Modernising community care: an action plan

Modernising community care: an action plan

Chapter 6 New powers for joint working

Removing barriers to working together

"Agencies and professionals should have the powers they need to commission and provide suitable cost-effective services."

6.1 Agencies are getting better at working across boundaries. But this chapter looks ahead at whether we need new powers to support this. Any changes would depend on decisions by the Scottish Parliament.

6.2 We want to make sure that agencies and professionals have the powers they need to commission and provide suitable cost-effective services and accommodation. Increasingly this means more than one agency being involved. A vulnerable person should not be more vulnerable because more than one agency is involved. In fact if we target services to meet particular needs, each person should receive better care. Unfortunately, this is not always the case.

6.3 There are already many mechanisms which allow the NHS, local authorities, and others such as Scottish Homes to use their financial resources to achieve shared aims. They already have a legal duty to co-operate and to plan together, and wide powers to spend money on relevant services which are consistent with jointly-agreed community care plans and strategies for particular care groups. Health Boards can make grants to voluntary organisations, supply goods and services to local authorities, and transfer money to local authorities to help support people moving from NHS care. Some resources, such as from the sale of property, can also be used to provide funding for housing if this is agreed locally.

Potential new powers

6.4 Statutory organisations are already able to co-operate, jointly fund services and transfer resources. But they want to be confident that new and effective care solutions will not be legally challenged. We would like views on areas where extra powers may be necessary to encourage co-operative working. Are there barriers to pooling budgets? Would it be useful for one agency to take the lead on managing a particular service? Would more integrated service providers make for better care results? And should local authorities have powers to make payments to health boards? Some of these questions are discussed below.

Pooled budgets

6.5 Local authorities and health boards already jointly finance services by pooling some resources. If they want to formally pool budgets, this would take joint commissioning, joint purchasing and joint services to a higher level by allowing pooled resources to be used for any care purpose. Do health boards, NHS Trusts and local authorities see any barriers to pooling budgets which might be removed by bringing in new powers?

Lead commissioning

6.6 Lead commissioning would allow one agency to transfer funds and functions to another to take full responsibility for commissioning health and social care. For example, the NHS might take responsibility for all mental health services in an area, or social work for people with learning disabilities. Do local authorities and health boards want to have lead commissioning powers? And should any proposed transfers of roles or resources be formally approved by the Secretary of State?

Integrated care service providers

6.7 Would people receive more consistent and suitable care packages if the existing powers were widened? This might allow NHS Trusts to provide some social care beyond their currently limited scope, and local authorities to provide some community health services (for example chiropody, physiotherapy, occupational therapy). Should the Secretary of State set conditions for using these powers?

Changes within housing

6.8 We have made clear we want councils to develop their relationship with other agencies to help meet the housing and social care needs of their communities. Most local authorities already have strategic agreements with Scottish Homes and many work closely with other housing providers such as housing associations. More generally, we are encouraging local authorities to develop new housing partnerships with tenants and the private sector to promote good quality rented housing in Scotland. These partnerships can take a variety of forms including transferring housing to alternative social landlords. The local authorities then enter into agreements with these new landlords to make sure that housing is available to meet community care needs.

6.9 We would welcome views on extending pooled budgets and lead commissioning to include housing with health and social work agencies. We would also welcome views on how to secure firm agreements on linking capital and revenue funding for supported housing.

Charging for care services

6.10 All the proposals in this action plan are based on the principle that NHS services are free and social work services may be charged for. Wherever there are joint care services, there will need to be clear understandings about charging.