Single Authority Model - Presentation / Evaluation of Options
Argyll and Bute Council · 1 September 2025
Back to Single Authority Model Short Life Working Group — 1 September 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Single Authority Model Joint Short Life Working Group
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Single Authority Model –Key Points • Looking to build on successes associated with a fully integrated health and social care system in Argyll and Bute • Presents an opportunity to extend this to a whole system approach, going further than clinical and care services • Support a wider place-based approach and needs taking into account the unique nature of Argyll and Bute • Support public sector collaboration in retaining and developing the associated workforce in the area • Needs to be considered in context of wider public sector reform agenda
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Background • Argyll and Bute is made up of a rich mix of remote, rural and island communities,which presents a number of challenges in terms of service delivery • There are 23 inhabited islands in Argyll and Bute more than any other local authorityin Scotland, representing 17.5% of the area’s population • Increasing demand and needs spread across a diverse landscape • Decreasing working age population • Council recently declared a housing emergency in Argyll and Bute • Greater integration, collaboration and coordination through joined up strategicplanning and delivery of public sector services could deliver better outcomes for the population of Argyll and Bute • In addition look to strengthen local democratic input to delivery of public sectorservices, enhancing community engagement and empowerment.
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Local Government Context • Local Governance Review was launched jointly by COSLA and the Scottish Government in December 2017 (Democracy Matters) to explore how power, responsibilities and resources might be shared across ‘spheres’ of government and with local communities • COSLA’s Plan (2022-2027) confirms that the Local Governance Review remains a key priority, and supports the following three inter-related empowerments as set out by the Scottish Government: • Community Empowermentthrough a new relationship with public services where communities have greater control over decisions. • Functional Empowerment of public sector partners to better share resources and work together. • Fiscal Empowerment of democratic decision-makers to deliver locally identified priorities. • Programme for Government: • 2024-2025 -‘continue to make progress towards concluding the joint review of local governance by the end of this parliamentary session’ • 2025-2026 -Preferred models for Single Authority Models in Argyll and Bute, Orkney and Western Isles that have been developed jointly by local government and health and enable a shift towards prevention. This will include a plan and timeline for implementation, with at least one area transitioning to shadow arrangements
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Public Sector Reform Strategy Health and Social Care Service Renewal Framework
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Scotland’s Population Health Framework
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Delivering better outcomes • The Christie Commission Principles: delivering better outcomes through: • People:Reforms must aim to empower individuals and communities by involving themin the design and delivery of the services • Partnership: Public service providers must work more closely in partnership, integratingservice provision to improve their outcomes • Prevention:Expenditure must be prioritised on public services which prevent negativeoutcomes • Performance:The public services system – public, third and private sectors – mustreduce duplication and share services to become more efficient • Greater integration, collaboration and coordination through joined upstrategic planning and delivery of public sector services could deliver better outcomes for the population of Argyll and Bute
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Options being explored (1) The following 5 options have been considered since the outset of the process:- 1. Status Quo This option would be a continuation of the current structures with the retention of the Health and Social Care Partnership with governance through the Integrated Joint Board. This option provides continuity, but offers limited options for shared services/efficiency savings, and doesn’t offer any change from the challenges currently experienced by partners. 2. Community Planning Plus This model would be based on the current Community Planning Model and would maintain separate organisations. It would give the opportunity to pool budgets and share resources, but employees and structures would remain separate. It would build on the provisions of the Community Empowerment (Scotland) Act 2015.
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Options being explored (2) 3. A New Integrated Authority This model would establish a new elected single legal entity which would have fully integrated service budgets, providing the opportunity for resource efficiencies and more shared services, and would be empowered by elected status to give clear and accountable leadership. The Authority would create specific Boards or Committees which would provide the governance and decision-making structures required to ensure that resources and services are managed effectively. Under this model, the Council would no longer exist and Council staff (as well as the staff from other partner organisations falling under the umbrella) would need to be moved over to the employment of the new Integrated Authority. This could lead to concerns about loss of identity, particularly for NHS staff. This type of model would require a significant change to structures across most, if not all, public bodies. It would also require a new scheme of public sector primary legislation to enable implementation.
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Options being explored (3) 4.A Fully Empowered Local Board The starting point for this model would be strengthening the IJB and the functions delegated to it by partners (Council and NHS Highland). It could initially build on the existing synergies and effective partnership working demonstrated to date. However, in an Argyll and Bute context, the maximum functions permissible under the 2014 Act have already been delegated to the IJB. As such, in order to build on existing successes of integration and go any further, the 2014 Act would need to be amended, or new primary legislation required, to expand the functions that could be delegated beyond health and social care (but with similar governance structures to the HSCP/IJB). For example, a statutory housing partnership, further/higher education partnership, enterprise partnership etc… However, if new statutory partnerships were created for all those service areas it is appreciated this might result in a complex landscape of partnerships/boards, making it difficult for the public sector and public to navigate.
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Options being explored (4) 5.Single Authority Partnership This model could be considered as a variant of the traditional Lead Agency arrangement (in place within Highland) under the banner of a “Single Authority Partnership”. This could take effect by conducting a review of the current Integration Scheme (Under Section 45 of the 2014 Act), preparing a new Integration Scheme (under Section 47 of the 2014 Act), and subsequently through the use of Directions (issued under the 2014 Act). Under such a Strategic Lead Agency arrangement, there would be no transfer of staff – only functions and resources. Under these terms the Health Board would delegate all functions and resources to the Council, as Lead Agency, which could then:- • redesign back office and business functions to secure maximum efficiency through a process of aggregation (e.g. the two asset management services coming together); • provide direction back to the Health Board to deliver its functions in accordance with a Strategic Plan conceived to deliver maximum functional integration alongside Council services; and • provide direction to the Health Board to devise operational arrangements that promote a single delivery agency. In practice, a Health and Social Care Board or Committee could become the engine room for health and social care delivery, with a membership similar to the IJB if this was desirable - local Elected Members, NHS Non-Executive Directors, professional leads, carers, third sector, etc.
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What are the possibilities? Incremental approach to realising significant transformation in delivering better outcomes?
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Evolution vs revolution • Option 4 references expansion of IJB model and examples such as ‘Statutory Housing Partnership, Further Education Partnership, and Enterprise Partnership’ • Option 2 –wider partnerships through community planning • Option 3 and Option 5 would involve significant structural change • Are there options we have not included or thought of? • Could an iterative approach be adopted?
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What are the benefits of change? • Several examples provided demonstrating success of health and social care integration through current model for the Argyll and Bute HSCP • What are we trying to achieve through a SAM that would add to this success? • What is working well? • Even better if?
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Impact (5+ years) High quality services aligned to local needs and priorities, sustainable for the long term. Services that support prevention rather than responding to crises. People trust in key decisions relating to the design and delivery of local services. Stronger and more participative local democratic systems and processes. Communities able to control and influence decisions over those issues that affect them most. Further decentralisation of power to sub-LA level. Changes support wider commitments in Local Governance Review to transform community level decision-making. Island communities more attractive as a place to live and work. Services are efficient and effective and focus on key priorities (including housing and jobs where people need them to help address depopulation). Improved population health and wellbeing. Improved healthy life expectancy, more people supported to stay at home, reduced levels of delayed discharge etc. Reduced social, economic and health inequalities. Integrated and targeted person-centred approaches Governance is streamlined and simplified, and savings are reinvested. Resources are pooled and shared in order to re-design services around the needs of local people. Full realisation of financial savings. Reinvested in prevention, infrastructure and other priority areas.
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OutcomesMedium term (3-5 years) Greater democratic participation. People are more likely to take part if they can influence decisions most important to them ( voting turnout, participation in local meetings, responding to consultations etc). Services are person centred. Increased flexibility via pooling of budgets. Services start by considering the needs of the individuals and are not constrained by organisational boundaries (including innovative and individualised care plans etc). Ongoing expansion of SAM model. To incorporate a wider range of sectors over time (including HE / FE and Housing etc). Short term (1-2 years) Greater confidence in ongoing service sustainability. Reduction in bureaucracy as result of streamlined governance with resource redirected to delivery. Efficiencies across existing organisational structures. Actions resulting in financial savings outlined in delivery plan implemented. Remove duplication between services and reduced costs (shared IT, procurement and HR functions). Decisions about the design of key services are made at a local level. People making decisions about services (health & social care, housing, transport, childcare etc) understand the needs of local communities. Services work better together to meet local needs / priorities (production of joint plans and strategies etc). Improvements in population health. Improvements in drug and alcohol outcomes, reductions in key medium-term outcomes relevant to health-related inequalities (e.g. child development inequalities) and mental health improvements Integrated service planning improves responses to demographic change. Investment in prevention is incentivised. Overtime savings from reduced demand and efficiencies can be re-invested. Statutory services are delivered collectively. Organisations work together creatively to deliver services Optimisation of financial opportunities. Financial savings reinvested.
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Other factors not covered… • Does the model allow for • The protection of Council and NHS identity/brand and protection for professional status and governance • Staff to remain on current terms and conditions, or would TUPE be required? • Does the model provide flexibility to expand the scope? • Does the model allow forthe parameters provided by Scottish Government officials
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Parameters overview Clinical Governance: Health bodies and integration authorities will retain their respective responsibilities for clinical governance Staff Governance The process of developing local proposals must consider health boards’ responsibilities as employers, notably in relation to staff governance and partnership working. Health matters that are not devolved Matters such as professional regulation are addressed at UK level. Anything that falls within this category is out of scope for single authority models. Primary Care: Independent Contractors Scottish Government will retain responsibility for development of current and future national policy and strategy relating to Primary Care to ensure universal coverage while fostering local population needs assessments to shape aspects of local delivery
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Parameters continued Accountability to Scottish Ministers As Scottish Ministers will retain overall responsibility for health service provision, suitable lines of accountability to Scottish Ministers must remain in place. NHS Renewal Any proposals for SAMs must fully reflect the outcomes and principles that are set out in the NHS Scotland Operational Improvement Plan in March 2025. The Population Health Framework and Service Renewal Framework. Legal and Financial Frameworks “Accountability” section of the Scottish Public Finance Manual explains that accountable officers should approve in advance all significant initiatives, policies, programmes and initiatives. They must conduct an Accountable Officer assessment against four standards: • Regularity • Propriety • Value • Feasibility for money The arrangements for the commission, submission and agreement of financial plans and financial reports, following the same schedule as the rest of the NHS, would need to remain in place.
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Other factors to consider • Local place based planning and delivery of services combined with regional and national planning delivery to deliver better outcomes: • what health and care services may achieve better outcomes through planning and delivery at local, health board, regional or national level • what are the options for organisational efficiencies across organisational boundaries at local, health board, regional or national level
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What are the benefits? • Several examples provided demonstrating success of health and social care integration through current model for the Argyll and Bute HSCP • What are we trying to achieve through a SAM that would add to this success? • What is working well? • Even better if? • How do each of the current options (or new options) align with building on success? • What are the risks of each of the options?
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Optl 2. Community Plan Plus 3. INew Integrated Authority 4. IFully Empowered Local Board 5. Single Authority Partnership Bar-.afb Positive Neutral or unknown Negative ■ncadloc■ Eflicl Rllllal Minimal risk Moderate or unknown risk Significant level of risk
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Decisions and next steps • An appraisal of the options by Senior officers has identified options 4 and 5, at this stage, as the two preferred options for an Argyll and Bute SAM • Recommendation from joint SLWG to September Board and Council meetings to endorse an option • Progress engagement activity (staffside and community) • Develop detailed proposals