Integration in Action Workshop Welcome – Angiolina Foster CBE Director, Health and Social Care Integration Scottish Gov

1. Integration in Action Workshop Welcome – Angiolina Foster CBE Director, Health and Social Care Integration Scottish Government

2. Integration: yes really!Experience from Fife: Intermediate CareFiona MackenzieFife Partnership Kirkcaldy and Levenmouth CHP

3. What were we doing? • Taking a wide range of services across the partnership that had been started over the years, and use them to reshape services in a fully integrated model. • We call this ICASS – Integrated Community Assessment and Support Service. • Started in 2009… still work in progress. • Overall aim to provide care at home wherever possible, in an easily accessible and fully integrated service model.

4. Integration – The Reality

5. KIRKCALDY & LEVENMOUTH – CURRENT MODEL IC 2009 PT HOSPITAL COMMUNITY Care Needs Identified Crisis Anticipatory No SPOA COT CRU SW EHCT DN IRT HC CAST Physio CRT Int Housing Transport Falls Response GP Com Hospital Com Pharmacy Vol Org Day Care Sport & Leisure Carers CPN’s Carers Trust Pt at Home Prevention of Admission Supporting App Early D/C Mixing Bowl

6. Just when you have a plan.. • New services come on board - Change Fund . • Intermediate Care comes of age. • Increasingly clear that current model not sustainable = everyone has a view especially about the role of others. • Partners are responding to issues in own area e.g budget and emergency access pressures, Council contact centre • Other initiatives get to implementation point, and need to be joined up coherently.

7. Access Point Administration 50 Rehabilitation Case Management Integrated Care Case Management 35 15 Assessment, Triage, Inreach to Acute Care, Managing Delays H@H Case Management 20 Home Care, Dementia and Frailty, Community

8. main actions • Model how we need to work – relationships always the priority • Leadership group established = one voice. • Access – review and recalculate how teams were working and where skill mix was needed to reduce admin and duplication of effort for staff • “Reach in” to acute care to improve decisions and hospital flow • Bring old teams together in new design = pain ++ • Ignore boundaries wherever possible

9. Simplify language for those outside the system, its difficult enough on the inside. • Acknowledge future aims e.g have one access point for ICASS and home care. • Coordinate/ manage the care around the person – explicit role of case manager built in. • Embed and join up the new roles for people (and there carers) with Dementia and Frailty. Based on 8 pillar model - at last, systematic ACPs as integral part of ICASS.

10. the good stuff.. • Staff want to improve outcomes – it is what motivates them • When the vision is agreed and others start to see how it fits • Collocation of key staff gave immediate results despite the trauma of the move. • Use of White Boards and systematic processes eg regular board rounds involving all of team inc Home care. • Easier to get the right care for the situation using local knowledge and shared responsibility • If we say everyone matters – we need to act like it.

11. … and the tricky stuff • Systematic evaluation of complex and cultural change • When things come in left field e.g review of home care ( again), Hospital at Home introduction. • Data either difficult to collect or not currently available to support changes – IT systems unable to deliver at present. • Different T&C’s and line management accountabilities. Can be overcome but not in some critical areas eg. medicines in the community. • Still essentially 2 + systems involved in developing and delivering integrated model on the ground. • Would really like to do that but….

12. and so…. • Hold the Vision • Don’t be fooled into thinking there is a road map for this • Sharpen your compass reading skills • Always design intentionally • Get leaders together and build the relationships • Adapt to whatever comes along – but stick to the vision • “Involve” like your life depends on it – with every stakeholder • Get the data right

13. Contact fiona.mackenzie3@nhs.net thankyou

14. Please discuss the presentation you have heard and agree on: • The single biggest lesson you have learned? • One “Do”? • One “Don’t”?

15. Improving Outcomes Through Integrated Working Older Peoples Services NHS Forth Valley & Stirling Council

16. The Improvement Agenda Aim - Shift balance of care - Support more people to remain at home or return home - Reduce admission to hospital and improve delays to discharge - Avoid premature admission to care homes Embarked on whole system approach • Reablement • Rehabilitation at Home • Short Stay Assessment Beds

17. Outcomes Comparison

18. Integrated Structure Achievements and Wicked Issues • Staffing and Culture • Location/Assets • Procedures • Service user contracts and financial impacts • Evidencing impact for individuals

19. Moving Forward Stirling Care Village A Health and Social Care Partnership

20. Please discuss the presentation you have heard and agree on: • The single biggest lesson you have learned? • One “Do”? • One “Don’t”?

21. NHS Scotland Event 2013 - Collaborating for Quality Integration in Action NHS Highland Jan Baird Director of Adult Care

22. Boldly Go………. 1 April 2012 Lead Agency Model 5 Year Plan

23. Professional Leadership (Practice Governance Framework) WWW Public Communication Programme Management Approach Governance Case for Change Staff Transfer Partnership Working

24. EBI ………. Evidence /Evaluation – attribution/ contribution challenges Quantum Managerial Reorganisation IT – access not integrated systems Evidence Base

25. EXAMPLES OF HOW THIS IS MAKING A DIFFERENCE

26. THE LONG AND WINDING ROAD BELFORD HOSPITAL EXAMPLES OF IMPACT SO FAR INVERNEVIS CARE HOME

28. Please discuss the presentation you have heard and agree on: • The single biggest lesson you have learned? • One “Do”? • One “Don’t”?