Context  

CF were commissioned by the Scottish government to develop a case for national investment in integrated local care. As part of this, we were asked to review the progress of three local integrated care pilots and make recommendations for how their progress could be accelerated. With our previous experience of supporting health care transformation in the West of Scotland and West Lothian, our NHS policy and clinical expertise and our experience of supporting implementation of integrated/local care systems across England we were well placed to deliver this work.    

Scotland is already committed through its National Clinical Strategy to a, “fundamental change in … hospital services and primary and community care with a shift to place based care”. Practical steps have been taken to implement this with joint health and care governance structures (Integration Authorities) overseeing local implementation and the 2018 Scottish GP contract expanding multi-disciplinary teams.  

Yet, despite clear benefits and national commitment, the pace and depth of progress has not been as fast as the Scottish government would wish with the consequence that the benefits to patient outcomes and experience, staff experience and the public purse have not yet been realised.   

Approach 

We took a whole system approach to the work, focusing on all aspects of care delivery within Scotland and how integrated care would fit, and the impact it would have. 

We focused on developing the desired clinical model for Scotland, building on an existing evidence base, whilst tailoring the interventions to those that would best suit the system. Using this extensive evidence base we were able to calculate the potential impact of implementing local care, particularly in terms of reduction in hospital activity. We examined the requirements to deliver, focusing on the workforce, the estates and the data. 

We travelled across the country to carry out in-depth interviews with the pilot sites to understand the challenges that were impeding their implementation of integrated local care.  This was combined with their responses to our in-house local care system maturity matrix. This matrix has been informed by expert clinical opinion and evidence of best practice. We conducted two workshops which brought these three ‘pathfinders’ together to share learning and challenges. Through these workshops we determined tangible actions which could be taken at a local, regional and national level to overcome these challenges.   

Based on this work we produced a set of bespoke recommendations for each of the three pilot sites for how they could speed up their integrated care implementation.   

Outcome  

Our work established that a set of clear actions need to be taken at national and regional levels to enable Scotland to deliver its policy ambition of local integrated care.   

As a result, the Scottish government is exploring our recommendation to establish a national implementation framework to deliver these actions.