If all goes well most patients and carers will not need to know what I am about to say.
Eternal optimists are invited to move on to other articles (assuming eternal optimists read newspapers.)
For those still with me, forgive me while I get past the boring bit, which you may know already. The Scottish Government is in the process of merging some of the work the NHS does with some of the care work councils do - a manoeuvring of responsibilities it has called "integration".
I do hope someone is still reading.
When I first wrote about the plans for this in 2011 the idea was to move 38,000 council staff who do the community side of caring for the elderly into the NHS. That way, the same organisation was responsible for a frail pensioner's care whether she was becoming a bit disorientated, had fallen and broken her arm, was lying in a ward waiting for a care package to be put in place or back in her house chatting to the carer getting her up in the morning.
Transferring all those local authority staff did strike me as a bit of a nightmare but the aim, based on successful set-ups elsewhere, made sense. It would, we hope, be much better for patients and their families to have the NHS in charge instead of two separate systems which may, or may not, communicate well with each other. Furthermore, I was interested to see whether some of the transparency and safety culture in the NHS could help drive up expectations and consistency of care in the community.
However, while NHS Highland has piloted this model, it does not look like integration is going to happen that way. Instead, most councils and health boards are creating between them - and I cringe as I say this - an integrated joint board, or IJB. This joint board will (from next April) have shared responsibility for many things, including preventing the frail elderly from falling at home and ensuring, should they need a spell in hospital, their discharge is not delayed.
My instinct, on realising this, was disbelief. To integrate two well known organisations do we really need to create a third, I thought. Now pensioners and their relatives thrown for the first time into the world of geriatric wards and social work assessments will have three different institutions to deal with. Care workers, instead of having the weight of the NHS behind them, will be hidden under this new layer of bureaucracy called the IJB.
I have since had the chance to sit with Scottish Government officials and talk it through. The creation of these IJBs is, I am told, a means of making councils and health boards work better together when it comes to planning services, allocating resources and meeting targets.
It should make the transition of patients between health and care services so smooth they never know the structure of the institutions co-ordinating it. Setting up a single contact phone number for the public will be one of the IJB's duties.
If the resources and levels of scrutiny are right this system deserves a chance. I just hope I do not write in five years of a bold plan to merge councils and the NHS with IJBs.
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