Understanding health and social care

Healthcare is increasingly integrated with social care as part of a national commitment to person-centred care. These are the current structures that deliver, plan and oversee this work (Figure 1).

• Health and Social Care Partnerships (HSCP): There are 31 of these across Scotland and contain the NHS and local council (aka Local Authority) for that area. They are responsible for adult social care, primary health care, and unscheduled adult hospital care. Some are also responsible for children’s services, homelessness and justice social work.
• Integrated Joint Boards (IJB): The body responsible for the actions of the HSCP. Has voting and non-voting members for decision-making. All voting members are either Local Councillors or Non-Executive Directors from the local NHS Health Board. Non-voting members include carer and service user representatives, as well as from staff, finance and other areas of HSCP specialty.
• Locality Planning Groups: There to support service planning for the HSCP. They have a wider group of participants with more community members and people who deliver supports and services in the area.
• Care Inspectorate, Healthcare Improvement Service and Mental Welfare Commission: Key regulators that oversee health and social care work in Scotland.
• In development – National Care Service: In progress since 2022, this is a new body that looks to bring healthcare and social care even closer.

The Scottish Parliament has power to make laws on a range of issues known as devolved matters. Some issues that have a UK or international impact remain the responsibility of the UK Parliament alone. These are known as reserved matters. Healthcare is a devolved matter and, therefore, the responsibility of the Scottish Parliament.

Policies are documents that set out what needs to be delivered. They are created through research that looks at the information from local services, the demographics of an area. and the feedback from people who use these services.

The Health & Social Care Partnerships will follow and deliver on these policies, including:

• Scottish Government’s Mental Health Strategy 2017-2027
• Scottish Government’s Creating Hope Together: Suicide Prevention Strategy 2022-2032
• Scottish Government’s Self Harm Strategy and Action Plan 2023-2027
• NHS Recovery Plan: this sets out the agenda for transformation in Primary and secondary care in relation to MH support
• Local HSCP Strategy: These are regularly refreshed and must go to the Scottish Government to be reviewed.
• Local Specific Mental Health Strategy: Each area will have either a separate or combined mental health specific strategy.

Policies and plans are founded on the legal needs of HSCPs. They help them meet the minimum requirement in what has been laid down in law around services and supports. Mental health related policies and legislation include the following, but there are many more on specific topics like justice and housing.

• Mental Health Act
• Adults with Incapacity
• Carers Act
• Equality Act (2010)
• Public Bodies (Joint Working) (Scotland) Act 2014 ("the Act")
• Human Rights
• Core Mental Health Standards

There are also practice guidelines that HSC professionals work to; for example, SIGN (Scottish Intercollegiate Guideline Network) and NICE (National Institute for Health and Care Excellence). These include a wide variety of topics, from cancer treatment to support for eating disorders.

Tip!: You can sign up to the Scottish Parliament newsletter and consultation web page if you are keen to influence at this level. Policies and practice guidelines are usually developed in consultation with the public and/or professionals.

Unfortunately, the reality of health and social care in Scotland does not match the ambition of the legislation and policies laid out by Scottish Government. In some areas integration is working well and in others there is much progress to be made. This compounds the impact of intersectional stigma and discrimination experienced by those using services. Health and social care ALLIANCE have a number of campaigns focused on change in this area.