Coalition of Care and Support Providers in Scotland

1. Coalition of Care and Support Providers in Scotland Annual Meeting 12 December, 2013 Tim Davison, Chief Executive Linda Irvine, Strategic Programme Manager NHS Lothian

2. In this presentation…. • An overview of integration across Lothian • Lothian’s Joint Mental Health and Wellbeing Strategy 2011- 2016 – “A Sense of Belonging” • The Transformation Station – a unique health and academic partnership • The Redevelopment of the Royal Edinburgh Campus – Public Social Partnership • Re:D Collaborative – enactment of Christie

3. Integration across Lothian • Biggest overall driver is transforming care for older people and addressing demographic shift • Reduce reliance on acute hospital care • Shift balance of care towards new models around prevention, anticipatory care, alternatives to admission, step up, step down facilities in the community, reablement, home care and care home

4. Shifting the balance means shifting the resources • Critical need to build new primary/social care infrastructure to allow safe transfer of care • Change fund may have prevented growth in admissions but not yet evidence of significant reduction in demand • Until then we can’t afford packages of care at £500 or £1000 per week, we can only afford hospital beds at £2000 per week

5. The current system does need fixing • Delayed discharges • 4 hour emergency access standard • Boarding • Deficit in home care provision • Deficit in care home provision • Inadequate flow/too many hand-offs/transactions • Poor quality and poor experience for many • Major overspending

6. Integration progress/timescales • Still planning for corporate body model • Shadow H&SCP Boards established with all four councils • Joint Directors of Health and Social Care appointed for all four shadow boards • Integration plans by April 2014 • Strategic commissioning plans being developed through 2014 • Go live by April 2015

7. Key areas to exert influence • Third sector involvement in the Partnership Boards (Voluntary Action East Lothian, Midlothian Voluntary Action, EVOC) • Third sector influence on the strategic commissioning plans • Help to find solutions to the wicked issue of how to provide more care of a higher quality at reduced overall cost – at pace that is more than glacial and scale that is more than another pilot…..

8. Strategic commissioning considerations • A minimum wage economy? • Recruitment and retention • Continuity of care(r) • Quality of care at home or in residential settings • Need a 5-10 year horizon but we need to get started NOW • Linda will drill down into some specific examples of some tangible current work

9. Economic Recession Social Recession Ill-judged reductions in spending - Increased demand for public service Radical reform – reducing spending and improving outcomes needs to focus on major drivers for costs for public services High rates of poverty, income inequality and social exclusion have a corresponding effect on demand for services – particular challenge for health, social care and justice Rescue and cure have immediate, tangible and measurable results Logic of prevention contradicts the “rescue principle” Challenge the ethics of failing to prevent harm Preventative measures are long-term, complex and hard to measure Address organisational structures and organisational processes, but, arguably more importantly, address the third level of culture and attitudes.

10. 2003 21 July Joint Programme Board -1st meeting Joint Planning Groups Working age adults only CMHTs/ Uni-professional groups Sector Service Management Continuity of consultant care Very long waiting times – not clear what people are waiting for Four psychiatric hospitals 216 acute beds 24 IPCU beds 113 rehab 50 forensic 0 mother and baby 0 eating disorders 2013 19 December – Joint Programme Board - c65th meeting Joint Planning Groups Life stages from 2011 More multi-professional teams Uni-professional management Inpatient and community roles Still some long waiting times- know where they are and what people are waiting for Two psychiatric hospitals 124 acute beds 24 IPCU beds 60 rehab 45 forensic 6 (3)mother and baby 12 (6) eating disorders “A Sense of Belonging” - Distance travelled…

11. Promoting Transformational Change Paradigm shifts and changes in thinking and planning on many levels • Further shifting service delivery to community settings from hospital settings • Model of care delivery that works in partnership with service users and their whole system of support as opposed to viewing the user only within the context of their symptoms or life events • Moving away from oppositional polarised views that investing in early intervention and awareness will negatively impact on care and treatment services Draw upon the widest range of evidence-based approaches to inform our redesign and development of services. • The recognition of the impact of psycho-social factors on health, • Public / patient / service user involvement and the need to take account of consumer views in deciding how and what should be measured as success • Service user lead research which draws upon people’s lived / living experiences • The Transformation Station • reviews research evidence for service provision • changes services in line with research evidence • builds research evidence for service provision

12. Enhanced community services – acute; rehabilitation; forensic How we use our inpatient facilities - mentally disordered offenders; substance misuse Maximizing opportunities for independence; Hopeful services Public Social Partnership Integrated Care Pathways Redirecting resources from out of area expenditure Using telecare and technology Transformation Station - Knowledge Transfer Partnerships Enacting Christie Commission A new Royal Edinburgh Hospital in 2017 - progressing on multiple fronts

13. What they are Strategic partnering arrangements Based on a co-planning approach Public sector connecting with third sector organisations to share responsibility for designing services based around service user needs Once designed and piloted, services can then be commissioned for the longer term through a competitive tendering process. Can be exceptions to this What they are not A cheap option A way to steal ideas A monopoly of larger 3rd sector providers A way to avoid procurement Public Social Partnership

14. Wayfinder • New rehabilitation pathway • Huge shift from institutional based rehabilitation to community • Agreed financial plan – clear timescales • Fourteen different 3rd sector providers to support delivery of a graded support model: • Person centered • Range of accommodation and support – a secure base • Meaningful days • Community connecting funding

15. Green space: art space growing and eating crafts environmental Art Community Participative Arts therapeutic spaces green exercise green play Testing the soil Saving the wood Feeding the workers Volunteering Peer Support Paid Employment Social Firms What works for whom?

16. The big Q If we were able to re-orientate the criminal justice system to focus on reducing reoffending behaviour by understanding the motivations for offending, which often stem from a complex mix of personal experience and circumstances, mental health conditions, drug and alcohol abuse and peer influence - would this begin to lessen the health inequalities experienced by a significant part of Scottish society?

17. Re:d Update • Film and narrative book produced detailing people’s lived experience • Leith Concept test of Peer Programme • Interpersonal Therapy for women committing low tariff offences • Working with prison officers and women with personality disorders in prison settings • Establishment of Community Justice Centre for Women • Exploring opportunity to apply problem solving justice – offering people rehabilitation/ abstinence programme as alternative to prison

18. Addressing the F Factor • Fear of failure • Fear of departing from the norm • Fear of freedom • Fear of the new • Fear of friction with colleagues • Fear of the “other” Hambleton, et al, 2012

19. Through the looking glass… Alice laughed. "There's no use trying," she said: "one can't believe impossible things.“ "I daresay you haven't had much practice," said the Queen. "When I was your age, I always did it for half-an-hour a day. Why, sometimes I've believed as many as six impossible things before breakfast."