4.1 There have been wide reaching programmes of reform to health and social support services in recent years, which are consistent with the wider principles of Public Service Reform  . This chapter provides an overview of the key developments.
4.2 This survey supports and informs all of these, by describing their impact from a user perspective. It is worth noting, however, that this survey relates to experiences in 2015, which is while some of these programmes were in the process of being implemented.
The 2020 Vision
4.3 In 2011, the Scottish Government set out a 2020 Vision  for achieving sustainable quality in the delivery of healthcare services across Scotland, in the face of the significant challenges of Scotland's public health record, our changing population and the economic environment. All healthcare policy in Scotland drives the delivery of this Vision, which states:
By 2020 everyone is able to live longer healthier lives at home, or in a homely setting and, that we will have a healthcare system where:
- We have integrated health and social care
- There is a focus on prevention, anticipation ('forward planning'?) and supported self-management
- Hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm
- Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions
- There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission
And which will be delivered according to three Quality Ambitions:
- Safe - There will be no avoidable injury or harm to people from healthcare, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all time
- Person-Centred - Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrates compassion, continuity, clear communication and shared decision-making
- Effective - The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated
Integration of Health and Social Care
4.4 The integration of health and social care is one of Scotland's major programmes of reform and is central to the achievement of the 2020 vision and Public Sector Reform priorities described above. At its heart, health and social care integration is about ensuring that those who use services get the right care and support whatever their needs, at any point in their care journey. It places a greater emphasis on community-based, more joined-up, anticipatory and preventative care which aims to improve care and support for those who use health and social care services.
4.5 All health and social care partnerships became fully operational on 1 April 2016, bringing together NHS and local council care services under one partnership arrangement for each area. Whilst a number of these Partnerships were established earlier in 2015/16, for the most part this survey took place before health and social care integration was fully in place, and the results should be interpreted in that context.
4.6 The National Health and Wellbeing Outcomes provide the strategic framework for the planning and delivery of health and social care services. They focus on the experiences and quality of services for people using those services, carers and their families. The outcomes are shown below.
4.7 They are supported by a Core Suite of Integration Indicators which provide an indication of progress towards the outcomes that can described at Partnership and Scotland level. Indicators 1-9 of this suite draw on questions from the Health and Care Experience Survey, and therefore results from the 2015/16 survey will form part of the baseline from which improvements in people's experience of care which arise from health and social care integration can be monitored.
Outcome 1: People are able to look after and improve their own health and wellbeing and live in good health for longer.
Outcome 2: People, including those with disabilities, long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community.
Outcome 3: People who use health and social care services have positive experiences of those services, and have their dignity respected.
Outcome 4: Health and social care services are centred on helping to maintain or improve the quality of life of service users.
Outcome 5: Health and social care services contribute to reducing health inequalities.
Outcome 6: People who provide unpaid care are supported to reduce the potential impact of their caring role on their own health and wellbeing.
Outcome 7: People who use health and social care services are safe from harm.
Outcome 8: People who work in health and social care services are supported to continuously improve the information, support, care and treatment they provide and feel engaged with the work they do.
Outcome 9: Resources are used effectively in the provision of health and social care services, without waste.
4.8 The Social Care (Self-directed Support) (Scotland) Act 2013 embeds a new approach to social care which gives adults, children and carers more choice, control and flexibility over how their care and support is delivered.
4.9 The primary contribution Self-directed Support makes to delivering the Health and Wellbeing Outcomes is empowering people to have greater choice and control of their lives.
4.10 The Health and Wellbeing Outcomes also includes a specific outcome (Outcome 6) relating to carers, although some of the other outcomes will also be relevant to those with caring responsibilities.
The Carers Strategy published in 2010, describes the following vision:
- carers are recognised and valued as equal partners in care;
- carers are supported and empowered to manage their caring responsibilities with confidence and in good health and to have a life of their own outside of caring;
- carers are fully engaged as participants in the planning and development of their own personalised, high-quality, flexible support and are not shoe-horned into unsuitable support. The same principle applies to carers' involvement in the services provided to the people they care for;
- carers are not disadvantaged, or discriminated against, by virtue of being a carer.
Primary Care Strategy
4.11 In June 2015, the Scottish Government announced a Primary Care Fund to support the transformation of primary care  , including General Practice, and to improve patient access to these services. Part of this investment is supporting GP practices to develop new models of care which align with the 2020 vision for Health and Social Care  . These involve working as part of multidisciplinary teams, which will enable the patient to receive the right care, from the right health care professional, at the right time and place
Out of Hours review
4.12 An independent review of out-of-hours primary care services and a new approach to unplanned, urgent care was launched by the Scottish Government in January 2015. The report  was published in November 2015. It recommended a model for out of hours and urgent care in the community that is clinician led delivered by a multi-disciplinary team; thus enabling patients to be seen by the most appropriate professional to meet their individual needs.