49. Scotland

This case study provides a brief overview of the NHS in Scotland and in particular NHS Highland, including the relevant health and integration policy context. NHS Highland is responsible for the largest health board area in the UK and includes some of the most remote and rural parts of the country. In March 2012 NHS Highland was the first health board in Scotland to integrate health and social care when they signed a formal partnership agreement with the local authority (The Highland Council). Under the new arrangements—known as the lead agency model—in April 2012 all adult social care services were transferred to NHS Highland from the Highland Council. This brought together for the first time within one organisation, community, primary, social care and acute services. The legal, financial and management implications of the lead agency model are explained. Benefits of new ways of working are considered and some of the lessons learned explored. The potential pit-falls in demonstrating direct impacts in such a new complex operating environment, especially in the short-term, are also considered.