7. Health and social care integration
The proposals in the consultation paper relate entirely to employees of NHSScotland, however the Scottish Government recognises that as integrating adult health and social care services is one of their top priorities there will be an expectation that the services of the INO should be accessible to those staff who deliver health and social care services in Scotland.
Consideration is being given to widening the scope of the role of the INO so that it can be accessed by employees of the social care sector.
Question 5: Do you think employees of adult health and social care services, who are not employed by NHSScotland, should have access to the INO?
50 respondents addressed this question, with a majority of 37 agreeing that employees of adult health and social care services, who are not employed by NHSScotland, should have access to the INO, and 13 disagreeing. Most respondent sectors were represented in both categories, reflecting diverging views across the board on this topic.
Nine respondents proposed that the extension of the INO to cover employees of social care services should be undertaken incrementally, informed by evaluation of the initial roll-out within the NHS sector. A few suggested further consultation prior to taking what they considered to be the next step
"It may be appropriate to proceed with an NHS focus initially so that the appropriate analysis and broader stakeholder consultation can take place" (Healthcare Improvement Scotland).
Views in favour of expanding access to the INO
Two main arguments prevailed in favour of expanding access to the INO for employees of adult health and social care services, who are not employed by NHSScotland.
Firstly, many respondents across four respondent categories argued that expanding access in this way makes sense in terms of reflecting the joint working which will result from the Public Bodies (Joint Working) (Scotland) Act 2014. It was felt that this would support joint risk-taking across sectors, holistic working arrangements, situations of concern which straddle health and social care provision, and a shared learning culture in which staff from different disciplines have the opportunity to observe and learn from each other at work.
Secondly, a common view again across four respondent categories was that access to the INO for those not employed by NHSScotland but working in adult health and social care services would provide parity across staff, with all treated the same and given the same protection. In this way a two-tier system would be avoided and consistency engendered:
"To provide a fair and consistent referral route for whistleblowing outcomes is important to give to all staff in health and social care" ( NHS Borders).
"Every opportunity should be given to give all staff in the IJB's the same processes to use. Why would different processes be given or a process only given to some in a team, if working side by side, if related to health" (Individual).
A variety of other rationales supporting the expansion of access to the INO were provided by a small number of respondents:
- In keeping with a patient-centred approach.
- Will ensure that the joint bodies are working to the same rigour and standards as the NHS.
- Otherwise opportunities for service improvement could be missed.
- Otherwise a negative signal is given out about the Scottish Government's commitment to the integration agenda.
- INO may be required especially during the integration process if problems arise with implementing revised policies and responsibilities.
Views against expanding access to the INO
The main argument against expanding access to the INO for employees was that the Integration Joint Board ( IJB) does not employ staff, with staff remaining under their previous employer who will have whistleblowing arrangements and protocol already in place. Attempts to expand access to the INO could cut across these. One respondent remarked that there has not been a review of adult social care whistleblowing procedures and therefore it is not yet known if the INO is required within this sector.
Two respondents including the Care Inspectorate highlighted specifically that the Care Inspectorate is recognised as the body to investigate whistleblowing complaints in care services:
"Replication of existing arrangements, or any confusion about terms of reference, would be undesirable and should be avoided" (Care Inspectorate).
Two further respondents opposed expansion on the grounds that the INO caseload could become unmanageable and should not proceed unless properly resourced.
One respondent suggested that a separate consultation examine the issues prior to a decision being made.
A few respondents raised queries about the scope of the proposed expansion to the INO remit. These revolved around the possibility of expanding access further to include:
- Independent sector organisations who provide commissioned services.
- Students and trainees across the services within the IJBs.
- Employees of children's health and social care services.
- Volunteers within the services.
Healthcare Improvement Scotland remarked:
"The general assumption for many Boards is that they will operate similar policies for volunteers as for staff where relevant, but the policies themselves often do not refer explicitly to volunteers, nor have they been designed with them specifically in mind."
Question 5a: If yes, which IJB services should be covered?
28 respondents addressed this topic. By far the most common response (22 mentions) was to recommend that "all" services are covered. A few respondents urged that independent and voluntary sector providers of services commissioned by adult health and social care services should be included. Other recommendations mentioned by only one or two respondents were for services in care/nursing homes to be covered; the inclusion of care services at home; services in day hospitals; primary care services such as clinics and GP practices; and integrated and shared services directly sourced from acute Health Boards.
Question 5b: If yes to Q5 do you have a view on how employees who have access to the INO could be defined?
22 respondents provided responses to this question. Two of these respondents did not provide a definition, but highlighted what they considered to be the importance of defining clearly which employees will have INO access. Another recommended that the word "employees" in the question suggested an exclusion of voluntary workers, which in their view should not be the case.
Others made the following recommendations:
- All public sector employees.
- Anyone employed by, or commissioned to work under, the jurisdiction of the health and social care partnership, that is, within the remit of the IJB.
- Any employee with a direct or indirect link to NHS/social care in Scotland.
- Any worker from an organisation regulated by a health systems' regulator (e.g. Health Improvement Service).
- Any employee who in respect of their duties is involved in the direct care of an individual or in a position to witness direct care of individuals involved in direct patient care services.
- By reference to the employees' profession e.g. health or social care worker.