INTEGRATION OF ADULT
HEALTH AND SOCIAL CARE
Strategic Planning Group Meeting
14/05/2015 at 10am-3pm
Venue – Easterbrook Hall
MEETING NOTES
1. Ann Stephenson opened the meeting and welcomed members
2. – 4. Vicky Freeman – presented
 Aims of the Day
 Role and remit of the strategic planning group
 Working draft of the Consultation Document relating to the Strategic Plan
and strategic Framework
 Plan governance structure
.
This included interactive sections where members were invited to participate in a variety of
open discussion on the key items presented.
Questions/Comments put forward to Vicky Freeman:
I.
How do we involve and engage communities and the most vulnerable in a different
approach?
Ans: the sessions throughout the day should help draw out the details that will inform a
Communication and Engagement plan. Localities have responsibilities with regard to
ensuring robust engagement with locality plans.
II.
Those on the ground receiving care do not actually have much interest in how the
plans are developed – just the service they receive at the time in need.
Ans: Some disagreements to this statement as it was suggested that in order to know
what people want and expect we must consult them.
III.
How can we determine how to write the consultation questions correctly in order to
capture the right information?
Ans: All of us are responsible for bringing these issues together and communicating with
the public in an appropriate manner – people understand a great deal more than we
sometimes think.
Need to be thinking about what services we currently have that help us to meet the 9
national outcomes, and what we might need to change in order to meet these.
6. Julie White discussed integration with the group and the importance of the
groups role in shaping and informing the direction that health and social care
strategy would take.
Q & A with Julie White
Q. What is your vision for what services will look like once integrated?
A. This will be described in the final strategic plan. Essentially, this will be determined by
this group and wider communities. We need to consider how we work with our partners
and community in order to work differently. We also need to change the relationships
between professionals and people who use services. We should also highlight the fact that
an ageing population, whilst does present challenges, is moreover, an asset to D&G. We
must recognise the idea of truly shifting the balance of care. It would be difficult to take
people out of secondary care and into communities until new ways of working and new
models of care are developed and the high demand and pressure on secondary services
is released.
Q. How can voluntary teams be supported to provide care within the community e.g.
training for Ambulance First Responders?
A. It is important to look at the totality of all resources available to us rather than just the
Integrated Care Fund and how best we use these to support communities
Q. Will integration continue to support the culture of tick box exercises and focus
on one need and ignore the rest?
A. We need to work hard to overcome this and work more collaboratively and share
information. There is an IT portal currently being developed by Graham Gault and Graeme
McIlorum to try and overcome some of these issues in order for professionals to work in a
holistic way.
Q. We must be careful not to overload communities – we need to recognise the work
of GPs, Nurses, Care providers etc.
A. We will listen and work with communities along the way. We recognise the challenge of
GP involvement and are considering how we support them. We are also engaging with
staff to work together to develop roles.
Six additional questions were put on flip charts for Julie. These were put to Julie by email
on 22 May 2015. The answers are expected in due course.
Additional comments were recorded from the morning on general post-it notes and flip
charts and can be found attached to these minutes:
14.05.15 Morning Session Notes
Afternoon Interactive Market Place
Group 1 - Focused on the Key Challenges section of the plan.
Group 2 - Focused on the Vision and purpose of the plan
Group 3 - Focused on the Consultation Questions in the plan
All comments were recorded from the afternoon sessions can be found attached to these
minutes:
14.05.15 Afternoon Session Notes
The day was closed at 3:30pm.
Dumfries and Galloway Strategic Planning Group (SPG) Thursday 14th May 2015
Flipchart notes – MORNING SESSION
General Introductory session
General comments on the draft working document
What does Assets- based mean? (Jargon)
Setting Pointless – Concerned that priorities identified by group are based on
evidence
What other sources of evidence are (or could be) draw able from this group?
Do not overwhelm with paperwork/ reading material, need to ensure information is
precise and necessary
Communication Key
Up and down structures as well as out with structures i.e. communities
Clear information in accessible ‘formats’ for all needs
Can a group of 45 people draft the plan or just consult on it?
Is it practical to ask a group of 45 to write something?
For partnership, need people involved to have the right attitude and to value
partnerships
Document must be circulated well in advance – at least two weeks
Ensure Quality signposting is person centred
Need to be more thinking and information on what is out there already
Want to ensure equality act requirements are observed
Mental Health – needs to be an integral part of plan – is there representation from
NHS for mental health
Clarity around expectations of us as individuals or representative groups
Locality plans of Third Sector Involvement and input
What is expected of us? I’m listed as a representative of Annandale and Eskdale, I
can’t represent everyone in Annandale and Eskdale
Why is there not any Mental Health professionals on the group
How we create conditions for empowerment/ meaningful risk taking
People should not use Jargon or difficult to understand words, when they do they
should explain them. Documents need a glossary
Questions for Integration – Julie White
In practice how different can each locality plan be? Will it work if people living next
door have a significantly different service?
You mentioned a lot about localities, but how are you going to provide equality of
provision strategically so there is No post code lottery
What happens when people in the health services (for example) DONT LISTEN? We
have been complaining for ages on behalf of folk to do with Mental Health (hospital
especially) to get nowhere – we are not heard
Will the localities have different level of services?
Would people feel they need to move to the locality with the best level of service to
them>
Are the locality plans already being formulated? Should they be? If so, can we have
copies as it is important for this group to have a full picture
PARADOX – Culture of scrutiny/ risk adverse – taking meaningful risks
Taking into account the views of localities from “Role and Remit of group”
Is it enough to just take it into account? Stuffed by governance
Need to have strategic – Agreements that overarch local plans so preventing
postcode lottery of provision and access to Integration and levels of expectation
Structures
Visual of how the localities work- e.g. what feeds in where? – Who to contact.
Hopefully all localities will have similar structures for us to work with
Need balance of localities PLUS sector make sure acute doesn’t dominate
Service delivery in localities need to feed in to regional services – how will this be
addressed
Link to community councils
Link to Third Sector First Thematic Groups
May require additional representation from localities to ensure diverse coverage
Listen to Yourself and others
What matters to the public? Whose needs will be met by this?
Need to find new ways of working together – partnership collaboration outcomes
Define Services being offered
Imbed quality measurements
Basis of measurement of customer satisfaction
Articulate locality priorities mapped against key strategic challenges
Mechanism in locality to engage with locality - How do we reach the “Hard to Reach”
Some merit in dovetail consultation on strategic and locality plans. We probably all
want to get the same feedback but at different levels of detail
Fear of the older carer of how to access appropriate services
Must get agenda for meeting and it should be mostly what the meeting will be about.
Should not be big changes made at the meeting
Electing a chair
For a chair we need a person who can make necessary commitment and deliver the
brief required so they will
 Have to put themselves forward
 Tell us about themselves
 We need to be able to question them
Personal
 Qualities
 Gravitas
 Discernment
 Self awareness
1. Clarity of commitment required- time etc
2. Members asked to submit expression of interest including deciding about
what they should bring to the role and their understanding of Strategic
Planning Group
3. Submissions circulated to group members and a vote organised
4. Need to do similar for Vice Chair
Specification for the role
Personal Specification – “formal” recruitment/ application process and Task & Finish
group to take this forward
Inviting people who are interested to write a bit about themselves so people can see
the skill set
Find out who would be interested
Per patient experiences and what they would bring
Ballot
Depute
Length and time of office depute
Independent Chair?
What would the roles and responsibilities of group community and nominations
Joint Strategic Planning Group – Rules of Engagement
Formation of short term. Task and finish groups for thematic work
On Line discussion forums – topic/threads
To continue/hone the dialogue
We should make a much bigger effort to make information more understandable to
more people
Need to look at Structure and culture – need to each respect culture and
understanding of everyone else
Recognising that each of us and each group we represent has very different needs
and expectations
Respect for each other – values and contributions
Potentially more time to “build the team” and get to know each other
Sharing of personal profiles?
Listening to each other
Respecting each other
Recognising that each person’s position is as valid as your own
Should work in ways that encourage us to think “out of the box”
All views and suggestions must be valued and considered
Virtual Meetings
Encourage and make it possible for us to send ideas, proposals, questions etc into a
central person in between our meetings and that information is to be passed onto
other members
Defining the services today
Sub groups that are representative of its group to assist the process – feed in to
contact coordinating group
Central co-ordinating contact for the group to feed into
We need to trust the sub groups to represent the full views of the people we
represent
Trust, Respect, Relationships
Human Resources Representation on SPG required
Behaviours reflect the way we want the localities etc to behave
Whilst we may find change difficult and worrying, it will have to happen and we
should remember it does happen all the time and it can be successful
Dumfries and Galloway Strategic Planning Group (SPG) Thursday 14th May 2015
Flipchart notes – AFTERNOON SESSION
Group 1 looked at section 4 - Key Challenges
Group 1 - Session 1
Q1 Comments on Plan
The Plan is tackling a large and varied
subject and is a great starting point that
can be built on
Human scenarios would be helpful in
starting to think through how we need to
change service delivery
Group 1 - Session 2
Perhaps too much looking back and not
as much ‘how’ going forward
Focus on peoples mental / emotional
health
Present and anticipated demand on
community based support/supported
housing options
Group 1 – Session 3
The use of language throughout is
professional but needs to be plain
English
Strategic Plan – is in language of the
‘powerful’
Group 1 - Session 1
Keeping people safe
Does technology have a bigger role to
play in delivering care
Workforce development
Our existing and supporting workforce
through the change and maximising the
resource we have
Identification of need and assessment of
individual not being constantly repeated
Increasing number of carers and
encouraging identification through all
sources
To develop real and meaningful
partnerships within integration in order to
achieve better outcomes for people
Use case examples to illustrate how it
could be
Train for reablement
Third sector vital to moving forward
Culture Challenges
How can we change the perceptions of
what can be done
Needs to be defined. Key challenge
Q1 Comments on Plan
Q1 Comments on Plan
Underpinning principle of integration,
empowerment/enablement
Where is the core inspectorate in all this
Q2 Key Challenges
Variability
 Prescriptions
 Referrals
What are the limits of our ability to deliver
care
Need for all to own partnership - if not
then integration will not be meaningful to
the individual
Make caring valued
How to share the burden – t/f skills
Learning disability and reaching hard to
reach
Put the person at the centre of care
outlined around carers
Challenge of transparency of resource
Group 1 - Session 2
Balancing day job with transformation is
a challenge and capacity within the
system to involve staff to move this
forward
Consistent message across Partners to
manage expectation
Early intervention, break the cycle of
hospital admissions
People who are medically fit do not need
to be in hospital
Prevention and early intervention for
people requiring services and not being
hospitalised
Resourcing; transitional arrangements for
services £ and skills
Taking the community with us,
encouraging the community at large to
accept and embrace the change
Moving services – people changing jobs,
changing culture. How do we change to
using that unique skill that different
professions can offer and using others to
do other parts of their jobs
‘SEED’ monies to develop new
approaches and services. Move
resources from traditional services to
new services
How do we attract people into jobs in the
first place
Agreeing an integrated workforce plan
with all partners:
Third sector, voluntary and independent
sector
Group 1 Session 3
Future sustainability of GP/primary care
services including out of hours
Need to tackle health and care
inequalities /poverty
Q2 Key Challenges
Challenges should address avoiding
unnecessary admission and facilitate
effective discharge and enablement
pathways to home/own community
Challenge – cultural shift of population to
be responsible for own health and
wellbeing
Improve flow for user (not system) to
meet their support requirements
Exercise is important for health both
physical and mental and to counteract
obesity. But when you are prevented
from moving due to injury, there is no
help
Shifting resources (widest sense) to
community
Shifting people’s expectations - with
rights go responsibilities
Getting people to think in a different way
so we can come up with significant
different approaches
Optimise the use of assets and
resources (including people) to support
the needs of the community
Lack of appropriate housing to meet
projected demand for housing, and
areas where people wish to live / creating
sustainable and balanced communities
Sustainability of care providers in the
region:
 Fees
 Staffing, recruitment etc
 Career posts
 Being valued
Nursing homes should be able to back
up hospitals with staff who are better
trained and with a career structure
Key Challenges
Present and anticipated demand on care
at home services
Reducing working age population
Recruitment of health and social care
professionals + care +mental health,
third and statutory sector
Rise in hospital admissions and delayed
discharges
Real partnerships need to be developed
(not at present) for true integration which
benefits all
Equality of provision. Local plan –vstrategic - possible postcode lottery
Group 1 Session 3 continued
People coping with multiple conditions
(including ageing) will include carers of
people with other conditions
Staff should not be protecting their own
patch to the exclusion of those regarded
as not qualified – but better placed to
bring about the right outcome
Key challenge – getting all to ‘buy in’ to
mental health services
Challenge of paradox – risk aware
culture – scrutiny vs. taking meaningful
risks – doing things differently
How do we attract people into the
workplace and then how do we keep
them
Increasing number of people with
multiple long term conditions, including
dementia
Lack of appropriate housing to meet
projected need
Various partners to ‘buy in’ and commit
to new ways of working e.g. not
protective of status quo. Co-production
and getting commissioning right
Input and involvement in locality plans for
third sector organisation which delivers
across the region
Key challenge, dealing with all
organisation’s egos
Key Challenges
Challenge – educating us all that we
should not expect to be able to get
everything that is possible, irrespective of
cost and resources
How we work together:
 What we have in common
 Build relationships of trust
Making sure we go back to values to help
integration
Sustaining people safely and
independently at home. Responding
quickly in a timely manner
Transport
Looking at the ‘Whole Person’ in
practice, holistic approaches and
integrated working across practitioners.
Staff need to look beyond the immediate
presenting problem which could include
Physical and mental health and wellbeing issues. There needs to be referrals
to other professionals and organisations
and those that need assistance
signposted to the right services and
support needed.
Cutting out duplication with information
sharing so that the person does not have
to provide the same information
repeatedly.
Changing culture in paid staff: staff are
not currently practicing in an integrated
way. The key challenge is to shift the
staff cultures and needs to be part of the
performance management and
supervision agenda with services. Staff
should have to demonstrate knowledge
and understanding of the Health and
Social Care integration and actual action
in their practice that demonstrates and
reflects a Health and Social Care
Integration.
Group 2 looked at section 5 - How we plan to achieve our Vision and Purpose
Group 2 – 1st Session
Deal with perceptions - explaining Technology and computers (necessity)
Enabling communities to overcome fear of computers/technology
Don’t use technology for its own sake – use it for a practical purpose
Include examples as part of consultation
Housing plans need to move forward based on current and projected needs.
Localities know what they need
Transport is a key issue country wide for health inequalities
Postcode lottery
Knowledge/Information signposting to support/ services available in locality and
beyond
How can people have more choice when they are in a mental health hospital and
their choices are taken away – i.e. visiting hours are awful and no bedside visiting
Be careful of “postcode lottery” of services. Need to be tied in with strategic plan
Building Safe Communities
Carer’s legislation will allow change from assessment to support plan. While this may
be for those in critical need – the third sector will be able to assist with less formal
plans that may not impact on services
Choice and Control
Need to know what is available before these options - This may differ in localities
and we need to ensure consistency and access
Need to move from silos of professional working
Focus on user and carer priorities not professionals
Developing Communities/ Community Resilience - Need to make sure Strategic
Outcomes are embedded in local plans
Optimising Efficiency – Develop a model for commissioning. Open / Transparent CoProduction partners letting go of services – disinvestment (re-evaluating)
Integrated Workforce Plan – Development – Across all partners Public/ Private, Third
Are we doing the right things to achieve the Vision and Purpose and address the key
challenges?
There was some discussion around ensuring the use of language is appropriate e.g.
what do we mean when we say optimising the use of technology – this is more than
using computers and suggest using examples to illustrate what we mean (door
sensors etc.)
Do the suggested approaches cover the needs of everyone who lives in D&G?
What do we mean by communities? This could be defined by geography, common
interests, conditions etc. We need to be careful with the language we are using.
Is there anything missing?
It was suggested that Prevention and Anticipatory Approaches are two different
things and these should be split.
Group 2 – Session 2
Locality Plans will be the area where we can cover the needs everyone in Dumfries
and Galloway. Locality however need not replicate each other
Invest in the support for getting the locality plan sorted
Bias against change – be clear about care for change
Strategic Plan should be brief enough not to need an exec summary
Group 2 – Session 3
Need to explain
 Investment and disinvestment
 Integrated workforce plan
 Preventive and Anticipatory
 Making use of technology
 Workforce Intelligence
Choices include life choices as well as what service you use, when to use it, which
GP you use etc.
Older people need support and education on which services to access i.e. a
champion
Revisit Dumfries and Galloway Carers Strategy in light of NHS/S/Work Transition
Expand the work of nursing home to be able to care for more complex medical
problems. Staff would need better recognition, a career structure and better pay
Technology
Needs to include all technology including equipment, Telecare and electronics
Role of adaptations and re-design of home environments
Technology
Access to web connection speed enabling technology
Keeping people safe
How to keep people fit and healthy and link with wider services e.g. sport and
leisure
More effective use of workforce skills
Single point of contact for people and efficient signposting
Preventative Anticipatory Approaches - Separate in to two
1. Prevention and well being
2. Anticipatory Approaches
Overall themes: Could be reflected in Strategic plans and locality plans
 Prevention
 Early intervention
 Capacity Building
 Care and Support
 Workforce Development – to support the above
Resources – savings are not the driver but if we get service right we will create
savings etc. E.g. early intervention initiatives
‘Shifting the focus from institutional care to home and community based services’
This to be changed to:
Shifting the focus from institutional care to care and support in the community’
Use frontline staff and practitioner links on the ground to link with people who use
services. Use contacts at a locality level to make links with people who use services
to encourage people to get involved take comments/feedback on consultation
documents. Suggestion to develop a single A4 flyer with 3 key messages on Health
and Social Care integration and points of contract for verbal discussion/verbal
feedback. Flyer to be given out at the point of contact with services.
Group 3 looked at section 8 – Consultation Questions
GROUP 3 – 1st Session
Explain in simple terms input including reasons for questionnaires
Structure questions to be more captive to reader
How will locality questions lead to strategic plan questions
Timing
Query wording of draft priorities
Q1 and Q2 are the same thing
What will the forms of communication be: Paper, web based, survey monkey, use
‘browse aloud’
Closed questions not popular
Engage with:
SCLD
SAIF
Timescales for actions
Should use the groups and organisations that exist and they can “personalise” the
questions and approach to their group
To engage with many of the community the wording of draft priorities will need to be
explained or made easier to understand
Structured interviews and severely Affected service users as well as gaining this
input it also informs the Strategic Planning group and is an interactive process
In Questionnaire, instead of telling people that these are “the draft priorities” Ask “do
you think these are good priorities or some such wording
Group 3 – Session 2
The consultation questions first of all presume that the people answering can read
and understand the strategic plan
Need to ask “Do you understand what this strategic plan means?”
Expert Facilitation skills required Know your audience
Accessibility – both physical and intellectual methods e.g. Non Instructed Advocacy,
Easy read verbal
Make sure people are interested by this and the facilitation right otherwise people will
think they are being preached at or not engaged
What would you like health and social care to look like in the future?
Or
What matters to you?
Is the consultation plan to include groups that clearly reach hard to reach groups
Engagement of Consultation Plan – needs to be far reaching, creative and ensure
available and supported consultation at local group and individual level
 Short term consultation plans
 Ongoing local consultation/ engagement using local ‘champions’ to feed into
interactive evolving strategic plan
 Process helps to build community
Have Community councils been involved?
Have missed out people’s rights – if people don’t know what their rights are, how can
we ask them if this meets those rights?
Think there needs to be public presentations using friendly language, followed by
these two questions to replace question 1: What healthcare needs and social care needs do you have?
 Does this plan meet your needs?
Assets mapping, what’s important to you as individuals/ communities?
What activities do you enjoy together as a community?
Inform Strategic Plan - what strategic decisions/planning priorities such as
community well being
In taking out to localities - raise asset mapping, the positives – services which are
achieving and not just negative. Then what they need
Group 3 – Session 3
Most Important Issues
Its missing: Keeping People Safe
Need spec of what final plan will look like – Strategic Planning Workstream
Very Challenging for Strategic Planning Group to develop plan when not promoted
with evidence of needs
Training for group in strategic planning
Use best practice / research to ‘hone’ feedback questions
Just ask 1 question – what do you think about our plan?
Reviewing of the strategic plan on a yearly basis
Does what you’ve read make you think your treatment and care would be better? If
not, what else would you like to see included?
Consultation with Public
Use of social media – Facebook (Locality agenda)
How could things be improved by you?
Include use of social media in consultation
Use existing tools for community engagement
Use to existing workforce to support community engagement process
Need more regular reviews of street plan (not three years)
Things change – suggest they should be done annually
Idea ok, the opportunity for discussion out-with the main group is helpful
Vision and Purpose’ Session - It was hard in this group to know what was being
asked for the discussion groups (and further consultation). You need really simple
and clear questions for people to answer and these were not simple and clear.