1. What is Shifting the Balance of Care & How do we make change happen? Sylvia Wyatt Sylvia.wyatt@scotland.gsi.gov.uk

2. Three types of shift Shift in responsibility Shift upstream Shift in location

3. Scope of SBC - 8 improvement areas 1.Maximise flexible & responsive care at home with carer support 2.Integrate health & social care and support for people in need 3.Reduce variation in unscheduled admissions 4.Improve capacity & flow for scheduled care 5.Extend the scope of services outside acute hospitals provided by non medical practitioners 6.Improve palliative and end of life care 7.Improve access to care for remote and rural populations 8.Improve joint use of resources

4. SBC as an umbrella More care at home with carer support Integrated Health & Social care Reduce variation In unscheduled admissions Capacity & flow for scheduled admissions Extend Services outside hospital Better remote & rural care Better EOL & Palliative care Joint use of resources Long term conditions 18 week RTT Workforce use Electronic Records Changing lives Personalis- ation Tele- healthcare Support for Carer A&E waits Equally well EOL care HUB CHI Home adaptations Local diagnostics Care Pathway redesign

5. SBC supports health and wellbeing improvements Single outcome agreements HEAT targets National performance framework High impact Changes x48 SBC improvement Areas x8 Improve health & wellbeing

6. SBC supports HEAT targets and SOA

7. Maximise care at home with support for carers Reduce avoidable unscheduled events Better integrated health & social care. Improve capacity & flow better use non medical practitioners Remote and rural Improve EOL care Better joint use of resources Enhance unpaid carer capacity aEnhance unpaid carer capacity Use tele-medicine & tele-health tEnhance unpaid carer capacity and supportEnhance unpaid carer capacity aEnhance unpaid carerSingle 24/7 point of contact f More investment into improvement in existing housing, Develop more near patient testingUse tele-care to provide 24/7 risk management, More investment into existing housing,Expand intermediate level services More extra care (new) houses Improve referral management byUse tele-medicine & tele-health to support care deliveryUse tele-medicine & tele-More extra care (new) housesBetter community transport Redesign home care servicesUse tele-care to provide 24/7 risk management,Redesign home careUnderstand and reduce variation in health and social careMulti-disciplinary extended community teamsAnticipatory care and crisis prevention.Redesign home care servicesVoluntary sector organisations contributions Use tele-care to provide 24/7 risk management,Use tele-medicine & tele-health to support care deliveryUse tele-care to provide 24/7 risk management,Redesign care pathways to optimise capacitySingle 24/7 point of contact for local information and access to community servicesMulti-disciplinary extended community teamsUse tele-care to provide 24/7 risk management,Continuity of information across organisational boundaries. Use tele-medicine & tele-health to support care deliveryAnticipatory care and crisis prevention.Use tele-medicine & tele-health to support care deliveryReduce pre-operative beddaysOvernight response for people in needRobust community emergency and urgent response systemsUse tele-medicine & tele-healthAlign health and social care terms and conditions of service Self directed supportCase manager or key worker to coordinate personalised careSelf directed supportImprove quality of health & social careExpand intermediate level services to provide alternatives to admission to acute hospitalsDevelop more near patient testingSelf directed supportBetter management of age transitions More domiciliary assessment and rehabilitationSingle 24/7 point of contact for local informationAnticipatory care and crisis prevention.Change referral permissions so that people can self referRobust community emergency and urgent response systemsBetter community transportMore domiciliary assessment and rehabiRedesign care pathways to optimise capacity Anticipatory care and crisis prevention.Overnight response for people in needCase manager or key workerScreening, consultation & treatment by NMAPDevelop more near patient testingVoluntary sector organisations contributionsAnticipatory care and crisis prevention. single point of access Case manager or key worker to coordinate personalised careExpand intermediate level services to provide alternatives to admissionMulti-disciplinary extended community teams including carers and users.Equitable funding for each CHPIntegrated equipment library and adaptations serviceMentoring, peer support/ expert patients to encourage self-careCase manager or key workerDevelop community hospitals/local care centres/hubs Single 24/7 point of contact for local informationRobust community emergency and urgent response systemsSingle 24/7 point of contact for local information Better medicines management by pharmacistsCo location of services and teams across agenciesMulti-disciplinary extended community teamsPool budgets between health and social care Overnight response for people in needIntegrated equipment libraryOvernight response for people in need Redesign care pathwaysImprove referral managementOvernight responseDevelop multi-skilled generic workers Develop more near patient testing Joint targeting of resources towards those people who are at riskExpand intermediate level services Improve quality and standardisation of routine health & social care through use of protocolsRedesign care pathways to optimise capacityExpand intermediate level servicesEquitable funding for each CHP Integrated equipment library and adaptations serviceVoluntary sector organisations contributionsRobust community emergency and urgent response systems Non medical prescribing within protocols for common conditionsElectronic prescribing and postal dispensingDevelop more near patient testing Self-held personal care plans/recordsContinuity of information.Better community transport Change referral permissionsMobile servicesIntegrated equipment User participation in care planningBetter medicines management by pharmacistsIntegrated equipment library and adaptations service Screening, consultation & treatment by non medical practitionersObligate networks between remote and rural areas and larger centresUser participation in care planning Joint targeting of resources towards those people who are at riskUnderstand and reduce variation in health and social careSelf-held personal care plans/records Better access to psycho-social supportEquitable funding for each CHPVoluntary sector organisations Voluntary sector organisations contributionsScreening, consultation & treatment by non medical practitionersUser participation in care planning Integrated services across health and social care with single point of access Continuity of information. Mentoring, peer support/ expert patients to encourage self-careCommunity based one stop shops/ ‘fast’ clinics Joint targeting of Community based one stop shops/ ‘fast’ clinics Increase clinical and social networks Better medicines management by pharmacistsMobile services to support community hospitalsVoluntary sector organisations contributions Equitable funding for each CHP community including acute hospital costs Redesign care pathways to optimise capacity Plan EOL care with family and carers with particular focus on last 48 hrsContinuity of information across organisational boundaries. Non medical prescribing within protocols Non medical prescribing within protocols for common conditionsDevelop community hospitals/local care centres/hubsIncrease clinical and social network effectiveness Better access to psycho-social support Electronic prescribing and postal dispensingEquitable funding for each CHPMentoring, peer support/ expert patients to encourage self-care Extend gold standard EOL care to everyone Plan EOL care with family and carers with particular focus on last 48 hrs Align health and social care terms and conditions of service Plan EOL care with family and carers Develop multi-skilled generic workers working across organisations Co location of services and teams across agencies Equitable funding for each CHP Better management of age transitions Better medicines management by pharmacists Understand and reduce variation in health and social care Redesign care pathways to optimise capacity Improve quality of routine health & social care Non medical prescribing within protocols Better access to psycho-social support with single point of access Community based one stop shops/ ‘fast’ clinics Mobile services Plan EOL care with family and carers Develop community hospitals/local care centres/hubs Pool budgets between health and social care Develop multi-skilled generic 140 + things to do at once

8. Pool budgets Self referral Self Directed support 24/7 local information Non medical prescribing Anticipatory care reducing crises Local care Centres/hubs User participation Continuity of information Redesigned home care Existing housing adaptations Extended Comm teams Referral management Mentoring Peer support Urgent care response Targeting resources EOL planning Telecare Domiciliary assess & rehab One stop shops Fast clinics Generic workers Case management Co-location Near patient testing Intermediate care alternatives Home care redesign redesign care pathways Enhance carer support SBC is complex More care at home with carer support Integrated health & social care Reduce variation in unscheduled admissions Capacity & flow for scheduled admissions Extend services outside hospital Better remote & rural care Better EOL& Palliative care Joint use of resources Improvement areas (8) Single outcome agreements HEAT targets Single point of access Tele-health Better pharma care Obligate networks Community transport Single point of access Management of age transitions Extra care housing High impact changes Overnight response Integrated equip library Self held records Voluntary Sector Network effectiveness Reduce pre- Operative days Mobile services Innovative prescribing Equitable funding Understand variation Protocols Gold standard EOL Plan EOL Psycho-social support Extend role of NMAPs

9. SBC changes are generic 1.Apply to health, social care, housing, and transport 2.Apply to several improvement areas 3.Are inter-dependent 4.Apply to any age group 5.Apply to any disease or dependency

10. Implementing change

11. Actions for communities Describe baseline position in relation to 8 improvement areas Outline actions that will lead to measurable changes in locally selected areas of Improvement and Resource Framework Demonstrate clear line of sight into workforce development plans, eHealth and eCare strategies and infrastructure investment plans

12. Suggested implementation process Measure baseline in priority areas Prioritise 8 SBC improvement areas Choose changes to address priorities Implement across whole CHP Measure SBC change across all 8 areas

13. Prioritisation of 8 improvement areas SBC improvement area x8 Starting point High Impact Changes being prioritised Local CHP/LA Measures Local CHP/LA Targets 2008/9 1.Maximise flexible & responsive care at home 2.Integrate health & social care and support for people in need 3.Reduce variation in unscheduled admissions 4.Improve capacity & flow for scheduled care 5.Extend the scope of services outside acute hospitals 6.Improve palliative and end of life care 7.Improve access to care for remote and rural populations n/a 8.Improve joint use of resources Overall position Area to prioritise

14. Sylvia Wyatt SPACE lead for SBC Evidence based SBC changes with greatest impact

15. Which of these....? Addresses priority improvement areas Fits with local population needs Addresses inequalities Improves patient experience Implement changes across whole system

16. implement across whole partnership

17. 1.Two + whole systems evidence based changes related to SBC Improvement Framework 2.Complete within 18 months 3.Robust plans for evaluating the process and measuring shifts in the balance of care 4.High level partnership involvement, bringing together other stands of work locally 5.Well articulated, operationalised new ways of working, shared information and/or joint use of resources 6.Commitment to disseminate what works and what does not work to shift the balance of care 7.Supports the delivery of HEAT targets and SOAs SBC Change Programme – possible criteria