Download 12-dec-Tim-and-Linda - Coalition of Care and Support Providers

Coalition of Care and Support Providers
in Scotland
Annual Meeting
12 December, 2013
Tim Davison, Chief Executive
Linda Irvine, Strategic Programme Manager
NHS Lothian
In this presentation….
• An overview of integration across Lothian
• Lothian’s Joint Mental Health and
Wellbeing Strategy 2011- 2016 – “A Sense
of Belonging”
• The Transformation Station – a unique
health and academic partnership
• The Redevelopment of the Royal
Edinburgh Campus – Public Social
Partnership
• Re:D Collaborative – enactment of Christie
Integration across Lothian
• Biggest overall driver is transforming care
for older people and addressing
demographic shift
• Reduce reliance on acute hospital care
• Shift balance of care towards new models
around prevention, anticipatory care,
alternatives to admission, step up, step
down facilities in the community,
reablement, home care and care home
Shifting the balance means
shifting the resources
• Critical need to build new primary/social
care infrastructure to allow safe transfer of
care
• Change fund may have prevented growth
in admissions but not yet evidence of
significant reduction in demand
• Until then we can’t afford packages of care
at £500 or £1000 per week, we can only
afford hospital beds at £2000 per week
The current system does need
fixing
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Delayed discharges
4 hour emergency access standard
Boarding
Deficit in home care provision
Deficit in care home provision
Inadequate flow/too many handoffs/transactions
• Poor quality and poor experience for many
• Major overspending
Integration progress/timescales
• Still planning for corporate body model
• Shadow H&SCP Boards established with
all four councils
• Joint Directors of Health and Social Care
appointed for all four shadow boards
• Integration plans by April 2014
• Strategic commissioning plans being
developed through 2014
• Go live by April 2015
Key areas to exert influence
• Third sector involvement in the
Partnership Boards (Voluntary Action East
Lothian, Midlothian Voluntary Action,
EVOC)
• Third sector influence on the strategic
commissioning plans
• Help to find solutions to the wicked issue
of how to provide more care of a higher
quality at reduced overall cost – at pace
that is more than glacial and scale that is
more than another pilot…..
Strategic commissioning
considerations
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A minimum wage economy?
Recruitment and retention
Continuity of care(r)
Quality of care at home or in residential
settings
• Need a 5-10 year horizon but we need to
get started NOW
• Linda will drill down into some specific
examples of some tangible current work
Economic Recession
Social Recession
• Ill-judged reductions in spending - Increased demand for public
service
• Radical reform – reducing spending and improving outcomes
needs to focus on major drivers for costs for public services
• High rates of poverty, income inequality and social exclusion
have a corresponding effect on demand for services – particular
challenge for health, social care and justice
• Rescue and cure have immediate, tangible and measurable results
• Logic of prevention contradicts the “rescue principle”
• Challenge the ethics of failing to prevent harm
• Preventative measures are long-term, complex and hard to measure
• Address organisational structures and organisational
processes, but, arguably more importantly, address the
third level of culture and attitudes.
“A Sense of Belonging” - Distance travelled…
2013
2003
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21 July Joint Programme Board -1st
meeting
Joint Planning Groups
Working age adults only
CMHTs/ Uni-professional groups
Sector Service Management
Continuity of consultant care
Very long waiting times – not clear
what people are waiting for
Four psychiatric hospitals
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216 acute beds
24 IPCU beds
113 rehab
50 forensic
0 mother and baby
0 eating disorders
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19 December – Joint Programme Board c65th meeting
Joint Planning Groups
Life stages from 2011
More multi-professional teams
Uni-professional management
Inpatient and community roles
Still some long waiting times- know where
they are and what people are waiting for
Two psychiatric hospitals
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124 acute beds
24 IPCU beds
60 rehab
45 forensic
6 (3)mother and baby
12 (6) eating disorders
Promoting Transformational Change
Paradigm shifts and changes in thinking and planning on many levels
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Further shifting service delivery to community settings from hospital settings
Model of care delivery that works in partnership with service users and their whole system of support
as opposed to viewing the user only within the context of their symptoms or life events
Moving away from oppositional polarised views that investing in early intervention and awareness will
negatively impact on care and treatment services
Draw upon the widest range of evidence-based approaches to inform our redesign and
development of services.
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The recognition of the impact of psycho-social factors on health,
Public / patient / service user involvement and the need to take account of consumer views in
deciding how and what should be measured as success
Service user lead research which draws upon people’s lived / living experiences
The Transformation Station
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reviews research evidence for service provision
changes services in line with research evidence
builds research evidence for service provision
A new Royal Edinburgh Hospital in 2017
- progressing on multiple fronts
• Enhanced community
services – acute;
rehabilitation; forensic
• How we use our
inpatient facilities mentally disordered
offenders; substance
misuse
Maximizing opportunities
for independence;
Hopeful services
• Public Social Partnership
• Integrated Care Pathways
• Redirecting resources from
out of area expenditure
• Using telecare and
technology
• Transformation Station Knowledge Transfer
Partnerships
• Enacting Christie
Commission
Public Social Partnership
What they are
• Strategic partnering
arrangements
• Based on a co-planning
approach
• Public sector connecting with
third sector organisations to
share responsibility for
designing services based
around service user needs
• Once designed and piloted,
services can then be
commissioned for the longer
term through a competitive
tendering process.
• Can be exceptions to this
What they are not
• A cheap option
• A way to steal ideas
• A monopoly of larger 3rd sector
providers
• A way to avoid procurement
Wayfinder
• New rehabilitation pathway
• Huge shift from institutional based rehabilitation
to community
• Agreed financial plan – clear timescales
• Fourteen different 3rd sector providers to support
delivery of a graded support model:
– Person centered
– Range of accommodation and support – a secure base
– Meaningful days
• Community connecting funding
Green space: art space
growing
and eating
Testing
the soil
environmental
Art
Community
Participative
Arts
therapeutic
spaces
green exercise
green play
crafts
Saving
the wood
Feeding
the
workers
Volunteering Peer Support Paid Employment Social Firms What works for whom?
The big Q
If we were able to re-orientate the criminal justice
system to focus on reducing reoffending
behaviour by understanding the motivations for
offending, which often stem from a complex mix
of personal experience and circumstances,
mental health conditions, drug and alcohol
abuse and peer influence - would this begin to
lessen the health inequalities experienced by
a significant part of Scottish society?
Re:d Update
• Film and narrative book produced detailing people’s lived
experience
• Leith Concept test of Peer Programme
• Interpersonal Therapy for women committing low tariff
offences
• Working with prison officers and women with personality
disorders in prison settings
• Establishment of Community Justice Centre for Women
• Exploring opportunity to apply problem solving justice –
offering people rehabilitation/ abstinence programme as
alternative to prison
Addressing the F Factor
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Fear of failure
Fear of departing from the norm
Fear of freedom
Fear of the new
Fear of friction with colleagues
Fear of the “other”
Hambleton, et al, 2012
Through the looking glass…
Alice laughed. "There's no use trying," she
said: "one can't believe impossible things.“
"I daresay you haven't had much practice,"
said the Queen. "When I was your age, I
always did it for half-an-hour a day. Why,
sometimes I've believed as many as six
impossible things before breakfast."