Integrated Health and Social Care In Scotland

13th November 2014 Donna Henderson

Scottish Centre for Telehealth and Telecare, NHS 24, Scotland 1

Facts and Figures

• Population: 5.3 million people and projected to rise

to 5.8 million in next 20 years

• Over next 20 years: number of people aged over 75

will increase by 60%. More people living with

complex long term conditions.

• Numbers of people with dementia: will double by

2035.

• Health: Scotland getting healthier but gap widening

between better well off and less well off

Health and

Social Care in

Scotland

Before integration:

32 Local Authorities – responsible for

social care, education, housing, transport

14 NHS Boards – acute, hospital,

community, primary care health services By April 2015:

32 new “Health and Social Care

Partnerships” jointly responsible for

delivery of social care, community health /

primary care and some hospital services

NHS Boards and Local Authorities will

continue to provide a range of other health

and care services

Long Term Conditions

Ageing population

Health Inequalities

Workforce Challenges

Affordability

Sustainability

System Drivers

National Policy Drivers

• Public Service Reform

• Public Bodies (Joint Working) (Scotland ) Act 2014

• Reshaping Care for Older People programme

• Telehealth and Telecare Delivery Plan for Scotland 2015

Scottish Public Service Reform: Ambitions

• a decisive shift towards prevention:

prioritise expenditure on public services which prevent negative

outcomes, prevent problems arising or deal with them earlier.

• greater integration of public services at a local level:

driven by effective partnership, collaboration and local service delivery,

bringing public, third and private sector partners together with

communities to deliver shared outcomes that really matter to people.

• greater investment in the people who deliver services:

through enhanced workforce development and effective leadership

• focus on improving performance:

through greater transparency, innovation and use of digital technology.

Public Bodies (Joint Working) (Scotland )

Act 2014 - Principles

• People are supported to live well at home or in the community for as much time as they can

• They have a positive

experience of health and social care when they need it

The Act introduces: • Principles for integrated health and social care services

• Nationally agreed outcomes for health and wellbeing

• Integrated governance arrangements for health and social care: delegation to

a body corporate or lead agency

• Integrated budgets for health and social care

• Integrated oversight of service delivery: Chief Officer (body corporate)

• Joint strategic planning

• Joint locality planning

National Outcomes driving Health &

Social Care Integration

1.Healthier living

2. Independent living

3.Positive experiences and outcomes

4.Carers are supported

5.Services are safe

6.Engaged workforce

7.Effective resource use

• Cross party support

• NHS support

• Local authority support

• Everyone (partners, stakeholders etc) agreed:

– A challenge exists

– Something needs to be done

• Having an agreed vision about what we are trying to

achieve

HOWEVER...... the difficulty is in the detail of how we will

achieve it.

What has helped integration?

• NHS and Local Authorities = statutory bodies

• Main concern - governance and finance

• Concerned about:

– Balance of power and authority

– Remaining accountable

– Budgets

– Ensuring they would have (an equal) seat at

the table

Key Challenges – NHS & Local Authorities

• Professional groups – e.g. Nurses, physiotherapists, social

workers;

• Main concerns were about service delivery but also:

– Worried about their new / changing role in service

delivery

– Engagement

– Involvement – will they be involved in decision making?

Key Challenges – Staff

• Main concern - principles and outcomes

• Started with a broad set of principles. Following

extensive discussions and lobbying by stakeholders we

amended the principles to also include:

– Quality

– Safety

– Dignity

– Strengthen the rights based approach

• Concern around being an equal partner on decisions and

resources – rather than being seen as a service provider

Key Challenges – Third sector

Key Challenges – the Bill Team

• Realising the vision

• Creating and enabling

collaborative

environments

What have we learnt so far?

• Integration requires an enormous amount of

effort and resources

– you need a large, stable team

• Timetabling – avoid key dates e.g. elections

• Keep people informed

• Keep stakeholders engaged (Communications

lead)

• Expect last minute changes

Next Steps for Scotland

Consultation on Regulations and development of

Guidance

MAY– AUGUST 2014

Regulations and guidance complete

NOVEMBER 2014 – FEB 2015

Integration goes live

locally

APRIL 2015

All integrated arrangements must

be in place

APRIL 2016

Reshaping Care: a Programme for

Change - 2011- 2021 10 year “whole system” transformation programme that will shift the location of care (from institution to community) and transform the culture and philosophy of care from reactive services provided to people towards preventative, anticipatory and coordinated care and support at home delivered with people.

£300 million Change Fund (2010 – 2014)

£120 million Integrated Care Fund (for 2015)

18

National Telehealth and Telecare Delivery Plan 2015

Recognises the significant role of Telehealth and Telecare in the reform of health, care, housing and wellbeing and in supporting integration in Scotland

19

3 Key Objectives:

• Telehealth and telecare will enable choice and control in

health, care and wellbeing services for an additional 300,000

people

• People who use our health and care services, and the staff

working within them, will proactively demand the use of

Telehealth and Telecare as positive options

• There is a flourishing Innovation Centre where academics,

care professionals, service providers and industry innovate to

meet future challenges and provide benefits for Scotland’s

health, wellbeing and wealth.

Conclusions

• We have taken a big step forward

However......

• We have not stopped old ladies falling out of bed

• We have not shifted money into anticipatory

spending

Biggest challenge biggest change the culture!

Sign-up to our newsletter at:

http://blogs.scotland.gov.uk/health-and-social-care-

integration

International Conference on Integrated Care 26 – 27 March 2015 – Edinburgh, Scotland

For more information:

http://www.scotland.gov.uk/Topics/Health/Policy/Adult-

Health-SocialCare-Integration

www.jitscotland.org.uk

www.sctt.nhs.scot.uk

Donna.henderson1@nhs.net

http://www.integratedcarefoundation.org/conference/1454