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This presentation will focus on the dimensions of integration in health and social care, including primary and community care, and outcomes for individuals. It will explore collaborative leadership principles, shared accountability, and the importance of person-centered care. The session will also discuss strategies for self-management, intermediate care options, and the promotion of healthy living. Additionally, it will highlight the role of integrated multidisciplinary teams and the importance of clear pathways between services.
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Health and Social Care Gathering, Stirling, 25th September 2019 ‘Rounding out’ the Integration Story: the primary, community and people (outcomes) dimensions David Rowland, Professional Adviser – Integration, Scottish Government (1) Julie Kidd, Integration Data Adviser, Scottish Government (2) On placement from NHS Ayrshire & Arran David.Rowland2@gov.scot On placement from ISDLIST Julie.Kidd@gov.scot / Julie.Kidd@nhs.net
A Framework for Community Health and Social Care Integrated Services Collaborative Leadership Principles of Integration Shared Accountability Spreading good practice to integrate care and improve outcomes People are supported to self-manage Range of Intermediate Care available People are safe & have equality of opportunity Clear pathways between services Integrated MDTs aligned to GP Practices People set their own priorities Professionals know roles and responsibilities GPs support those with complex needs Focus on Home First as the norm Community-based urgent care services Clarity of Vision Improving outcomes by working more effectively to deliver: Making services more accessible and responsive by developing: Promoting healthy, independent living, supporting people to: Well Developed Relationships National Health and Wellbeing Outcomes Adopt an assets based approach Manage their own conditionsConnect with their communities Live independently at home Single Point of ContactAnticipatory Care Planning Reablement within all servicesIntermediate care models Fully integrated community teams Teams aligned to General PracticeSeamless working with acute care Enhanced care in Care Homes and Supported Accommodation Culture and Values Strong Team Ethos Clinical and Care Governance
Some of the Mechanisms, Techniques, Tools:Service users and Carers Experience National Health and Care Experience (HACE) Survey Other standard tools e.g. CARE measure Locally devised or commissioned surveys Structured tools to support Outcomes and Recovery discussions I.ROC (Mental Health) Scottish Government Recovery Outcomes Web (Drugs & Alcohol) Outcomes Stars – various SHANARRI outcomes (Getting it Right For Every Child) Measures of functional status, wellbeing Indicator of Relative Need (iORN), Life Curve Quality of Life measures e.g. EuroQoL Scales to measure anxiety/depression Wellbeing measures e.g Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) Locally devised or commissioned surveys Personal Outcomes Approaches What Matters to You Talking Points Talking Mats Case studies, service user and carer stories, complaints, compliments
Some of the Mechanisms, Techniques, Tools:Staff Experience / Wellbeing iMatter staff survey Regular Local Authority Staff Surveys Dignity at Work surveys Employee wellbeing surveys Staff engagement, training, feedback Wide variety, such as:- Team meetings Partnership events Training sessions / programme
