IMPROVING OUTCOMES AND SUPPORTING INNOVATION
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IMPROVING OUTCOMES AND SUPPORTING INNOVATION
Dr Margaret Whoriskey Director, Joint Improvement Partnership Board
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A Scottish Approach to Public Service Reform> Prevention – decisive shift: Reduce future demand by
preventing problems arising or dealing with them early on.
> Partnership – Bringing public, third and private sector partners together with communities to deliver shared
outcomes that really matter to people.> People – We need to unlock the full creativity and
potential of people at all levels of public service, empowering them to work together in innovative ways. We need to help create ways for people and communities to co-produce services around their skills and networks.
> Performance – To demonstrate a sharp focus on continuous improvement of the national outcomes.
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Our 2020 Vision…
By 2020 everyone is able to live longer healthier lives at home, or in a homely setting.
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Health & Social Care IntegrationUnderpinned by Legislation:
• nationally agreed outcomes;
1.Healthier
2. Independent Living
3.Positive experiences and outcomes
4.Carers are supported
5.Services are safe
6.Engaged workforce
7.Effective resource use
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Principals/Defining Outcome Focused Approach• Understand outcomes as the
impact or end result of support and/or services on a person’s life:
• BUT start by defining expectations and outcomes with the person
• Focus on strengths and capacities more than deficits
• Identify the person’s role as well as other people in their life and services
• Outcomes can be measured both for the individual and for the service as a whole
• Believing that the participation of the person is core to practice
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What do we mean by outcomes? The “So what?” question – if we have provided support or
service to someone, what did that achieve? Did the person benefit and how do they see it?
This requires both the services, and the person themself to think through together what matters and how it can be best achieved.
The big challenge is to develop what we often do well at the individual level to be the basis of our whole organisational approach – keeping people and what they want at the heart of everything we do. We refer to this as a personal outcomes approach.
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Supporting people at Home
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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 res
iden
ts 6
5+
Projected
Actual
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Hospital emergency admission 65+: occupied beddays
2100000
2400000
2700000
3000000
3300000
bedd
ays
Projectedbeddays
Actualbeddays
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Trend in emergency admissions (Index) by length of stay (LOS), aged 75+
90.0
100.0
110.0
120.0
130.0
140.0
150.0
160.0
2005/6 2006/7 2007/8 2008/9 2009/10 2010/11
Ind
ex
(y
e M
arc
h 0
6=
10
0) 0 days
1 day
2 days ormore
All LOS
Source data ISD
Chart PK JIT
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Current service provision by service type
65+
89.5%
Home care
Care home
NHS Continuing Care
All others
75-84
97%
88%
60%
75-84
65-74
85+
“Most older people (89.5%) do not receive ‘formal’ care in NHS
continuing care, a care home or a home care service organised
by social work agencies.”
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Reshaping Care: Integration in Action
• 10 Year National Programme 2011-2021• £ 300 million Change Fund 2011 - 2015• 32 Partnership Change Plans agreed by: NHS: primary, acute and mental health services Local Authority: social care and housing Third sector Independent sector• Reshaping Care and Integration Improvement
Network to support partnerships to transform care
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Reshaping Care Pathway
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The Change Fund and RCOP
2012/13– CF built on current initiatives and developments - Only 1-2% of total spend build on wide range of other innovative work underway early reflections on Joint Commissioning
2013/14 – Joint Commissioning Strategies with a 10 year horizon to shift the balance of care
Change Plans as lever to change : Investing to maximise improvements in outcomes Maximising potential for resource shifts by bridging to new
service models Investing to lever otherwise inaccessible resources
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Going Forward: Joint Strategic Commissioning
• “all the activities involved in assessing and forecasting needs, links investment to agreed desired outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place.”
• First iteration prepared for 13/14 focusing on older people
• Will be a legislative requirement from 2015 onwards for all adult care groups
• National support programme launched• http://www.jitscotland.org.uk
/action-areas/commissioning/
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Joint Commissioning Plans
• Increasing focus on dementia• Post diagnostic support • Focus on Physical environment , housing,
adaptations, telecare • Training for all • Anticipatory care• Reablement
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What needs developed
• Need for better integration across mental health, older people services and support
• More focus required on post diagnostic support • Support for care homes• 8 Pillars – needs to be integrated in wider work • Dementia friendly communities • More opportunities for telecare • More recognition and support for carers
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Learning from demonstrators • Communication tool app for phones and tablets for people with dementia• Care and repair • Perth and Kinross open access memory clinic and disinvestment from
community hospital beds to alternative NHS services in the Strathmore locality
• Midlothian family group conferencing initiative and detailed IRF work with primary care
• North Lanarkshire dementia cafe work (for which they have received an award); reminiscence initiative re football; dementia friendly community work in Motherwell involving local traders and other statutory agencies; outreach from day care work.
• Housing initiative with all sites• Reablement
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Supporting Innovation at Scale
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Expanding Range of Telecare Equipment
Wristcare
Medication Reminder
Wayfinder
Locator
Epilepsy
sensor
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A useful enabler…
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In five years to 31/3/2012, 325 users of the Renfrewshire Care 24 telecare
service had dementia; over 30% of all users. The Service has provided a
range of equipment including door contacts, pressure mats and bed
monitors, operates a Responder service in the event of an alarm being
triggered and has a specific dementia pathway; all with the aim of keeping
these vulnerable people safely at home.
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The Renfrewshire Telecare service estimated 114
hospital and 88 care home admissions were
avoided by this group because of telecare.
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