1. Head of Improvement Support
June Wylie
Head of Improvement Support
Living Well in Communities, Focus on Dementia and Place Home and Housing
Title slide option 1

2. A long time ago !

4. Home Assessments

5. Hazels New Bathroom

8. There’s no place like home
Vision
The Improvement Hub (or ihub for short) vision is simple - to support health and social care organisations to design and deliver services and support that better meet the changing needs and aspirations of people, families and communities in Scotland.
The Improvement Hub has programmes which support the prevention of unplanned admissions to hospital or long-term care. This will help people to benefit from an improved quality of life, maintaining independence for longer and minimising their support needs.

9. One organisation many parts
The Organisation
One organisation many parts
Participation Standard
Service Change
Our Voice
Evidence
Scottish Medicines Consortium, Health Technology Assessments, SIGN Guidelines
Scottish Health Council
Improvement Hub
Quality Assurance
Quality of Care, Older People's Inspection,
Hospital Environment Inspections, Medical Revalidation
The new resource will form part of the solution to providing more person centred care across social and health settings.
It is part of Healthcare Improvement Scotland, who also provide Evidence for Improvement (guidelines, standards and advice), Quality Assurance for improvement (including inspections and reviews) and the Scottish Health Council who work to ensure the public voice is heard in shaping and improving services.
The Improvement Hub will build on the combined expertise, resources and best practice of three previous programmes - Healthcare Improvement Scotland’s Safety and Improvement Team, and the Scottish Government’s Joint Improvement Team (JIT) and Quality and Efficiency Support Team (QuEST) and can offer a unique combination of expertise to help improve the experience of those accessing care.
*some examples of the functions within each Directorate.

10. Focus of our improvement support
NHS boards
Integration
Authorities
Local Authorities
Who the Improvement Hub programmes for
The Improvement Hub programmes are designed to support those delivering health and social care across Scotland (including health and social care partnerships, third sector organisations, the independent care sector and housing organisations).
The Improvement Hub also provides national improvement support for NHS boards.
Focus on:
continuous quality improvement
system redesign
Improvement Hub focus includes health, social care, third sector, independent sector and housing.

11. Our approach to supporting improvement
creating the conditions nationally for improvement work to flourish locally
Context
So we thought this was a helpful conceptualisation – but not enough to provide a coherent framework under which we could integrate the strengths of the three existing improvement organisations – so we developed the following, the basic structure of which will be familiar to many of you
A co-created system
Adapted from Napper (2010)

12. ihub approach to supporting improvement
Start Here
By what method/model do you test and implement change ?

13. White Report – emphasised following general approach
locally focused and tailored support to meet local contextual needs
support to build improvement capacity and capability within local systems
a range of improvement support offers and resources
strengthened ways of sharing knowledge and learning networks
coordinated support from HIS across its full range of improvement support
collaborative working with other national improvement agencies and organisations

14. and Responsive Improvement Support Grants and Allocations
Improvement Programmes
Care Delivery
Living Well in Communities
Primary Care
Mental Health
Acute
Dementia
Place, Home and Housing
Maternity and Children’s
System Enablers
Strategic Planning
Outcomes-based commissioning
Transformational Service Redesign
Third and Independent Sector Engagement
QI Infrastructures
Evidence, Evaluation and Knowledge Exchange
Person Centred Health and Care
Tailored
and Responsive Improvement Support
Grants and Allocations

15. Delayed discharges – housing reasons
Nationally...
Aberdeen…
Better communication across sectors
Dedicated member of housing staff
Close working with third sector – particularly Disabled Persons Housing Service
Earlier identification and assessment
Changes to Council’s housing allocation policy
Associated with longer delays
74 days compared to 36
c30% of all longer delays
And a couple of illustrations of the sort of work we are doing – and the impact we are having
The first in relation to our housing and hospital programme
Click 1 and 2 – we have analysed national data on delayed discharges. Across Scotland there’s been a rising trend in the number of people delayed for housing related reasons – from 13 in April 2011 to just under 40 at the beginning of A relatively small proportion of all delays (c 15%). But….
Click 3 – delays tend to be longer. And represent a greater % of longer delayed discharges.
Click 4 – Aberdeen Adapting for Change partnership took up the issue
Click 5 – and they tackled the issues they found in 5 ways. None of these actions were costly – the dedicated member of housing staff was a re-organisation rather than an additional post
Click 6&7 – they reduced the number of people delayed where there was a housing factor to about 5
Click 8&9 – they discovered that they had a local supply issue for bariatric cases. So, they adjusted their build programme to create 2 homes suitable
There’s a video clip on the Place, Home & Housing page of the ihub website
Next steps – taking the learning to other areas and adjusting the model in different contexts (rural areas, small councils will not have the capacity to have a dedicated member of staff)
Delays down from more than 20 to c5
Investment in new specialist housing provision

16. Community equipment 2014 self evaluation
1 adequate, 9 weak
supported improvements
service re-design
Social care & nursing prescribing
Train the trainers
2016 self evaluation
1 very good, 4 good, 4 adequate, 1 weak
Value of recycled equipment increased from under £10k to more than £400k
74 requests preventing hospital admission, a cost avoidance of £88k
Second area from our community equipment programme.
Self evaluation tool based on the Care Inspectorate performance improvement model. Includes scrutiny by the assessment group of evidence provided to support the assessment findings. For info - 10 areas looked at are
Governance, Service Model, Partnership Arrangements, Finance, Communication, Service User and Carer Involvement, Assessment & Provision of Equipment, Store Service, Performance, Training & Development
Click 1 – the then JIT supported a self evaluation – Not Good! Then provide support across the areas of weakness with a new model identified and introduced (used Change Fund ££s to get it underway). Recent re-evaluation shows level of improvement
Click 2 – huge increase on recycling
Click 3 – and helped avoid hospital admission
Click 4 – and increased independence and better quality of life
And IJB agreed in June to mainstream the new model.
“I wouldn’t have been able to leave hospital as soon as I did without the equipment and I no longer need carers”

18. Living Well in Communities

19. Improvement Challenges
Implementation
Releasing capacity to do improvement work/seeing improvement as the day job
Service Pressures
Workforce pressures
Financial pressures
Competing Priorities ( whose priorities are most important ? )
Acute v Prevention
Data – lack of primary care and community
Spread and scale up

20. There’s no place like home
Vision
The Improvement Hub (or ihub for short) vision is simple - to support health and social care organisations to design and deliver services and support that better meet the changing needs and aspirations of people, families and communities in Scotland.
The Improvement Hub has programmes which support the prevention of unplanned admissions to hospital or long-term care. This will help people to benefit from an improved quality of life, maintaining independence for longer and minimising their support needs.

21. Health & Social Care Integration
Thank you
Web: ihub.scot