Transcript Document
Living well with Multiple Conditions Shifting the Paradigm Dr Anne Hendry National Clinical Lead for Integrated Care Joint Improvement Team What Matters to Me > > > > Coordination and continuity of care Trusted relationships Accessible information and advice Good communication with, and between, staff Number of people in Scotland with two or more long term conditions People living in more deprived areas in Scotland develop multiple conditions around 10 years before those living in the most affluent areas Mental health problems are strongly associated with the number of physical conditions, particularly in deprived areas in Scotland Current paradigm Future paradigm System geared towards acute / single condition System designed around people with multiple conditions Hospital centred Embedded in communities and their assets Doctor dependent Multi-professional and team based care Episodic care Continual care and support when needed Disjointed care Well coordinated integrated health and social care Reactive care Preventive and anticipatory care Patient as passive recipient Informed empowered patients and clients Self-care infrequent Self management / self directed support enabled Carers undervalued Carers supported as equal partners Low-tech Technology enables greater choice and control Locality: the Engine Room of Integration > Where we will best engage and empower those who deliver and receive health and social care > Where service changes can have a real and quick impact on outcomes > Where we will build effective relationships and create local integrated networks of care and support Creating conversation and space that enables people to understand, reflect upon and reconsider their purpose, attitudes, roles and relationships 9 Health & Wellbeing Outcomes (proposed) People are able to look after and improve their own health and wellbeing and live in good health for longer. 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. People who use health and social care services have positive experiences of those services, and have their dignity respected. Health and social care services are centred on helping to maintain or improve the quality of life of service users. People who provide unpaid care are supported to reduce the impact that their caring role has on their health and wellbeing. People who use health and social care services are safe from harm. 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. Health and social care services contribute to reducing health inequalities Resources are used effectively in the provision of health and social care services, without waste. Considering inequalities: what are the implications for health and social care services? Dr Pauline Craig Health Scotland Deprived areas • Area planning versus services for people • More of the same in areas with greater need? • How much more? • Or different services? Impact of social inequalities on health • Poverty, discrimination, family breakdown, domestic and community violence, addiction, fear of crime, dangerous environments, support networks • Who are the poor? Hard to reach, easy to ignore etc (recent reports) • Single parents, people with disabilities, some ethnic minorities, people with mental health problems, people with addictions Service planning: right to health and AAAQ • Available: location, opening hours etc? • Accessible: physically, geographically, nondiscriminatory? • Acceptable: culturally and ethnically, person centered? • Good Quality: environment, premises, safe and effective, as good as they can be? Health Inequalities Impact Assessment • Combined approach covers equality, human rights and social inequalities • Impact on different population groups, consider diversity and complexity, voice of the voiceless, literacy etc • How do services need to adapt? Discussion • 1. Who can help you and your team to improve outcomes for people with multiple conditions ? • 2. How will you build effective relationships with partners across all sectors ? • 3. What actions will you and your team take to help reduce inequalities within localities ?