This document discusses integration within the NHS Scotland healthcare system from the perspective of Derek Feeley, Director of Healthcare Policy and Strategy for NHS Scotland. It notes that NHS Scotland serves a population of 5 million people with integrated and unified boards. It highlights differences between legislation governing the NHS in Scotland and England, and outlines NHS Scotland's approach of promoting continuous, team-based, and preventative care that is integrated both within communities and across clinical, financial, and cultural levels. The rationale for integration includes aligning with patient-centered values and allowing flexibility to shift resources for innovation. Benefits of integration include aligned incentives, easier navigation for patients, and enabling whole system approaches.

1. Different routes to integration….
A perspective from Scotland
Derek Feeley
Director of Healthcare Policy and Strategy
NHS Scotland
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2. NHS Scotland
• c. 5 million population
• Spend £1788 per
head
• Devolved (since
1999)
• 14 Unified Boards
• Integrated system
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3. 3

4. Deprivation
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5. Spot the difference….
National Health Service Act 2006
• Secretary of State’s duty to promote health service
• (1) The Secretary of State must continue the promotion in
England of a comprehensive health service designed to secure
improvement—
• (a) in the physical and mental health of the people of England,
and
• (b) in the prevention, diagnosis and treatment of illness.
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6. And this…?
National Health Service (Scotland) Act 1978
General duty of Secretary of State.
(1) It shall continue to be the duty of the Secretary of
State to promote in Scotland a comprehensive and
integrated health service designed to secure—
(a) improvement in the physical and mental health of
the people of Scotland, and,
(b)the prevention, diagnosis and treatment of illness,
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7. 7

8. Better Health Better Care
The future model of health care – shifting the balance
Current view Evolving model of care
Geared towards acute conditions Geared towards long-term conditions
Hospital centred Embedded in communities
Doctor dependent Team based
Episodic care Continuous care
Disjointed care Integrated care
Reactive care Preventive care
Patient as passive recipient Patient as partner
Self care infrequent Self care encouraged and facilitated
Carers undervalued Carers supported as partners
Low tech High tech
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9. Towards a Mutual NHS
• Strengthen public ownership by
strengthening rights to participate
–Public Partnership Forums
–Patient experience
–Patient Rights
–Board elections
–Participation standard / ownership
report / independent scrutiny
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10. Mutuality and Integration
“We intend to ensure that NHS Scotland
is based on a mutual ethos. This will
not involve changes to the financial
arrangements of the NHS. Neither
will it require structural change. On
the contrary, it is entirely consistent
with our existing approach of
integrated care, based on the values
of co-operation and collaboration
through unified Boards.”
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11. 4 ways to deliver public services
(LeGrand 2007)
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12. Rationale for integration
• Consistency with;
• political requirements
• patient centred approach
• values/ (equity, universality)
• mutuality
• emphasis on professional networks
• need to position healthcare as part of
wider public service reform.
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13. All cause death rates, M 0-64, 2001
Glasgow City
Inverclyde
West Dunbartonshire 30%
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14. Integration at a number of
levels
• System
• Community
• Clinical
• Financial
• Culture and ethos
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15. System Integration
• Unitary Health Boards
• No purchaser/ provider split
• Clear and consistent accountabilities
• Duty to collaborate
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16. Community Integration
• Community Planning
• Community Health Partnerships
• Shared Budgets
• Single Outcome Agreements
• Elected Boards
• Participation standard
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17. Clinical Integration
• Managed Clinical Networks
• Community Resource Hubs
• Team Based care
• eHealth
• Health and Healthcare
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18. Financial Integration
• Unhypothecated budgets
• Independent budget allocation formula
• Freedom to shift resource
• Contractual alignment
• Collaborative contracts
• Managed Service Networks
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19. Culture and ethos
• Clear and shared vision
• Going with the flow
• Values professionalism
• Challenges appropriately
• Transparent
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20. Benefits of integration
• Buy in/ Shared goals
• Easier for patient to navigate and for
the public to participate
• Aligned incentives
• Whole system approaches enabled
(resources for innovation and
collaboration)
• Easier to work across boundaries
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21. Lessons learned
• Integration is a means to an end
• Beware of silos
• Integration is not the “soft option” – it
has to work as well as the alternatives
• People are the key – policy only
creates the right environment
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