IntegrationA model for success

Garry Coutts Chair, NHS Highland Convener, Scottish Social Services Council

Recessions I have known

• Early 1980s – Thatcher’s recession 5.8% drop in GDP

• Early 1990s – Major’s recession 2.5% drop in GDP

• Late 2000s – Brown’s recession 7.1% drop in GDP

How do we deal with recessions?Make cuts

Raise the bar

Increase charges

It’s pants!

This is different

• Length of time • Banks not lending• Size of deficit• Few political alternatives being offered

But.......• Record levels of investment in the public

sector over the last 20 years

– The majority of over-65s have 2 or more conditions– The majority of over-75s have 3 or more conditions

Multimorbidity is common in Scotland

If we always do what we have always done we will get what we

always got

And it is not good enough

So we need a different approach

Fatuous saying of the moment

“We don’t need to work harder, we need to work smarter”

Aye, right!

“Every system is perfectly designed to achieve exactly the results it gets”

Don Berwick

So we need to change the system

And support staff, providers, service users, carers and governors to become effective change agents

Changes in Highland

• Social Care staff to NHS Highland = 1,500• Health staff to The Highland Council = 250• Budget to NHS Highland = £90m• Budget to The Highland Council = £8m• Partnership agreement = 400 pages!• Legislative and regulatory changes• New management and governance structures

Family &Friends

OT

Care Home

Day Services

Acute Hospital

NeighboursHome Carers

Respite Care

Physio

GP

Day Services

Consultants

Residential care

Social Workers

PharmacyDistrict Nurse

Voluntary

Community Hospital

Family &Friends

Care Home

Day Services

Acute Hospital

Neighbours

Home Carers

Respite Care

PhysioGP

Day Services

Consultants

Residential care

Social Workers

Pharmacy District Nurse

OT

Voluntary

Community Hospital

Care Co-ordinator

Key questions to check if you have an effective system

• Does your system have single budgets?• Does your system have single management?• Does your system have single governance?• Is there a process for service improvement

and redesign?• Do you have measures in place to monitor

improvement?• Are you involved in improvement?