Chamber and committees

That sounds positive. I hope that that is the case.

When it comes to the word “efficiency”, one of my thoughts is that, certainly when I was in the care sector, there was a move from smaller to larger care homes. Certainly, some third sector care homes and others are quite small. One means of efficiency is to close the smaller care homes and have much bigger ones. Glasgow has tended to go down that route. Is that part of your thinking as well, or is that separate?

While we are on the subject of the national care board, has there been a decision about whether that will be a legal entity, a public board on its own or some other type of body?

Do you expect the NHS and the local council to hand over a sum of money to the local integration authority, such that the authority then has complete freedom over what it does with it, or are we expecting both the council and the NHS to take a hands-on approach, especially as to how money is spent but on other things, too? Would the national care board have any involvement in spending and so on?

So there will still be room for a bit of variation around the 31 integration authorities. Presumably, the way that Shetland does things and the way that Glasgow does things will always be slightly different.

There is something that I noticed in the programme business case that I do not think we got round to discussing on Tuesday. It says:

“Another key area of benefits resulting from the NCS is the possibility of efficiency savings.”

What kind of efficiency savings would there be? Does that involve the third sector and the private sector, too?

One of the answers that we had on Tuesday was that we would better understand unmet need, and I think that you are confirming that. I am a little surprised that we do not know what that need is. For example, I guess that some people who are at home need to be in a care home but that there is no budget or space for that.

Okay, so there are two different kinds of unmet need, in a sense: the one that we know about and the one that we do not know about.

Are the third sector and the private sector involved in that discussion?

The convener touched on various areas, and I want to explore the integration authorities a little more.

This might be my ignorance, but a lot of terms are floating around. We used to talk about integration joint boards; in Glasgow, we talk about the health and social care partnership; and now we are talking about an integration authority. Are those just three different names for the same thing?

Okay—that is helpful. I will probably explore that on my own at some future point.

Some of the points that have been made refer back to the way in which funding has worked for integration joint boards or integration authorities. Sometimes, it seems that the council and the health board have put in funding and then almost taken it back. There is a suggestion—if I can find the wording—that it is an almost circular process. At one point, the business case document says:

“funds were ceded to IAs and then largely given back to the hosts”.

At another point, it says:

“In practice much of the funding appears to be ‘circular,’ with funding allocated to the IJB from the local authority and health board, which then directs it back to the local authorities and health boards (and Health and Social Care Partnerships)”.

Will the new system work better? Will there be better integration? On the one hand, integration is a good thing, but it can also make it difficult for councils and health boards to follow the pound.