IMPROVING OUTCOMES AND SUPPORTING INNOVATION

Dr Margaret Whoriskey Director, Joint Improvement Partnership Board

A Scottish Approach to Public Service Reform> Prevention – decisive shift: Reduce future demand by

preventing problems arising or dealing with them early on.

> Partnership – Bringing public, third and private sector partners together with communities to deliver shared

outcomes that really matter to people.> People – We need to unlock the full creativity and

potential of people at all levels of public service, empowering them to work together in innovative ways. We need to help create ways for people and communities to co-produce services around their skills and networks.

> Performance – To demonstrate a sharp focus on continuous improvement of the national outcomes.

Our 2020 Vision…

By 2020 everyone is able to live longer healthier lives at home, or in a homely setting.

Health & Social Care IntegrationUnderpinned by Legislation:

• nationally agreed outcomes;

1.Healthier

2. Independent Living

3.Positive experiences and outcomes

4.Carers are supported

5.Services are safe

6.Engaged workforce

7.Effective resource use

Principals/Defining Outcome Focused Approach• Understand outcomes as the

impact or end result of support and/or services on a person’s life:

• BUT start by defining expectations and outcomes with the person

• Focus on strengths and capacities more than deficits

• Identify the person’s role as well as other people in their life and services

• Outcomes can be measured both for the individual and for the service as a whole

• Believing that the participation of the person is core to practice

What do we mean by outcomes? The “So what?” question – if we have provided support or

service to someone, what did that achieve? Did the person benefit and how do they see it?

This requires both the services, and the person themself to think through together what matters and how it can be best achieved.

The big challenge is to develop what we often do well at the individual level to be the basis of our whole organisational approach – keeping people and what they want at the heart of everything we do. We refer to this as a personal outcomes approach.

Supporting people at Home

Trend in Care Home residents aged 65+ in Scotland: actual vs projected numbers

15000

20000

25000

30000

35000

40000

2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

N o

f res

iden

ts 6

5+

Projected

Actual

Hospital emergency admission 65+: occupied beddays

2100000

2400000

2700000

3000000

3300000

bedd

ays

Projectedbeddays

Actualbeddays

Trend in emergency admissions (Index) by length of stay (LOS), aged 75+

90.0

100.0

110.0

120.0

130.0

140.0

150.0

160.0

2005/6 2006/7 2007/8 2008/9 2009/10 2010/11

Ind

ex

(y

e M

arc

h 0

6=

10

0) 0 days

1 day

2 days ormore

All LOS

Source data ISD

Chart PK JIT

Current service provision by service type

65+

89.5%

Home care

Care home

NHS Continuing Care

All others

75-84

97%

88%

60%

75-84

65-74

85+

“Most older people (89.5%) do not receive ‘formal’ care in NHS

continuing care, a care home or a home care service organised

by social work agencies.”

Reshaping Care: Integration in Action

• 10 Year National Programme 2011-2021• £ 300 million Change Fund 2011 - 2015• 32 Partnership Change Plans agreed by: NHS: primary, acute and mental health services Local Authority: social care and housing Third sector Independent sector• Reshaping Care and Integration Improvement

Network to support partnerships to transform care

Reshaping Care Pathway

The Change Fund and RCOP

2012/13– CF built on current initiatives and developments - Only 1-2% of total spend build on wide range of other innovative work underway early reflections on Joint Commissioning

2013/14 – Joint Commissioning Strategies with a 10 year horizon to shift the balance of care

Change Plans as lever to change : Investing to maximise improvements in outcomes Maximising potential for resource shifts by bridging to new

service models Investing to lever otherwise inaccessible resources

Going Forward: Joint Strategic Commissioning

• “all the activities involved in assessing and forecasting needs, links investment to agreed desired outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place.”

• First iteration prepared for 13/14 focusing on older people

• Will be a legislative requirement from 2015 onwards for all adult care groups

• National support programme launched• http://www.jitscotland.org.uk

/action-areas/commissioning/

Joint Commissioning Plans

• Increasing focus on dementia• Post diagnostic support • Focus on Physical environment , housing,

adaptations, telecare • Training for all • Anticipatory care• Reablement

What needs developed

• Need for better integration across mental health, older people services and support

• More focus required on post diagnostic support • Support for care homes• 8 Pillars – needs to be integrated in wider work • Dementia friendly communities • More opportunities for telecare • More recognition and support for carers

Learning from demonstrators • Communication tool app for phones and tablets for people with dementia• Care and repair • Perth and Kinross open access memory clinic and disinvestment from

community hospital beds to alternative NHS services in the Strathmore locality

• Midlothian family group conferencing initiative and detailed IRF work with primary care

• North Lanarkshire dementia cafe work (for which they have received an award); reminiscence initiative re football; dementia friendly community work in Motherwell involving local traders and other statutory agencies; outreach from day care work.

• Housing initiative with all sites• Reablement

Supporting Innovation at Scale

Expanding Range of Telecare Equipment

Wristcare

Medication Reminder

Wayfinder

Locator

Epilepsy

sensor

A useful enabler…

In five years to 31/3/2012, 325 users of the Renfrewshire Care 24 telecare

service had dementia; over 30% of all users. The Service has provided a

range of equipment including door contacts, pressure mats and bed

monitors, operates a Responder service in the event of an alarm being

triggered and has a specific dementia pathway; all with the aim of keeping

these vulnerable people safely at home.

The Renfrewshire Telecare service estimated 114

hospital and 88 care home admissions were

avoided by this group because of telecare.

For more info:

@jitscotland

www.jitscotland.org.uk

Margaret.whoriskey@scotland.gsi.gov.uk