Inquiry into the Scottish Government’s Public Service Reform programme - Public service organisations

The Integration Joint Board (IJB) is the Governance Board of the Argyll and Bute Health and Social Care Partnership.

It has responsibility for the planning, resourcing and overseeing of the operational delivery of integrated services. IJB membership comprises:

elected councillors
NHS Highland Board members
individuals from a range of sectors and stakeholder groups including the Third Sector, Independent Sector, patients/service users, Trade Unions, staff and carers.

Argyll & Bute Health & Social Care Partnership

The Argyll and Bute Health and Social Care Partnership (HSCP) is responsible for the planning and delivery of all community and acute health and social care services for adults and children throughout the region. Its partners are NHS Highland and Argyll and Bute Council. This includes services we deliver directly and a wide range of services which are purchased from external providers including NHS Greater Glasgow and Clyde.

Argyll and Bute is home to 85,430 people, covers an area of 690,946 hectares and is the second largest local authority by area in Scotland. It has 23 inhabited islands, with 17% of the population living on these islands. Argyll and Bute provides a number of unique opportunities for those who live and work here, however we also face a number of significant challenges. The geography associated with dispersed communities in remote and rural areas and islands presents a challenge in delivering services within the resources available. Of the population, 69% live in “remote” or “very remote” areas and 45% live in areas in the 20% “most deprived for geographic access to services”. Argyll and Bute has a higher proportion of older people than Scotland as a whole, with 11.6% aged 75+ compared to 8.5% in Scotland. This presents a serious demographic challenge, in the context of a reducing population which is having an impact on our funding and ability to recruit staff to deliver services.

The Argyll & Bute HSCP utilises buildings and land owned by NHS Highland and Argyll and Bute Council.

Most of the property portfolio (circa 70 buildings) is well used, particularly buildings which are used for direct health and social care service provision to members of the public. Recent expansion of staff teams and the re-mobilisation of services following Covid19 has resulted in some space shortages. However, the properties operated by the HSCP are generally in poor condition and have suffered from a lack of investment over many years. This has resulted in derelict and close to derelict properties in some areas. The HSCP is participating in place based reviews to consider how the Estate could be better utilised with key partners. It has also recently invested in increasing management capacity to address backlog maintenance, strategic investment business case development and carbon reduction plans.

Scope for efficiencies through estates rationalisation is limited without withdrawal of key services from the relatively small towns and rural communities served by the HSCP.

Investment in existing properties will likely provide opportunities for improved energy efficiency and reduced energy costs. Further development of shared services with partners may generate some opportunity for office accommodation efficiencies, this is being progressed on a place based basis.

The HSCP also has land and assets which are not in use and these could potentially generate some capital receipts for NHS Highland or be used to help progress local development plans.

TBC pending annual accounts

Embedding and expanding innovative practices such as ‘virtual wards’ and ‘near me’ provides an opportunity to improve efficiency by reducing patient travel time and improving the use of available staff time.

The HSCP continues to suffer from digital systems not being fully integrated between health and social care and this results in inefficiency through duplication of bureaucratic processes. Addressing this properly requires investment but would provide opportunities for front line staff to work more effectively and support staff efficiencies.

As above, some opportunities exist for co-location with partners. However significant investment in replacement facilities is a priority for the HSCP. This investment would in turn provide opportunity for reform and be a driver for place based development and improvement of communities in the area. It also provides an opportunity to consider new models of care, new partnership working arrangements (for example with the housing sector) and improve the estate, including residential care facilities which are in need of renewal. Some reduction in the number of buildings operated could result.

The HSCP sector is currently facing significant uncertainty as a consequence of the delays to the co-production phase of the National Care Service. It has responded in detail to the consultation process associated with the NCS. This project clearly presents an opportunity for reform and improvement but there is a current lack of certainty which is making longer term planning and transformation particularly challenging.

The disruption and costs associated with reform need to be carefully analysed alongside the benefits. The challenges associated with implementing change and delivering the expected benefits in the public sector require to be realistically considered.

Opportunities are limited, the majority of the activity of the HSCP is NHS related. For social care services the HSCP does seek to maximise income where it can. New charges for services are considered regularly, revenue from the roll out of electric vehicles and their charging infrastructure is being actively considered, although this will not offset the net additional cost of electrification of the vehicle fleet. Development of renewable energy generation within the estate may also be an option for revenue maximisation, this requires support to develop feasibility studies.

Improving public procurement should remain a priority. Recent developments in this area have tended to complicate procurement processes. They have also resulted in an increased reliance on procurement professionals (now difficult to recruit), even for relatively minor and straightforward procurements. There are also instances where public procurement processes can make it difficult for smaller and local suppliers to access contracts. It can be challenging to purchase services in remote and island communities due to lack of suppliers active in these areas.

Perhaps the focus has shifted too far towards regulation of almost all procurement, including relatively low risk and low value procurement while there remain on-going problems with cost over-runs, delays and risk transfer with larger scale, complex and high risk procurement process. Introducing additional gateway review processes may be helpful but also result in additional business case development costs and very lengthy lead in times for getting projects approved.

For the HSCP sector there is a lack of clarity and delay relating to the implementation of the NCS. There are additionally structural financial issues in the NHS which require to be addressed through increased funding or prioritisation for service change by Government. The HSCP is currently working with NHS Highland on its financial recovery plan. Clear and more specific guidance is required urgently if these deadlines are to be met. The actual implementation of significant change is unlikely to be deliverable in 2024/25.

Key stakeholder in delivering the Local Child Poverty and Children and Young Peoples Service Plan.

Investment in this area to develop strategic approach

Reflected in the actions of the strategic plan with a focus on remote and island agenda and development.

This target does not currently apply to HSCPs. Recent funding has been allocated to increase staffing and this has taken some time due to well publicised workforce pressures and shortages in the health and social care sector. The HSCP does have a transformation and saving programme in place which will result in some reductions in staffing, however, reducing reliance on expensive agency staff by increasing permanent and sustainable staffing is priority.

The HSCP has a public value / best value ethos and understands the wider role it has in the life of local communities and in supporting the most vulnerable in society. It also fully recognises the key role it plays in local economies as a large employer and provider of resourcing to other local organisations.

The HSCP works closely in partnership with Argyll and Bute Council and NHS Highland in this regard. It engages effectively with both partners and is also active in several place based reviews which include a wider range of local partners with an interest in specific areas or towns.

Additionally the HSCP is committed to working with 3rd sector charities and private sector providers to help deliver a wide range of services. The HSCP is building collaborative approaches rather than an outdated commissioner and provider relationship however this involves considerable time and effort.

Confidence in health and social care services should be recognised as an important component of ensuring that communities throughout the area thrive and expand.

Improved clarity on funding plans is required, recent high levels of price inflation have made it exceptionally difficult to integrate longer term operational and financial planning. Continued prioritisation and expansion of specific services or aspects of care (in line with government policy) can be to the detriment of core service provision and local priorities and management of available resources. Workforce continues to be a constraint and there are occasions where it has been exceptionally difficult to recruit appropriately trained and experienced staff to deliver on these priorities.

The primary care improvement project is a further example of where there has been late changes made to a long term change programme which has resulted in local operational and relationship difficulties. It is also an example of a change programme which perhaps didn’t fully consider how it could be implemented in very small remote and rural communities and lacked a sensible level of flexibility at the outset.

The HSCP is also of the opinion that the challenges (financial and others) of delivering small scale services in remote and island communities could be better understood and supported by Government.

Improved longer term workforce planning is essential along with demographic modelling. The pressures on health and social care associated with an ageing population will become increasingly unmanageable. Action is required in the short term to quantify and plan for expected future service demand and care models. Workforce availability, skills modelling and training should be prioritised. The government and health and care sector as a whole will probably be required to value and remunerate its staff (social care staff in particular) better to manage future service need.

In the short term the HSCP is seeking to improve efficiency and mange financial pressure without diminishing local services. This is particularly challenging when so many services delivered by the HSCP are of a very small scale and dependent on a very small number of health and social care professionals.

It is acknowledged that service transformation and redesign is required. Workforce and financial constraints are key drivers of this. However, a lack of investment in infrastructure in HSCP assets adds to the challenge of developing and implementing transformational change projects.

Work on preventative projects is underway and this is resulting in the formation of new local partnerships and is initially considering how preventative approaches and interventions can reduce the need for more intensive hospital and residential care.

The HSCP seeks to be open and transparent in this regard, it has a detailed performance management system. This ensures that nationally identified performance indicators are reported upon regularly. The HSCP also seeks to review performance in a more holistic way and is in the process of improving the way in which it engages and consults with the communities it serves.