sector’s capacity to fully participate in shaping and implementing integrated services and better outcomes for people must be supported in the same way as that proposed for GPs and other statutory professionals.
  • We must ensure that the voices of service users and carers sit at the heart of integration.

Key Points

The Critical Role of the Third Sector

Over the last few months, in evidence sessions and in one to one meetings with MSPs and Ministers, SCVO and its colleagues and members have laid out the vital role of the third sector in delivery within the health and social care field.

Many third sector organisations provide support and services which lead to positive health and wellbeing outcomes – they are an essential part of the health and social care landscape e.g. peer support, lunch clubs, food/shopping projects, older people’s social groups, community transport, support for vulnerable adults, carer support etc.

Successful strategic and locality planning must understand and involve this totality of resource if we are to gain a clear picture of need and provision – and gaps in support – in each integration board area. The East Dunbartonshire Health and Social Care Pathfinder will help in this regard.

The pathfinder is funded by the Scottish Government and is the first stage of a national programme by SCVO to demonstrate how a strategic investment in the capacity of the third sector can enable prevention at a locality and primary care level, by reducing demand on mainstream statutory services and enable commissioners to make more effective use of resources. The pathfinder will ensure that the role, contribution and potential of the third sector is understood and valued.  Charities, community groups, social enterprises and voluntary organisations will be encouraged and supported to play an increasing role and deliver change in the context of health and social care integration.

Learning from Reshaping Care

Let’s not lose what has been gained in Reshaping Care and work to implement the Change Funds.  The third sector became an equal partner because it got to sign off the Change Fund Plans (supported by the Scottish Government). It also brought a huge amount of resources and expertise to the table. Relationships with the sector were, in some areas, only initiated because it had to sign off those Plans. Those partnerships with strong relationships are able to show the type of investment in communities envisaged by the policy outcomes for integration (see Alliance briefing, page 13-14).

There are some early, anecdotal signs that perhaps this valuable progress may be reversed, that the sector may be less involved in the new partnerships – it is not always seen as an equal partner.  This increases the risk that strategic and locality plans will not be based on a total view of each area and the activity that is going on within it.  How can integration planning pick up community based projects and support which contribute to health and social care outcomes if these organisations are not able to come to the table?

National organisations such British Heart Foundation, Red Cross, Parkinsons UK and others have a key contribution to make as well as bringing additional resources to the table.  If there is no third sector ‘focal point’ in the strategic planning bodies and at locality level, how do they connect?

Capacity of Sector

Resources attached to the RCOP programme/Change Funds represent only a fraction of health and social care spend – the third sector has the ability to transform and deliver preventative services which have a real and positive impact on people’s lives and wellbeing.

It must play a part in shaping that total spend, and to be able to bring additional resources, expertise and experience to strategic and locality planning tables. As it stands, the Bill focuses on the two statutory partners, on structural, budget and boundary issues.  Without the sector’s involvement, that focus may well continue – to the detriment of people at the receiving end of health and social care services.

Infrastructure to support the involvement of the sector does exist as a result of Reshaping Care for Older People – the sector and this infrastructure will need some investment to help it play a full part in shaping integrated services in the same way that capacity issues for GPs/health professionals have been (e.g. Stage 1 Report, 2013).  The role of third sector interfaces is crucial (see Alliance briefing attached, pages 4-6).

Service Users and Carers at the Heart

We must ensure that the voice of carers and service users are at the table and are supported to help shape the very services which connect so deeply with their lives.  The Bill makes little reference to unpaid carers in their own right – we must avoid a situation where they have less of a voice in shaping services which directly affect their quality of life and the quality of life of those they love and support.

Questions

As you move into the debate please consider:

  • If the sector is not included on the face of the Public Bodies bill, will the regulations be able to make a strong case for its involvement in shaping integrated services?
  • As many partnerships are already on the way to being established prior to the Bill becoming law, the chances are that the regulations may well happen ‘after the fact’ – and new structures may exclude or give a less powerful voice to the very people who need to be involved.
  • Think of the many voluntary organisations which you know of and which are critical to supporting independent living, family carers, which help people to live full lives in their communities. Does the Bill do enough to ensure they are able to bring their experience to both strategic and locality planning? Do they need support to enhance their capacity in this regard?
  • Does the Bill do enough to ensure that families and carers are able to directly shape the resources and services which affect their lives in a very real way?  Consider your own caseloads in relation to social care, and the issues which families are facing in relation to tightening eligibility criteria and charging.

Conclusion

Our final comment comes from Nigel Henderson’s (CCPS/Penumbra) input during Stage 1 of the Bill:

“It is interesting to reflect that we are trusted to provide care and support to some of the most vulnerable people in Scotland but are not trusted or respected as equal partners”.

The Bill must send out a strong message about the need to co-produce the strategic and locality plans.