What is Integration?

Health and social care integration is a Government-led, legislative change taking place across Scotland. All councils and health boards across the country are involved with legal Partnerships being formed on 1 April 2016.

People are living longer with more complex care needs. Our ageing population and the increasing demands for services means our current arrangements for older peoples care are not sustainable. Over the coming years, GPs, hospitals, health workers, social care staff and others will increasingly work side-by-side to share information and take a much more co-ordinated approach to the way services are delivered. It is up to each area on how they do this. Key elements of the new system will be:

Community Health Partnerships have been replaced by Health and Social Care Partnerships, which include adult social work services, and are now the joint responsibility of the NHS and local authority, working in an integrated approach with the Third and independent sectors.

Partnerships are accountable to Ministers, leaders of local authorities, Health Boards and the public for delivering new nationally agreed outcomes.

In Fife our focus is to improve adult and older people’s care and Children’s Community Services. Our aim is to:

  • improve the lives and continue to meet the needs of those we serve.
  • prevent and delay ill-health and to support people to live independently in good health in their home for as long as possible.
  • reduce how often and how long people stay in hospital
  • NHS Boards and local authorities are required to produce one integrated budget for all adults and older people’s services to bring an end to the ‘cost-shunting’ that currently exists.
  • Focusing on local solutions will strengthen the role of clinicians and social care professionals in the planning of services.  A smaller proportion of resources – money and staff – will be directed towards institutional care and more resources will be invested in community provision.This will mean creating new or different job opportunities in the community. 


How are health and social work services joining up in Fife ?

National consultation laid out two models available and described these as follows:

  • Lead agency model – one partner can delegate some of its functions and resources to the other, which then hosts the service and integrated budget on behalf of the Partnership.
  • New Corporate Body – the Health Board and Council could delegate agreed functions, including agreement on the range of services and amount of resource, to the Integrated Health and Social Care Partnership.

In April 2013, members of NHS Fife’s Board and Fife Council’s Executive Committee agreed that an integrated (New Corporate Body) approach was the best way to join up health and social care services in Fife. For examples of how we are starting to work closer together and improve the experience for people visit Change Projects.

Which services are being integrated?

Services currently identified for integration include:

  • All adult and older people Social Work Services
  • Community Health Partnership services, e.g. district nurses, health visitors, mental health
  • Some services provided in hospital, e.g. medical care of the elderly
  • Children’s Community Services provided by NHS Fife – Health Visiting Services
  • Elements of housing services which provide housing support to vulnerable adults and disability adaptations

Together, this equate to:

  • around 5,000 staff,
  • a budget of approximately £470million, and;
  • Fife being one of the largest Health and Social Care Partnerships in Scotland, next to Edinburgh and Glasgow.

What has been the timeline of events?

April 2013:

NHS Fife Board and Fife Council Executive Committee approve recommendations for an integrated approach.

June 2013:

Scottish Government put forward the Health and Social Care Bill. Part 1 of the Bill was published on 18 November 2013. Part 2 was published on 29 January 2014 and Part 3 was published on 25 February 2014.

June 2013 to April 2015:

During 2014, further formal regulations and guidance came from the Scottish Government to support the detail of how the integrated approach will operate. Fife Council and NHS Fife continue to work in an integrated approach to develop new ways of working, build on existing good practice and develop structures, processes and procedures to support an integrated approach and deliver services wrapped around the individual to meet need.

From April 2015:

The legislation comes into effect. On the 1 April 2015, our Community Health Partnerships (CHPs) ceased to technically exist as a result of the Scottish Government’s new Act. This made way for the emergence of Health and Social Care Partnerships (HSCPs) across Scotland.

1 April 2016:

Fife’s Health and Social Care Partnership is established.

How has Fife prepared for this change?

During 2013/2014 a joint Shadow Board was established. This temporary Board oversaw the changes needed before Legislation came into effect.

A series of Consultations have involved patients, service users, staff, partners and the public.

These are as follows:

  • Strategic Plan for Fife (7th October to 6 January 2016)
  • Integration Scheme Consultation (10 December 2014 to 31 January 2015)
  • Localities Consultation (11 August 2014 to 3 November 2014)

Visit Consultations to find out more.

Involving service users, patients, carers, families and partners began from the earliest stage. The Public Reference Group was set up as early as 2012 and since this time, our rolling programme of communications has reached out to the hundreds of patient and service user representatives and partner agencies to glean views and to ensure the voices of the most vulnerable are heard in Fife.

In October 2015, the Integration Joint Board for Fife’s Health and Social Care Partnership was legally formed. Currently Fife Council appoints 8 Councillors and NHS Fife appoints 8 Board members to be members of the Integration Joint Board. Integration Joint Board members will hold office for a maximum period of 3 years.

What happened to the previous Health and Social Care Partnership in Fife?

Not all regions had a partnership like this, so in many ways, Fife’s joint working has been leading the way. But, the previous Health and Social Care Partnership was not set up to support this level of integration. It had a different scope and remit. On the 1 April 2015, our Community Health Partnerships (CHPs) ceased to technically exist as a result of the Scottish Government’s new Act. This made way for the emergence of new Health and Social Care Partnerships (HSCPs) across Scotland. CHPs formed the backbone of service delivery and over the years delivered innovative and effective services to meet local need. This foundation is critical to Fife’s success moving forward. The employment status of staff did not change as a result and staff continue to be employed by their current employer.

What does the new Partnership and integrated working mean for prioritising how money is spent nationally and locally?

For integration:

  • Central Government spending will reflect the shift from institutional to community-based care, with resources (cash and staff) being directed towards more local facilities.
  • NHS Boards and Councils are required to produce one, integrated budget.

What are the benefits for service users and patients?

Our integrated approach will help to improve services for local communities and meet the aspirations of individuals. By working together, a combined package of care and support will help keep vulnerable people healthier and independent for longer. Developments undertaken now will set a foundation for further joint services in the future. By working together, our aim is to:

  • improve the lives and continue to meet the needs of those we serve.
  • prevent and delay ill-health and to support people to live independently in good health in their home for as long as possible.
  • reduce how often and how long people stay in hospital.

How are users of services getting involved?

Involving the public from the start has been vital. As part of the joint preparation work, a Public Reference Group was formed in 2012.Since this time, this has evolved into a new Participation and Engagement Network (P&EN).  The Network brings together service user, patient and carer representatives as well as members from the third and independent sector. Working locally and at a Fife wide level, the Network has a wealth of experience, knowledge and skills. They are the eyes and ears of the community, ensuring we adhere to the principles and values set out in Fife’s Strategic Plan, our blueprint for change.  You can read the Blog from the Chair of the P&EN here.

In addition, we involve the public and staff together as we undertake consultations on the re-shaping and transforming of services themselves as well as the development of an improved participate and engage approach with the public, users of services and their families.

Over the last year we have reached over 4,000 people through the 40 stakeholder channels across the third and voluntary sector and held a series of joint face to face events with which is generating thousands of ideas. By listening and sharing experiences, the people of Fife are actively informing and shaping the future of services for Fife.  A copy of the Participation and Engagement Strategy can be found in the Publications section. 

How are the Third and Independent sector involved?

The Third and Independent sector play a vital role in the successful integration of services and developing new ways of working under the new Partnership. A proactive approach has been taken in Fife. All partners have been engaged on Health and Social Care Integration and how NHS Fife and Fife Council are jointly preparing. Care Providers from across the Third and Independent sector as well as members of the public and representative groups have been attending events held by NHS Fife and Fife Council.

The events generate a lot of lively debate, discussion and raise some challenging questions about how we can all work together to provide care.Feedback includes:

“…my views were appreciated and taken on board.”

“At the table everyone listened as well as talked.”

“Facilitator actively encouraged input from everyone.”

“Information excellent – going away with food for thought!”

“Openness from all concerned”

“The event exceeded expectations”

“…it’s important we get it right in Fife.”

Under the new Partnership, the Independent and Third sector service partners continue to be fully involved the engagement programmes, which will include targeted and tailored events.