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John Gillies: Health and Social Care Integration in Scotland 2018


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Integration of health and social care – predicting the quality, costs and consequences 17.4.2018

Published in: Healthcare
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John Gillies: Health and Social Care Integration in Scotland 2018

  1. 1. Health & Social Care Integration in Scotland 2018 John Gillies OBE FRSE FRCGP Deputy Director of the Scottish School of Primary Care Honorary Professor of General Practice University of Edinburgh Scottish School of Primary Care
  2. 2. Vision: Sustainable and equitable high quality primary care that meets the needs of the people of Scotland. Scottish School of Primary Care • Inform our key stakeholders by collating relevant evidence, and actively contributing to the evidence base. • Support the continuing growth of Academic Primary Care in Scotland. • Promote Scottish Academic Primary Care internationally Stewart Mercer Director, John Gillies Deputy Director
  3. 3. With thanks to: Dr Alison Taylor Head of Integration, Scottish Government Dr Gregor Smith, Deputy Chief Medical Officer Professor Stewart Mercer, SSPC
  4. 4. Population 5.4 million Devolved Parliament Universal healthcare Integrated delivery system £13.1 billion budget 14 + 8 NHS Health Boards 31 Integration Authorities Free personal care for 65+
  5. 5. Projected % change in Scotland’s population by age group, 2010 - 2035
  6. 6. Multimorbidity in Scotland Lancet 2012; 380: 37–43 Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study Karen Barnett, Stewart W Mercer, Michael Norbury, Graham Watt, Sally Wyke, Bruce Guthrie
  7. 7. People living in more deprived areas in Scotland develop multimorbidity 10-15 years before those living in the most affluent areas
  8. 8. Public Finances – Fall in Government Expenditure
  9. 9. Vision People should be supported to live well at home or in the community for as much time as they can People should have a positive experience of health and social care when they need it
  10. 10. Guiding principle: “. . . effective services must be designed with and for people and communities – not delivered ‘top down’ for administrative convenience” The Christie Commission Report Commission on the future delivery of public services, June 2011
  11. 11. Key dates • Consultation – May – October 2012 • Bill introduced to Parliament – May 2013 • Bill passed – unanimously – February 2014 • Royal Assent – April 2014 • Secondary legislation complete – December 2014 • First Integration Schemes approved – February 2015 • First partnerships go live – April 2015 • All partnerships in place – April 2016
  12. 12. Our children have the best start in life and are ready to succeed We live longer, healthier lives Our people are able to maintain their independence as they get older Our public services are high quality, continually improving, efficient and responsive NATIONAL OUTCOMES Our vision is of general practice and primary care at the heart of the healthcare system. People who need care will be more informed and empowered, will access the right professional at the right time and will remain at or near home wherever possible. Multidisciplinary teams will deliver care in communities and be involved in the strategic planning of our services. PRIMARY CARE VISION We are more informed and empowered when using primary care Our primary care workforce is expanded, more integrated and better co-ordinated with community and secondary care Our primary care services better contribute to improving population health Our experience as patients in primary care is enhanced Our primary care infrastructure – physical and digital – is improved Primary care better addresses health inequalities PRIMARY CARE OUTCOMES People can look after own health Live at home or homely setting Positive Experience of Services Services improve quality of life Services mitigate inequalities Carers supported to improve health People using services safe from harm Engaged Workforce Improving Care Efficient Resource Use HSCP OUTCOMES We start well We live well We age well We die well
  13. 13. Learning from successful integrated systems Four common characteristics: • Plan for populations, not delivery structures • Pool resources – money and people • Embed clinicians and care professionals in service planning, investment and provision • Strong local leadership
  14. 14. Adult hospital care • A&E • Inpatient beds: • general medicine • geriatric medicine • rehabilitation medicine • respiratory medicine • psychiatry of learning disability • palliative care • palliative care • addictions and dependencies • mental health services, except secure forensic mental health services • addictions and dependencies • GP beds Integration Authorities – minimum functions Adult primary and community healthcare • Primary medical services • Out-of-hours services • District nursing services • General dental services • Public dental service • Community ophthalmic services • Community pharmaceutical services • Community and outpatient AHP services • Community addiction and dependency services • Community geriatric medicine • Community palliative services • Community learning disability services • Community mental health services • Community continence services • Community dialysis services • Services provided by health professionals that promote public health Adult social care
  15. 15. “A focus on supporting people, rather than single disease pathways with a solid foundation of integrated health and social care services based on new models of community- based provision.”
  16. 16. Challenge Higher public expectations of the health and care system as more people live longer and into very old age, with an increasing prevalence of illness, particularly chronic conditions, supported by new medicines and technologies, which together with inflation make healthcare less financially sustainable each year. And not just a sustainability challenge, a quality challenge.
  17. 17. The nature and scale of the challenges facing our NHS - in particular the challenge of an ageing population - mean that additional money alone will not equip it properly for the future. To be blunt, if all we do is fund our NHS to deliver more of the same, it will not cope with the pressures it faces. To really protect our NHS, we need to do more than just give it extra money - we need to use that money to deliver fundamental reform and change the way our NHS delivers care. John Swinney, DFM Budget Speech, 12/15
  18. 18. “Let me be clear about the objectives of this programme of reform. We want to ensure that adult health and social care services are firmly integrated around the needs of individuals, their carers and other family members; that the providers of those services are held to account jointly and effectively for improved delivery; that services are underpinned by flexible, sustainable financial mechanisms that give priority to the needs of the people they serve rather than the needs of the organisations through which they are delivered; and that those arrangements are characterised by strong and consistent clinical and professional leadership.” Nicola Sturgeon, MSP, Deputy First Minister and Cabinet Secretary for Health and Wellbeing, December 2011
  19. 19. Key ingredients • Nationally agreed outcomes, supported by indicators • Primary, community and social care together with those aspects of hospital care linked to unplanned admissions • New accountable boards that plan and commission services, with a focus on localities • Single budget for health and care • Operational integration of services Public Bodies (Joint Working) (Scotland) Act 2014
  20. 20. High Resource Individuals
  21. 21. Realising realistic medicine • Culture • Collabora te • Connect • Communic ate Relationships
  22. 22. Health & social care delivery plan 2016 • Better health • Better care • Better value Through: • Strengthened primary, community and social care • Focus on realistic medicine • Better interfaces between primary and secondary care
  23. 23. Need for collaborative leadership! • Health services and Councils have very different employment/ HR policies • Different & diverse cultures and leaderships styles • Where things work well, usually because of good local leadership • Leading for Integration programmes may be effective. e.g: RCGP/ NHS Education/ Scottish Social Services Council • home/portals-and- topics/leadership-- management/programmes/you-as- a-collaborative-leader.aspx Type to enter a caption.
  24. 24. Improving Together: A National Framework for Quality and GP Clusters in Scotland set out the intrinsic and extrinsic functions of clusters as follows: Intrinsic Extrinsic Learning network, local solutions, peer Support Collaboration and practice systems working with Community MDT and third sector partners Consider clinical priorities for collective Population Participate in and influence priorities and strategic plans of Integrated Authorities Transparent use of data, techniques and tools to drive quality improvement – will, ideas, execution Provide critical opinion to aid transparency and oversight of managed services Improve wellbeing, health and reduce health inequalities Ensure relentless focus on improving clinical outcomes and addressing health inequalities
  25. 25. It's about the outcomes, but people often want to talk about the process… It's about behaviours… Everyone wants change, but it's easier when other people have to do it… There are some really hard-edged challenges where it has to work quickly, but change takes time… It's iterative, we are making large and small gains all the time…
  26. 26. Some signs of progress… From Scottish Government: • A key focus for integration is to shift away from inappropriate use of unscheduled inpatient care. this shift has been in unscheduled care. The SG’s Delivery Plan set a 2017-18 target of reducing the number of occupied bed-days in acute care by as many as 400,000 through reducing delayed discharges, avoidable admissions and inappropriately long stays in hospital. • There are clear on-going improvements being achieved in reducing unscheduled bed occupancy, in part through on-going improvements in delayed discharge performance. The latest published data (February 2018) demonstrates that since August 2016, the number of days spent in hospital by people where discharge was delayed has reduced from just over 45,500 to 38,394, a reduction of over 15%.
  27. 27. What’s actually happening? • National Health and Wellbeing Outcomes Framework: 6/downloads • Suite of core indicators: t-Health-SocialCare- Integration/Outcomes/Indicators/Indicators • Rigorous overview by Audit Scotland: http://www.audit-