About the Council

About Fife Health & Social Care Partnership

Fife Health and Social Care Partnership is an integrated care system. We work in partnership with NHS Fife, Fife Council, independent care organisations and voluntary organisations to improve the health and wellbeing of people living in Fife.

Fife Health and Social Care Partnership is responsible for these services and functions:

All adult and older people Social Work Services
Community health services, for example district nursing, physiotherapy, and mental health services
Children’s community health services
Health visiting housing services which provide support services to vulnerable adults, and disability adaptations
The planning of some services provided in hospital
Medical care of the elderly

Fife's Health Landscape

Our Vision

To enable the people of Fife to live independent and healthier lives

Our Mission

We will deliver our vision by working with individuals and communities, using our collective resource effectively. We will transform how we provide services to ensure these are safe, timely, effective, high quality and based on achieving personal outcomes.

Our Values

Person-focused
Integrity
Caring
Respectful
Inclusive
Empowering
Kindness

Our Strategic Priorities

Every health and social care partnership in Scotland must have a strategic plan that sets out the vision and future direction of their health and social care services. This includes how the nine national health and wellbeing outcomes for health and social care will be delivered locally, along with the six public health priorities for Scotland. Strategic plans are reviewed regularly to make sure that they are still relevant to the needs of the area and the people who live there.

Organisational Structure

Lynne Garvey (1)

Lynne Garvey
Chief Officer and Director of Health & Social Care

As a Senior Leadership Team we are committed to being systems leaders. This means helping to create the conditions where people willingly work together towards a common vision and give their best by focusing on relationships, building trust and putting people at the centre. We believe in collective leadership to achieve improved outcomes across the whole organisation not just our part of it, and serve others so they also work in this way, celebrating when they do and learning about self, team and system along the way. Working in ways that promote integrity, courage, authenticity, curiosity, humility, kindness, compassion and empowerment.

Any members of the Senior Leadership Team will be happy to speak to candidates about the Partnership, their roles, our priorities and ways of working. You are encouraged to make contact with the team, and this can be arranged via Carol Notman by email carol.notman-hsc@fife.gov.uk.

Operational Service Delivery

SLT Leads for operational management, delivery and business outcomes for a portfolio of services

Jillian Torrens
Head of Complex & Critical Care Services
Lisa Cooper
Head of Primary & Preventative Care Services
Christopher Conroy
Head of Community Care Services

Business Enabling

SLT Leads for Corporate Services and functions inc. financial governance, strategic planning, performance, transformational and organisational development

Audrey Valente
Chief Finance Officer and Head of Transformation and Corporate Services
Fiona McKay
(retiring December 2024)
Head of Strategic, Performance & Commissioning
Roy Lawrence
Principal Lead Organisation Development & Culture

Professional & Quality Standards

SLT Leads for quality, safety, experience, clinical and care governance, prefessional regulation and standards

Lynn Barker
Director of Nursing
Helen Hellewell
Medical Director
Vacant
Principal Social Work Officer

Our Leadership Success Statements

We are committed to systems leadership and developing leadership at all levels within the Health and Social Care Partnership. We have a well established Extended Leadership Team to actively engage with all senior leaders within the organisation to enable:-:

Listen: Inform and connect us as “one Health and Social Care Partnership”
Voice: Share collective experience and forum to influence developments
Promote: Open Networks and engagement with the Senior Leadership Team and Peers
Impact: Focus on common priorities and ensure collective impact

Through the work of the Extended Leadership Team we have co-produced leadership success statements that underpin our leadership aspirations within Fife Health and Social Care Partnership. The principal social worker, alongside all members of the Senior Leadership team will champion and support delivery of these success statements alongside all members of the Extended leadership team, engaging with the Local Partnership Forum, Frontline staff and partners.

Our Leadership ability and Organisational Culture

Everyone understands they are a leader within the partnership and that they represent us all whenever they deliver a service
Our people believe they are treated fairly, feel included in our future and recognise we are all in this together to be the best we can be

Opportunities for our Workforce to thrive and perform to their potential:

Our people will feel supported to try new ways of working to improve the service they deliver
Our people will feel proud and passionate about the work of the Partnership

Our ability to Transform our services

Our people work together to design new ways to deliver the best possible care and support across the whole partnership
Our people use technology and other resources to sustain new ways of working that change people’s lives for the better

Our ability to get the best value from our Financial resources and Sustain our services:

We plan to deliver and deliver what we plan within the resources available
Our planning demonstrates a forward-looking vision for the future to make sure we can continue to deliver high quality service

Our performance in affecting people’s lives Earlier to Prevent the need for hospital and reduce the need for health and social care services:

We can show how we are working in a way that helps people to help themselves and build strength in their communities
There will be less emergency hospital admissions

Our ability to empower our Local Places to influence the service they receive:

We can show we are listening to people and supporting them to get the service they need wherever possible
We can show how local voices are helping us design the future of the Partnership

Our Standards of Practice Excellence & Quality

Our people challenge themselves to provide the best possible care and treat others as they would like to be treated
We celebrate the great work of our people and have a track record of high-quality care that improves people’s lives

Our Reputation with our Citizens and our Staff

The citizens of Fife believe our partnership works with them to achieve the best possible outcomes in their lives
Our people believe the partnership is an excellent place to work and that their contribution to our success is valued

Operational Service Delivery

The Principal Social Work Officer covers professional leadership and assurance social work and social care delegated services working closely with all members of the Senior Leadership Team and to support the priorities of the Health and Social Care Partnership

Primary and Preventative Care Services

Lisa Cooper
Head of Primary & Preventative Care Services

Common focus on Integrated Primary and Preventive Care Services; population health, primary care, prevention, self care, promoting health and wellbeing and universal services.
Aligned to the outcomes of integration: People are able to look after and improve their own health and wellbeing and live in good health for longer; Health and social care services contribute to reducing health inequalities; People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on health and well-being.
Focused on the delivery of the strategic plan for: Working with local people and communities to address inequalities and improve health and wellbeing outcomes across Fife
The Principal Social Work officer will work closely with the Heads of Service and Associate Directors on shared priorities such as prevention and early intervention, pathways of care, wellbeing, community led support, locality working, health inequalities and self management.
Have requirements to deliver against multiple national priorities and performance targets for example: Primary Care Transformation, Smoking Cessation, Urgent Care Transformation.
In addition to close working across community care services; complex and critical and business enabling services these teams will work closely with Localities and Communities; Third Sector Early Intervention; Primary Care including General Practice, Community Pharmacy, Ophthalmology, Dental; Community Planning, Education, Sports and Leisure; Public Health.
key functions: Universal Service; In & out hours primary care; Prevention; Inequalities; Health Improvement/wellbeing; Early Intervention; Community Support; Self Management & Independence.

Key Services areas

Children's Services
Urgent Care
Sexual Health / Rheumatology
Primary Care (General Practice, Community Pharmacy, Community Dental, Community Ophthalmology)
Podiatry
Physiotherapy
Speech and Language Therapy
Dietetics
Occupational Therapy
Dental
Immunisation
Health Improvement / Promotion

Community Care Services

Christopher Conroy
Head of Community Care Services

Common focus on Intermediate Care, Care at home/homely setting, reducing emergency hospital admissions, re-ablement, long term conditions palliative & end of life care.
Aligned to the outcomes of integration: People, with long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community; Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services; People who use health and social care services have positive experiences of those services.
Focused on the delivery of the strategic plan for: Living well with long term condition.
Have requirements to deliver against multiple national priorities and performance targets for example: Bed Based / Community Hospital Redesign, Delayed Discharge; winter planning
In addition to close working across primary and preventative care services; complex and critical and business enabling services these teams will work closely with Acute Services; Independent Sector (Care Homes and Care at Home, day care, respite); Housing; Voluntary Sector Providers; Services in peoples’ homes/homely settings; Long Term Conditions Teams.
The Principal Social Work Officer will work closely with the Heads of service and Associate Directors on shared priorities such as social care resilience, care home assurance, social work practice and pathways of care, reduce delayed discharge, winter planning, proactive discharge from hospital, end of life care, unmet need in the community and bed and community based models of care.
The key functions include: Enabling People to Live at Home or in a Homely setting (Inc; residential); Frailty; Long Term Conditions Management; Intermediate Care; Day Care; Community Hospital.

Key Services areas

Home Care (inc. telecare/link)
Community Hospitals
Residential Care Homes
Day Care
Palliative Care
District Nursing
Integrated Discharge Hub
Integrated Community Assessment and Support Services
Hospital at Home
Specialist Long Term Conditions Management
Rehabilitation & Re-ablement

Complex and Critical Care Services

Jillian Torrens
Head of Complex & Critical Care Services

Common focus on: Complex & Critical needs; Mental Health, Learning Disability; Social Work
Aligned to the outcomes of integration: People, including those with disabilities or long term conditions, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community; People who use health and social care services are safe from harm; People who use health and social care services have positive experiences of those services, and have their dignity respected; Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services.
Focused on the delivery of the strategic plan for: Promoting mental health and wellbeing; Living well with long term conditions; Learning Disability and Complex Physical HealthCare
Have requirements to deliver against multiple national priorities and performance targets for example: Promoting mental health and wellbeing; Living well with long term conditions; Learning Disability and Complex Physical Health Care.
In addition to close working across primary and preventative care services; community care and business enabling services these teams will work closely with Mental Health Services; Learning Disability Services; Social Work (Adult, Criminal Justice and Children’s to enable transitions); Housing; Independent and Vol Sector Specialist Providers.
The Principal Social Work Officer will work closely with the Heads of Service and Associate Directors on shared priorities such as mental health, learning disability, addictions, adult social work practice and pathways of care to reduce delayed discharge, care pathways, transitions of care from children and families to adult social work, community based models of care and supported accommodation.
The key functions include: Assessment and planning of specialist care needs for both physical and mental health needs; Complex and Critical Needs; Mental health and wellbeing; Case management; Adult and Older Adult Social Work; Case Management.

Key Services areas

Mental Health
Addictions
Child and Adolescent Mental Health Services
Learning Disability Services
Psychology
Adult Protection
Social Work

Business Enabling Services

Audrey Valente
Chief Finance Officer and Head of Transformation and Corporate Services

Fiona McKay
Head of Strategic, Performance & Commissioning

Roy Lawrence
Principal Lead Organisation Development & Culture

Common focus on Services that support service delivery and work closely with business partners in both NHS Fife and Fife Council to assure the performance, corporate, business and financial functions.
Aligned to the outcomes of integration: Resources are used effectively and efficiently in the provision of health and social care services; People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide.
Focused on the delivery of the Strategic Plan for: Managing resources effectively while delivering quality outcome; Working with communities, partners and our workforce to effectively transform, integrate and improve our services
Have requirements to deliver against multiple national priorities and performance targets for example: Ministerial Steering Group Outcomes; Financial; Oversight of Transformational change; Integration Performance targets; Professional Standards.
In addition to close working with all Health and Social Care Partnership Services, services will enable joint working Business Partners at NHS Fife and Fife Council, engage with wider stakeholders support a strategic interface for commissioning, performance and professional standards.
The Principal Social Work Officer will work closely with colleagues in business enabling services as appropriate to the role to provide a professional contribution in support of and to professionally assure strategic planning, performance, commissioning, transformation, risk and cultural change.
The key functions include: Enabling Delivery of the Health and Social Care Partnership Outcomes; Clinical & Care Governance; Performance & Outcomes; Financial Governance; Transformational Change; Business Support; Corporate Functions; Participation and Engagement; Commissioning; Risk; Information Services; Clinical / Professional Leadership

Key Services areas

Business Support
Administration & Finance
Change & Transformation
Corporate Functions
Performance & Assurance
Commissioning
Resilience
Risk
Information Compliance

Supporting information

Integration in action

Legislation

The Public Bodies (Joint Working) (Scotland) Act 2014 (The Act) requires Health Boards and Local Authorities to integrate planning for, and delivery of, certain adult health and social services.

This legislation brings together health and social care in to a single, integrated system and created 31 integration authorities across Scotland who are now responsible for £9 billion of funding for local services. These services were previously managed separately by NHS Boards and local authorities.

Delegated Services

Within Fife it has been agreed that this delegation will be a third body called the Integration Joint Board under s1 (4) (a) of the Act commonly referred to as a “Body Corporate” arrangement.

In Fife, we have one Joint Integration Board and the purpose of health and social care integration is to transform people’s experience of care and the outcomes they experience. This is necessary because when services are planned and delivered together, closer co-ordination will enable the fundamental changes in care models required to keep pace with people’s changing needs.

There is a diverse range of delegated services (defined in the Integration Scheme which was updated in 2022) and close working with partners in the Voluntary Sector and Independent Sector. The full range of services delegated within Fife Health and Social Care Partnership are listed within the published Integration Scheme.

Fife is coterminous with one Council, one Health Board, one Integration Joint Board and one Health and Social Care Partnership. NHS Fife and Fife Council remain the employers and the services that are delegated are managed through the Chief Officer accountable to the IJB for strategic planning and in their capacity as Director of Health and Social Care reports to both Chief Executives.

Our Approach to Integration

The Health and Social Care Partnership is committed to enabling the people of Fife to live independent and healthier lives. This will be delivered by working with individuals and communities, using collective resources effectively and to transform to ensure these are safe, timely, effectively, high quality and based on achieving personal outcomes. This will be underpinned by the agreed values to be person focused, respectful, inclusive, empowering and acting with integrity and care. The Health and Social Care Partnership is committed to the protection and enhancement of Equality and Human Rights.

Service users and carers will see improvements in the quality and continuity of care and smoother transitions between services and partner agencies. These improvements require planning and coordination. By efficiently deploying multi-professional and multi-agency resources, integrated and coordinated care systems will be better able to deliver the improvements we strive for; faster access, effective treatment and care, respect for people’s preferences, support for self-care and the involvement of family and carers.

Integration must be about much more than the structures that support it. The behaviours of Senior Leaders must reflect these values. It is only by improving the way we work together that we can in turn improve our services and outcomes for individuals who use them. We will work closely with NHS Fife, Fife Council, Independent, and Voluntary Sector to support a whole system approach. This is what we refer to as the “Team Fife” approach.

Integration Joint Board

The Integration Joint Board is made up of representatives from Fife Council and NHS Fife as well as representatives of the public, carers, professional advisors and partners within the Independent and Voluntary Sector. This diverse group of individuals bring their talents, expertise and perspectives in order to further our mission to improve the lives of those living in Fife.

The Integration Joint Board, has legal responsibility for services delegated to it and is fully responsible for:

Overseeing the development and preparation of the Strategic Plan for services delegated to it.
Allocating resources in accordance with the Strategic Plan
Ensuring that the national and local Health and Wellbeing outcomes are met.

The IJB then commissions (or ‘directs’) the local authority and health board to deliver services in line with the strategic plan and allocates the budget for delivery accordingly. The local authority and health board deliver these services within the budget and any parameters directed by the IJB. The directions policy defines this process.

Each IJB has responsibility to appoint a chief officer to lead implementation of the strategic plan and an officer responsible for its financial administration (Section 95, Chief Finance Officer). The chief officer has a direct line of accountability to the chief executives at the health board and the local authority.

A requirement of the Act is that the IJB also produces an annual performance report outlining progress towards delivery of the nine National Health and Wellbeing Outcomes within its local area.

Fife Localities

The Kingdom of Fife is a peninsula in eastern Scotland with a coastline of 170 kilometres (105 miles) bounded by the Firth of Forth to the South and the Firth of Tay to the North. It is the third largest local authority area in Scotland with a population of over 370,330. This represents 7% of the total population of Scotland. 96% of Fife residents live in 134 settlements, the largest of these being Kirkcaldy, Dunfermline and Glenrothes.

By 2039, the population of Fife is expected to increase by 4.5% to 387,214. The 16 to 19 age group is expected to reduce and those aged 75+ to see the greatest increase. This may be attributed to a declining birth rate and increased life expectancy in Fife, which is currently greater than the Scottish average for both males and females.

The extent of deprivation in Fife is fairly evenly spread across the different data zone bands from most to least deprived. The 2009 Scottish Index of Multiple Deprivation (SIMD) indicates that Fife has an increasing share of Scotland’s most deprived areas. Fife has the sixth highest local authority share of the 15% most deprived data zones in Scotland. 51 (5.2%) of the 976 data zones in the top 15% across Scotland are located in Fife, 8 of which fall into the top 5%. The 2009 data also confirms enduring deprivation in specific areas of Fife. In recent years Fife’s economy has moved away from traditional manufacturing industries towards the service sector.

Chief officers lead the development of integrated services and actions at a local level, so that approaches are tailored to local communities and circumstances. This localism is fundamental to integration as the Act requires health and social care partnerships to divide their area into at least two localities and within Fife there are 7 localities:

North East Fife
Glenrothes
Levenmouth
Kirkcaldy
Cowdenbeath
Dunfermline
South West Fife

Localities aims to achieve the aspirations we share for health and social care integration, with partners across the health and social care landscape, and their stakeholders, focusing together on our joint responsibility to improve outcomes for people. Profiles for each of the localities are available on the Health and Social Care Partnership website.

National Health and Wellbeing Outcomes

The main purpose of integration is to improve the wellbeing of people who use health and social care services, particularly those whose needs are complex.

This is intended to support achievement of the National Health and Wellbeing Outcomes prescribed by the Scottish Ministers in Regulations under Section 5 (1) of the Act namely:

People are able to look after and improve their own health and wellbeing and live in good health for longer.
People, including those with disabilities or long -term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community.
People who use health and social care services have positive experiences of those services, and have their dignity respected.
Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services.
Health and social care services contribute to reducing health inequalities.
People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing.
People using health and social care services are safe from harm.
People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide.
Resources are used effectively and efficiently in the provision of health and social care services.

Health and Social Care Standards

The Health and Social Care Standards set out what people should expect when using health, social care or social work services in Scotland.

They seek to provide better outcomes for everyone; to ensure that individuals are treated with respect and dignity, and that the basic human rights we are all entitled to are upheld.

The objectives of the Standards are to drive improvement, promote flexibility and encourage innovation in how people are cared for and supported.

The Standards are underpinned by five principles; dignity and respect, compassion, be included, responsive care and support and wellbeing.

The Standards are based on five headline outcomes:

I experience high quality care and support that is right for me.
I am fully involved in all decisions about my care and support.
I have confidence in the people who support and care for me.
I have confidence in the organisation providing my care and support.
I experience a high quality environment if the organisation provides the premises.

Joint Inspection

In 2022, a first in Scotland, a joint inspection of adult services, focusing on the outcomes and experiences of adults with physical disabilities and complex needs in the Fife Health and Social Care Partnership, found clear strengths in how integrated health and social care services are positively supporting people’s health and wellbeing outcomes. Inspectors also identified areas which could further improve.

Key strengths

Most people had positive experiences of integrated and person-centred health and social care, which supported an improved quality of life.
Many people and carers told us that they were listened to by workers who treated them with dignity, respect and kindness.
Almost all people had support from a key worker during assessment, review and care planning processes. Overall, when people had the support of a key worker, coordination was good.
The widespread adoption of collaborative approaches with external care providers improved the partnership’s ability to respond to and recover from the pandemic.
The Fife partnership’s senior leadership team and extended leadership team had developed a strong collaborative culture. Most staff strongly agreed or agreed that joint working was supported by line managers and leaders.

Key areas for improvement

The partnership should:

Continue to drive targeted efforts to improve outcomes for people and carers and make sure it has an integrated approach to providing information and advice.
Improve its processes for anticipatory care planning and how it responds seamlessly from the point of view of people and carers.
Make sure it balances responding to local needs with a consistent response by monitoring performance at a locality level.
Leaders should continue to evaluate the effectiveness of organisational development across the wider workforce.
Further progress is needed to maximise the impact of integrated service delivery on ensuring good outcomes and experiences for people going forward

The Principal Social Work Officer, alongside all members of the senior leadership team will continue to build on the good work that has commenced and support our commitment to continuous quality improvement to address the areas for improvement. The full report is available at: Joint inspection of adult services in Fife Health and Social Care Partnership (careinspectorate.com)