Transcript Document

Integrated Health and
Social Care Partnerships
IHM Conference
9 October 2014
Context - Demand
• Population Changes – People Living Longer
• Rise in population from 5.22m to 5.49m in 2020
and to 5.76m by 2035
• Over 65s to rise by 22% in 2020 and by 63% in
2035
• Over 75s to rise by 22% by 2020 and by 80% in
2035
• 85 plus to rise by 39% by 2020 and by 147% by
2035
• As we get older we consume more health and
social care - Fact
Joe Clancy
Change & Innovation - 11 November 2013
3
Multimorbidity
New action plan in Scotland, recognising:• Most people with multimorbidity are <65
• Multimorbidity occurs 10-15 years earlier in deprived
areas compared with affluent areas
• Combination of physical and mental health
conditions has strong association with health
inequalities and negative outcomes
• Current spend on adult health and social care in
Scotland is >£10.9billion and will rise through
increasing demand because of demography,
multimorbidity and poly-pharmacy
Multimorbidity is common in Scotland
– Most over-65s have 2 or more conditions, and most 75+ have 3 or more conditions
– More people with a LTC have more than one condition
Government Response
– Christie Report
• “Reviewing Scotland’s Public Sector” (2011)
• Four Pillars around which sustainable future
will be built
A shift to prevention
Greater integration and partnerships
Strong leadership
Greater focus on OUTCOMES based
performance management
Draft Regulations Relating to Public Bodies (Joint
Working) (Scotland) Act 2014 – Set 1
• Prescribed information to be included in the Integration
Scheme
• Prescribed functions that must be delegated by Local
Authorities
• Prescribed functions that may or that must be delegated by a
Health Board
• Prescribed National Health and Wellbeing Outcomes
• Interpretation of what is meant by the terms health and social
care professionals
• Prescribed functions conferred on a Local Authority Officer
Draft Regulations Relating to Public Bodies (Joint
Working) (Scotland) Act 2014 – Set 2
• Establishment, membership and proceedings of the joint
monitoring committee
• Membership, powers and proceedings of the joint monitoring
committee in lead agency arrangements
• Prescribed groups which must be consulted when drafting
integration schemes, prescribed consultees for draft strategic
plans, prescribed consultees for localities, prescribed
consultees for revised integration schemes
• Prescribed membership of strategic planning groups
• Prescribed form and content of performance reports
Functions that must be Delegated by Local
Authorities
• Social work services for adults and older people
• Services and support for adults with physical
disabilities, learning disabilities
• Mental health services
• Drug and alcohol services
• Adult protection and domestic abuse
• Carers support services
• Community care assessment teams
• Support services.
Cont/
Functions that must be Delegated by
Local Authorities
Cont/
• Care home services
• Adult placement services
• Health improvement services
• Housing support services, aids and adaptions
• Day services
• Local area co-ordination
• Respite provision
• Occupational therapy services
• Re-ablement services, equipment and telecare.
Functions that “May or MUST” be Delegated by
a Health Board
• All adult primary and community health
services
• A proportion of hospital sector provisions
• All services already within the scope of CHP’s
Hospital Functions and Budgets (and
operational Delivery within hospitals)
Cont/
• The focus is on including unscheduled hospital
care within the scope of integrated strategic
planning which is the responsibility of the
Integration Authority
• Specialities that exhibit a predominance of
unplanned bed day use for adults are included
as a minimum.
Cont/
Health Services That Must be Included Within
Integration
• Unplanned inpatients
• Outpatients – Accident & Emergency
• Care of Older People (previously known as
geriatric medicine)
• District Nursing
• Health Visiting
• Clinical Psychology
• Community Mental Health Teams
• Community Learning Difficulties Team
• Addiction Services
Cont/
Unplanned Care
Expenditure
Specialty
Accident & Emergency
Geriatric Medicine
General Medicine
Infectious Diseases
Palliative Medicine
GP Other than Obstetrics
General Psychiatry
Psychiatry of Old Age
Renal Medicine
Learning Disability
Rehabilitation Medicine
Respiratory Medicine
Anaesthetics
Cardiology
Neurology
General Surgery (exc Vascular)
Vascular Surgery
Gastroenterology
Neurosurgery
Trauma and Orthopaedics
Other medical specialties
Clinical Oncology
Haematology
Dermatology
Plastic Surgery
Ear, Nose & Throat
Medical Oncology
Rheumatology
Urology
Cardiac Surgery
Gynaecology
Oral and Maxillofacial Surgery
Thoracic Surgery
Oral Surgery & Medicine
Ophthalmology
Dental
Elective Non Elective
£m
£m
0.0
14.5
12.0
380.6
21.3
461.5
1.1
22.3
0.7
12.4
6.6
109.9
19.7
280.6
17.0
161.5
3.1
28.9
5.3
46.0
6.3
46.9
8.4
48.2
15.1
56.6
36.2
98.8
10.6
12.4
203.6
227.5
21.1
20.8
26.4
25.3
27.3
26.1
170.2
154.1
1.6
1.0
33.7
20.8
48.2
27.2
6.5
3.0
35.2
15.1
33.2
12.4
29.8
10.9
9.0
3.1
67.1
21.4
45.2
13.8
63.6
17.0
18.6
4.7
16.5
4.2
3.9
0.7
67.7
6.2
0.7
0.0
1,092
2,397
Occupied Bed Days
Total
£m
14.5
392.6
482.8
23.4
13.1
116.5
300.3
178.5
32.0
51.4
53.2
56.6
71.8
135.0
23.0
431.1
41.9
51.7
53.4
324.2
2.6
54.4
75.3
9.6
50.3
45.6
40.7
12.1
88.5
59.0
80.6
23.3
20.8
4.6
73.9
0.7
3,489
Elective Non Elective
Days
Days
21
14,325
43,778
1,322,298
25,929
1,113,468
1,576
38,145
1,616
27,909
14,798
288,852
59,958
683,975
61,836
482,764
3,515
47,875
5,206
68,266
13,581
106,385
10,125
112,114
6,246
30,443
10,138
135,650
6,487
14,945
124,461
393,937
20,793
46,172
8,168
47,497
16,927
29,955
115,920
255,980
1,574
2,296
25,264
32,063
21,385
33,710
12,024
5,569
13,772
14,429
13,755
18,261
5,560
10,333
5,411
3,767
43,759
46,736
23,620
8,881
33,244
20,786
9,647
4,237
12,869
5,362
663
913
6,425
6,626
48
0
780,097
5,474,922
Total
Days
14,345
1,366,076
1,139,397
39,721
29,525
303,649
743,933
544,600
51,390
73,472
119,966
122,239
36,689
145,788
21,432
518,398
66,965
55,665
46,882
371,900
3,870
57,327
55,095
17,593
28,201
32,016
15,893
9,178
90,495
32,501
54,030
13,883
18,231
1,577
13,050
48
6,255,019
Unplanned
expenditure
as proportion
of total
%
99.9%
96.9%
95.6%
95.3%
94.5%
94.3%
93.4%
90.5%
90.3%
89.6%
88.2%
85.1%
78.9%
73.2%
54.0%
52.8%
49.6%
49.0%
48.9%
47.5%
39.6%
38.2%
36.1%
31.8%
30.0%
27.2%
26.7%
25.4%
24.2%
23.4%
21.1%
20.3%
20.3%
15.6%
8.4%
0.9%
68.7%
Health Services That Must be Included Within
Integration
Cont/
• Women’s Health Services (includes family planning services)
• Allied Health Profession Services
• GP Out of Hours
• Public Health Dental Service (previously known as
community dental services)
• Continence Services
• Home Dialysis
• Health Promotion
• General Medical Services (GMS)
• Pharmaceutical Services – GP prescribing
Next Steps – H&SCPs
•
•
•
•
•
•
Integrated Transition/Shadow Boards
Integrated Care Fund
Integration Scheme
Communications Plan
Services to be included
Joint Strategic Commissioning Plans
Next Steps – H&SCPs
•
•
•
•
•
•
Governance Arrangements
HR/OD Framework
Performance Framework
Financial Plans
IM&T Strategy
Asset Management
The Lanarkshire Context
• 2 x Health and Social Care Partnerships
• Each circa £400m
• Each circa 3,000 wte staff
• GPs central to process
• Locality focussed service design/care provision
• Strong emphasis on co-production
• Prescribing - £133m (circa 25% total health cost incl FHS)
The Importance of Primary Care
Over 90% of interactions with healthcare start
and finish in primary care.
Key to addressing:
Inequalities in health and care;
Access to health (and often social) care
Self management of long term conditions
Overall resource utilisation
The Lanarkshire Context
• COPD
)
• Diabetes
)
• Cancer Care
)
• Palliative Care
)
• CHD
)
• Others
)
All require effective 24/7 care
pathways (Anticipatory Care
Plans - ACPs) which are
available to and understood by
all key stakeholders – Patient,
Next of kin, GP, NHS 24/OOH ,
Ambulance, A&E, inpatients.
Integrated Community Care
Social work resources
inc. Community
Occupational therapists
GP
Physiotherapists and
occupational therapists
Home care and Supporting
your Independence staff
District nurses 24 hr
service
Other services or support from the wider
community e.g. family, 3rd sector, specialist
teams e.g. Old Age Psychiatry and independent
providers
The Lanarkshire Context
– Redesign - Prescribing
• GP Incentive Scheme
• Joint training for home care staff – incl medicines management
• Seek to reduce waste/costly prescribing
• Manage demand more effectively
• H&SCPs holding budget
Total Cost ~ £1,400
Integration : Critical success
factors
•
•
•
•
Focus on outcomes
Leadership and culture
Strategic commissioning
Locality and community focus
Integrating to improve outcomes
1. People are able to look after and improve their own health and wellbeing and
live in good health for longer.
2. People, including those with disabilities, long term conditions, or who are frail,
are able to live, as far as reasonably practicable, independently and at home
or in a homely setting in their community.
3. People who use health and social care services have positive experiences of
those services, and have their dignity respected.
4. Health and social care services are centred on helping to maintain or improve
the quality of life of service users.
Integrating to improve outcomes
5. Health and social care services contribute to reducing health inequalities.
6. People who provide unpaid care are supported to reduce the potential impact of their
caring role on their own health and well-being.
7. People who use health and social care services are safe from harm.
8. People who work in health and social care services are supported to continuously
improve the information, support, care and treatment they provide and feel engaged
with the work they do.
9. Resources are used effectively in the provision of health and social care services,
without waste.
Integral role of strategic commissioning
“the term used for all the activities involved in assessing and
forecasting needs, linking investment to agreed desired
outcomes, considering options, planning the nature, range
and quality of future services and working in partnership
to put these in place.”
Strategic Commissioning Cycle
Making it happen on the ground
• Delayed discharge in Renfrewshire
– Targeted joint improvement plan
– BDL fallen from to 1920 (Oct 11) to 210 (Jun 14)
– Significant pressure on community resources
• Clinical Services Review
– Funded demonstration programme
– Initiatives to prevent admission /facilitate appropriate discharge e.g.
comprehensive geriatric assessment, care at home resettlement service,
anticipatory care planning
• Development of Joint Strategic Commissioning Plans
– Older people complete
– Other client groups ahead of April 2015