Integrated Health and Social Care Partnerships IHM Conference 9 October 2014

Context - Demand Population Changes – People Living Longer Rise in population from 5.22m to 5.49m in 2020 and to 5.76m by 2035 Over 65s to rise by 22% in 2020 and by 63% in 2035 Over 75s to rise by 22% by 2020 and by 80% in plus to rise by 39% by 2020 and by 147% by 2035 As we get older we consume more health and social care - Fact

Joe ClancyChange & Innovation - 11 November 20133

Multimorbidity New action plan in Scotland, recognising:- Most people with multimorbidity are <65 Multimorbidity occurs years earlier in deprived areas compared with affluent areas Combination of physical and mental health conditions has strong association with health inequalities and negative outcomes Current spend on adult health and social care in Scotland is >£10.9billion and will rise through increasing demand because of demography, multimorbidity and poly-pharmacy

– Most over-65s have 2 or more conditions, and most 75+ have 3 or more conditions – More people with a LTC have more than one condition Multimorbidity is common in Scotland

Government Response – Christie Report “Reviewing Scotland’s Public Sector” (2011) Four Pillars around which sustainable future will be built  A shift to prevention  Greater integration and partnerships  Strong leadership  Greater focus on OUTCOMES based performance management

Draft Regulations Relating to Public Bodies (Joint Working) (Scotland) Act 2014 – Set 1 Prescribed information to be included in the Integration Scheme Prescribed functions that must be delegated by Local Authorities Prescribed functions that may or that must be delegated by a Health Board Prescribed National Health and Wellbeing Outcomes Interpretation of what is meant by the terms health and social care professionals Prescribed functions conferred on a Local Authority Officer

Draft Regulations Relating to Public Bodies (Joint Working) (Scotland) Act 2014 – Set 2 Establishment, membership and proceedings of the joint monitoring committee Membership, powers and proceedings of the joint monitoring committee in lead agency arrangements Prescribed groups which must be consulted when drafting integration schemes, prescribed consultees for draft strategic plans, prescribed consultees for localities, prescribed consultees for revised integration schemes Prescribed membership of strategic planning groups Prescribed form and content of performance reports

Functions that must be Delegated by Local Authorities Social work services for adults and older people Services and support for adults with physical disabilities, learning disabilities Mental health services Drug and alcohol services Adult protection and domestic abuse Carers support services Community care assessment teams Support services.Cont/

Functions that must be Delegated by Local Authorities Cont/ Care home services Adult placement services Health improvement services Housing support services, aids and adaptions Day services Local area co-ordination Respite provision Occupational therapy services Re-ablement services, equipment and telecare.

Functions that “May or MUST” be Delegated by a Health Board All adult primary and community health services A proportion of hospital sector provisions All services already within the scope of CHP’s

Hospital Functions and Budgets (and operational Delivery within hospitals) Cont/ The focus is on including unscheduled hospital care within the scope of integrated strategic planning which is the responsibility of the Integration Authority Specialities that exhibit a predominance of unplanned bed day use for adults are included as a minimum. Cont/

Health Services That Must be Included Within Integration Unplanned inpatients Outpatients – Accident & Emergency Care of Older People (previously known as geriatric medicine) District Nursing Health Visiting Clinical Psychology Community Mental Health Teams Community Learning Difficulties Team Addiction Services Cont/

Unplanned Care

Health Services That Must be Included Within Integration Cont/ Women’s Health Services (includes family planning services) Allied Health Profession Services GP Out of Hours Public Health Dental Service (previously known as community dental services) Continence Services Home Dialysis Health Promotion General Medical Services (GMS) Pharmaceutical Services – GP prescribing

Next Steps – H&SCPs Integrated Transition/Shadow Boards Integrated Care Fund Integration Scheme Communications Plan Services to be included Joint Strategic Commissioning Plans

Next Steps – H&SCPs Governance Arrangements HR/OD Framework Performance Framework Financial Plans IM&T Strategy Asset Management

The Lanarkshire Context 2 x Health and Social Care Partnerships Each circa £400m Each circa 3,000 wte staff GPs central to process Locality focussed service design/care provision Strong emphasis on co-production Prescribing - £133m (circa 25% total health cost incl FHS)

The Importance of Primary Care Over 90% of interactions with healthcare start and finish in primary care. Key to addressing:  Inequalities in health and care;  Access to health (and often social) care  Self management of long term conditions  Overall resource utilisation

The Lanarkshire Context COPD ) Diabetes ) Cancer Care ) Palliative Care ) CHD ) Others ) All require effective 24/7 care pathways (Anticipatory Care Plans - ACPs) which are available to and understood by all key stakeholders – Patient, Next of kin, GP, NHS 24/OOH, Ambulance, A&E, inpatients.

Physiotherapists and occupational therapists Social work resources inc. Community Occupational therapists Home care and Supporting your Independence staff District nurses 24 hr service Other services or support from the wider community e.g. family, 3 rd sector, specialist teams e.g. Old Age Psychiatry and independent providers GP Integrated Community Care

The Lanarkshire Context – Redesign - Prescribing GP Incentive Scheme Joint training for home care staff – incl medicines management Seek to reduce waste/costly prescribing Manage demand more effectively H&SCPs holding budget

Total Cost ~ £1,400

Integration : Critical success factors Focus on outcomes Leadership and culture Strategic commissioning Locality and community focus

Integrating to improve outcomes 1. People are able to look after and improve their own health and wellbeing and live in good health for longer. 2. People, including those with disabilities, long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. 3. People who use health and social care services have positive experiences of those services, and have their dignity respected. 4. Health and social care services are centred on helping to maintain or improve the quality of life of service users.

Integrating to improve outcomes 5. Health and social care services contribute to reducing health inequalities. 6. People who provide unpaid care are supported to reduce the potential impact of their caring role on their own health and well-being. 7. People who use health and social care services are safe from harm. 8. People who work in health and social care services are supported to continuously improve the information, support, care and treatment they provide and feel engaged with the work they do. 9. Resources are used effectively in the provision of health and social care services, without waste.

Integral role of strategic commissioning “the term used for all the activities involved in assessing and forecasting needs, linking 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.”

Strategic Commissioning Cycle

Making it happen on the ground Delayed discharge in Renfrewshire – Targeted joint improvement plan – BDL fallen from to 1920 (Oct 11) to 210 (Jun 14) – Significant pressure on community resources Clinical Services Review – Funded demonstration programme – Initiatives to prevent admission /facilitate appropriate discharge e.g. comprehensive geriatric assessment, care at home resettlement service, anticipatory care planning Development of Joint Strategic Commissioning Plans – Older people complete – Other client groups ahead of April 2015