Methodology and legislative context

Legislative context

The Public Services Reform (Scotland) Act 2010 places a duty on a range of scrutiny bodies to cooperate and coordinate their activities with each other, and to work together to improve the efficiency, effectiveness and economy of their scrutiny of public services in Scotland. Healthcare Improvement Scotland has been working in partnership with the Care Inspectorate and under the direction of Scottish Ministers to deliver joint inspections of services for adults since 2013.

The Public Bodies (Joint Working) (Scotland) Act 2014 also sets the legislative framework for integrating adult health and social care. Health and social care services need to be integrated to ensure that people have access to the range of services and support they need, their care feels seamless to them and that they experience good outcomes and high standards of support. This is particularly important for the increasing numbers of people with multiple, complex, long-term conditions in Scotland. Since April 2017, the Care Inspectorate and Healthcare Improvement Scotland have had joint statutory responsibility to inspect and support improvement in the strategic planning and commissioning undertaken by integration authorities under Sections 54 and 55 of this Act.

Ministerial Strategic Group recommendations

In February 2019, following a review of progress with integration, the Ministerial Strategic Group (MSG) for Health and Community Care made a series of proposals to ensure the success of integration going forward. In regard to scrutiny activity, the MSG asked that joint inspections should better reflect integration. Specifically, the Care Inspectorate and Healthcare Improvement Scotland will ensure that:

• Strategic inspections are fundamentally focused on what integrated arrangements are achieving in terms of outcomes for people.
• Joint strategic inspections examine the performance of the whole partnership – the Health Board, Local Authority and Integration Joint Board (IJB), and the contribution of non-statutory partners – to integrated arrangements, individually and as a partnership
• There is a more balanced focus across health and social care in strategic inspections

Revised approach to joint inspections of services for adults

In response to the MSG recommendation, the Care Inspectorate and Healthcare Improvement Scotland put forward a proposal to the MSG in February 2020 outlining the planned approach for the next phase of joint inspections, which would seek to address the following question:

How effectively is the partnership working together, strategically and operationally, to deliver seamless services and contribute to good health and wellbeing outcomes for adults?

We already have an established joint inspection methodology, which we have continually developed following learning from inspections of services for older people (2013-2017) and joint inspections of strategic planning and commissioning processes (2017-2019). We built on this methodology, and the existing tools, augmenting and revising where necessary.   

The underpinning Quality Improvement Framework (QIF) was updated to reflect the shift in focus from strategic planning and commissioning to include more of a focus on peoples’ experiences and outcomes. The quality illustrations in the QIF have been developed in the context of, and illustrations built around the requirements in, the national health and well-being outcomes framework, the integration planning and delivery principles, the MSG recommendations and the national health and social care standards. 

Adapting to circumstances

The next phase of inspection activity recognises the impact COVID-19 continues to have on HSCPs. It is important that scrutiny activity is robust and reintroduced in a timely way. Scrutiny approaches and activities will take cognisance of the continued impact of the pandemic and pressure on services as they transition from emergency response to recovery.

We have worked hard to ensure that the methodology remains robust. Therefore, we’ve reduced the length of our inspections though they remain based on the established methodology and tools used across the joint inspection programme. We will conduct inspections remotely for the short to medium term while optimising the value to services from the inspection process, findings and recommendations.

The thematic approach explained

We will conduct a rolling programme of themed inspections, scrutinising how integration of services positively supports people’s experiences and outcomes. 

It is important to note that these thematic inspections are not scrutinising the quality of specialist care for each care group;  identifying and talking to groups of people with similar or shared experiences will allow us to understand the  health and social care integration arrangements that resulting in good outcomes. A strong focus of the inspection will be to talk to people who use health and care services to understand how integration is supporting them to do what is important to them. 

In this way, we are looking at integration through the lens of different care groups which taken together will in time build a picture of what is happening in health and social care integration and how this is experienced by people and the outcomes achieved. 

For the first set of inspections in the 2022-23 year, the theme was people with physical disabilities and complex needs aged 18-64.  

For the inspections in the 2023-24 year, the theme is people with mental health needs aged 18-64. The reasons for choosing this theme are that: 

• The previous three rounds of joint inspection focused on physical disability, strategic planning and services for older people respectively
• There is a clear and long-standing evidence base that outcomes for this group are significantly improved through integrated health and social care
• It provides an inspection scope to allow an effective balance between health and social care functions delegated to integration authorities; prevention/early intervention and more intensive support; and the role of third and independent sector partners 

What partnerships can expect

Our inspection of each partnership will identify how integrated arrangements are supporting positive outcomes or where improvement is needed. The partnership can also use the QIF to carry out their own self-evaluation if they choose.

In this inspection, we are primarily looking at people’s experiences and outcomes in a two year period that encompasses the period of the coronavirus pandemic. This is not a pandemic-specific inspection programme. We are however mindful of the impact of the pandemic on the delivery of services and on people’s experiences. The inspections and the subsequent published reports will take into account and reflect the context in which health and social care partnerships have been operating since the onset of the pandemic in March 2020.

The joint inspection process and reports will contribute additional assurance and value to partnerships’ internal performance management, joint working, and quality assurance processes, while focussing on outcomes experienced by people.

Resources to support you