The structure of integration: Scotland runs ahead


By Gareth Davies, Policy and Technical Manager, CIPFA

From 1 April 2016 – four years ahead of the parallel requirement in England – Scottish authorities had to move to integrated health and social care services, as specified in the Public Bodies (Joint Working) Scotland Act 2014.

To do so, they had to choose between an integrated joint board (IJB), a joint venture arrangement between the relevant local authority and health board which establishes a new and distinct local government body for each integration area; or an integrated joint monitoring committee (IJMC) or ‘lead agency’ model resulting in the delegation of service delivery from one partner to the other, with consequential staff transfers. Only one area, which had already established joint arrangements, opted for the latter arrangement.

Whichever model was chosen, each area now has a strategic plan for the delivery of integrated services. In recognition of the fact that these are still early days in the integration journey, and that there is still much to do before significant changes in the balance of care are seen, the Scottish Finance Advisory Network recently held an event titled ‘Integration of Health and Social Care – What Next?’.

A policy update from the Scottish Government was extremely informative. The planned review of health board numbers and structures was noted as a cause of uncertainty. The intention to provide guidance on prioritisation, with the crucial expectation that this will include guidance on disinvestment, is likely to be significant in supporting decision making. Further areas of information include living wage implementation, hospitalisation rates, sources of service consumption data, and the analytical support available to utilise this data.

With IJBs having been established before 31 March the annual accounts process for 2015/16 was reviewed. The treatment of support services and the potential for VAT liabilities to arise as a result was a key concern for many. The wider relationship issues arising for finance staff were also considered with some areas for future development highlighted. The importance of listening to stakeholders, as well as trust, transparency and co-location of staff between partnership bodies, were emphasised in discussions. 

The budgeting process for 2016/17 was very much a ‘first attempt’ with some issues arising which will hopefully be addressed for the 2017/18 planning process. Key factors to consider in financial modelling were also identified. The day ended with an external audit perspective on the audit risks and issues arising, with ten year financial plans being suggested as a means of evidencing the sustainability of service delivery. The importance of good governance was also stressed.

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