The joint future initiative in Scotland: the Development and Early Implementation Experience of an Integrated Care Policy

The focus of this article is an examination of the policy and early implementation of an integrated community care initiative targeted at older people. The research examined four geographical areas. The policy prescriptions behind integrated care were viewed in historical context. Two key aspects of current policy, the drive from central government and the focus on users and outcomes, were analysed in terms of first, the purpose and design behind the initiative, and second the early implementation experience. The policy purposes of collaborative partnering and user focus were clearly observed. However, the early implementation experience, while showing that partnership structures were in place, indicated differing levels of authority and responsibility from health and local authority managers causing some frustration for local partnership management. The research showed that in practice the extent of user-outcome focus was limited. Users and clients were involved in agreeing to the design of their care package as demanded by legislation, yet there was little evidence of a broader collective, participative dimension. There was some devolution of financial authority to managers at the client interface level and this marked a clear difference from earlier practice, but the approach to this was patchy with some of the areas studied completely separating assessment and authorization of care processes. The focus on local outcome – effectiveness – measures to calibrate achievement was less well developed, giving support to those who regard as unlikely the comprehensive adoption of such approaches in the public spending arena. The article concludes by outlining the significance of the Joint Future initiative for policy development as well as indicating a research agenda for some wider debates in public policy and management.