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?
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