IMPROVING OUTCOMES AND
SUPPORTING INNOVATION
Dr Margaret Whoriskey
Director, Joint Improvement Partnership Board
A Scottish Approach to Public
Service Reform
> Prevention – decisive shift: Reduce future demand by
preventing problems arising or dealing with them early on.
> Partnership – Bringing public, third and private sector
partners together with communities to deliver shared
outcomes that really matter to people.
> People – We need to unlock the full creativity and potential
of people at all levels of public service, empowering them
to work together in innovative ways. We need to help
create ways for people and communities to co-produce
services around their skills and networks.
> Performance – To demonstrate a sharp focus on
continuous improvement of the national outcomes.
Our 2020 Vision…
By 2020 everyone is able to live longer
healthier lives at home, or in a homely
setting.
Health & Social Care Integration
Underpinned by Legislation:
• nationally agreed outcomes;
1. Healthier
2. Independent Living
3. Positive experiences and outcomes
4. Carers are supported
5. Services are safe
6. Engaged workforce
Principals/Defining Outcome Focused Approach
• Understand outcomes as the
impact or end result of support
and/or services on a person’s life:
• BUT start by defining
expectations and outcomes with
the person
• Focus on strengths and capacities
more than deficits
• Identify the person’s role as well
as other people in their life and
services
• Outcomes can be measured both
for the individual and for the
service as a whole
• Believing that the participation of
the person is core to practice
What do we mean by outcomes?
The “So what?” question – if we have provided support or
service to someone, what did that achieve? Did the person
benefit and how do they see it?
This requires both the services, and the person themself to think
through together what matters and how it can be best
achieved.
The big challenge is to develop what we often do well at the
individual level to be the basis of our whole organisational
approach – keeping people and what they want at the heart
of everything we do. We refer to this as a personal outcomes
approach.
Supporting people at Home
Trend in Care Home residents aged 65+ in Scotland:
actual vs projected numbers
40000
N of residents 65+
35000
30000
Projected
25000
Actual
20000
15000
2003 2004 2005 2006 2007 2008 2009 2010 2011
Year
Hospital emergency admission 65+:
occupied beddays
3300000
beddays
3000000
Projected
beddays
2700000
2400000
2100000
/03 3/04 4/05 5/06 6/07 7/08 8/09 9/10 0/11
2
0
0
0
0
0
0
0
0
1
20 20
20 20 20 20 20
20 20
Actual
beddays
Trend in emergency admissions (Index) by length of stay (LOS),
aged 75+
160.0
Index (ye March 06=100)
150.0
0 days
140.0
1 day
130.0
120.0
2 days or
more
110.0
All LOS
100.0
90.0
2005/6
2006/7
2007/8
2008/9
2009/10
2010/11
Source data ISD
Chart PK JIT
Current service provision by
service type
NHS Continuing
Care
65-74
97%
65+
Home care
Care
home
88%
75-84
75-84
All others
89.5%
60%
85+
“Most older people (89.5%) do not receive ‘formal’ care in
NHS continuing care, a care home or a home care
service organised by social work agencies.”
Reshaping Care: Integration in Action
• 10 Year National Programme 2011-2021
• £ 300 million Change Fund 2011 - 2015
• 32 Partnership Change Plans agreed by:
NHS: primary, acute and mental health services
Local Authority: social care and housing
Third sector
Independent sector
• Reshaping Care and Integration Improvement
Network to support partnerships to transform care
Reshaping Care Pathway
The Change Fund and RCOP
 2012/13– CF built on current initiatives and
developments - Only 1-2% of total spend


build on wide range of other innovative work underway
early reflections on Joint Commissioning
 2013/14 – Joint Commissioning Strategies with a 10
year horizon to shift the balance of care
 Change Plans as lever to change :



Investing to maximise improvements in outcomes
Maximising potential for resource shifts by bridging to new
service models
Investing to lever otherwise inaccessible resources
Going Forward: Joint
Strategic Commissioning
• “all the activities involved in assessing and
forecasting needs, links 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.”
• First iteration prepared for 13/14 focusing on older
people
• Will be a legislative requirement from 2015
onwards for all adult care groups
• National support programme launched
• http://www.jitscotland.org.uk/actionareas/commissioning/
Joint Commissioning Plans
• Increasing focus on dementia
• Post diagnostic support
• Focus on Physical environment , housing,
adaptations, telecare
• Training for all
• Anticipatory care
• Reablement
What needs developed
• Need for better integration across mental health,
older people services and support
• More focus required on post diagnostic support
• Support for care homes
• 8 Pillars – needs to be integrated in wider work
• Dementia friendly communities
• More opportunities for telecare
• More recognition and support for carers
Learning from demonstrators
• Communication tool app for phones and tablets for people with dementia
• Care and repair
• Perth and Kinross open access memory clinic and disinvestment from
community hospital beds to alternative NHS services in the Strathmore
locality
• Midlothian family group conferencing initiative and detailed IRF work with
primary care
• North Lanarkshire dementia cafe work (for which they have received an
award); reminiscence initiative re football; dementia friendly community
work in Motherwell involving local traders and other statutory agencies;
outreach from day care work.
• Housing initiative with all sites
• Reablement
Supporting Innovation at Scale
Expanding Range of Telecare Equipment
Wristcare
Locator
Medication
Reminder
Wayfinder
Epilepsy
sensor
A useful enabler…
In five years to 31/3/2012, 325 users of the Renfrewshire Care 24 telecare
service had dementia; over 30% of all users. The Service has provided a
range of equipment including door contacts, pressure mats and bed
monitors, operates a Responder service in the event of an alarm being
triggered and has a specific dementia pathway; all with the aim of keeping
these vulnerable people safely at home.
The Renfrewshire Telecare service estimated 114
hospital and 88 care home admissions were
avoided by this group because of telecare.
For more info:
@jitscotland
www.jitscotland.org.uk
Margaret.whoriskey@scotland.gsi.gov.uk