Abstract
Introduction:This paper analyses the important enablers, barriers and impacts of country-wide implementation of integrated health and social care in Scotland. It offers insights for other systems seeking to advance similar policy and practice.Description:Landmark legislation was based on a shared vision and narrative about improving outcomes for people and communities. Implementation has involved coordination of multiple policies and interventions for different life stages, care groups, care settings and local context within a dynamic and complex system.Discussion:Relational and citizen led approaches are critical for success, but it takes time to build trusting relationships, influence organisational and professional cultures and cede power. Assessing national impacts is challenging and progress at a national level can seem slower than local experience suggests, due in part to the relative immaturity of national datasets for community interventions. Five years on there are many examples of innovation and positive outcomes despite increasing demographic, workforce, and financial challenges. However, inequalities continue to increase.Conclusion:Realising the true value from integration will require a stronger focus on place-based prevention and early intervention to achieve a fairer Scotland where everybody thrives. Solidarity, equity, and human rights must guide the next phase of Scotland’s story.
Highlights
This paper analyses the important enablers, barriers and impacts of country-wide implementation of integrated health and social care in Scotland
It does not purport to be an independent academic evaluation. It presents the experience of expert stakeholders in developing and implementing national policy for integrated health and social care and a critique of the related enablers, barriers, and impacts
Various published insights on Scotland’s integration story describe critical issues of leadership, culture, workforce, difficulties with demonstrating impact and managing a challenging financial context [22, 31, 39, 44, 64, 65, 102, 103]. From analysis of these reports and reflecting on our accumulated wisdom as expert stakeholders collaborating in developing and implementing this policy reform for over a decade, we offer five key lessons for other systems considering similar reform: 1. Engage and Involve: Start with the ‘why’ and coproduce a compelling vision about improving lives and creating a better, more sustainable future
Summary
Relational and citizen led approaches are critical for success, but it takes time to build trusting relationships, influence organisational and professional cultures and cede power. Assessing national impacts is challenging and progress at a national level can seem slower than local experience suggests, due in part to the relative immaturity of national datasets for community interventions. Five years on there are many examples of innovation and positive outcomes despite increasing demographic, workforce, and financial challenges.
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