This issue of Healthcare Quarterly includes the second of a three-part series developed by Ontario’s The Change Foundation featuring international perspectives on health service delivery models that improve system integration and ensure seamless services and better coordination. Part 1 featured Chris Ham, chief executive of the London-based King’s Fund think tank. In this issue, Geoff Huggins, director for Health and Social Care Integration in Scotland, discusses Scotland’s experience and lessons learned after legislating integrated health and social care in 2015.
We want to ensure that adult health and social care services are firmly integrated around the needs of individuals, their carers and other family members; that the providers of those services are held to account jointly and effectively for improved delivery; that services are underpinned by flexible, sustainable financial mechanisms that give priority to the needs of the people they serve rather than the needs of the organizations through which they are delivered and that those arrangements are characterized by strong and consistent clinical and professional leadership.
Nicola Sturgeon, Member of the Scottish Parliament, Deputy First Minister and Cabinet Secretary for Health and Wellbeing, December 2011
Ontario’s current moves toward integrating healthcare reflect an understanding that the well-being of its citizens is determined by a dynamic mix of circumstances, including family history, employment, income and personal relationships. Yet the services the province offers to support those lives – notably its systems for social welfare and healthcare – are rigidly designed and operate separately, even when providing help to patients and caregivers who need services from both. Scotland, once in the same situation, is changing that with a bold plan for integrating health and social care that has lessons for Ontario and Canada as we look to align how we provide care with how people live.
To share some of those lessons, Geoff Huggins (director for Health and Social Care Integration in Scotland) was invited to speak at The Change Foundation’s Toronto office in late 2017. Huggins was the second health leader from the UK to speak at a series of meetings on integrating care organized by The Change Foundation with partners from the University of Toronto: the Institute of Health Policy, Management and Evaluation, the Health System Performance Research Network and the Dalla Lana School of Public Health.
For generations, Scottish life expectancy was comparable to that of its neighbours, but it has been losing ground since the 1960s, a trend researchers have attributed to growing socioeconomic disparity (Dodds 2014). A 2014 report from the Scottish government said the country has “long standing problems of health and well-being,” ranking last for life expectancy among 16 Western European countries (Burns 2017).
In the face of clear indications of worsening health, and after many years of focusing care on complex chronic conditions and multimorbidity, Scotland officially launched integrated health and social care, with legislation that came into effect in April 2016. The law created 31 “Integration Authorities,” further subdivided into 101 “localities.” The structure puts heavy emphasis on local action for local needs (Scottish Government 2018).