The GatheringDerek FeeleyChief Executive NHS Scotland

Partnership working

6 Key ChallengesPoliticalEconomicDemographicEpidemiologicalPopulation HealthChanging Expectations

And so..Questions; Is the answer to this range of challenges likely to be one dimensional?

Is the optimal response likely to lie in just doing more of the same or just changing everything?

How should we deploy our combined efforts to thrive in this new environment?

Its complicated.Too bad all the people who know how to run the country are busy driving cabs and cutting hair. -- George Burns

Triple AimHealth of the PopulationExperience of CareBest Value for MoneyThe Triple AimIntegration

Quality, Quality and more QualityMutually beneficial partnerships between patients, their families and those delivering healthcare services. Partnerships which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.

No avoidable injury or harm from the healthcare they receive, and that they are cared for in an appropriate, clean and safe environment at all times.

The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, with no wasteful or harmful variation.

Our 2020 Vision

EVERYONE IS ABLE TO LIVE LONGER HEALTHIER LIVES, AT HOME, OR IN A HOMELEY SETTING

We will have a healthcare system where we have integrated health and social care, a focus on prevention, anticipation and supported self management. When hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm. Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions. There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

The future Gathering all 3 curvesTimePerformancePerformanceImprovementCo-production& assets

The 3rd Curve

Given the challenges hard to see sustainable route without this cant treat our way through this.Untapped potential of public activationPatients and families tell us that healthy living is a key outcome for themShifting the balance of care and shiftin gthe balance of power

Assets and Co Production: In Plain EnglishMade here by usNothing about us, without us, is for usBuilding the boat not just steering itWorking with us, not doing things to or for usOn tap not on topLighting 1000 fires all over the communityI have a problem I want help to fix itWhat can I do?

Assets vs DeficitsAssets thinkingStrengths basedHow can we create community spirit?What can I do?Were all in this togetherWere getting thereWork with engaged peoplePeople have the answersPeople control their lives

Deficit thinkingProblem orientatedHow to fix this problem?Someone needs to sort thisUs versus themProblems are embeddedDo things to people People are a problemPeople cant be trusted to decide/be in control

Some foundations?

Use the tools (and strengths) we haveEngagement MatrixChange Fund ProgrammeGaun yerselAll together nowCo-production guide

Making change happenPromote shift to assets thinking & behavioursDevelop a shared understanding, clear & consistent message across policies & initiativesEmpower & skill workforce and people/communitiesSupport better links, hubs, joining up Support learning and sharing of what worksImprove intelligence on whether we are delivering outcomes people & communities want

Theory 1 The leaders of the future need to be experts in performance, quality and co-production. They will be comfortable with complexity and conflict and generous with power.

Theory 2Reliability of values, ethics and behaviours is likely to be just as important as reliable professional practice.

Keep it RealDont get lost in theory and jargonThis is about people and communities There are examples of assets rich communities and fiery spirits everywhereWe know how to do thisWe want to do itJust do it

Just start!!!

Partnership working these are the partners in developing the new online resource launched today called- discover the third sector to Improve health and wellbeing in Scotland: Supporting better partnership across the third and statutory sectors The resource is run by a small core team from across the third and statutory sectors, co-ordinated by the Health and Social Care Alliance Scotland and supported by the Scottish Government.

*****Lots of examples here are some of phrases used by community groups to describe what they meanThey vary in their ambition and boldnessHow bold and ambitious do we want to be?Do we want people to design the boat or even decide theyd rather have a bicycle?

*A quick reminder of the differences.

Assets based and deficit based approaches take policies and services down radically different routes, radically different ways of thinking and going about the business

Christie and others link many of our current intractable problems in policies and services which define people by what they cant do or their problems, treat them as passive recipients incapable of and not to be trusted with determining their own lives and so further disempowering and alienating them. They argue that doing things to people has been ineffective and resource intensive. Structural inequalities reinforce powerlessness and hopelessness and create barriers to self fulfillment and realisation of assets allowing inequalities in outcomes such as health to flourish.

A lack of assets creates and sustains transient and troubled communities which are disconnected, powerless and passive. Lacking connections, self worth and empathy, they are riven by prejudice, intolerance. Sectarianism, anti social behavior, hate crimes and disrespect thrive in weak and threatened communities and on poverty and inequality.

**Making assets our main approach will require major system change. It will require better support for joining up across boundaries and silos; learning and reflective practice and a focus on empowerment.***