26th May 2014 - V4

Health & Social Care Integration: Outline SWOT analysis of Options

NHS Shetland as Lead Agency

A)Introduction & Objectives

This is a high level SWOT analysis of implementing the Lead Agency Model for Integration based on NHS Shetland as the Lead Agency.

The Objectives for Integration against which this SWOT analysis has been developed are:

  1. Improve Joint STRATEGIC PLANNING for Health & Care services in Shetland
  1. Minimise the BUREAUCRACY required for Governance to release time and resources for the front line services
  1. Improve the SERVICE for the local community by increasing the SEAMLESS PROVISION of all Health & Care services. This will be delivered through:
  1. Pooling of Staff & Financial Resources
  2. Clear accountability and devolved responsibility for the management of service resources
  3. Flexibility in the use of Resources
  4. Single set of Support systems for staff working in Health & Care services
  1. Supports the SUSTAINABILITY of locally provided Health & Care services
  1. Supports the future REDESIGN of services to address challenges of a growing elderly population
  1. Ensures LOCAL CONTROL over the provision, strategic planning and resource allocation of Health & Care services
  1. Increases the Local DEMOCRATIC input to the oversight of Shetland’s Health & Care Services

B)Outline of Model – NHS SHETLAND as LEAD AGENCY

Governance:

Integration Joint Monitoring Committee (Board members and Councillors) provides oversight for the Planning and Operational Delivery of all Health & Care services.

SIC specifies Level of Service and Budget to be devolved to the Partnership for the services for which they have statutory responsibility. SIC uses internal scrutiny / commissioning process to monitor provision of services by partnership against required service / budget allocation (method and level of scrutiny to be developed / agreed).

Strategic Planning;

Joint Strategic Committee responsible for developing Integrated Strategic Plan for Shetland’s Health & Care services (in conjunction with relevant stakeholders)

Operational Management:

Would include all NHSservices, all Community Care resources and adult Social work (with exception of Chief Social Work officer and Mental Health Officers)[1].

NHS Shetland would be responsible on a day to day basis for the Operational management and delivery of all services. Joint Line Management arrangements developed. All Resources delegated to NHS Shetland to manage in year. Some services maybe contracted out to a third party as at present.

It may / or may not be decided that the transfer of staff (using the TUPE principles) is beneficial. This should be part of a separate analysis.

C)SWOT ANALYSIS

STRENGTHS

  • Easy to Include all Health & Care Services in single management structure – from Tertiary services Commissioned on Scottish Mainland to Community Services in smallest Islands
  • Clear responsibility for Operational delivery of services sits with Single body (NHS Shetland)
  • Simple to develop and agree clear lines of Management Accountability for services
  • Single focus & priority of NHS Shetland on Health & Care services
  • Reinforces role of NHS Shetland and therefore sustains Local decision making for Health services in Shetland
  • Retains NHS Services within wider NHS in Scotland, maximising opportunities for Recruitment & Retention of staff from other NHS systems

WEAKNESSES

  • Creation of potential barrier between core SIC Care services and other SIC services (i.e. Housing)
  • Separation of Social work function across two agencies[2]. Separation of MHOs from other adult social work.
  • Potential impact on Recruitment of Social work staff
  • Less visible commitment; both managerial and political by SIC to Care services

OPPORTUNITIES

  • Easier to develop of single set of Internal Governance systems (i.e. Clinical (Quality), Staff and Audit to operational management of services
  • Easier to develop single set of support systems for staff managing / working in the service (i.e. Risk management / Incident reporting, HR. Financial etc)
  • Potential to maximise and easily redesign services across the whole Patient pathway (maximising opportunity to shift resources from Scottish Mainland to Shetland and Acute to Community services)
  • Increase Councillor Input to the management and strategic development of all local health services
  • Creates an effective Health & Care partnership based on Shetland with local Democratic input. Potential in future to develop this towards a Single Public Authority if appropriate / desirable

THREATS

  • Creation of negative “oversight” culture between NHS & SIC
  • Potential for a loss of democratic accountability and ownership for Community care as services become less “visible” to Councillors (potentially offset through close involvement of Councillors in Locality planning)
  • Loss of day to day responsibility for operational service delivery and “visibility” from the Council leads to a lower priority given to Investment in Care services
  • Reduced opportunity for cross subsiding cost pressures on the joint budget by reallocation of resources from other parts of either Health or Council services
  • Industrial relations issues depending on decisions made around transfer of staff, application of TUPE pay equality issues

1

[1]Other council services maybe included depending on the regulations. Draft regulations due to be published on 12th May.

[2]Need to ensure effective professional oversight from Chief Social Work officer

Need to ensure robust 24/7 Social work service is maintained