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Reading: Health and Social Care Reform in Scotland: What Next?


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Health and Social Care Reform in Scotland: What Next?


Anne Hendry ,

IFIC Scotland University of the West of Scotland, GB
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Maimie Thompson,

University of Stirling, GB
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Peter Knight,

Public Health Scotland, GB
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Eleanor McCallum,

Health and Social Care Scotland, GB
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Alison Taylor,

The Scottish Government, GB
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Helen Rainey,

University of the West of Scotland, GB
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Andrew Strong

The Health and Social Care Alliance Scotland, GB
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Introduction: Much of the evidence for integrated care is based on small scale studies or specific care groups. Landmark legislation to integrate health and social care for adults in Scotland was introduced in 2014 based on a shared vision and narrative about improving outcomes for people and communities. This case study reflects on the experience of implementing reform at scale in Scotland, reports outcomes observed from 2015 to date and considers lessons for recovery post pandemic.

Methods: A documentary review of published data and reports was conducted in 2019 by a cross sector team of experts from IFIC Scotland’s Reference Network. The enablers and barriers of country-wide implementation of integrated health and social care were identified and framed according to IFICs nine conceptual pillars. The impacts of system change were based on analyses of key trends over time in publicly available health and care data using data linkage systems to reflect outcomes for population health, resource use, quality and experience of care.

Highlights: Published reports noted positive progress in collaborative working and encouraging evidence of impacts, albeit with significant local variation. Relational and citizen led approaches were considered critical for success, but system leaders and managers reported it takes time to build trusting relationships, influence organisational and professional cultures and cede power.  A constraint noted was significant turnover in key personnel in Ministerial, policy and senior management posts. Despite some frustration at the pace and scale of progress, five years on there are many examples of innovation and positive outcomes despite increasing demographic, workforce, and financial challenges. In particular, there has been a significant shift in the balance of care for older people towards care at home, avoiding institutional care costs and releasing resource for investment in community health and care support and services. However serial patient and carer experience surveys highlight a continuing need for greater continuity and coordination of care.  Relative inequalities have widened over the last decade prompting a commitment to improve community wellbeing, particularly for vulnerable populations who have experienced greater health and economic impacts from  Covid-19.


Conclusion: Implementing major reform after a prolonged period of austerity required considerable agility in coordinating multiple interdependent policies and interventions for different care groups, care settings and local context.  Assessing and attributing impacts was challenging and progress at a national level seemed slower than local experience suggests, due in part to the relative immaturity of linkable national datasets for community and primary care interventions.  Realising and evidencing the true value from integration will require a stronger focus on implementing place-based prevention and early intervention supported by data linkage systems for community and citizen level data.  

Implications: The pandemic has accelerated local collaboration and enhanced capability to facilitate system changes at unprecedented speed.  Careful reflection and analysis of this recent experience is required to fully understand the respective contributions of people, communities, organisational structures, processes and enabling technologies. This case study offers insights for those seeking to reflect on integrated care policy implementation at this pivotal time for integrated systems.
How to Cite: Hendry A, Thompson M, Knight P, McCallum E, Taylor A, Rainey H, et al.. Health and Social Care Reform in Scotland: What Next?. International Journal of Integrated Care. 2022;22(S3):319. DOI:
Published on 04 Nov 2022.


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