Commissioning for Outcomes

IRISS Engagement with Shetland Islands Partnership26/27 January 2015

Vision

• 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

NOTstructure

culture

leadership

outcomes

commissioning

team

What does the evidence tell us?

• Planning for populations, not delivery structures

• Pooling resources – money and people• Embedding GPs, other clinicians and care

professionals in the processes of service planning, investment and provision

• Very strong local leadership

Projected percentage change in Scotland’s population by age group, 2010 - 2035

Projected real demand for Health and Social Care to 2030, £ bn, (2009-10 prices)

4

6

8

10

12

14

16

2010 2015 2020 2025 2030

Year

Dem

an

d, £ b

n

No change in HLE

Change in HLE assumed to be half the change LE

Change in HLE assumed to be equal to the change LE

2010/11 Unplanned Bed days 75+

0.0

100,000.0

200,000.0

300,000.0

400,000.0

500,000.0

600,000.0

700,000.0

800,000.0

Glasgow

City

Com

hairle nan Eilean S

iar

Inverclyde

West D

unbartonshire

Midlothian

Scottish B

orders

City of E

dinburgh

Renfrew

shire

East Lothian

Dundee C

ity

Aberdeen C

ity

Dum

fries & G

alloway

East D

unbartonshire

Argyll &

Bute

Highland

East R

enfrewshire

Orkney Islands

South Lanarkshire

East A

yrshire

North A

yrshire

North Lanarkshire

West Lothian

South A

yrshire

Moray

Aberdeenshire

Perth &

Kinross

Fife

Falkirk

Angus

Stirling

Clackm

annanshire

Shetland Islands

Torbay

Bed

day

s p

er 1

0000

0 75

+

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

• Principles for integrated health and social care

• 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 delivery: Chief Officer (body corporate)

• Strategic planning

• Locality planning

LocalitiesLocalities are acknowledged as the ‘engine room’ of the reform agenda and where the greatest impact on outcomes can be achieved. The Public Bodies (Joint Working) (Scotland) Act 2014 requires Integration Authorities to identify at least two localities and it is recognised that Locality Arrangements are key to achieving integration.

• Role and function of localities - recognising the importance of natural communities

• Resonance with community planning• The need to address inequalities and recognise the importance of

community development and coproduction processes• Engaging local staff – culture and skills• Direction of travel – Budget? Commissioning?

Key Drivers for Change

Demand Money Innovation Quality

Law Political Co-production Tackling Inequalities

Social Care (Self-directed Support) Act 2013

• Comes into force in 2014. Replaces the previous legislation on Direct Payments & Self-Directed Support (SDS).

• Requires a step change in how we view individuals – as commissioners of their own support regardless of their chosen option

“Individuals will have greater choice and

control over the services they use through self-directed support for

social care and person-centred

healthcare.”

Joint Strategic Commissioning

“Strategic commissioning is the term used for all the activities involved in assessing and forecasting needs, links investment to all agreed desired outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place.”“Joint commissioning is where these actions are undertaken by two or more agencies working together, typically health and local government, and often from a pooled or aligned budget.”

Public Bodies ( Joint Working) (Scotland ) Bill 28.05.13 – Policy Memorandum Adopted from the National Steering Group definition

Legislative requirements

• The Public Bodies ( Joint Working) (Scotland) Act requires that the new integrated health and social care partnerships will oversee the development and delivery of the Strategic Plans, (Joint Strategic Commissioning Plans)

• Strategic Plans, (Joint Strategic Commissioning Plans), which incorporate a Financial Plan, will be required for all adult care groups by April 2015

• The Act requires partnerships to establish a Strategic Planning Group for the purpose of preparing a Strategic Plan

A Tool for…. Understanding long term demand giving a common perception of the world.

Understanding the best approaches and methods for meeting that demand.

Improving and modernising supports and services to achieve better outcomes.

Encouraging innovative solutions by ALL providers.

Achieving best value by better configuration of delivery and greater efficiencies.

Managing and facilitating the market in a climate of changing independent and third sector providers.

Working across boundaries.

An outcome-based approach

The aim of an outcome-based approach is to:

"...shift the focus from activities to results, from how a programme operates to the good it accomplishes.“

Margaret Plantz, Martha Greenway & Michael Hendricks (1999). Outcome Measurement: Showing Results in the Non-profit Sector. United Way of America Online Resource Library

Definitions

Outcome – result or upshot Output – production; the amount of

services produced in a given time Process – procedure, method or means Input – contribution or effort

Levels of outcomesLevel Focus Example

Individual or personal

Defined by the person as what is important to them in life

I want to be able to get back to my bowling club

Service Defined by the service as a key focus to work towards with people

We work with older people to improve their ability to get out and about

Strategic or population

Defined commissioners or government as a key area to work towards across organisations

Improve the social inclusion of older people

Types of outcomes

National Health and Wellbeing Outcomes

Outcome 1: People are able to look after and improve their own health andwellbeing and live in good health for longer. (Healthier Living)

Outcome 2: People, including those with disabilities, long term conditions, orwho are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. (Independent Living)

Outcome 3: People who use health and social care services have positive

experiences of those services, and have their dignity respected. (Positive Experience of Services)

Outcome 4: Health and social care services are centred on helping to maintainor improve the quality of life of service users. (Quality of Life)

Outcome 5: Health and social care services contribute to reducing healthinequalities. (Reducing Health Inequality)

Outcome 6: People who provide unpaid care are supported to reduce thepotential impact of their caring role on their own health and well-being. (Carers Are Supported)

Outcome 7: People who use health and social care services are safe fromharm. (People are Safe)

Outcome 8: People who work in health and social care services are supportedto continuously improve the information, support, care and treatment they provide and feel engaged with the work they do. (Supported and Engaged Workforce)

Outcome 9: Resources are used effectively in the provision of health and

social care services, without waste. (Effective Use of Resources)

Integration of health and social care – national outcomes

Core Suite of Integration Indicators

History

• Health & Community Care Act (1990)• Modernising Community Care (1997)• Joint Future (2000)• Community Care Outcomes Framework (2007)• Review of CCOF (led by SCCBN) 2011• Agreement to National Outcomes 2012• National Health & Wellbeing Outcomes (2014)

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, 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 who use health and social care services are safe

from harm.

People who work in health and social care services are

supported to continuously improve the information,

support, care and treatment they provide and feel engaged

with the work they do.

Resources are used effectively in the provision of health and

social care services.

(a) Outcome indicators based on survey feedback:

• Percentage of adults able to look after their health very well or quite well

• Percentage of adults supported at home who agree that they are supported to live as independently as possible.

• Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided.

• Percentage of adults supported at home who agree that their health and care services seemed to be well co-ordinated

• Percentage of adults receiving any care or support who rate it as excellent or good

(a) Outcome indicators based on survey feedback:

• Percentage of people with positive experience of their GP practice

• Percentage of adults supported at home who agree that their services and support had an impact in improving or maintaining their quality of life

• Percentage of carers who feel supported to continue in their caring role

• Percentage of adults supported at home who agree they felt safe

• Percentage of staff who say they would recommend their workplace as a good place to work

• Community connectedness - proposed

(b) Outcome indicators based on administrative data that represent undesirable population outcomes:

• Premature mortality• Suicide rate• Rate of emergency admissions for adults (including

proposal to also look at rate of emergency bed days for adults)

• Readmissions within 28 days• Proportion of last 6 months of life spent at home or in

community setting• Falls rate per 1,000 population in over 65’s –

investigating

(c) Outcome indicators that measure aspects of service delivery:

• Proportion of care and care at home services rated 3 or above in Care Inspectorate Inspections

• Delayed discharge – 14 days, 72 hours, bed days lost – TBC

• Percentage of adults with intensive needs receiving care at home

• GP practice participation in SPSP – proposed• Cost of delayed discharge – proposed• Cost of end of life care in acute hospital – proposed• Cost of emergency admissions – proposed