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Report of the Joint Future Group

CHAPTER 1 INTRODUCTION

1.1 Susan Deacon, Minister for Health and Community Care, set up the Joint Future Group (JFG) chaired by Iain Gray, Deputy Minister for Community Care, to:

• agree a list of joint measures which agencies need to have in place to deliver effective services, and to set deadlines for that;
• advise on the balance between residential and home based care;
• advise on options for charging for care at home; and
• advise on how to identify and share good practice.

The Group’s remit is set out in full in Appendix 2.

1.2 Modernising Community Care: An Action Plan1 had set the agenda, not only for joint working but also the organisation and delivery of services within agencies. It had sought specifically:

• quicker and better decision-making, through delegated decision-making and financial responsibility;
• more flexible and better quality home care services, including a shift in the balance of care towards these services; and
• agencies working in partnership in localities, through better operational and strategic planning, joint budgets, joint services and joint systems.

Context

1.3 When the Scottish Executive came into being in May 1999 it was clear that the principles of Modernising Community Care were accepted, but progress on the ground was mixed. As is the case today, there were many examples of good practice in pockets, pilots or projects. But the positive outcomes, especially as a result of joint working, were not available consistently. At the seminar of leaders of councils, health boards and NHS trusts in November 1999, Ministers made clear that they were not seeking structural change, but that the status quo — in terms of joint working — would not do. A new lead was needed. The Joint Future Group was charged with providing that lead.

1.4 At the same time the expected shift in the balance of care for older people towards more care at home, first expressed in Caring for People2 and subsequently reaffirmed in Modernising Community Care, has not materialised. Indeed, it could be said that the balance has got worse. A number of factors have combined to undermine this long -standing policy objective, as discussed more fully in Chapter 3.

1.5 Community care is now far more organised than prior to 1993. But as the origins of the Group suggest, there is a long way to go if people across Scotland are to receive consistently high standards of care which match their rising expectations. We recognise that many areas of Scotland have made considerable progress, and our approach reflects that. The task for the future is to ensure that these higher standards are achieved more uniformly.

Policy Context

1.6 Community care does not stand still. The policies introduced in 1993 have been updated, expanded and refined as community care as a whole develops and improves. Modernising Community Care (together with its companion "The Housing Contribution")3 remains the cornerstone of how we want agencies to work together. But there are also major new policies, which need to be read alongside it. The Framework for Mental Health Services in Scotland, the Learning Disability Review and the Carer’s Strategy all advance significantly the way people should be supported both within and between agencies. And the development of national standards will define what users should expect from services, and influence outcomes. We have had regard to that changing agenda as we went about our work.

1.7 Planning and financial systems are also changing. Community planning offers an opportunity for comprehensive area-based planning, and to rationalise the range of plans currently produced. More generally, the Scottish Executive’s 21^st Century Government Agenda will focus much more on outcomes, on which development work is currently being progressed through pilot studies.

1.8 Best Value, which aims to secure sound governance and continuous improvement in the way agencies perform, both individually and together, is also part of the context. So too is the thinking emerging from the Strategic Issues Working Group of a new resourcing framework for local government, focusing more on the relationship between new resources and outcomes, and measures to gauge performance.

The Joint Future Group’s Role

1.9 Our task was specific. It was not to develop new policy, but to identify ways of making existing policies work better. The task was short-term and focused, and principally about statutory agencies working better together. That does not diminish the roles of or the need for joint working with the voluntary or private sectors or, indeed, people who use services and their carers.

1.10 The seminar in November 1999 underlined that responsibility for the success of community care is shared. It rests with local authorities, usually through their social work and housing departments, with health boards and NHS trusts, and with Scottish Homes. The interfaces between parts of the system - for example between acute hospital services for older people and services in the community - are often critical.

1.11 We have drawn up an action plan, mostly for the short to medium term, with timescales for implementation. In accordance with our remit, some measures relate only to services for older people; some are based on older people but extend equally to other care groups; and finally those on joint working apply across the board. We aim to make these distinctions clear in this report.

1.12 Our recommendations will deliver a step change. We have identified a challenging but fair agenda. Many of our proposals are not new: they already exist in parts of Scotland. More importantly, they have been proven to work. That is one of the strengths of our work. The measures should make a real difference to people who use services. People now deserve access to the essential services we recommend to see for themselves the benefit of joint management of services, more focused assessments, and better organised equipment services.

1.13 We believe the climate is right to offer a strong lead on some of the most important aspects of community care. We now want agencies to grasp the opportunity to make real progress, not based on theory but on sound, effective approaches that will make a real difference.

1.14 Our membership was drawn from a range of backgrounds. But in building for the future we concentrated on what is best for community care. We achieved broad consensus on our chosen way forward and presented our findings accordingly to the consultation seminars towards the end of September.

1.15 We note that the Minister for Health and Community Care’s statement on older people on 5 October included the Executive’s intention to implement a number of the Group’s recommendations, as follows:

• more intensive care at home;
• rapid response teams in every local authority area;
• free home care for the first 4 weeks after discharge from hospital;
• a shopping/home maintenance service in every area;
• more short breaks;
• joint resourcing and joint service management of services for older people.

The statement also indicated that the Executive would provide new resources to support change.

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