Head of Improvement Support June Wylie Head of Improvement Support Living Well in Communities, Focus on Dementia and Place Home and Housing Title slide option 1

A long time ago !

Home Assessments

Hazels New Bathroom

There’s no place like home Vision   The Improvement Hub (or ihub for short) vision is simple - to support health and social care organisations to design and deliver services and support that better meet the changing needs and aspirations of people, families and communities in Scotland. The Improvement Hub has programmes which support the prevention of unplanned admissions to hospital or long-term care. This will help people to benefit from an improved quality of life, maintaining independence for longer and minimising their support needs.

One organisation many parts The Organisation One organisation many parts Participation Standard Service Change Our Voice Evidence Scottish Medicines Consortium, Health Technology Assessments, SIGN Guidelines Scottish Health Council Improvement Hub Quality Assurance Quality of Care, Older People's Inspection, Hospital Environment Inspections, Medical Revalidation The new resource will form part of the solution to providing more person centred care across social and health settings.   It is part of Healthcare Improvement Scotland, who also provide Evidence for Improvement (guidelines, standards and advice), Quality Assurance for improvement (including inspections and reviews) and the Scottish Health Council who work to ensure the public voice is heard in shaping and improving services. The Improvement Hub will build on the combined expertise, resources and best practice of three previous programmes - Healthcare Improvement Scotland’s Safety and Improvement Team, and the Scottish Government’s Joint Improvement Team (JIT) and Quality and Efficiency Support Team (QuEST) and can offer a unique combination of expertise to help improve the experience of those accessing care. *some examples of the functions within each Directorate.

Focus of our improvement support NHS boards Integration Authorities Local Authorities Who the Improvement Hub programmes for   The Improvement Hub programmes are designed to support those delivering health and social care across Scotland (including health and social care partnerships, third sector organisations, the independent care sector and housing organisations). The Improvement Hub also provides national improvement support for NHS boards. Focus on: continuous quality improvement system redesign Improvement Hub focus includes health, social care, third sector, independent sector and housing.

Our approach to supporting improvement creating the conditions nationally for improvement work to flourish locally Context So we thought this was a helpful conceptualisation – but not enough to provide a coherent framework under which we could integrate the strengths of the three existing improvement organisations – so we developed the following, the basic structure of which will be familiar to many of you A co-created system Adapted from Napper (2010)

ihub approach to supporting improvement Start Here By what method/model do you test and implement change ?

White Report – emphasised following general approach locally focused and tailored support to meet local contextual needs support to build improvement capacity and capability within local systems a range of improvement support offers and resources strengthened ways of sharing knowledge and learning networks coordinated support from HIS across its full range of improvement support collaborative working with other national improvement agencies and organisations

and Responsive Improvement Support Grants and Allocations Improvement Programmes Care Delivery Living Well in Communities Primary Care Mental Health Acute Dementia Place, Home and Housing Maternity and Children’s System Enablers Strategic Planning Outcomes-based commissioning Transformational Service Redesign Third and Independent Sector Engagement QI Infrastructures Evidence, Evaluation and Knowledge Exchange Person Centred Health and Care Tailored and Responsive Improvement Support Grants and Allocations

Delayed discharges – housing reasons Nationally... Aberdeen… Better communication across sectors Dedicated member of housing staff Close working with third sector – particularly Disabled Persons Housing Service Earlier identification and assessment Changes to Council’s housing allocation policy Associated with longer delays 74 days compared to 36 c30% of all longer delays And a couple of illustrations of the sort of work we are doing – and the impact we are having The first in relation to our housing and hospital programme Click 1 and 2 – we have analysed national data on delayed discharges. Across Scotland there’s been a rising trend in the number of people delayed for housing related reasons – from 13 in April 2011 to just under 40 at the beginning of 2016. A relatively small proportion of all delays (c 15%). But…. Click 3 – delays tend to be longer. And represent a greater % of longer delayed discharges. Click 4 – Aberdeen Adapting for Change partnership took up the issue Click 5 – and they tackled the issues they found in 5 ways. None of these actions were costly – the dedicated member of housing staff was a re-organisation rather than an additional post Click 6&7 – they reduced the number of people delayed where there was a housing factor to about 5 Click 8&9 – they discovered that they had a local supply issue for bariatric cases. So, they adjusted their build programme to create 2 homes suitable There’s a video clip on the Place, Home & Housing page of the ihub website Next steps – taking the learning to other areas and adjusting the model in different contexts (rural areas, small councils will not have the capacity to have a dedicated member of staff) Delays down from more than 20 to c5 Investment in new specialist housing provision

Community equipment 2014 self evaluation 1 adequate, 9 weak 2014-16 supported improvements service re-design Social care & nursing prescribing Train the trainers 2016 self evaluation 1 very good, 4 good, 4 adequate, 1 weak Value of recycled equipment increased from under £10k to more than £400k 74 requests preventing hospital admission, a cost avoidance of £88k Second area from our community equipment programme. Self evaluation tool based on the Care Inspectorate performance improvement model. Includes scrutiny by the assessment group of evidence provided to support the assessment findings. For info - 10 areas looked at are Governance, Service Model, Partnership Arrangements, Finance, Communication, Service User and Carer Involvement, Assessment & Provision of Equipment, Store Service, Performance, Training & Development Click 1 – the then JIT supported a self evaluation – Not Good! Then provide support across the areas of weakness with a new model identified and introduced (used Change Fund ££s to get it underway). Recent re-evaluation shows level of improvement Click 2 – huge increase on recycling Click 3 – and helped avoid hospital admission Click 4 – and increased independence and better quality of life And IJB agreed in June to mainstream the new model. “I wouldn’t have been able to leave hospital as soon as I did without the equipment and I no longer need carers”

Living Well in Communities

Improvement Challenges Implementation Releasing capacity to do improvement work/seeing improvement as the day job Service Pressures Workforce pressures Financial pressures Competing Priorities ( whose priorities are most important ? ) Acute v Prevention Data – lack of primary care and community Spread and scale up

There’s no place like home Vision   The Improvement Hub (or ihub for short) vision is simple - to support health and social care organisations to design and deliver services and support that better meet the changing needs and aspirations of people, families and communities in Scotland. The Improvement Hub has programmes which support the prevention of unplanned admissions to hospital or long-term care. This will help people to benefit from an improved quality of life, maintaining independence for longer and minimising their support needs.

Health & Social Care Integration Thank you Twitter: @ihubscot Email: info@ihub.scot Web: ihub.scot