What is Shifting the Balance of Care & How do we make change happen? Sylvia Wyatt

1. What is Shifting the Balance of Care & • How do we make change happen? • Sylvia Wyatt • Sylvia.wyatt@scotland.gsi.gov.uk

2. Three types of shift Shift in location Shift in responsibility Shift upstream

3. Scope of SBC - 8 improvement areas Maximise flexible & responsive care at home with carer support Integrate health & social care and support for people in need Reduce variation in unscheduled admissions Improve capacity & flow for scheduled care Extend the scope of services outside acute hospitals provided by non medical practitioners Improve palliative and end of life care Improve access to care for remote and rural populations Improve joint use of resources Provisional

4. SBC as an umbrella More care at home with carer support Integrated Health & Social care Reduce variation In unscheduled admissions Capacity & flow for scheduled admissions Extend Services outside hospital Better remote & rural care Better EOL & Palliative care Joint use of resources Tele- healthcare Long term conditions Electronic Records A&E waits 18 week RTT Workforce use Equally well EOL care HUB Support for Carer Local diagnostics Care Pathway redesign Changing lives CHI Home adaptations Personalis- ation

5. SBC supports health and wellbeing improvements High impact Changes x48 National performance framework SBC improvement Areas x8 Improve health & wellbeing Single outcome agreements HEAT targets

6. SBC supports HEAT targets and SOA

7. 140 + things to do at once

8. SBC is complex Self Directed support Improvement areas (8) Enhance carer support Equitable funding More care at home with carer support Near patient testing Co-location Obligate networks Better pharma care Protocols One stop shops Fast clinics Case management Integrated health & social care Intermediate care alternatives Single outcome agreements Community transport Existing housing adaptations 24/7 local information User participation Reduce variation in unscheduled admissions Single point of access Single point of access redesign care pathways Extended Comm teams Understand variation High impact changes Extra care housing Capacity & flow for scheduled admissions Management of age transitions Targeting resources HEAT targets Extend role of NMAPs Self referral Redesigned home care Psycho-social support Non medical prescribing Tele-health Extend services outside hospital Overnight response Mentoring Peer support Telecare Domiciliary assess & rehab Urgent care response Plan EOL Better remote & rural care Local care Centres/hubs Integrated equip library EOL planning Referral management Self held records Better EOL& Palliative care Voluntary Sector Home care redesign Network effectiveness Pool budgets Gold standard EOL Reduce pre- Operative days Joint use of resources Anticipatory care reducing crises Continuity of information Mobile services Innovative prescribing Generic workers

9. SBC changes are generic • Apply to health, social care, housing, and transport • Apply to several improvement areas • Are inter-dependent • Apply to any age group • Apply to any disease or dependency

10. Implementing change

11. Actions for communities • Describe baseline position in relation to 8 improvement areas • Outline actions that will lead to measurable changes in locally selected areas of Improvement and Resource Framework • Demonstrate clear line of sight into workforce development plans, eHealth and eCare strategies and infrastructure investment plans

12. Suggested implementation process Prioritise 8 SBC improvement areas Measure baseline in priority areas Choose changes to address priorities Implement across whole CHP Measure SBC change across all 8 areas

13. Prioritisation of 8 improvement areas Area to prioritise Area to prioritise Area to prioritise Area to prioritise

14. Sylvia Wyatt SPACE lead for SBC Evidence based SBC changes with greatest impact

15. Which of these....? Addresses priority improvement areas Fits with local population needs Addresses inequalities Improves patient experience Implement changes across whole system

16. implement across whole partnership

17. SBC Change Programme – possible criteria Two + whole systems evidence based changes related to SBC Improvement Framework Complete within 18 months Robust plans for evaluating the process and measuring shifts in the balance of care High level partnership involvement, bringing together other stands of work locally Well articulated, operationalised new ways of working, shared information and/or joint use of resources Commitment to disseminate what works and what does not work to shift the balance of care Supports the delivery of HEAT targets and SOAs