1. RCOP Outcomes Framework Workshop Lisa Cohen NHS Health Scotland 21 st May 2013

2. Making a difference to Older People’s lives – What we want to achieve What we do

3. Where we got to…..

4. OUTPUTS – Direct Control Key terms: Outputs, Outcomes, Results, Impacts RESULTS – Visible & Direct Influence Expected IMPACTS – not Visible, Indirect Influence Outcomes chain INPUTS Resources ACTIVITIES What you do OUTPUTS What is produced REACH Who the outputs reach (target group) Short term OUTCOMES Immediate results of use/uptake, knowledge, attitudes, skills, aspirations, process Medium term OUTCOMES Changes in behaviour, practice or environments Long term OUTCOMES Changes in population health status OUTCOMES

5. Our challenge today 1.Agree content of strategic model and outcomes triangle 2.Ensure inequalities, RCOP high level policy outcomes and H & SC integration outcomes ‘integrate’ 3.Define population groups 4.Agree how carers will be addressed 5.Agree ‘nested’ models and who needs to be involved 6.Actions and next steps

6. Reshaping Care of Older People (RCOP) Strategic Outcomes Framework Evidence base Helen Frost Atlantic Quay, Glasgow May 21 th 2013

7. Evidence tables What type of evidence is included in the tables? What are the main findings? Where are the Gaps? Gulf between outcomes, evidence and practice Discussion - What to work on next?

8. Type of evidence Systematic reviews Randomised controlled trials Controlled longitudinal studies Uncontrolled longitudinal studies Cross sectional studies and case studies Expert opinion “ Experts are of the opinion that….” “There are signs that…” “It is likely that….” “It is shown that …” Generate a hypothesis (bias ++) Establish causality ( bias -- ) Mainly review-level data including measure of quality e.g. Cochrane, NICE, DARE, SCIE

9. Maintain acceptable Quality of Life Good evidence to support: Physical activity interventions (primary, secondary and tertiary prevention) Falls prevention Occupational therapy and advise on assistive devices Community care after hospital discharge Comprehensive geriatric assessment for some groups End of life home-care Housing improvements –warmth improvements and energy efficiencies can generate health improvements Access to transport and variety of environments (open space) Some evidence but uncertainty remains Interventions to prevent social isolation Some assistive technology Some components of intermediate care reablement

10. Maximise independence Good evidence to support: Physical activity interventions Some evidence but uncertainty remains For unplanned hospital admission Integrating health and social care Integrating primary and secondary care Hospital at home early discharge (similar cost to hospital costs) Patient self-management Discharge planning NO evidence Case management (Huntley 2013, Purdy 2012 NICE)

11. Maintain and optimise physical health and function Good evidence to support: Physical activity interventions- improve function (less evidence for reducing disability) Falls prevention Community care after hospital discharge Comprehensive geriatric assessment for some groups Some evidence but uncertainty remains Interventions to prevent social isolation Some assistive technology Some components of intermediate care (reablement) Nutritional interventions and supplements

12. Maximise and protect mental health and wellbeing Good evidence to support: Physical activity interventions e.g walking interventions for some groups (not falls) Some psychological interventions e.g. cognitive training Various occupational and physiotherapy interventions Quality of built environment is important and has significant impact on wellbeing Some evidence but uncertainty remains Social interventions (buddying, self–help networks, exercise groups)

13. Individual behaviours Relationship between health damaging lifestyle and deprivation means lifestyle factors contribute and compound health inequalities Wood and Bain (2001) Smoking, nutrition and physical activity/ sedentary behaviour are all important BUT a major challenge to change e.g. ++ evidence for effects of exercise BUT NO evidence that community-wide interventions effectively increase population levels of physical activity (Baker et al 2011)

14. Identifying gaps

15. GAPS in evidence Evidence base lacking for: 1)Interventions for older people with multi-morbidity 2)People in long-term care homes (dependent OP) 3)Minority groups (particularly for outcomes relating to loneliness and isolation) 4)Cost effectiveness data 5)Interventions that increase physical activity 6)Financial / material security

16. Most common definitions of successful ageing given by 854 people aged >50 in Britain. Bowling A, Dieppe P. BMJ, 2005 331(7531):1548–51.

17. Gulf between evidence and practice in Scotland Outcome Maximise and protect mental health and well- being Maximise independence Evidence Psychological interventions Strong evidence for effectiveness (NICE 2008) Health and social care integration. Some evidence for reducing UHA (NICE 2012) Practice Unacceptable access to psychological treatments (Older People’s Therapies’ Working Group 2011 ) Integrated care between primary and secondary and health and social care is inconsistent (Wyke et al 2011)

18. Discussion - What to work on next?

19. RCOP Outcomes Framework Erica Wimbush, NHS Health Scotland Workshop 2 21 May 2013

20. Consistency Outcomes – are we all talking the same language? Consistency and fit of Outcomes at all levels RCOP policy National outcome (NPF) Local outcomes (SOAs) H&SCI Outcomes Integrated service delivery Personal outcomes Quality of life Change Process

21. Direct control Are we all talking the same language? Direct Influence Indirect influence Outcomes chain INPUTSACTIVITIES OUTPUTSREACH OUTCOMES External factors

22. From Personal to National Outcomes Source: Talking Points: Personal Outcomes Approach, JIT June 2012

23. Outcomes triangle Inputs Activities/Outputs Reach Short - term outcomes Intermediate outcomes Long-term outcomes National Performance Framework, Single Outcome Agreements National Outcome Outcomes Chain

24. RCOP Outcomes Framework Individual behaviours Age friendly physical environment Social connectedness Financial security LONG-TERM OUTCOMES INTERMEDIATE OUTCOMES SHORT-TERM OUTCOMES Reach Inputs Activities/ Outputs Person-centred support, care and services e.g. improved access, information, confidence, skills, mobility, reduced symptoms RCOP Outcomes (link with NPF and SOAs ) National vision: Older people in Scotland are valued as an asset, their voices are heard and older people are supported to enjoy full and positive lives in their own home or in a homely setting Maintain and optimise physical health & function Maximise independence Maintain acceptable quality of life Maximise and protect positive mental health & wellbeing Service delivery outcomes (link with 2020 vision, H&SCI) Key population groups

26. Where/how do these fit? RCOP policy National outcome: Our people are able to maintain their independence as they get older and are able to access appropriate support when they need it H&SCI Outcomes Healthier living Independent living Positive experiences & outcomes Carers are supported Services are safe Engaged workforce Effective resources use Personal outcomes Quality of life (feeling safe, having things to do, seeing people etc) Change (improved confidence, skills, mobility, symptoms) Process (having a say, treated with respect, listened to, etc)

27. Key questions and task 1.Feedback: What works and doesn’t work about the models? 2.Outcomes: Does the proposed outcomes hierarchy/chain make sense? 3.Anything missing? Are there any other important outcomes we have missed? e.g. related to end of life 4.Four key population groups (incl carers) – Are these groups right? Definitions for each group 5.Fit with other outcome sets : What do people think about the proposed fit across RCOP, HSCI, Talking Points outcomes? 6.Outcomes language/wording in models – consistency 7.Visuals – Are there alternative visual ways of presenting the models? Please draw on flipchart

29. Outcome framework – next steps ActionTimescale Agree nested models and stakeholder group for each model End May 2013 Finalise strategic model and triangleFirst week in June Write up evidence base for strategic modelEnd June Convene groups to draft models and consider evidence base June – July 2013 Review draft models/consultation (development group) August – Sept 2013 Finalise draft nested models including writing up evidence base October 2013 Develop monitoring and evaluation planOctober – November 2013 Peer reviewDecember – January 2014 Finalise frameworkFebruary 2014