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Inspecting integrated health and social care in Scotland: A journey of transformation in scrutiny, assurance and improvment


Kevin Mitchell ,

Care Inspectorate, Scotland, GB
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Helen Happer,

Care Inspectorate, Scotland, GB
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Fidelma Eggo

Care Inspectorate, Scotland, GB
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Inspecting to provide public assurance and support improvement in a complex and evolving integrated health and social care landscape is challenging. The Care Inspectorate and Healthcare Improvement Scotland (HIS) have developed new ways of working, breaking down barriers from differing cultures, priorities and approaches between these two large inspection bodies. This is the journey so far and the aspirations we share to transform approaches to inspection and improvement so that we add value and help improve outcomes for people. 

The road to health and social care integration has been long. The Joint Future agenda in 1990s eventually led to formal integration under The Public Bodies Joint Working) (Scotland) Act 2014. This Act required Health Boards and Local Authorities to delegate all adult social care services, primary care, community health and some hospital services to Integration Authorities. Legislation extended the remit of the Care Inspectorate and HIS to inspect the planning, organisation and co-ordination of the delegated services.  These inspection bodies had to work together to develop the methodology and carry out joint inspections. The aim of these joint inspections is to provide independent assurance, support improvement and innovation and improve experiences and outcomes for people.

The scrutiny and assurance approach developed is focussed on services for adults including older adults.

Highlights include:

Development and delivery of a joint and fully integrated EFQM based approach to inspection. This included shared approaches to quality assurance of the inspection process and public reports. This new model of inspection focusses on leadership, strategic commissioning and performance.  It was applied in three Integration Authority areas in 2017-2018.

Publication of jointly developed Health and Social Care Standards (2017) following a wide consultation and engagement process. 

Effective teamwork with interchangeable inspection leads, drawing on the skills, knowledge and experience of both organisations. Shared resources including inspection support functions of planning, intelligence gathering and analysing and synthesising inspection evidence. A fully accessible web-based secure shared electronic workspace.

A commitment to continuous review and development of our processes, methodology, team working and leadership of inspections. The new model of inspection was revised for 2018-19 building on lessons learned from completed inspections, after action reviews and feedback from the integration authorities inspected. Joint training was delivered and a quality assurance group established to support inspection improvement. 

An increasingly integrated approach to improvement support for Integration Authorities post-inspection drawing on improvement methodology and expertise from both organisations.

The issues faced in Scotland are likely to be similar wherever health and social care is moving towards more integrated models of planning and delivery. The challenges, and solutions found, in  bringing together different scrutiny bodies each with different organisational structures, cultures, focus and priorities may be applicable to others called upon to inspect integrated services in an integrated way.     

Developing clear leadership, shared resources, joint training and collaborative

working brings challenges, but also exciting opportunities for increasingly

integrated approaches to inspection and improvement in adult health and social

care to improve experiences of, and outcomes for people.

How to Cite: Mitchell K, Happer H, Eggo F. Inspecting integrated health and social care in Scotland: A journey of transformation in scrutiny, assurance and improvment. International Journal of Integrated Care. 2019;19(4):290. DOI:
Published on 08 Aug 2019.


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