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Joint Improvement Partnership Board

Inaugural Meeting on Thursday 30th May 2013, 14:00

Caledonian 1, CoSLA Offices, Edinburgh

AGENDA

1. Welcome and Chair’s remarks 2. Apologies Items for Decision 3. Draft Scheme of Delegation 4. Draft Strategic Plan and

Insights from National Data

5. Badging Options Items for Discussion 6. JIT Director’s Report 7. JIT Programme Budget 2013/14 8. Joint Strategic Commissioning: JIT Role and Implications 9. Future Meetings Cycle – best dates;

13 August 2013, 14:00

22 October 2013, 14:00

12 December 2013, 10:00 Items for Information 10. Annual Report 2012/13 (to follow) 11. Integration Enquiry Report 12. AOCB

Paper no: JIPB/01/03/2013

Meeting date: 30 May 2013

Agenda item: 3

Purpose: FOR DECISION

Title:

Joint Improvement Partnership Board : Draft Scheme of Delegation – for approval

Key Issues:

The Draft Scheme of Delegation provides the operating principles and working arrangements within which the Joint Improvement Partnership Board should operate. It is set out as an Annex to the Memorandum of Understanding “The Joint Improvement Team in Scotland” . The draft Scheme provides a general description of the Board’s powers, membership, quorum, working arrangements , the role of the Chair, JIT Director and JIT Team. The Board can review and amend the Scheme of Delegation as required.

Action Required:

The Board is asked to consider, amend as required and approve the draft as the Joint Improvement Partnership Board’s Scheme of Delegation.

Author: David Heaney Date: 10 May 2013

Name: Margaret Whoriskey Date: 10 May 2013

DRAFT THE JOINT IMPROVEMENT TEAM IN SCOTLAND PARTNERSHIP BOARD RESERVATION OF POWERS AND SCHEME OF DELEGATION

Version 1 – 10.12 12 SCHEME OF DELEGATION AND RESERVATION OF POWERS 1. General 1.1 This Scheme of Delegation and Reservation of powers has been developed by the Partnership Board of the Joint Improvement Team (hereinafter referred to as “JIT” and should be read in conjunction with the Memorandum of Understanding which has been agreed by all partners. 1.2 The JIT Partnership Board is not a legal entity and as such will draw its authority from the partners, as defined in the MOU. It will therefore operate in a way similar to that of a “Programme Board” in the discharge of its functions and oversight of the delivery of the JIT’s programme of work. 1.3 This document sets out those powers reserved to the Partnership Board for decision collectively at its Board meetings. 1.4 The Board may delegate any of its functions to the Director or through the Director any other member of the JIT Team but may not authorise any other person to approve its 3 year Strategic or annual work programme budget and its annual report. 1.5 The Board will remain accountable for all of its functions not withstanding any such delegation and will put in place reporting arrangements to oversee the exercise of those delegated functions 2. The Partnership Board and Reservation of Powers 2.1 The Board shall comprise executive Representatives from each of the sponsoring bodies – Scottish Government, CoSLA and NHS Scotland (hereinafter referred to as “substantive members”; and Executive Representatives from each of the Strategic Partners – The Third and Independent sectors - (hereinafter referred to as “Strategic members”.) Additional members can be co-opted on the Board as agreed by Board members. 2.2 In addition a Chair will be appointed, independent of the representatives defined in 2.1 2.3 The Board will normally meet on a two monthly cycle with a programme of meetings and in places to be agreed annually. Other meetings may be arranged on the agreement of the Board or at the discretion of the Chair 2.4 The Board has corporate responsibility for ensuring that JIT fulfils its aims and objectives and to promote the efficient and effective use of resources. In so doing the Board will be directly responsible for ensuring -

• High standards of corporate governance • That the overall strategic direction of JIT contained within a 3 year strategic

plan is within the policy framework agreed with the Scottish Government and the partners

• That a programme budget is agreed with Scottish Government each year , for

which the Board will be accountable for delivering through an efficient and effective prioritised work programme

• That JIT operates within the limits of its role and purpose as agreed by the

partners • That equality and diversity are central to the policies of JIT • That partner agencies are kept informed with progress on JIT’s activities and

delivery of its strategic objectives • That it receives and reviews regular reports on the Strategic, financial and

operational performance of JIT to allow it to consider any impact on its strategic direction. This should be based on quarterly monitoring information and reported to the next available Board Meeting

• That an Annual report on the past year’s activities is agreed, published and

made widely available 2.5 The quorum of the Board shall be 6 members (excluding the chair)and which should include at least one member from each of the substantive partners. Notwithstanding , and at the discretion of the chair, it would be open for the meeting to continue , subject to any decisions being homologated at a future meeting or by other means 2.6 Decisions of the Board shall normally be reached by consensus. In the event of a vote being required this would involve only the substantive members, taking advice from the strategic members. In the event of an equality of votes, the Chairman would have the right to exercise a casting vote, if it was considered that a further opportunity to debate the issue at a later date was not possible. 2.7 Minutes of Board Meetings shall be drawn up timeously after each meeting, circulated with a note of actions , submitted to the next Board meeting for approval as a correct record and duly signed by the Chair of that meeting 3. The Chair 3.1 The Chair shall be responsible to the partners for ensuring that JIT fulfils its role and purpose by providing Strategic Leadership including – • The formulation of the JIT Strategy for discharging its role

• Encouraging high standards of probity and promoting efficient and effective use of resources

• Ensuring that, in reaching decisions, JIT takes proper account of guidance from Scottish Government

3.2 The Chair shall preside over all Partnership Board meetings except that, when absent, it shall be open to the Board to appoint one of its number to preside over that meeting 3.3 The Chair will ensure that all new Board members are fully briefed on the terms of their appointment 3.4 The Chair may nominate any Board member to represent the interests of JIT at any external meeting or event 4 The Director and JIT Staff Team 4.1 All activities of JIT that have not been reserved to the Board shall be managed on its behalf by the Director either directly or through one of the JIT senior staff Team 4.2 In the main employment arrangements for full time JIT staff shall be made through Scottish Government with consideration to appropriate ‘hosting ‘ arrangements for some individual staff by one or more of the national partners as deemed appropriate. Alternative arrangements may be agreed with the Board at some later date 4.3 In this context, the duty of safeguarding the use of public funds and in effectively managing staff and resources including good corporate governance, performance management and continuous improvement and delegated authorities will be governed by these employment arrangements 4.4 The Director shall ensure that reports required to be submitted to the Board to assist it in discharging its responsibilities on Finance, Performance and Strategic Direction are submitted timeously in accordance with the agreed programme. 5 Review of arrangements 5.1 The Board will review the arrangements contained in this Scheme on an annual basis and at other times in exceptional circumstances if particular issues may inhibit the efficient operation of the Board -------------------------------------------------End-----------------------------------------------------

Paper no: JIPB/01/04/2013 Meeting date: 30 May 2013

Agenda item: 4


Title:

Draft Strategic Plan 2013/16 – including 2013/14 Management Plan

Key Issues:

The JIT Scheme of Delegation requires that we prepare a three year plan setting out JIT’s strategic direction. The Draft Strategic Plan sets out JIT’s priorities for 2013 - 2016;

The draft plan has been developed in discussion with a range of key stakeholders, and is built upon the four pillars of public service reform in Scotland, and underpinned by key national policy and strategy

The draft plan sets out JIT’s strategic priorities and puts personal outcomes at the heart of our approach. It describes what we will do and what changes we expect to make over the three year period and describes our detailed management plan for 2013/14 which will be refreshed and updated annually

The draft plan summarises our proposed approach and method of measuring impact. This will provide the basis for future reports to the Board on progress, provide JIT with performance data, and enable us to communicate with stakeholders on JIT’s overall performance and effectiveness

JIT has to remain capable of responding to new demands, and over the years it has become clear that it needs to balance delivery of strategic commitments with the ability to respond flexibly to emerging demands and requests from local partnerships. With the emergence of health and social care integration, this is likely to become a more prominent feature over the period of this plan.

JIT has a strong track record of delivering its objectives within its available budget and performing efficiently. Equally, it has been successful in attracting additional resources to the Programme Budget to deliver key priorities. In the context of health and social care integration and likely increase in demand this will generate for JIT, it will be vital that it remains efficient and is able to attract additional resources to meet new demands.

Action Required:

The Board is asked to consider and approve the Draft Strategic Plan for 2013-16, subject to any amendments by Board members, to approve of the approach set out to measuring impact, and to seek updates on the delivery of the 2013/14 Management Plan from the JIT Director at agreed intervals.



Draft Strategic Plan 2013-2016

May 2013

THE JOINT IMPROVEMENT TEAM The Joint Improvement Team (JIT) is a unique partnership between Scottish Government, CoSLA, NHSScotland, and the third, independent and housing sectors, tasked with accelerating the pace of local change and improvement in the quality of Scotland’s care and support services. The Joint Improvement Team (JIT) was established in 2004 under Circular CCD12/20041 to promote joint working between local authorities, NHSScotland, independent and third sectors. JIT’s shared accountability has been re-affirmed with the establishment of a Joint Improvement Partnership Board in April 2013, comprising senior representatives of the founding partners (Scottish Government, COSLA and NHSScotland) , and invited representatives from the Independent Sector, the Third Sector and the housing sector. The JIT remit as set out in the Memorandum of Understanding2 is to support partners to:

Achieve the outcomes and targets agreed by the national partners;

Provide leadership in the delivery of health and social care reform to drive local change and improvement;

Improve performance by developing sustainable solutions to challenges that inhibit the provision of best value and best quality care and outcomes;

Develop more integrated approaches to the redesign, commissioning and delivery and evaluation of health, housing and social care services;

Embed the use of preventative spend, and preventative approaches in general;

Adopt an assets-based approach such as co-production, and embed a personal outcomes approach.

The remit includes the requirements of Section 17 of the Community Care and Health (Scotland) Act 2002 which sets out the “ladder of Support and intervention” for NHS and local authorities to participate in joint working arrangements, where an improvement in this will lead to better outcomes for people who use community care services and their carers. The JIT has a flexible and responsive business model. We have a small core team of a Director, support staff and small number of secondees with established track records of innovation, and service redesign , based within the Scottish Government’s Health and Social Care Integration Directorate. This team is supported by JIT Associates/Leads , who work with the JIT on a part-time basis or through a secondment from their employing organisation: the Leads all have strong delivery

1 Community Care and Health (Scotland) Act 2002: Ministerial Powers of Intervention – Guidance on Ladder of

Support and Intervention 2 Formation of Joint Improvement Partnership Board – Memorandum of Understanding between The Scottish

Government, The NHS in Scotland and COSLA (acting on behalf of Scottish Local Authorities); Acting in

Strategic Partnership with Scottish Care (representing the Independent Sector) and SCVO (representing the

Third Sector). 1 February 2013

http://www.scotland.gov.uk/Topics/Health/care/JointFuture/Publications/SupportIntervention

http://www.scotland.gov.uk/Topics/Health/care/JointFuture/Publications/SupportIntervention

http://www.jitscotland.org.uk/news-and-events/newsletters/?id=130

experience in health, social care, housing or voluntary sectors. The JIT Action Group is a larger pool of subject experts, who are available to support specific pieces of work. These experts are drawn from health, social care, housing, voluntary and independent sectors, academia, scrutiny bodies, and carer organisations. This model enables the JIT to provide continuity of support through a single point of contact for local partnerships: the partnership ‘lead’ gives ongoing advice, support and challenge in regard to partnership activity, and acts as the primary link between the Partnership and the JIT core team and Action Group to agree and co-ordinate the range of supports to be provided by the JIT. The wider Action Group enables JIT, when required, to mobilise additional resources quickly from people who have direct and relevant expertise. JIT’s co-sponsorship positions us with significant opportunity and authority. It also strengthens our credibility with local stakeholders and with our national partners. Our credibility also comes from our reputation, the evidence of our impact, and the profile and experience of our team. . The JIT is one of a number of improvement and support teams with a focus on supporting effective change in public services, each with its own particular approach and contribution. We recognise the value of collaboration in combining the skills from across the different improvement and support teams for particular tasks: this approach has proved highly effective. During the period of this plan, we will seek to extend, embed and systematise this collaboration.

Our approach We work with partnerships to create the conditions for improvement, to implement national strategies and to deliver better outcomes in health, social care and housing services – the Meso system in the 3-step Improvement Framework for Scotland’s public services.

Exhibit 1

1) Change

the

world

2) Create the conditions

3) Make the improvement

Macro system

Vision, aim and context.

Meso system

Capacity & challenge.

Communicate changes,

empower workforce,

change the culture

Micro system

Implementation,

measurement and

improvement

The 3-step Improvement Framework for

Scotland’s public services

Creating the conditions for improvement involves working at national and local levels, maintaining a clear line of sight from national policy and strategy to local improvement activity. We help to build shared understanding and common aims, informed by best quality knowledge and expertise. We:

Engage with national partners and policy leads and help to ensure a shared understanding and vision within and across sectors.

Work with statutory, third and independent sector partners, and with people who use services and with their carers, to help partnerships create the conditions and to build local capacity and capability for innovation, improvement and transformation.

Support strategic engagement with leaders to facilitate culture change and build capacity and capability for effective partnership working and integration.

Help practitioners, teams and partnerships accelerate the spread of local improvements through local, regional and national learning sessions, and support for redesign, innovation, measurement and evaluation.

We aim to be first class in all we do and to provide the highest quality and value to all our customers, stakeholders and partners. We do this by:

Constructively challenging those we work with to consider different approaches, to draw on good practice and so to achieve more for the same resource;

Helping partnerships to successfully transfer practices and approaches - shown to be effective elsewhere - to their local context;

Advising on changes in local policy and practice, based on an in-depth understanding of the local issues;

Building capacity and developing skills amongst partnerships by ensuring that what we do is informed by high quality knowledge and expertise;

Synthesising and reflecting back experience of local delivery , so that it can support realistic and achievable policy development at national level;

Improving the ability of partnerships to identify the root causes not the symptoms, thereby shifting local systems towards sustainable solutions;

Nurturing innovation, including the adoption of new technology, so that new approaches can be tested and the learning shared across Scotland;

Sharing knowledge about effective practice at policy, strategy and delivery levels;

Supporting partnerships to use local and national health, housing and social care information well, to continually improve outcomes through effective analysis, benchmarking and needs assessment.

JIT STRATEGIC PLAN 2013-2016 This strategic plan sets out our programme for the next 3 years, providing focus for our activities over the medium term. It supports implementation of key Scottish Government policies including:

Renewing Scotland’s Public Services

The Quality Strategy and 20:20 vision

Integration of Health and Social Care

Reshaping Care Programme and the associated Change Fund

Age, Home and Community, Scotland’s national strategy for housing for older people

Telehealth and Telecare Delivery Plan

Dementia Strategy

Strategies in relation to particular groups or approaches e.g. Self-Directed Support, Carers, Learning Disability, Mental Health

In particular, our approach and priorities contribute to delivering the 4 pillars of successful public service reform:

1. a decisive shift towards prevention 2. greater integration of public services at a local level driven by better

partnership, collaboration and effective local delivery 3. greater investment in the people who deliver services through enhanced

workforce development and effective leadership 4. a sharp focus on improving performance, through greater transparency,

innovation and use of digital technology.

JIT core priorities We have identified, in discussion with our national partners, stakeholders and local partnerships, six core priorities. We believe our priorities are mutually reinforcing and collectively provide the best opportunities for us to support local partnerships to continue to improve outcomes for their local populations.

All of our work aims to support a reshaping of our care and support to meet people’s personal outcomes: this sets the values which shape and inform all our priorities. In line with the public service reform agenda, we will give priority to achieving a decisive shift to prevention, and to improving integration, partnership and collaboration. In addition, given the importance people place on their homes, we will give priority in this strategy to improving the place –home and community – in which people live. These take forward nationally agreed aims and ambitions. The JIT exists to provide practical support and assistance to local health, housing and social care partnerships across statutory, voluntary and independent sectors. This practical support is centred on improving practice and performance and building capabilities of those who provide these public services.

Exhibit 2 JIT’s Six Priorities

Our contention is that local partnerships need to address all six core priority areas in order to achieve the best outcomes for their communities. The JIT was established to support local partnerships across all community care population groups; however in practice our focus has been significantly directed toward older people, particularly since the launch of the Reshaping Care for Older People Programme and the associated Change Fund. We anticipate, however, that during the life of this Delivery Plan we will increase our contribution for other adult population groups. This is in line with the proposals for health and social care integration, which encompass all adults, but also reflects that much of our work has wider relevance – not only to all adults, but, to some extent, children’s services. This has become particularly relevant in relation to joint strategic commissioning, but is also evident in requests for our support in other areas. The JIT approach and resources are as applicable across all adult services including the range of specific work streams, e.g. Telecare, Talking Points, Intermediate Care, Reablement ,Community Capacity and Co – Production. How we manage this expansion of roles without losing focus, integrity and quality will be a key challenge for the JIT Board and team.

Person centred

outcomes

Improving our own performance The Scottish Ministers have made it clear that they wish to see a wider range of partnerships benefitting from the improvement support resources that we offer, especially in the light of the forthcoming integration of health and social care. This will place additional demands on the JIT team and make it even more important that we make best use of the resources we have. We have therefore identified a further “internal” priority – to strengthen JIT strategic and performance management. During the next three years we will improve and develop our strategic management systems and processes to ensure they are capable of supporting delivery of the strategy, and can provide the appropriate levels of accountability to the Joint Improvement Partnership Board, Scottish Ministers and CoSLA. JIT has a strong brand image and equally strong reputation in Scotland. We want to build on this success by developing new ways of communicating with our partners and stakeholders. We will complete the redesign of our website in 2013, and the process of re-badging JIT taking account of the new strategic partnership represented by the Joint Improvement Partnership Board. We will continue to improve our planning and budget management systems and processes to enable a clear line of sight between what we intend to achieve and how we will fund it. This will provide the reassurance that our strategic commitments are financially viable. However, there will be a requirement to identify opportunities for additional resources to respond to the ambitions and expectations of national partners and stakeholders. This plan sets out an ambitious improvement programme, which is likely to grow during the coming three year period. It is essential therefore that we provide opportunities to develop our team to ensure we have both the capacity and capabilities required to succeed.

How we will measure success The JIT’s purpose is to support delivery of nationally agreed outcomes through creating the right conditions – building capacity and capability, communicating the changes required, and changing the culture – and through supporting change at local level. Ultimately the JIT needs to be able to demonstrate the positive impact it makes in supporting local partnerships to deliver better outcomes, and to identify the actions and inputs that make the biggest positive impact. This can be difficult: we make an important contribution to effective change and improvement, but success will always be shared with our partners. Evidence of JIT impact has been largely through the testimonies from local partnerships where we have worked and through triangulating performance data that demonstrates improved outcomes. To date this combination enables the JIT to take

some credit for the overall improved performances in care over the last decade evidenced through such things as significantly lower levels of delayed discharges from hospital, expansion of telecare/telehealth (where JIT developed and lead the national telecare programme) , the spread and impact of re-ablement, the greater focus on prevention and anticipatory care for older people through the RCOP and the shift to personal outcomes and co-production as a consequence of JIT programmes. Our approach to measuring JIT’s effectiveness reflects the complexity of attributing improvement to our individual contribution. Our approach will be proportionate, so that we avoid resource costly research or information gathering; it will be focussed, so that we identify ways in which we can use our skills and resources more effectively; and it will be forward looking, in order to help us and our partners identify future challenges. We will use a combination of indicators and sources of information which will include

Activity monitoring – we will monitor delivery of this plan and the associated work plans.

360o stakeholder and partner survey - conducted annually to a standard format, we will seek feedback on the effectiveness of our contribution from our stakeholders, and our partners.

Thematic evaluations – some approaches and services, particularly tests of change and early implementers, will be evaluated in detail to inform effective development and support strategies.

Partnership: Review of impact and improvement - undertaken with individual partnerships to review outcomes against agreed programme of work

Progress against national targets & indicators – we will set information and feedback from other sources within the context of performance on national indicators and outcomes.

In addition JIT may commission an external review to evaluate delivery of key objectives as has been undertaken to date by the University of Stirling in 2006, IRISS in 2011 and more recently the review undertaken by Colin Mair from the Improvement Service in August 2012.

Delivering our Plan The next section provides a summary of what and how JIT will seek to take forward each of our core priorities during the life of this Delivery Plan . This will be reviewed on an annual basis to take account of developments, emerging issues and resources available to JIT.

Person centred outcomes A focus on personal outcomes – making sure that public services are designed and deliver what people want – is a central plank of national policy, set out in the Christie report and the Government’s response. It underpins the co-production approach. Shifting systems and services to a focus on personal outcomes is complex, and requires changes in the design of services, in the skills of those working in public services, and in the culture within public sector organisations. Enabling people to meet their personal outcomes also often requires cross sector collaboration – beyond health and social care. The JIT has led the way in Scotland in promoting a personal outcomes approach, supporting the development of Talking Points, a user designed approach to identifying people’s personal outcomes, which then inform the design and review of care and support services. Personal outcomes approaches are now being used in all partnerships but the extent to which it is embedded as standard practice varies considerably. We will continue to promote the adoption of Talking Points across all partnerships as a key component of personalising our support and care and delivering the outcomes which are important to people. We will also work with national partners to achieve greater alignment across programmes.

Exhibit 3

Talking Points: Outcomes Important to Service Users

Quality of Life Process Change

Feeling safe Listened to Improved confidence

Having things to do Having a say Improved skills

Seeing people Treated with respect

Improve mobility

Staying as well as you can

Treated as an individual

Reduced symptoms

Living where you want/as you want

Being responded to

Dealing with stigma/discrimination

Reliability

A core focus of our work will be on extending and embedding co-production. Statutory partners cannot do it alone: there is evidence that co-produced policies and strategies are more effective and acceptable, and national policy emphasises the importance of working with those who use public services. This agenda has particular importance in the context of a shift to prevention and to community-based services and support. This is a challenging and relatively new agenda for health and social care, and the JIT has dedicated expertise and resources to support partners to understand in greater detail what is involved in co-production, and to provide practical support to make it a reality. This includes supporting the

contribution of the third sector in local Change Plans, and supporting the sector to develop and build local capacity.

The JIT, with others, has been supporting the development of Self-Directed Support (SDS), including contributing delivery experience to the policy and guidance associated with the new SDS legislation. The JIT will support partnerships to embed SDS within their local arrangements, alongside their support for reablement, self management, co-production and community capacity building, and local activities around prevention. Central to enabling people to achieve their personal outcomes is that they know about the options and choices they have. Independent information and advice is an integral part of Self-Directed Support. There are however other information and advice requirements, and Age, Home and Community has identified information and advice about housing options as one of five main areas for improvement. The role and contribution of the JIT in supporting developments on information and advice will be clarified in the early period of the plan.

Over the three years of this Delivery Plan, our approach to improving the focus on personal outcomes will be through providing practical support to partners to:

Design, commission, deliver and review services using a personal outcomes approach;

Embed co-production as mainstream practice in the design; commissioning, delivery and review of services;

Realise the potential of Self Directed Support, reablement and self-management to enable people to manage their long term conditions;

Empower people by providing comprehensive, accessible and relevant information and advice.

We will support partners to:

We will do this by

Design, commission, deliver and review services using a personal outcomes approach

Supporting partnerships to embed and mainstream Talking Points into service design and delivery.

Providing expert support to NHS Education for Scotland (NES) and the Scottish Social Services Council (SSSC) to develop capabilities of the workforce in relation to personal outcomes.

Working with the Quality Alliance Board and The Health and Social Care ALLIANCE to support the use of Personal Outcome Measures across different settings and care groups.


We will do this by

Ensuring connections and alignment are achieved with the Person Centred Health and Care Programme.

Embed co-production as mainstream practice in the design, commissioning, delivery and review of services

Providing expert support and challenging partnerships to adopt co-production, so that it becomes integral to the decision-making of health and social care partnerships.

Building capacity in partners from the third sector and independent sectors so that they are able to contribute their full potential to Reshaping Care, joint strategic commissioning, and health and social care integration.

Working with the Third Sector Division and the Quality Unit to build a strategic approach to engaging with the third sector.

Realise the potential of Self Directed Support, reablement and self-management to enable people to manage their long term conditions

Supporting the work of policy leads for Self Directed Support and Self-Management.

Providing expert support on possible information resources including measures derived from the Indicator of Relative Need (IoRN), Resource Allocation Systems (RAS) and Talking Points in the development of SDS, including during the SDS Bill stage.

Providing support to local partnerships to embed SDS within their approach to procurement of care and support and joint strategic commissioning.

Providing expert support to identify workable models for those with complex care and support needs.

Empower people by providing comprehensive, accessible and relevant information and advice

Supporting local partners to developing information and advice on housing options – building on existing housing option hubs.

Identifying models for making available comprehensive information and advice, across health, housing and social care.

By 2016, we expect the following key changes to have been achieved

Person-centred outcomes

All partnerships have achieved a step-progression towards embedding

and mainstreaming a personal outcomes approach in local health and care systems.

Increased awareness and use of co-production approaches is evident in

partnership service planning and delivery models, and workforce and organisational development activity

Local partnerships are developing and integrating SDS within their commissioning and service delivery models.

Decisive shift to prevention

We must achieve a greater emphasis on prevention – focussing on the root causes of problems rather than symptoms. Redesign of our systems towards prevention requires a long-term commitment and a clear strategy to shift systems and services ‘upstream’.

There are particular opportunities over the next two years through the Change Fund. JIT will provide support and challenge to partnerships to maximise the leverage of the Fund and to embed effective approaches to support this decisive shift to prevention.

Exhibit 4

Change Fund investments Reshaping Care Pathway

SCOTLAND

Preventative and anticipatory care

Proactive care and support at home

Effective care at times of transition

Hospitals and long stay care homes

Enablers

% % % % %

2011/2012 Change Plans

19 27 24 23 7

2012/2013 Change Plans

23 25 28 16 8

2012/13 projected spend at Mid-Year

25 27 24 12 12

Overall, in 2012/13, Partnerships are projecting to spend over 52% of their Change Fund on preventative, anticipatory and more proactive community based services to support people to live at home or closer to home. This increase is primarily represented by a shift away from hospitals and long-stay care homes over the course of year 2012/13 with a sizeable drop in spend on the latter from 2011/12 – from 23% to 12% – and a rise of 6% on spend on upstream preventative and anticipatory care from 2011/12

There are challenging targets to meet over the period of this plan in preventing avoidable or premature admissions to hospital or long term care amongst older people and reducing delays in their discharge. A key strand of our work will be to support partners to put in place a range of safe and effective Intermediate care alternatives to emergency hospital admission and to enable earlier return home or provide care closer to home. We will also work to support the further spread of Reablement approaches to supporting people to regain and maintain their independence as far as possible.

At the same time, we will work with partners at national and local level to extend upstream, preventative support, building on the assets of older people, their families and local communities. We will promote active and healthy ageing across sectors, with contributions by local communities, housing organisations, recreation and leisure as well as health and social care.

Scotland is a pathfinder in Europe in its use of telecare and telehealth, and has secured significant funding to further develop services through the Technology Strategy Board’s DALLAS programme for ‘Living it Up’, and through the

European SmartCare and United4Health Projects. We will work in partnership with the Scottish

Centre for Telehealth and Telecare (SCTT), hosted by NHS 24, to support the implementation of the National Telehealth and Telecare Delivery Plan3, and to extend adoption of telecare and telehealth by health, housing and care services, and by the wider public by helping to enable greater choice and control in health, care and wellbeing services.

Growing numbers of people will be affected by dementia and improving the support they and their families receive is a major national priority. The JIT has played a central role in the Demonstrator Sites and Post Diagnostic Sites to identify effective approaches which can be adopted by all partnerships. Achieving the ambitions set out in the new Dementia Strategy will be complex and challenging, requiring multi agency and multi sector collaboration. Our approach to support this agenda will equally be wide-ranging.

3 A National Telehealth and Telecare Delivery Plan for Scotland to 2015: Driving Improvement, Integration and

Innovation

Exhibit 5 Provision of telecare varies significantly across local partnerships

Telecare (mainly community alarms) is now provided to most people who receive home care and to an even larger number of older people who do not receive home care.

http://www.scotland.gov.uk/Publications/2012/12/7791

http://www.scotland.gov.uk/Publications/2012/12/7791

The contribution of informal carers is key to helping older people to maintain their independence and wellbeing: the Scottish Government has set out a major agenda for improving support for informal carers and including a Ministerial commitment to increase investment to improve support for informal carers (at 20% of the Change Fund). Our initial focus will be on challenging and supporting partnerships to use this Change Fund investment to maximum effect, and then to ensure that investment in further improvements are taken forward through joint strategic commissioning.

Over the three years of this Delivery Plan , our approach to driving a decisive shift to prevention will be through providing practical improvement support and challenge to partners to:

Maximise the impact and leverage of the Change Fund in achieving a shift to prevention;

Provide 7 day access to a core menu of Intermediate Care services;

Increase the use of Reablement approaches

Adopt and scale key preventative approaches;

Increase use of telehealth and telecare technology;

Improve support to people affected by dementia;

Deliver the commitment to carers.


We will do this by

Maximise the impact and leverage of the Change Fund in achieving a shift to prevention

Supporting and challenging partnerships to focus on root causes not symptoms in developing their plans for change.

Providing expert support in identifying strategies and approaches to shift systems and investment towards prevention, maximising the Change Fund’s leverage.

Supporting partners, particularly in the third, independent and housing sectors, to contribute effectively to the re-design of local systems to shift towards prevention.

Provide 7 day access to a core menu of Intermediate Care

Promoting, testing and spread of ‘Hospital at Home’ and a menu of Intermediate Care for people with complex care and support needs.

Encouraging and supporting partners to adopt effective practices in terms of:

establishing a single point of contact for Intermediate Care;

introducing productivity tools so that capacity is increased in community hospitals, and home care


We will do this by

and community rehab teams. Adopt and scale key preventative approaches

Identifying and providing practical support on re-design or introduction of services and approaches that focus on prevention and release resource;

Supporting and challenging local partnerships to have put in place a local Active and Healthy Ageing implementation plan, and to have made identifiable progress in its delivery;

Improving prediction of those at risk of emergency admission, in particular by:

o Working with ISD so that the enhanced SPARRA tool is routinely used by GP practices and community teams;

o Promoting use of risk prediction tools in acute care, housing and care homes.

Working with national partners so that Anticipatory Care Planning is being delivered at scale.

Increase use of technology

With SCTT, supporting delivery of the European United4Health and SmartCare Programmes.

Supporting pathfinder local partnerships to expand innovative models through the Scottish Government and Technology Strategy Board’s DALLAS programme – Living it Up.

Supporting partnerships, local communities and providers to reduce digital exclusion.

Supporting partnerships to implement the key priorities in the Telehealth and Telecare Delivery plan

Engaging with key stakeholders and local partnerships to provide improvement support and challenge in delivering the actions in the National Delivery Plan.

Improve support to people affected by dementia

Providing expert improvement support to the Dementia Demonstrator sites, and the Post Diagnostic Support Demonstrator sites.


We will do this by

Co-Leading the National Dementia Improvement Programme, sharing learning from the dementia demonstrators of effective approaches, and supporting uptake across Scotland.

Building capacity within the housing sector to provide housing based solutions for people affected by dementia.

Deliver the Carers Strategy

Supporting and challenging partnerships to embed support for carers as a key focus in their planning and delivery of services and support, and to meet national requirements to spend at least 20% of their Change Fund allocation on supporting carers

Working with national partners to meet improvement and support needs of GPs in their role to identify carers

Providing support to carer organisations so that they can contribute effectively to local partnerships

Develop their approach to reablement

Working with the Scottish Community Care Benchmarking Network to improve understanding of the flow of money and impact of reablement on budgets

Pilot new training materials for Care at Home workers, produced with Alzheimer Scotland and Stirling University (NES and SSSC), in three partnerships in Scotland

Further development of Telecare and Telehealth linkages

Further analysis of the impact of turnover in reablement particularly in relation to different type of models


Decisive shift to prevention

All partnerships have delivered a year-on-year shift of Change Fund

investment to upstream, sustainable prevention.

All Partnerships provide a core menu of effective alternatives to emergency admission for people with complex needs, enabling a return home from hospital, or closer to home, without delay.

Telehealth and telecare has enabled choice and control in health, care and wellbeing services for an additional 300,000 people, with the use of telehealth and telecare proactively demanded as positive options.

The 8 pillar model of community support for people affected by dementia has

been adopted by local partnerships, and effective pathways and support are evident.

All partnerships will have a better understanding of the financial impact of reablement and the most effective delivery models will be in operation

Integration, partnership and collaboration

During the three years of this plan, the JIT will build on our success in promoting effective collaboration and facilitating improvement in the new context of health and social care integration. As set out in the Memorandum of Understanding, we will provide leadership in the delivery of health and social care reform to drive local change and improvement . We will support partnerships during the transition period and work with all of the new health and social care partnerships at a strategic and operational level, and with their local housing, third and independent sector partners, to support and challenge them to take full advantage of the opportunities to deliver a step-change in the pace of improvement.

The integration of adult health and social care is a central component of Public Service Reform. Integration tackles the ‘disconnects’ that exist currently between health and social care, and aims to accelerate improvement in both the quality of services and the outcomes achieved. The JIT will facilitate strategic engagement and partnership development and provide local partnerships with advice and practical support in building their readiness for integration and challenge partnerships to develop and deliver local implementation plans. The JIT’s role in this area will become clearer as the national policy for health and social care integration is further developed and the implications and requirements on local partnerships become evident. However, Ministers’ expectations are that JIT will support partnerships in their efforts to reshape practice and tackle the cultural shifts that will be needed to deliver on integration.

We carried out an Enquiry on progress with Health and Social Care Integration in local Partnerships earlier this year. The outcome from this exercise was reported to the Health and Community Care Delivery Group and Ministerial Strategic Group in April 2013. The report set out progress made by partnerships to date and highlighted examples of good practice which partnerships would be willing to share and to identify support needs going forward. There is clear evidence that health and social care partnerships need support to undertake joint strategic commissioning. The scope of the support required is substantial: increasing the understanding of the role and contribution of joint strategic commissioning; enhancing local skills and capability; and building implementation capacity. The JIT will lead an improvement programme involving all national improvement and support partners. The JIT’s specific contribution will be on driving a focus on strategic (rather than operational) issues and approaches within the process. The JIT will also support and facilitate improvements in the connections with strategic housing planning, with an initial step being the development of a Housing Contribution Statement as part of the Joint Strategic Commissioning Plans. The opportunity to consider the wider joint commissioning agenda to collaborate with children’s services will be an area for further work during the first year of this plan. The JIT’s experience in supporting partnership and collaboration means that we are asked to contribute to other wider cross-sector programmes. In the initial period of the plan, this will be in relation to improving healthcare for those in police custody.

Over the three years of this plan, our approach to improving integration, partnership and collaboration will be through providing practical support to partners to:

Build partnerships’ readiness for health and social care integration at both strategic and operational levels and support the implementation of national policy on integration and associated outcomes;

Develop and deliver local joint strategic commissioning plans for adults and older people, and support joint commissioning for children’s services;

Spread learning across wider, cross-sector programmes.


We will do this by

Build partnerships’ readiness for health and social care integration and support the implementation of national policy on integration

Identifying the changing improvement and support for leaders and needs of local partnerships, and putting in place supports, approaches and tools to address these at strategic and operational levels.

Providing customised support for individual partnerships, who want to improve their effectiveness.

Providing expert support to the housing sector to reach local agreement on their role, contribution and relationship with the new health and social care partnerships.

Organising and facilitating events at national, regional and local levels to support local partnerships to address particular issues, as they occur and facilitate shared learning .

Support partners to: We will do this by Develop and deliver local joint strategic commissioning plans for adults and older people, and support joint commissioning for children’s services

Leading the development and delivery of the National Improvement Programme for Joint Commissioning with key stakeholders.

Leading the development and roll out of the National Learning Framework and facilitating its use by local partnerships.

Providing ‘critical friend’ support to the development of local joint strategic commissioning plans.

Guiding and mentoring partnerships during the transition years 2013-15 in order to ensure alignment between their commissioning arrangements, and integration plans.

Supporting implementation of social care procurement guidance in the context of wider commissioning work.

Providing expert support to Partnerships in developing their adult joint commissioning plans and Children’s Services commissioning plans.

Providing expert support to partners in housing to improve alignment of strategic housing planning and


We will do this by

joint commissioning, particularly through the Housing Contribution Statements.

Spread learning across wider cross sector programmes

Providing expert support to the team leading the development of a new framework for the healthcare of people in police custody.

Providing expert support to emerging cross sector programmes and Change Funds – e.g. police and health; drugs and alcohol; early years.

Inform policy development

Providing advice and support to policy development by synthesis and reflecting back experience of local delivery to support realistic and achievable policy development at national level


Integration, partnership and collaboration

All partnerships have implemented effective governance and associated

arrangements, including locality planning, for health and social care integration.

All partnerships have agreed joint strategic commissioning plans for

adults and older people’s services, which set out long term plans for investment and disinvestment to achieve national and local outcomes and priorities

The housing sector’s relationship with the new health and social care

partnerships has been defined, has secured support, and is being implemented

All partnerships are reporting progress on the National Integration Outcomes and associated measures

Place, home and community

People consistently emphasise the importance to them of “place” – their home and their local community. Our strategy for reshaping our care services needs to incorporate and address issues about the ‘place’ in which care is provided: people’s homes, the local community and the wider environment. This is particularly important to achieve a decisive shift to upstream, sustainable prevention.

People consistently say that they want to stay in their homes for as long as possible, within supportive local communities: it is however clear that certain communities provide more supportive environments than others. Building the capacity of local communities is an integral part of achieving a shift in the balance of our care and support, and meeting many specific objectives, such as healthy and active ageing, improving support for people with dementia, meeting the commitment to carers, and enabling those using services to have greater control.

There is a wider recognition of the contribution that housing and the housing sector can make, through its relationships with local communities, the work of the social rented sector in areas of deprivation (and poor health outcomes), and the care and support services provided by many housing organisations. There is still a requirement to further raise awareness and understanding amongst both the housing sector, and partners in health and social care. The integration of health and social care offers particular opportunities to develop more effective working relationships at both strategic and operational levels.

Exhibit 6 More older people are living in housing, rather than in care homes.

By the latest time point on the chart (2011) the actual number of residents is 17% below the projected number based on the 2003 rate. The difference between the actual and the projected is a reflection of changes which must have occurred in the period: for example, changing thresholds regarding admission to a care home; changing preferences of older people (and their families); the availability of a wider basket of options which enable people to live longer in their own homes may be a critical factor.

The JIT has an established record in nurturing innovative practice, sharing the learning, and encouraging other areas and partners to adopt approaches found to be effective. During the course of this plan, we will focus on supporting innovation in relation to community-based and community-controlled services. We will also explore ways in which local communities can offer opportunities for volunteering.

Age, Home and Community, the national strategy for older people’s housing, sets out a substantial programme of change. The JIT has played a major role in supporting the development of that strategy and will continue to support its delivery. New building programmes will play a part in providing suitable housing options, but the great majority of people will live in housing which already exists. Making best use of that housing stock is essential. An early priority will be identify housing with care models which provide fit for purpose housing in local communities, are affordable and support wider objectives to enable older people to remain at home for longer.

The JIT has highlighted the contribution of equipment and adaptations in supporting people to retain their independence. The guidance issued in 2009 was accompanied by a programme of support from the JIT to local partnerships to undertake service improvements. The programme has achieved important improvements in community equipment services: this support will continue over the course of this plan. More recently, the Adaptations Working Group’s final report has recommended major reform of the current arrangements for housing adaptations. The JIT provided support to that group, and will continue to support the next stage of the reform of housing adaptations.

Care homes will remain a key part of local health and social care systems, and providing a particular form of care and support. The development of intermediate care, the emphasis on rehabilitation and reablement, and a personal outcomes approach have clear implications for the service design and delivery in care homes. There may be wider opportunities to extend the contribution that care homes make to the wider local community. JIT will continue to support providers of care homes to respond to the challenges and opportunities of health and social care integration and the reshaping care programme.

Over the three years of this plan, our approach to improving the focus on place, home and community will be through providing practical support and challenge to partners to:

Build on local assets and increase community capacity to develop resilient and supportive communities;

Ensure that home and housing issues are integral to re-design of care and support;

Nurture new models and approaches to community, and home-based care and support;

Increase the range of suitable housing options available to older and disabled people;

Re-shape equipment and housing adaptation services;

Enhance the range and quality of supports offered by care homes.


We will do this by

Build on local assets and increase community capacity to develop resilient and supportive communities

Promoting the contribution that community capacity building, and its links to co-production and assets based approaches, makes to improving personal and system outcomes.

Supporting the role of communities, including faith communities, in developing resilience in individuals and neighbourhoods and building their confidence to co-produce solutions to their own care.

Extending the contribution that housing providers make as community anchor organisations, and in

building community capacity. Ensure that home and housing issues are integral to re-design of care and support

Extending the understanding of the housing sector’s role and contribution to health and social care agendas.

Supporting the housing sector to contribute to its full potential in Reshaping Care, and the development of local joint strategic commissioning.

Illustrating the range of contributions that social housing providers can make to reshaping care.

Nurture new models and approaches to community, and home-based care and support

Promote and support innovative provider models such as social and community enterprises/co-operatives/community ownership.

Develop and encourage “supported volunteering” which integrates with contracted /commissioned care.

Increase the range of suitable housing options available to older and disabled people

Sharing learning across Scotland about re-modelling existing housing to provide a range of housing options – such as extra care housing, and community hubs with outreach support.

Identifying opportunities for wider use of existing housing and facilities to support community activities.

Reviewing advice on design standards at modernisation and upgrading to reduce the risk of accidents and to improve people’s independence.


We will do this by

Re-shape equipment and housing adaptations services

Providing expert support to Partnerships to review and improve Community Equipment service provision, in line with established good practice.

Supporting a major review of the organisation and funding of housing adaptations – and follow on implementation.

Enhance the range and quality of supports offered by care homes

Extending the contribution made by care homes in providing intermediate care and short breaks.

Share learning across Scotland about palliative and end of life care in care homes.


Place, home and community

Increased focus in all partnerships on place based approaches to build

resilient and healthy communities with the principles of co-production embedded throughout.

Fit for purpose, sustainable models of housing with care have been

identified, and form part of current or forward plans in all local partnerships.

Exemplars of integrated, outcome focused and person-centred housing

adaptations systems have been developed.

Improving practice and performance

The JIT provides practical improvement support to local health and social care partnerships to deliver national targets and improve outcomes. National HEAT targets include a specific focus on reducing the rate of 75+ emergency bed days and delayed discharges.

The challenging targets to 2015 are intended to enable partners to release capacity to re-invest in prevention and support at home as at the heart of the 20:20 vision. Supporting partnerships to deliver these targets will continue to be a key priority for the JIT. We will build on the success achieved to date and help partners to release resource for re-investment through re-design of their system with an emphasis on prevention.

The JIT, in collaboration with QuEST ( SG Quality Efficiency and Support Team), will also support the delivery of the Post Diagnostic Support HEAT target as a key element of the national Dementia Strategy 2. Improving practice and performance requires access to, and use of, relevant, improvement-related information. The major programme of change – particularly an outcomes approach, the shift to prevention, and joint strategic commissioning – all place new demands on information to support improvements in practice and performance. The JIT is supporting the development of a single suite of outcome indicators and measures for health and social care integration, which will underpin the new integrated health and social care partnerships. We will also continue to support and challenge partnerships to strengthen their use of improvement-related information, with a particular focus on identifying the impact and effectiveness of preventative approaches, the use of personal outcomes data, and reporting of benchmarking data in collaboration with the Scottish Community Care Benchmarking Network (SCCBN).

Exhibit 7 Older people are spending less time in hospital following an emergency admission.

The total number of days that people aged 65 and over occupied hospital beds following an emergency admission has fallen over the past two years. It is significantly below the projected ‘beddays’ based on levels in 2002/03

Over the three years of this plan, our approach to improving practice and performance will be through providing practical support to partners to:

Deliver their 75+ emergency bed day targets and delayed discharge targets;

Deliver the Post Diagnostic Dementia target;

Strengthen the analysis and use of performance improvement information


We will do this by

Deliver their 75+ emergency bed day targets, and their delayed discharge targets

Leading the HEAT target support group for emergency admission bed says in partnership with ISD, ASD, QuEST and the Improvement Network.

Supporting the delivery of the 4 week and 2 week targets and the implementation of the recommendations of the Delayed Discharge Expert Group.

Supporting and challenging Partnerships to make progress against their trajectories for reductions to 2015.

Supporting and challenging NHS Boards and their partnerships to identify the variation and productive opportunities associated with delayed discharges and avoidable emergency admissions.

Working with QuEST to support a whole system approach to demand, capacity and flow.

Deliver the Post Diagnostic Support target

Working with QUEST to support delivery of the post Diagnostic Dementia HEAT target.

Strengthen the analysis and use of performance improvement-related information

Coordinating the development of a single suite of outcome measures for health and social care integration .

Trialling systems for capturing comprehensive and coherent partnership level information, to enhance strategic joint commissioning and investment.


We will do this by

Realising the potential of Talking Points in capturing service level outcomes and to inform service improvement.

Supporting development of joint performance improvement frameworks, in parallel with health and social care integration.

Identifying the role of contribution analysis in identifying contributions to achieving outcomes – including testing in three national demonstrator projects.

Supporting the ‘Stitch in Time’ evaluation of the third sector’s contribution to the preventative agenda


Improving practice and performance

National targets are being met by all partnerships in relation to:

reducing maximum delays to discharge to 4 weeks from 2013, and to 2 weeks by 2015;

trajectories for reducing rates of 75+ emergency inpatient bed days; providing post-diagnostic support to people affected by dementia.

All partnerships are actively using integrated, fit for purpose information

to support planning, decision-making and performance improvement

Health and Social Care Partnerships will have been established and will be utilising and reporting on the suite of Integration Outcomes and associated measures

We will have a clear understanding of the contribution of the third sector to the preventative agenda

Building capabilities

A key component of the reform of our public services is the importance of building the capabilities of those who are involved in the delivery of public services. We will also support partners to share learning and to adopt practices and approaches found to be effective in improving performance, productivity and outcomes. We have built a significant library of resources on the JIT website, including evidence summaries from research, local experience from case studies and practical improvement toolkits. These will be reviewed, maintained and updated throughout the period of the plan so that we can continue to provide partnerships with useful material that encourages and supports local improvement. The ambitious programme of improvement involved in the integration of adult health and social care, and the reshaping care programme will demand increased capacity from those working in health and social care. The JIT’s Improvement Network will provide support to sharing learning and providing challenge to partners across health and social care practice and performance. The Network has become an established and popular source of information for local partners in health and social care, and other sectors. It has an ambitious and wide-ranging programme, using WebEx, e-bulletins, national and regional events, and a regional support network. Effective community planning arrangements will be at the core of public service reform, driving an increased focus on prevention and continuous improvement. An important element in the response to the recent review of Community Planning Partnerships (CPPs) will be to ensure that CPPs have the skills and capacities to deliver improved outcomes for their communities. The JIT is a key partner in the programme led by the Improvement Service to improve the capacity of CPPs. The JIT will have a particular focus on governance, achieving an outcomes approach, supporting integration and promoting co-production.

Over the three years of this plan, our approach to improving practice and performance will be through providing practical support to partners to:

Share learning across partnerships about practices and approaches effective in improving performance, productivity and outcomes;

Build capacity to support reshaping and improving services.

Support capacity building in relation to community planning;


We will do this by

Share learning across partnerships about practices and approaches effective in improving performance, productivity and outcomes

Coordinating improvement and support activity in relation to reshaping care and health and social care integration.

Building capacity and developing skills amongst partnerships to share knowledge about effective practice at policy, strategy and delivery levels.

Improving knowledge management across all improvement programmes, through reviewing and updating of JIT website, case study collection, and links with other improvement websites.

Providing relevant, up-to-date tools to support partnership improvement and to build capability for successful integration.

Encouraging and challenging partnerships to build on learning, spread local improvements, and increase the pace of change; and maximise the impact of the range of local and national improvement support available.

Build capacity to support reshaping and improving services

Deliver a programme of events through the Improvement Network to share and explain effective approaches across all improvement programmes.

Work with NES and SSSC to support Action Learning in partnerships as a vehicle to build local capability for integration.

Improve the quality of key skills in leadership and governance; management; partnership; production in joint commissioning.

Support capacity building in relation to community planning

Working with other improvement and support bodies in relation to:

governance, accountability and operation of CPP boards;

outcomes based resourcing and co-production;

outcomes based organisational design and management.


Building capabilities

Partnerships will have benefited from a comprehensive programme of

improvement techniques and events

Partnerships will be equipped to maximise the opportunities arising from the integration of health and social care

Community Planning Partnerships will be fully engaged with the integration of health and social care

Annex 1: Management Plan 2013/14 The Joint Improvement Team (JIT) has a vital role to assist partnerships, service users and carers to drive radical improvements in how health and social care are designed and delivered for, and with, the people of Scotland. Our team is made up of senior professional experts from all spheres of the health, housing and social care sectors, each with a track record of innovation, service redesign and business transformation and supported by a small policy and administration team from the Scottish Government. In 2013, we have been considerably strengthened by the newly formed Joint Improvement Partnership Board which brings together the national partners at the heart of leading public service reform - making us even more accountable to the people of Scotland, cementing positive partnerships, leading and challenging culture and practice and influencing policy. Our 2013/14 Management Plan sets out the key priorities for the team over the course of the year. It represents the first step in fulfilling our new three year Strategic Plan and will be refreshed annually to take account of progress and any changes in our operating environment. The Management Plan follows the structure of the Strategic Plan. Its central focus is on improving personal outcomes for the people who use health and social care services in Scotland. This aspiration is supported by our priorities to achieve a decisive shift towards prevention; integration, partnership and collaboration; place, home and community; and improving practice and performance. These are ambitious objectives and in order to ensure we are geared up to reach them, we will take a series of steps to improve and strengthen our strategic management systems throughout the year.

Programme Priority

Key Activities Milestones Timescale Lead

Pers

on

al

Ou

tco

mes

Design, commission, deliver and review services on the basis of personal outcomes

A co-ordinated national plan agreed with partners (Alliance, NES, SSSC, Scottish Care) offering all partnerships bespoke development inputs on a personal outcomes approach, with the first 50 sessions delivered.

March 2014 Chris Bruce

Develop commissioning for outcomes as the basis for developing SDS and delivering choice, control and quality in delivered services

Local partnerships are developing and integrating SDS within their commissioning and service delivery models. Partnerships are aware of new models of outcomes based commissioning, and are developing new approaches with providers that are predicated on systematic outcomes based assessments, care planning and reviews. Partnerships are developing capability to capture and utilise personal outcomes data to underpin Joint Commissioning Strategies.

March 2014

March 2014

March 2014

Tony Homer

Empower people by providing comprehensive, accessible and relevant information and advice

Support local partners to develop information and advice on housing options building on existing housing option hubs

September 2013

Amanda Britain

Programme Priority


Decis

ive S

hif

t to

Pre

ven

tio

n

Maximise the impact and leverage of the Change Fund in achieving a shift to prevention

All partnerships achieve a quantifiable shift of investment in shifting to prevention in their use of the Change Fund Case examples are available of the demonstrable impact of Change Fund investment, and of disinvestment, in supporting a shift to prevention The third and independent sectors report greater engagement with Change Fund activity at a local and national level.

March 2014

March 2014

March 2014

Tony Homer

Adopt and scale key preventative approaches

The Reshaping Care Outcomes Framework and Contribution Analysis define key preventative approaches in the context of Reshaping Care for Older People.

December 2013 Gerry Power

Decis

ive S

hif

t to

Pre

ven

tio

n

Increase use of technology Develop opportunities to enable telehealthcare services for people with disabilities and long term health and care issues to be accessed via Self-Directed Support. Identify solutions for the delivery of telehealth and telecare services to people who live in areas with limited or no mobile or broadband connectivity.

March 2014

March 2014

Alistair Hodgson

Programme Priority


Decis

ive S

hif

t to

Pre

ven

tio

n


Put in place an improvement and support programme, linking dementia related support to reshaping care support, for all partnerships.

September 2013

Douglas Philips

Deliver the carers’ strategy All Partnerships have a robust approach to identifying and supporting carers.

March 2014 Margot White

Provide urgent seven day access to a core menu of Intermediate Care

Establish and lead a cross sector steering group on Intermediate Care and establish and support task and finish groups on workforce development, information and impact, and use of technology Further support for partnerships to scale up reablement Undertake a benchmarking survey of Intermediate Care in partnerships Work with NES and Community Hospitals Executive leads to establish an Intermediate Care community of practice Embed Intermediate Care and Hospital at Home in national and local Action Plans for Unscheduled Care Organise a national learning event in collaboration with BGS, Community Nursing, ADSW, AHP and Unscheduled Care leads

April 2013

April 2013

May 2013

October 2013

September 2013

November 2013

Anne Hendry

Programme Priority


Decis

ive S

hif

t to

Pre

ven

tio

n

Adopt and scale key preventative approaches

The Reshaping Care Outcomes Framework and Contribution Analysis define key preventative approaches in the context of Reshaping Care for Older People.

December 2013 Gerry Power

Increase use of technology Develop opportunities to enable telehealthcare services for people with disabilities and long term health and care issues to be accessed via Self-Directed Support. Identify solutions for the delivery of telehealth and telecare services to people who live in areas with limited or no mobile or broadband connectivity. Facilitate year 1 development of the Clyde Valley and Ayrshire European Projects (SmartCare & United4Health), including initial recruitment state. Secured ‘Reference Site’ accreditation from the European Commission as part of the European Innovation Partnership in Active and Health Ageing, allowing Scotland to be formally recognised as one of the leading areas in Europe for integrated care.

March 2014

March 2014

March 2014

July 2013

Alistair Hodgson

Programme Priority


Decis

ive S

hif

t to

Pre

ven

tio

n


Put in place an improvement and support programme, linking dementia related support to reshaping care support, for all partnerships.

September 2013

Douglas Philips

Deliver the carers’ strategy All Partnerships have a robust approach to identifying and supporting carers.


Follow up action arising from the 2013 reablement study

Further work on understanding performance, the flow of money and impact of reablement on budgets in conjunction with the Scottish Community Care Benchmarking Network Pilot new training materials for Care at Home workers, produced with Alzheimer Scotland and Stirling University (NES and SSSC), in three partnerships in Scotland to assist staff to respond using reablement techniques to work with individuals and families. Further development of Telecare and Telehealth linkages Further analysis of the impact of turnover in reablement particularly in relation to different type of models

October 2013

October 2013

March 2014

October 2013

Alex Davidson

Programme Priority


Inte

gra

tio

n, P

art

ners

hip

an

d

Co

llab

ora

tio

n

Work with partnerships to create the conditions for improvement to support more cost effective implementation of national strategies and to deliver better outcomes in health, social care and housing services

A dedicated JIT Lead in each Partnership area to support development and implementation of the Change Plan and Joint Commissioning Strategy providing a link to national resources and information. Provision of support for developing work on health and social care integration at both strategic and operational levels and facilitation of shared learning Bespoke development support for Change Plans and joint commissioning as agreed with individual partnerships Provide programmes of improvement support as a consequence of challenges such as delayed discharge or other performance issues agreed with partnerships Utilisation of JIT Action Group members, with appropriate levels of expertise, to undertake specific tasks which would be agreed with the partnership before being added to this general brief.

March 2014

March 2014

March 2014

March 2014

March 2014

Partnership Leads

Programme Priority


Inte

gra

tio

n, P

art

ners

hip

an

d

Co

llab

ora

tio

n

Build partnerships’ readiness for health and social care integration

A co-ordinated programme of improvement support is in place and being delivered, which is responsive to expressed needs of partnerships in relation to integration, using a combination of survey and JIT contact with partners Provide customised support for individual partnerships, to address specific issues or to build capability for integration Facilitate and provide expert support to the housing sector to contribute to the development of health and social care integration Maintain and develop cross directorate links and networks to do with Reshaping Care and other related programmes across Scottish Government

October 2013

March 2014

March 2014

March 2014

Margot White Partnership Leads Gerry Power

Programme Priority


Inte

gra

tio

n, P

art

ners

hip

an

d

Co

llab

ora

tio

n

Develop and deliver joint strategic commissioning

The National Improvement Support Programme for joint strategic commissioning will be implemented. A national learning programme will be delivered to 20 out of 31 partnerships addressing the key leadership and delivery skills. Partnerships are working to extend their approach to joint strategic commissioning to incorporate all adult groups. Effective links are made between joint strategic commissioning and community planning at national and local levels. Partnerships’ capabilities and capacity to develop Joint Commissioning Strategies are increased through customised feedback, learning and support. Working in collaboration with the Carers Coalition, carers will be better informed and supported to strengthen their engagement with partnership working on joint strategic commissioning.

March 2014

March 2014

March 2014

March 2014

March 2014

October 2013

Tony Homer

Programme Priority


Inte

gra

tio

n,

Part

ners

hip

an

d

Co

llab

ora

tio

n Spread learning across wider

cross sector programmes Health/police partnerships are equipped to introduce the new framework for the health care of people in police custody.

March 2014 David Pigott

Programme Priority


Pla

ce,

Ho

me a

nd

Co

mm

un

ity

Build community capacity to support co-production and the development of supportive communities

All partnerships are implementing plans to increase the capacity of communities to participate in the re-shaping of local health and care.

March 2014 Gerry Power

Embed co-production as mainstream practice in the design, commissioning and delivery of services

All partnerships have a prioritised co-production support programme in place, and agreed interventions have been provided Increased awareness and use of co-production approaches is evident in partnership service planning and delivery models, and workforce and organisational development activity.

March 2014

March 2014

Gerry Power

Ensure that home and housing issues are integral to re-design of care and support

Home and housing issues are addressed in all relevant national policy programmes.

March 2014 Amanda Britain

Nurture new models and approaches to community, and home-based care and support.

Exemplars of alternative approaches to providing care and support are available for sharing across all partnerships.

March 2014 Mike Martin

Programme Priority


Pla

ce, H

om

e a

nd

Co

mm

un

ity

Increase the range of suitable housing options available to older and disabled people .

Six innovative housing with care projects are being developed across Scotland.


Re-shape equipment and housing adaptations services

Six partnerships are re-designing equipment and/or housing adaptations services.


Enhance the range and choice of support offered by care homes

Review Joint Strategic Commissioning Plans and Change Plans for 2013/4 to monitor progress and identify examples of good practice to ensure all partnerships are increasing the range of support offered by care homes.

March 2014 Stan Smith

Programme Priority


Imp

rovin

g P

rac

tice a

nd

Perf

orm

an

ce

Deliver national targets in relation to 75+ emergency inpatient bed days, delayed discharge, and post diagnostic support.

National targets are being met by all partnerships in relation to:

sustaining maximum delays to discharge of 4 weeks from 2013, and working towards 2 weeks by 2015;

trajectories for reducing rates of 75+ emergency inpatient bed days;

providing post-diagnostic support to people affected by dementia.

March 2014

Chris Bruce Anne Hendry

Strengthen the analysis and use of performance improvement-related information

All partnerships are actively moving towards using integrated, fit for purpose information to support planning, decision-making and performance improvement, whilst recognising the local skills base to enable this will evolve over time.

March 2014 Pete Knight

Programme Priority


Bu

ild

ing

Cap

ab

ilit

ies

Share learning across partnerships about practices and approaches effective in improving performance, productivity and outcomes

We will have delivered a continuously evaluated programme of support through the Improvement Network. This includes;

Quarterly e-bulletins

WebEx programme

Case studies

National and regional events

Multi-platform communications


Build capacity to support reshaping and improving services

We will have begun a process of enhancing JIT capacity through a Connections Programme review of toolkits and improvement methodology. We will have initiated local programmes to improve Partnerships’ capacity through bespoke interventions in two areas who have requested this assistance.

December 2013

October 2013

Margot White

Supporting capacity building in relation to Community Planning

Through our participation on the National Group on Community Planning, we will provide targeted support for self-assessment for Community Planning Partnership Boards and support for Executive teams and Board members.

August 2013 Margot White

Programme Priority


Imp

rovin

g O

ur

Str

ate

gic

Man

ag

em

en

t Better Planning and Budget Management

We will have developed a process to align our strategic planning and budgeting processes and improve our budget reporting processes We will have developed an integrated performance and reporting system

October 2013

October 2013

David Heaney

Supporting and developing the Joint Improvement Partnership Board

We will provide support to enable the Board to discharge its functions effectively We will make arrangements for completion of the Board’s first partnership agreement review

May 2013

March 2014

David Heaney

Better Procurement and Contract Management

We will have in place a revised system of procurement representing best value and sustainability We will have re-modelled our partnership support system and established a system that balances flexibility, equity and affordability

August 2013

March 2014

David Heaney

Programme Priority


Imp

rovin

g O

ur

Str

ate

gic

Man

ag

em

en

t Getting Our Message Across Our new website will be operational and we will deliver a range of events, conferences and WebExes up to March 2014 We will complete our re-badging process and signed off our engagement plan.

September 2013

August 2013

David Heaney

Developing our Team We will have fully implemented the Policy & Administration Team review and secured increased capacity to meet new pressures. All staff will have had their appraisals completed and have agreed opportunities for personal and professional development with their line manager. We will have completed the review of the Action Group and assigned individual JIT Leads to oversee the work of Action Group members, and provided a programme of learning and development.

September 2013

March 2014

March 2014

David Heaney Margot White

Paper no: JIPB/01/4a/2013


Agenda item: 4

Purpose: FOR DISCUSSION

Title:

Examples of presentation of key statistics – ‘A look into the Rear-view mirror’ discussion paper

Key Issues:

The JIT has been promoting widely the use of multi-agency data to improve decision-taking on an integrated basis. The attached report was prepared to serve two related purposes – to provide a perspective of care delivery changes which have been underway across Scotland over the past decade, in order to inform future decisions and to act as an exemplar on the analysis and use of the nationally and locally available data. The analyses in the paper are examples of the kind which the JIPB may wish to consider be prepared for monitoring and evaluation of progress more generally and with regard to the JIT Strategic Plan.

Action Required:

The JIPB are invited to consider the content of the paper from the point of view of what kind of tables/charts/data would be helpful to receive in the future.

Author: Peter Knight Date: 22 May 2013


Reshaping Care for Older People: ‘A look into the rear-view mirror’ or Further Insights from national data – a

discussion paper (revised 19 May 2013)

Peter Knight JIT Programme Lead on Partnership Information

Summary This discussion paper presents a retrospective analysis of trends on a selection of national measures which have relevance to Re-shaping Care for Older People in Scotland. It also weaves in additional analyses of the data in a way which takes account of the demographic shifts which have occurred during the past decade. The paper discusses some of the factors which are likely to have influenced the trends. With an eye on future changes to come, the report adds further insight and awareness about the magnitude and direction of changes which have already occurred in the care and support of older people in Scotland. In conclusion it draws attention to some of the key issues referred to in this paper and which the JIT is addressing with stakeholders.

Introduction By 2009 a set of analyses including forward projections of age related emergency admissions to hospital and potential social care needs were sharply heightening awareness of the full potential impact of population change in Scotland on health and care for older people. It was evident from the analyses, which were presented at a series of meetings of Scotland’s leaders in the health and social care field in early 2009, that change was essential. The conclusion was reinforced by an emerging and largely unprecedented fiscal climate. With this backdrop serving as context, the Re-shaping Care for Older People Programme was established, providing a national framework for changes that would be necessary in the short, medium and longer term. The Change Fund was introduced in 2011/12, providing the catalyst for a cohesive response from partnerships engaging in what is essentially a whole system transformation programme. . This report looks at some of the trends in national measures up to the establishment of the Re-shaping Care programme and more recently. What these trends reveal is that there is no fixed status quo, looking back – change has been a continuous presence. To illustrate this, the analyses presented here not only show the actual trends based on the published figures for each year shown but also show a ‘projected trend’ which are the values obtained by applying the 2003 (or 2002/03) rate to the population aged 65+ in each year thereafter. This provides a way of seeing how far the actual trend has diverged from the trend which would have occurred had population change been the only factor at play. The specific aspects of care included in these analyses are:

long stay care home residents;

local authority home care (and Telecare); and

for people admitted as an emergency to Scotland's general acute hospitals: beddays used and admission numbers.

Care and support of older people is multi-faceted and each element of the analyses shown here adds to our overall understanding. Setting the different elements alongside each other has the additional benefit that it is possible to reflect how the different trends differ. All the analyses are based on routinely collected national data and have the potential to be replicated locally. The information provided here is relatively high level and it is beyond the scope of the paper to give a comprehensive account, with appropriate evidence, of all the factors behind the trends. Reference is made in the text however to key factors which have reasonable credibility and which are likely to have at least contributed in some respect to the direction of the trends.

Demographic context The backdrop to this paper is the changing demographics in Scotland and the way these bear upon health and care. Both health and (social) care needs are very influenced by age, with a greater need for care and support, in general, in later life. Population projections show that the population structure of Scotland is getting older and that this feature is going to accelerate during the next few decades. As is shown in the table the growth in numbers of people aged 65 or over, or 75 or over, which occurred in the decade up to 2011 is expected to be superseded by an even greater rise in numbers in those age groups in the current decade and decade after that.

Actual and projected change in population aged 65+ and 75+, Scotland

65+ 75+

In ten year period:

Actual increase 2001 to 2011 85.2 52.5

Projected increase 2010 to 2020 195.3 92.9

Projected increase 2020 to 2030 249.8 157.1source: GRO Scotland

thousands

About the analyses Each of the analyses in this paper uses the same general approach: the trend in the actual activity in the period from 2003 to 2011 is presented, alongside a calculated ‘projected trend’. The projected trend shows what the trend would been if nothing had changed (or if changes had cancelled out) since the start of the period (i.e. 2003 or 2002/03), apart from the known changes which had occurred in the size and structure of the 65+ population. The difference between the two sets of figures (i.e. actual and projected) in each chart show the net effect of changes in service delivered, adjusted for changes in population structure, since 2003. Note that in all the bar charts below the y-axis scales do not start at zero.

Care home residents The actual number of older people resident long term in care homes at the census point at the end of March has stayed fairly level since 2003 (Chart 1). Because of the growth in the 65+ population this means that the proportion (or rate) of older people supported long term in care homes has actually gone down in the period. The projected numbers shown on the chart provide some measure of this difference. Specifically they indicate what would have happened had the long term resident rate remained constant from 2003 onwards. By the latest time point on the chart (2011) the actual number of residents is 17% below the projected number based on the 2003 rate. The difference between the actual and the projected is a reflection of changes which must have occurred in the period. It is probable that a number of factors account for the difference: for example, changing thresholds regarding the necessity of admission to a care home and changing preferences of older people (and their families) could affect the rate. The availability of a wider basket of options (e.g. see Home Care below and note 1 of the Appendix) which enable people to live longer in their own homes may be a critical factor. Chart 1

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 re

sid

ents

65

+

Projected

Actual

Home care Between 2003 and 2005 the total number of people provided with local authority funded home care rose in Scotland, in line with the demographic changes in the population aged 65+ (Chart 2). After 2005 there was a sustained year-on-year reduction in the number of individuals receiving home care, through to 2011. In the same period the projected number (based, as before, on the 2003 rate) rose steadily year-on-year and the net effect, the difference between the projected and the actual, has grown each year. By 2011 the actual number receiving home care is 19% below the projected number.

A range of factors may have contributed to this trend including changes in the application of local eligibility criteria or a move away from the use of low intensity home care with substitution by other forms of care and support (e.g. Telecare – see below). Chart 2

Home care clients 65+

30000

40000

50000

60000

70000

2003 2004 2005 2006 2007 2008 2009 2010 2011

Year

N o

f cl

ien

ts 6

5+

Projected

Actual

A somewhat contrasting trend is found with the number of people provided with intensive home care (i.e. 10+ hours home care). Here the trend in the actual numbers receiving these intensive level packages of home care is higher (+13% in 2011) than the projected trend (Chart 3). This means that a greater number of people are provided with 10 or more hours of home care than would be expected on the basis of population change alone since 2003. Chart 3

An analysis of the total hours of home care provided by local authorities reveals a similar divergence between actual and projected. In 2011 the actual hours provided

are 20% higher than the projected (Chart 4). (Note that this analysis differs in some respects from the other analyses presented. The hours of home care relate to clients of all ages. The projection method used is slightly different from the method used elsewhere – see note 2 of the Appendix) Chart 4

Drawing these analyses together, it is evident that there has been a steeper than projected rise in hours of home care provided in the period from 2003, whilst the overall number of clients receiving home care has fallen in the same period. This suggests that while the ageing of the population brings with it the likelihood of higher demand for care and support, in terms of the allocation of home care resources local authorities have increasingly focussed on people with higher needs. Viewed alongside the trend information on long term care home resident numbers it may be that the relatively static number of care home residents is in part a flip side of the higher-than-expected rise in home care provided. Thus it may be that these trends are the reflection of a greater emphasis towards care and support at home even for people with higher levels of care need. Looking ahead, the community/home based improvement and development initiatives which are emerging or underway, including re-ablement and intermediate care (including further flexibility in the use of care homes), and the application of self-directed support, will lead to even more marked changes in these trends.

Telecare provision As a corollary to the analyses above it is also relevant to look at the emerging figures on telecare provision by local authorities. Telecare is strongly orientated towards the prevention end of the care and support spectrum and has become a significant feature in delivery of support in an integrated system. Although trend data are not available nationally we know there has been a growing provision of telecare in recent

years, in part supported by Scottish Government initiatives and funding and with the active support of the Joint Improvement Team (JIT) through the national Telecare Programme. We do know from the latest available figures (2011) that telecare (mainly community alarms) is now provided to most people who receive home care and to an even larger number of older people who do not receive home care (Chart 5). The likely extension of the use of telehealthcare in the future as part of a wider integrated care and support package for people with long-term conditions and/or at risk of falling is another reason for assuming that the trends of the past decade discussed earlier may not reflect future trends. Chart 5

Local authority services: Telecare & home care

Scotland 2011

21%

25%

54%

Telecare no homecare

Home care+Telecare

Other home careclients

Although constrained by the single year of data available, it is interesting to note that the dark bar (the ‘actual’) in the 2011 column in Chart 2 would double in height were it to include also the Telecare-only clients.

Emergency hospital inpatients: Occupied beddays The benefits to older people of avoiding emergency admission to hospital, except where it really is clinically necessary, have been widely discussed. Emergency hospital inpatient stays are also known to account for the largest single area of expenditure on the care and support of older people. There is an existing HEAT target designed to lead to reduced hospital bedday rates by people aged 75 and over, thus focussing specifically on the age group most likely to use hospital inpatient beds. For consistency with the earlier analyses in this paper, the analyses below look at the 65+ age group but the general conclusions also apply to the 75+ age group. The trend in the use of hospital inpatient beds following emergency admission since 2003/04 is, in general, rising until 2008/09 (Chart 6). As mentioned earlier, the Re-shaping Care programme was launched in 2009 and building on the earlier initiatives within the long term conditions programme added a sharper focus to efforts to

change the direction of this trend. By 2010/11 the number of beddays had fallen to its lowest level since 2003/4. Using a similar approach to the method used on the social care data, the 2002/03 rate of beddays has been applied to the population in each of the subsequent years to give projected values up to 2010/11. As is evident from the chart, if the increase in beddays had kept in step with the increasingly older population after 2002/03, the additional bed requirement would have been substantial. In fact even up until 2008/09 the number of beddays based on the 2002/03 projection is higher than the actual beddays used. From 2009/10 onwards, the gap between the projected beds and the actual beds has grown substantially, with a difference of 11% by 2010/11. Chart 6

Hospital emergency admission 65+:

occupied beddays

2100000

2400000

2700000

3000000

3300000

2002/03

2003/04

2004/05

2005/06

2006/07

2007/08

2008/09

2009/10

2010/11

be

dd

ays

Projected

beddays

Actual

beddays

There are likely to be many reasons for a growing divergence between actual and projected. Partnerships have worked hard to avoid unnecessary delays in moving people on from hospital once their care and treatment is complete and there has been a well documented reduction in the number of delayed discharges. This success in partnership working will undoubtedly have made a contribution. There is also evidence from surveys of a long term improvement in healthy life expectancy in the population at large which might well have had some impact. After 2008/09 however, where a tipping point occurs in the trend, it is likely that the Re-shaping Care and long term conditions programmes, in combination with associated HEAT targets, will have been essential factors. For Scotland as a whole the challenge remains to sustain and improve upon these trends. This would allow resources to be released to deliver on the longer term aims of the Re-shaping Care programme – to enable older people to live well at home as independently as possible. The projections which are referred to in the first sentence of the introduction showed that the demographic changes could lead to a need for more and more hospital beds in Scotland unless alternative care and support, including anticipatory and preventative measures, can be developed. This conclusion

is still as valid today as it was in 2009. Even in the short spell since 2008/09 had the bedday rate per 1000 population aged 65+ continued at the 2008/09 level to 2010/11 almost 500 beds more would have been required in Scotland’s hospitals.

Numbers of emergency admissions The HEAT targets rightly focus on bed days because of the consensus around the potentially detrimental effect for older people associated with prolonged stays in hospital, higher risk of long term care and the associated costs. It is also important however to retain interest in the number of emergency admissions: although many emergency admissions are entirely appropriate, the process of emergency admission to hospital is potentially disruptive for the patient and their families and the front-end costs of emergency care are significant. A year on year rise in the number of emergency admissions of older people has been observed since 2003 but is especially evident from 2006/07 onwards. In 2006/07 the gap between the actual and the projected volume increased markedly and has been sustained since then (Chart 7). In 2010/11 the actual number of admissions was nearly 7% higher than the projected number. Emergency admissions, arriving through A&E or directly referred into hospital, continue to challenge the flow through acute care and more recent unpublished figures show that the upward trend is continuing. Chart 7

Hospital emergency admissions 65+

120000

140000

160000

180000

200000

220000

240000

2002/03

2003/04

2004/05

2005/06

2006/07

2007/08

2008/09

2009/10

2010/11

Year

em

erg

en

cy a

dm

issi

on

s

Actual

admissions

Projected

admissions

Other analyses (not shown here) show that a much bigger percentage rise has occurred in admissions which result in short stays in hospital (e.g. 1 day or less) than the percentage rise in admissions which result in longer lengths of stay. There are likely to be a mix of reasons for this pattern including:

more older people with complex and multiple conditions managed in the community;

changing thresholds for emergency admission for specific conditions;

influence of algorithm driven referrals for chest pain, stroke/ TIA and breathlessness, availability of senior decision makers;

access to diagnostics;

access to ambulatory alternatives to emergency admission; and

unintended consequences of other targets such as the four-hour A&E standard.

Bundling together the analysis on beddays and actual admissions of older people admitted as an emergency it is clear that whilst much is being achieved regarding reduced hospital bed use the number of emergency admissions is still an impediment to progress and continues to rise. With support from the Change Fund many of the emerging initiatives in local partnerships have the reduction of admissions or support for earlier discharge as intended outcomes. If partnerships are able to achieve success with these initiatives, drawing upon the improvement support of the Joint Improvement Team and others as required, they will have gone a long way towards the re-shaping of care and support for older people which is absolutely necessary for Scotland

Conclusions

1. The paper features key trends in a number of areas of activity in care and support for older people. It presents new analyses using a method which illustrates what the trends might have been had the increasing number of older people, in this case people aged 65+, been the determining and only factor which changed in the period covered. The bringing together here of different measures and the use of the latter method means that we are able to contrast the different activities and draw wider inferences than is possible from a fragmented analysis of each measure individually.

2. The differences between the actual trends and the population driven trends

(‘projected’) shows the net impact of a mix of other factors including changing local practice and policies. These changes have been achieved, in part at least, from the continuing improvement initiatives which have been a feature in Scotland, as well as the result of many individual local decisions. The available data largely pre-date the impact of the Change Fund which can be expected to drive further change.

3. One of the inferences suggested by the social care data is that there is a

partial correlation between the static or falling number of care home residents at Scotland level, despite the rising number of older people since 2003, and the trend in the number of hours of home care which have grown even more than would be expected as a consequence of the expanding population. While home care client numbers have fallen overall since 2005, there has been a rise in the number receiving intensive levels of home care. Intensive levels of home care are likely to be possible alternative form of care and support to long term care home admission.

4. Orientated strongly towards the prevention end of the care and support

spectrum, Telecare provision has become a significant feature. The number of people who were provided with Telecare support in 2011 outstrips the number getting home care.

5. Convincing progress at Scotland level towards a reduced reliance on inpatient

beds for emergency care has been achieved since 2008/09. The presence of a HEAT target in this regard will help partnerships focus on further progress in the next few years. This is a sentinel area of focus within local Change Plans and an area where the JIT is actively providing support.

6. A continuing rise in the number of older people being admitted as an

emergency continues to challenge acute care services. Much of the growth in these admissions is for short spells in hospital. This key issue has been identified as a specific area for JIT and others to focus improvement effort with local partnerships, along with the on-going improvement work to reduce delayed discharges.

PK JIT 19 May 2013 (original version issued in March 2013)

Technical notes (revised May 2013) Calculation of projected numbers In the case of the care home residents, home care clients (ie not the 10+ hours or the care hours overall) and the hospital admissions projections the calculation involved applying the age related rate at 2002/03 or 2003 to the estimated population in each year. In the case of the 10+ hours home care and home care hours it was not possible to use this method and an alternative approximation of was used. Details are available on request. 1. The following observation is made by Scottish Government’s Analytical Services Division which was responsible for collecting Care Home Information for much of the period covered by the analysis: Introduction of standards by Care Commission resulted in

closure of small residential care homes unable to meet new standards. New Care Homes tend to be large purpose built Nursing Homes. Evidenced by increasing size of care homes and shift towards private sector (older people care homes.)

Care hours projection figures 2. In addition, the published home care hours data are not age-specific insofar as they are able to be used in the general method used for projecting the 2003 rates. Because of this a different, less reliable, method for projecting the care hours is adopted here. The projections for the care hours uses all ages data adjusted each year by an estimate of the growth in the population at risk in that year. The reliability of this method is uncertain. If better alternative methods are identified these will be used.

Data sources: Care Home residents: ISDScotland/ASD Home care & Telecare: H&SC ASD Emergency admissions: ISDScotland Population: NRS (GROScotland)

Paper no: JIPB/01/05/2013 Meeting date: 30 May 2013

Agenda item: 5


Title:

Badging Options – for approval

Key Issues:

The JIT logo is now a well-recognised and respected brand in Scotland.

The establishment of the Joint Improvement Partnership Board extends representation beyond JIT’s founding members being the Scottish Government, CoSLA and NHS Scotland

As well as these partners, the Memorandum of Understanding has been signed off by SCVO and Scottish Care representing third and independent sector interests.

It is therefore appropriate to revisit JIT’s current badging scheme to ensure it adequately reflects the membership of the Board and their interests

The attached options are therefore offered to Board members for consideration and agreement on a scheme of badging.

Action Required:

The Board is asked to consider, amend as required and approve its preferred badging scheme to be used in all JIT publication sand public events from this point.



Option 1

Option 2

JIT: DIRECTORS REPORT

Following the first Board informal session on 17th April, we have done some further work on our draft Strategic Plan for the next three years and published our Annual Review Report for 2012/13. The draft JIT Strategic Plan for 2013 – 2016 sets out our priorities and expected key deliverables for the next three years. The Strategic Plan and associated annual Management Plan(s) will require to be reviewed in the context of both the resources available, and the developing policy and delivery landscape. There will be an opportunity for the Joint Improvement Partnership Board to influence the improvement and support priorities for health, housing and social care going forward, and in the light of the forthcoming Spending Review.

Given the ambitious developments in context of both the personalisation agenda and

integration, the JIT faces an expansive range of potential work areas to be considered in the context of finite capacity. Despite our flexible and agile approach to deploying our capacity, this presents significant considerations for the Joint Improvement Board to determine how and where the JIT should direct its resources, and to support opportunities to secure additional resources to deliver on the expectations and ambitions. The Annual Report sets out the JIT story for 2012/13. It has been a year of change and transition, not least with the establishment of the Joint Improvement Partnership Board and associated Memorandum of Understanding. This provides a great opportunity for collective sponsorship of JIT’s unique, added value to provide leadership and support to the delivery of health and social care reform. The Improvement and Support Group, under the leadership of JIT, provides a forum to engage with the range of improvement services and national partners to ensure collaborative gain and effective targeting of resources and capacity, and sharing our learning and expertise. Our recent Integration Enquiry Report, for example, will inform the priorities for support and knowledge exchange to support partnerships during the transition period as the health and Social Care Integration Bill progresses through Parliament.

Board members had the opportunity to meet the JIT team at our April session and programme leads will contribute to Board discussions going forward on specific areas of our work. Myself and colleagues have recently contributed to a number of major national, UK and European events and conferences, with significant interest being expressed in JIT and our approach. We will provide updates to the Board on events throughout the year. Dr Margaret Whoriskey JIT Director 30 May 2013



A

genda item: 7

Purpose: FOR DISCUSSION

Title:

JIT Programme Budget 2013/14

Key Issues:

The Joint Improvement Team is funded by the Scottish Government. Its core programme funding is £1.087 million. This is supplemented by income to support specific workstreams. The Centrally Managed Budget (£114,000), funds JIT’s national and regional events and the Administration Budget (£229,000) funds the Director’s post and Civil Service policy/ administrative support posts. Some of the key financial challenges are;

JIT’s core programme budget has remained static since 2007

Non-recurring income for programme specific work from other the Scottish Government Divisions makes up more than a quarter of JIT’s programme spend

The Minister for Public Health has made clear his aspiration for JIT to extend its “footprint” into all 32 partnership areas to meet the challenges of integration. The Minister is of the view that there will need to be early consideration given to the resources needed by JIT to deliver future priorities and commitments

To meet emerging demands for support to partnerships in advance of integration as well as meeting our existing commitments we estimate our Core Programme Budget will need to increase to around £2 million in the current financial year.

Action Required:

The Board is invited to discuss the 2013/14 Programme Budget and consider how best to address the resource implications associated with the JIT extending its “footprint” in line with Ministerial priorities.



JIT Budget Overview 2013/14

1. The Joint Improvement Team (JIT) is funded entirely by the Scottish Government. The core programme funding of £1.087 million for JIT was originally top-sliced from the national Delayed Discharge funding of £30 million. Since 2007, the balance of this funding has been included in the non-ring-fenced Local Government allocation in line with the Concordat. The Core Programme Budget is managed by the JIT Director and is allocated on the basis of our annual management plan.

2. The Core Programme Budget is supplemented by income from across other

Scottish Government Divisions on a non-recurring basis. This stream of income is used to deliver work on key priority programmes such as joint commissioning, intermediate care, co-production and dementia. We anticipate that overall income from this route will amount to around £450,000 in the current year and work is currently underway to confirm these amounts.

3. The Centrally Managed Budget (£114,000), funds JIT’s national and regional conferences, events, seminars and publications, and the Administration Budget (£229,000) funds the Director’s post along with a small team of Civil Service policy/ administrative staff.

4. The final component of our financial framework is the Scottish Government’s Central Secondee Budget. This provides funding for three members of JIT’s core team.

5. In some cases, JIT has made direct allocations to NHS Boards, Local Authorities or other organisations to enhance their capacity and for the release of staff time for sessional work to create time-limited additional capacity to lead local improvement work. In the past, JIT has also provided some resources to support local innovation or to commission relevant work in line with work plan objectives.

6. In previous years, JIT has also had access to additional funds through the Shifting the Balance of Care Programme from 2008/9 (£2 million) to 2010/11 (£0.5 million). In 2011/12, £400,000 was allocated from the Directorate of Health and Social Care Integration, and £427,000 was allocated in 2012/13 to support the work programme.

7. Demand for JIT’s support is increasing and Ministers have highlighted the more strategic role to be played by the team, and the need for more partnerships to engage with JIT and derive the benefits available from it especially as we move towards integration and the challenges that will present.

8. Ministerial priorities are to engage stakeholders in partnerships who have

previously not been engaged with JIT and support all partnerships in their

efforts to reshape practice and tackle the cultural shifts that will be needed as a result of integration. Ministers have expressed the view that there would need to be early consideration given to the resources needed by JIT to deliver future priorities and commitments.

9. We currently have an audit process underway that will begin to quantify the

financial implications’ of supporting all partnerships in the way envisaged by Ministers, and we will report the results of this to the Board in due course. However, it is possible at this point to estimate that to deliver all of our programme priorities and begin to respond to emerging requests for support from partnerships around their readiness and planning for integration, we will require around £2 million within our Programme Budget compared to our overall anticipated income of around £1.46 million in this financial year. We will progress discussions in an effort to secure additional resources.

10. There are a number of issues for the Board to consider in relation to the 2013/14 budget;

JIT’s core programme budget has remained static since 2007

JIT relies entirely on its core budget being supplemented by contributions for programme specific work from other Scottish Government Divisions. This makes up more than a quarter of JIT’s programme budget

The Minister for Public Health has made clear his aspiration for JIT to extend its “footprint” into all 32 partnership areas and ensure all partnerships can benefit from the support available to meet the challenges of integration. The Minister is of the view that there will need to be early consideration given to the resources needed by JIT to deliver future priorities and commitments

To meet emerging demands for support to partnerships in advance of integration as well as meeting our existing commitments we estimate our Core Programme Budget will need to increase to around £2 million in the current financial year.



Agenda item: 8

Purpose:

FOR DISCUSSION

Title:

Joint Strategic Commissioning: Implications for JIT

Key Issues:

This report provides the context and key priorities for JIT’s work programme to support Joint Strategic Commissioning (JSC). The report is focused on: Recently delivered priorities;

Maintaining a clear view of resource levels in light of the evolving JSC programme of work;

Increased role of JIT Partnership Leads in supporting the JSC programme locally;

Ensuring sufficient resources for the ongoing development of the JSC course and its future delivery;

Scoping the impact of a JSC approach across all adult care groups; and

Monitoring progress/issues relating to the children’s services commissioning work.

Action Required:

Board members are asked to note the contents of the report, discuss its key messages, improvement support priorities and implications for JIT’s Joint Strategic Commissioning programme, and to seek further updates at future meetings.

Author: Tony Homer Date: 23 May 2013


Joint Strategic Commissioning Implications for JIT

1. Introduction

1.1. Joint Commissioning has been a focus of the JIT work programme since

2005, initially through the development of Commissioning Workbooks (Older People and learning Disability) which helped partnerships to scope future demand for services on the basis of demographic projections and to plan whole system change.

1.2. Over the following years the emphasis shifted to more bespoke support for partnerships, combining system level approaches to supporting the management of change with support packages dealing with more technical issues for individual partnerships.

1.3. JIT led the development of the Procurement of Care and Support Services Guidance, with key stakeholders, which was published in 2010. As Audit Scotland in their review of social care procurement identified, there is still further work required to ensure the Guidance is implemented consistently. This will continue to be a focus for JIT and others as part of the Joint Strategic Commissioning programme going forward.

1.4. Over the past two to three years, however, there has been a growing recognition of the need to develop a more detailed understanding of learning needs around joint strategic commissioning in order to grow the scope and depth of improvement support. This recognition reflects the well-documented, continued shortfall in skills and competencies in this area and heightened expectations relating to the integration agenda.

1.5. Early steps to support this work have been:

the establishment of a Joint Strategic Commissioning National Steering Group, a sub group of the Health and Community Care Delivery Group;

the setting down of a definition of joint strategic commissioning to ensure greater consistency and understanding; and

the development and publication of a JSC Learning Development Framework, produced in conjunction with the Institute of Public Care from Oxford Brookes University.

2. National Improvement Support Programme

2.1. The National Improvement Support Programme (NISP), launched at the

recent (14th May 2013) Joint Strategic Commissioning Conference ‘Delivering our Ambition’, is supported by the JSC National Steering Group which has tasked the JIT with leading and co-ordinating the programme. The programme is intended to incorporate learning and support activity across a wide range of national bodies in order to deliver improved awareness and access to these resources and, over time, to bring greater coherence and a

measure of co-ordination to the support provided by national bodies to this important agenda.

2.2. In addition the programme will involve facilitating and co-ordinating dialogue between the national partners in order to ensure that the programme is appropriately comprehensive and that effective channels of communication and shared learning are sustained nationally, as the basis for the on-going development of the programme.

3. JIT Joint Strategic Commissioning Action Plan

3.1. As part of the NISP, a detailed Action Plan has been developed for the JIT. Early priorities within this plan delivered over recent months include:

an improvement and support review of the first JSC Plans for Older People developed by partnerships earlier in 2013, by JIT and its national partners. A summary of headline findings is attached as Annex A;

delivery of a national conference to feedback on the review of JSC Plans and launch the NISP and assist in reinforcing the nature and scale of the commissioning challenge that lies ahead for partnerships, held on 14th May;

delivery by IPC, in association with JIT, of an accredited short course on joint strategic commissioning with a focus upon partnership development and learning. This has recently been launched with a pilot course involving the Lothian Partnerships held during April and May;

support for an initiative to test an option appraisal methodology, PBMA (Programme Budgeting Marginal Analysis) and on-going work to further enable the appropriate use of IRF (Integrated Resource Framework)data, both of which are led by SG policy colleagues working closely with JIT and partners; and

securing additional resources in the JIT to support delivery against the significant increase in expectations and activity required.

3.2. On-going developments that are now being addressed:

refining the Action Plan, particularly in light of the learning from the improvement and support review of JSC Plans for older people;

ensuring the smooth roll-out of the JSC Course from autumn 2013 for all partnership areas in Scotland and planning the shape and focus of future learning support in this area with key national partners;

piloting the application of the JSC Learning Development Framework in a small number of partnerships to model the most appropriate role for the JIT and to better understand the issues encountered in planning and delivering improvement support to the wide range of roles and tasks involved in strategic commissioning;

developing a new model for co-ordinating partnership support relating to JSC between the central JSC team and partnership JIT Leads;

developing a number of Action Research initiatives with SG policy colleagues and national partner bodies to test and develop new practice

models relating to important policy areas that have an important bearing upon commissioning arrangements, e.g. locality planning, carers, Self-Directed Support , personalisation and procurement;

working with policy colleagues, scoping the implications of a requirement to adopt a strategic commissioning approach across all adult care groups and to understand what this will mean for the JIT and other national support bodies, regarding improvement activity and resources;

engaging with the Improvement Service’s programme to increase the capacity of Community Planning Partnerships and developing our approach to supporting a JSC approach by Health & Social Care Partnerships in the context of their emerging relationship with CPPs; and

considering how best to ensure that the learning from recent JSC improvement activity is represented in the process of developing the Integration Bill guidance relating to the new statutory requirement to produce commissioning strategies.

4. Children’s Services

4.1. In recent months the JIT has been approached by colleagues in the SG

Children and Families Division to support the development of a commissioning approach for Children’s Services, building on our work to date. Following extensive discussions involving colleagues from across the children’s services landscape, including ADSW and CELCIS, (Centre for Excellence for Looked after Children in Scotland) firm proposals are now in place with the resource implications and required actions under detailed consideration.

4.2. Linking the developing work across adult and children’s services should provide opportunities for shared learning, effective use of our collective resources and expertise, and serve as a good example of collaborative working.

4.3. The proposal would see the JIT becoming the locus for two dedicated Children’s Services Programme Manager posts and related support capacity to support:

Clinical assessment and epidemiological studies in a number of Council/Partnership areas and

A National Children’s Strategic Commissioning Programme

4.4. The approach to collaborating on this programme will be evaluated to capture shared learning opportunities and impact on JIT work programme.

5. Issues for the Board

5.1. The scale of the JIT’s planned activity reflects what we know about current

capacity and capability within partnerships and the additional demands that policy initiatives are likely to bring. Prioritising the programme will enable us to achieve a measure of ‘fit’ between what needs to be done and what we are capable of achieving. However, improving strategic commissioning practice is a complex and long term task and most of the recently acquired resources

are of a short term nature. On-going planning to ensure that the JIT is able to deliver on the expectations that are now placed upon it in this area will be vital if its impact is to be sustained.

5.2. In the short term, the nature and scale of the work involved in supporting JSC will require substantial additional input from JIT Partnership Leads, working in conjunction with the JSC Programme Managers. This will require further consideration but provides an opportunity to build on the work to date with Partnerships on Reshaping Care for Older people and Change Plans.

5.3. The JSC Partnership Development Course is proving to be of great interest to partnerships. We have secured funding for the current level of planned delivery. This will mean that up to four people from each partnership, including third and independent sector personnel, will have benefitted from attendance by April /May 2014. We are anticipating that demand for places on the course may exceed the planned capacity for which resources are currently available. Options will be to either seek additional central funding or to ask Partnerships to contribute through use of their Change Fund, for example. Arrangements are also in place to enable wider cascading of the learning that takes place. However, further development of the course will be required during 2014 in order to ensure that it continues to be fully fit for purpose as the new integrated arrangements and CPP role unfolds and that those in new posts, including Jointly Accountable Officers, can be afforded the opportunity to participate. At present the resources to undertake this development work and to support access to future dedicated learning is not in place. JIT will progress discussions on this in context of any funding available to support health and social care integration going forward. The Board’s view on this would be helpful.

5.4. Uncertainties about the implications of adopting a JSC approach across all adult care groups mean that it is presently unclear if or what additional demands will be made of the JIT in supporting improvement and facilitating a coherent approach. A further report setting out the implications for JIT can be provided to the Board. The Children’s Services initiative demonstrates the potential for the JIT to bring its generic skills and experience in JSC to bear upon a different care group / sector when arrangements can be developed which combine these assets with additional, suitably specialist and credible resources.

6. Conclusion

6.1. The key to effective strategic commissioning is understanding the relationship between demand, activity, costs and outcomes and acting upon that understanding. Exactly the same equation will need to be addressed in ensuring that what is a significantly expanded area of activity and resourcing within the JIT delivers real and substantial benefits for partnerships, and is sustainable. Central to doing this will be harnessing the contributions of others and sowing the seeds of a shared passion and determination to deliver the scale of change that is required.

Brief Headlines from the Review of JSC Plans for Older People 2013

The whole system overview provided by plans scoped the available resource pot including acute hospital activity but there was no analysis of acute hospital activity and nothing about how the acute spend will be used. Perhaps more surprisingly there was limited presentation and analysis of community assets and novel activities/approaches by informal/community stakeholders. Investment/disinvestment decisions are not being made on the basis of the systematic appraisal of options. Establishing clear criteria, undertaking a robust decision making process and ensuring the identification and application of relevant and focussed information have yet to emerge as the standard way in which whole system change across health and social care is being affected. Use of information and our analysis of it is improving but we are not making best use of available national data and are slow at growing local information. Use of the IRF is widespread but its application is not used well to understand and support re-modelling proposals. Personal outcomes were recognised in the partnership self-evaluations as the area of greatest challenge – and evidence from the review confirmed this to be the case. SDS and personalisation do not feature strongly and consistently in many plans. Recognising, capturing and applying personal outcomes data; using outcomes to shape re-design activity; understanding and addressing the culture change implications in single agencies and particularly across partners and securing services that will deliver improved outcomes – contracts and commissioning / procurement links Governance and partnership working arrangements are largely constructive and fit for but not all partners are embedded within many important JSC roles/tasks - and they need to be if the positives associated with the operation of the Change Fund are to be carried forward into the whole system JSC arrangements Clear, consistent senior leadership is too often noticeable by its absence with little evidence of clear sponsorship of substantial workstreams by senior officials or alignment with corporate priorities in a way that brings clear local political support. The thematic reviews identified important progress in many areas of practice/re-design but little progress as yet, with how to enable communities and local assets to engage and contribute to the strategic agenda.

Health and Social Care Integration Enquiry

JIT in conversation with Partnerships February – March 2013

1. Introduction

1.1 The Health and Community Care Delivery Group, in November 2012, expressed interest in hearing about, and sharing examples of, approaches to integration underway or being planned to inform wider learning. The MSG, at their meeting in December, heard presentations form Highland, Edinburgh and West Lothian Partnerships setting out models of integration and learning points to date. 1.2 The Improvement and Support Sub Group (ISG) at its January meeting agreed a brief ‘enquiry’ template and Joint Improvement Team partnership leads undertook an informal enquiry on progress being made by local partnerships in preparing for integration. The exercise aimed to reflect the position of partnerships at a point in time in their journey towards health and social care integration, to identify progress and any examples of good practice which partnership would be happy to share, and to identify any support needs going forward.

1.3 The process used a semi-structured conversation with either a partnership group or officers in each partnership. These conversations were framed around a set of enquiry questions (Appendix 1). These questions had been agreed and some of the interviews were completed in advance of the publication of the Scottish Government response to the consultation. As we are currently in the process of reviewing the Joint Commissioning Plans and an overview report is in preparation, this area was not included as a focus for this Enquiry. 1.4 JIT had the opportunity to have an ‘enquiry’ conversation with 26 out of 31 partnerships between February and March. This report can only be a snapshot in time and, in some cases, the view given will be dependent on the organisation and position of the individual / people interviewed. Although partnerships appear to be at very different stages, it is clear that we can expect to see significant progress over the next 3-4 months with many intending to have shadow Boards in place during 2013/14.

1.5 At a recent meeting of the Improvement and Support sub group, members explored key themes around integration and implications for the improvement and support partners. The outputs of this discussion are also summarised as Appendix 2. 1.6 JIT leads, together with other improvement organisations and national partners will continue to work with local partnerships to address the improvement and support needs identified and facilitate shared learning going forward.

2. Planned process, timescale and shadow arrangements Partnerships were asked about their planned process and timescale for integration and particularly if shadow arrangements are being considered.

2.1Current Position

2.1.1 There was a wide range of responses about the process and timescales.

One partnership is already operating a fully integrated arrangement from April 2012;

Three existing CHCPs are already operating in shadow form with aspects relevant to the new legislation to implement such as partnership agreement adjustment/formally pooled budget, locality planning etc;

Thirteen partnerships already have processes in place to establish integrated health and care partnerships with 10 of these actively planning shadow arrangements during 2013/14;

Four partnerships are still at early stages in their discussions; and

A further five partnerships had not yet agreed process or timescales. . 2.2 Support Required/ Issues to be considered

2.2.1 Partnerships emphasised the need for adequate time to implement outcomes focussed arrangements. Some of the CHCPs who had already been through similar processes reflected that successful integration is much more complex and challenging and takes longer than generally realised. 2.2.2 Partnerships had some concerns about the potential for the required organisational effort to distract from other strategic and operational priorities. Another risk identified was that people may put on hold existing and emerging good integrated working pending agreement on formal integration.

2.2.3 Some partnerships are actively considering the potential early appointment of a Single Accountable Officer during 2013 /14, with shadow appointments underway in a few areas. Partnerships are keen to ensure there

is an opportunity for sharing practice in the related process and job descriptions etc. Some concern was expressed that early appointments may require to be reviewed in terms of timing of any guidance which the Scottish Government may subsequently set out. 2.2.4 Partnership requested an improvement and support focus as this work develops and for this to be along the lines of the JIT approach to facilitate shared learning and offer constructive dialogue, local support and challenge with partnerships.

3. Planned scope

Partnerships were asked what would be their planned scope for integration – for example how are Children and Family, Criminal Justice, Housing and other specialist services being considered. 3.1 Current Position

3.1.1 The responses here do not represent a comprehensive picture as not all service areas were referred to in every conversation. There may be other discussions progressing for these service areas that are not captured here.

85% of partnerships had already confirmed their focus as being on all adult services.

Four partnerships are definitely intending to include, at least some aspects of, children’s services and a further six are still actively considering their inclusion.

Four partnerships intend to include criminal justice in their integrated arrangements, pending the outcome of the Scottish Government consultation on proposals to redesign the community justice system in late 2013. Inclusion of criminal justice is under active consideration in a further five partnership areas.

3.1.2 There are still some issues about where Housing best fits. No partnership had intentions to include their housing departments in formal integration arrangements. For a number of partnerships, housing support is already integrated within social work. Three partnerships noted that inclusion of housing was under active consideration.

3.2 Support Required/Issues to be considered

3.2.1 Partnerships reflected that wherever the net of integration is cast, this will leave areas on the boundaries of the integrated partnership. Therefore continued efforts are needed to fully engage with other services, particularly housing, and with the wider community planning partners to address important issues such as transport, leisure and other supports for wellbeing.

. 3.2.2 The emergence of different partnership arrangements across local authorities with a single health board is seen as an area of added complexity. Some respondents expressed a desire for a degree of consistency of structure and process across the health board area, particularly to ensure a strategic focus and to avoid fragmentation where there are existing effective hosting or Board wide management/professional arrangements. Partnerships would welcome exchanging learning across health areas who already engage with multiple Local Authorities.

4. Proposed Model 4.1 Current Position 4.1.1 Of the partnerships interviewed, all who had identified their existing or proposed model, with the exception of Highland, were considering a Body Corporate model. Five areas are still considering all models at this stage and five have not had such discussions to date. 4.2 Support required/ Issues to be considered 4.2.1 There was some concern expressed about having a third set of infrastructure with the body corporate model. Partnerships indicated a desire to avoid additional audit and expense. 4.2.2 There was also some degree of concern about risk of remoteness or reduced ownership of the body corporate by host bodies. 4.2.3 All partnerships are keen to ensure support for shared learning going forward.

5. Acute services

5.1 Current Position 5.1.1 Sixteen partnerships have had limited discussion to date on what acute services are being considered or felt that it was too early to judge. In some areas, this issue was being considered by the health board only, rather than by all of the partners. A couple of partnerships reflected that this is currently an area of disagreement. 5.1.2 Seven partnerships had started some early work on scoping acute services in context of integration. 5.1.3 Three areas had already confirmed that all acute services would be included within the remit of the integrated health and care partnership.

5.1.4 Partnerships are waiting further guidance on inclusion of acute services and will consider implications and opportunities 5.2 Support Required/ Issues to be considered 5.2.1 In most cases, partnerships are awaiting national guidance on this area. Support for strengthening links across primary and secondary care, for example supporting a real partnership approach to unscheduled care, was requested.

6. Engaging with key partners 6.1 Current Position 6.1.1 Almost all partnerships have held stakeholder/leadership events and discussions on integration locally, but there was significant variation in the level at which this is happening and the agencies engaged. Some partnerships spoke as if naturally assuming that all four partners were fully engaged in the discussions with some specifically citing Reshaping Care partnerships as an excellent building block for integration. 6.1.2 However, nine partnerships reflected that discussion on integration to date had largely been between senior leaders and officers of statutory agencies. 6.1.3 Six partnerships felt that their arrangements were well integrated with Community Planning Partnership structures, but that this may need reviewed 6.2 Support Required/Issues to be considered 6.2.1 Continued support from JIT, and other improvement partners to engage with all sectors, building on Reshaping Care and Change Plan partnership working. 6.2.2 A number of partnerships would like to ensure linkage with supports for

Community Planning Partnerships.

7. Clinical and professional advisory arrangements

7.1 Current Position 7.1.1 All partnerships propose to build on and integrate current clinical and professional advisory arrangements. Some partnerships – notably existing CHCPs had experience in this area that they are happy to share. Two partnerships were establishing new Professional Reference Group/ Advisory Groups. 7.2 Support Required/Issues to be considered 7.2.2 Encouragement, at a national level, of GP leadership would be welcome. Learning from existing integrated partnerships/CHCPs on getting the right balance of managerial/professional advisory participation was also felt to be useful. 7.2.2 The need to engage with acute clinicians was also emphasised as important.

8. Existing joint teams / integrated practice

8.1 Current Position 8.1.1 All partnerships are able to highlight some existing and developing integrated team /practice arrangements – around clusters, localities, co-location or service-specific models/care groups (e.g. rapid response; hospital at home, intermediate care). There are some good examples developing in context of the Change Fund/Change Plans. Many of these actively involve third and independent sector service staff, but some referred only to statutory agencies. 8.1.2 Fully integrated teams tend to be in areas such as mental health, learning disability and addictions services with some citing Intermediate care and Reablement as developing examples. 8.2 Support Required/Issues to be considered 8.2.1 Ensuring we maximise the learning from experience in mental health, learning disability and addictions services of what works/ what doesn’t work was felt to be useful as was learning from Highland’s experience in integrating all their community health and care services. 8.2.2 Guidance/sharing of job descriptions and terms and conditions was requested from some partnerships 8.2.3 Support from JIT to work with partnerships in engaging frontline staff in the change process was also requested.

9. Progress on Integrated performance management arrangements 9.1 Current Position: 9.1.1 Eight partnerships already have integrated performance management arrangements in place with nine currently developing arrangements, some of these based on those developed for Reshaping Care. 9.2 Support Required/Issues to be considered 9.2.1 It was noted that even where fully integrated arrangement exist, parent bodies often require prompting to scale back or integrate their demands for information. 9.2.2 Support for maintaining the focus on outcomes and reducing the risk of getting bogged down in process would be appreciated. Linking the work on outcomes to the workforce development agenda was requested. Some partnerships offered to share examples of balanced scorecard/dashboard/integrated performance management approaches.

10. Locality planning development

10.1 Current Position 10.1.1 There was generally strong support for a place-based approach with the locality focus welcomed. Partnerships are at very different stages on introducing locality planning arrangements. 10.1.2 Whilst some areas have strong operational delivery focussed in localities, joint planning – usually because of the size and capacity of partners, especially in third sector – is focussed centrally. Other partnerships are building on existing, well developed locality planning arrangements. Two partnerships are looking to extend the scope to include locality commissioning. 10.1.3 In some areas there had been no discussion yet as to what would constitute a locality. In a couple of partnerships, there was a perception of tension/duplication between area committees and neighbourhood/locality community planning partnerships where both co-exist. 10.2 Support Required/issues to be considered 10.2.1 Access to good quality data at locality level and to GP data would be welcomed as would shared learning on different approaches to adopting a locality focus.

11. Shared Learning and Practice 11.1 There was enthusiasm for sharing practice and for learning from others. A raft of suggestions has been put forward to be explored and developed into case study/shareable formats. 11.2 Areas in which partnerships offered to share practice include:

integrated teams and services;

funding models;

integrated Committee structures;

Partner engagement;

clinical and professional advisory arrangements;

organisation development,

outcomes focus;

integrated locality structure;

culture; engagement and leadership of Chief Executives;

Integrated performance management;

health improvement;

‘place’ initiatives;

Community Planning Partnership linkages

locality working with GP, Police , community care, housing.

11.3 The JIT will incorporate these areas of support into its workplan and the resources provided through the Improvement Network. In doing so it will look for ways of reducing the potential overload on existing integrated partnerships in sharing and being asked for visits repeatedly. 11.4 The JIT is also exploring the use of technology to increase access to good practice examples and experience e.g. Integration talks – short videos on specific topic areas which can be web accessed and used at events. Dr Margaret Whoriskey Director JIT /Chair of Improvement and Support Sub group 15th April 2013

APPENDIX 1

RESHAPING CARE AND INTEGRATION IMPROVEMENT AND SUPPORT

INTEGRATION QUESTIONS

1

What is your planned process and timescale? eg if shadow

arrangements are proposed, what do these involve?

2 What is the planned scope? e.g. how are Children and Family, Criminal

Justice, Housing and other specialist services being addressed - and how does this link with the CPP arrangements?

3

What model are you proposing? e.g. management, budgetary and multi-disciplinary arrangements?

4

What acute services are being considered for inclusion?

5

How are you engaging with the range of key partners within your CPP - and

beyond its boundaries?

6 What clinical and professional advisory arrangements do you propose?

7

What joint teams / integrated practice do you already have?

8

What progress are you making on integrated performance management arrangements?

9

How are you proposing to develop locality planning?

10

What will be different and better than current arrangements- e.g. solutions to knotty issues?

Appendix 2

Improvement and Support Sub Group (ISG)

Exploration of key themes around integration and implications for the improvement and support partners

Members of the ISG participated in an appreciative enquiry to assess existing improvement capacity and resources in place to support integration and areas for development. The diagram below sets out initial suggestions, which need tested prior to

being developed into a collaborative development of improvement supports around integration. Some issues emerging:

JIT and IS , working with others, have a lot of experience in supporting partnership engagement and joint governance including arrange of tools and materials

It would be helpful to map what resources are available - this could link to developing work on Community Planning and Quality Improvement Hub

JIT and others need to continue to keep a focus on developing effective partnership working at all levels in support of transitional arrangements

Opportunity to build on experience in areas such as mental health, learning disability, addition services where there are well integrated services and teams etc

The developing approach to multi agency inspection will inform improvement priorities

Need to ensure third and independent sectors are part of professionally led locality planning and work to date on Change Plans is helping build sector capacity to engage effectively. We need to include all workforce across sectors in redesign etc.

Need to balance ‘professionally led’ with focus on personal outcomes

Importance of ‘place’ in context of locality working and in how we work together to address health inequalities

Spread evidence of what works and learning from emerging developments The ISG provides a valuable cross sector resource to inform focus for improvement and support for integration and to maximise collective contributions across a range of improvement services and resources. The ISG will continue to work on this to ensure collective resources are being targeted effectively and areas for development agreed. This work will inform and be informed by the integration working groups going forward.

Dr Margaret Whoriskey Chair ISG

Range of support and sectors

Develop JIT and other capacity to support wider integration for all adult groups

Further develop focus on housing contribution, role of RSLs and key role in prevention

Use of benchmarking and data

Develop connections across sectors

Improvement support for recommendations from joint inspections

Apply learning from efficiency work in NHS to partnership

Implications of contractual arraignments with GPs – implications re role of Board and Health and Social Care Partnerships

Regulators enable innovative approaches to workforce redesign

Postcode level data

Joint professional leadership and QI development across sectors

Local multiagency productivity / demand and capacity work to Release time to care and for locality planning

Engage relevant hospital specialties in the community agenda- involving MCNs and colleges in ‘looking local’

Workforce 2020 levers integrated team based care

Total Place Pilots

Community Capacity Building

Community Planning Structures and refresh

Models of transformational change (including use of driver diagrams

How to bring together different values/approaches – evaluation

Return on investment

Standardisation and Simplifying of information

Data linkage across sectors

Information demands on providers, for example

Use of info to improve quality

Improve approach to and use of information and data

Existing reports/data

Audit Scotland

Measuring Variation

IRF

Data collection in third sector

Balance guidance/legislation and local application/modification

Bring different communities and improvement resources together

Modelling behaviour and monitoring on outcomes – breaking down barriers for local teams

Balance ‘professionally led’ and community led/co-production

Use existing improvement methodologies at design/mapping stage

Senior civic local and national leadership and buy-in. Authentic behaviours and attitudes

Measure & monitor leadership for improvement nationally

Leadership – all levels Outcomes Practice Culture Development

Community Planning Capacity Building

Joint Commissioning

JIT supports

JIT tools /materials

3rd sector capacity building

Independent

Sector

capacity building

Existing Improvement Supports

joint improvement partnership board - jit improvement partnership board ... was established in 2004...

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