Integration for a Purpose Angiolina Foster Director of Health & Social Care Integration

Vision People are supported to live well at home or in the community for as much time as they can They have a positive experience of health and social care when they need it

Why integrate? To address variability of health and social care outcomes in different parts of Scotland, particularly for older people. To make it easier to provide services to help people stay at home, rather than being admitted to hospital. To make it easier to get people out of hospital quickly and back into a homely setting.

Key features of legislation Nationally agreed outcomes Joint accountability –Health and Social Care Partnerships –Jointly Accountable Officer (Chief Officer) Integrated budgets Locality planning – professional leadership

Principles of Integration Services should be planned so that they: Are integrated from the point of view of recipients Take account of the particular needs of different recipients Take account of the particular needs of recipients in different parts of the area in which the service is being provided Are planned and led locally in a way which is engaged with the community and local professionals Best anticipate needs and prevent them arising, and Make the best use of the available facilities, people and other resources

Focus on Dementia Accounts for large proportion of spend on older people Gearing effect Projected increase in prevalence Progressive condition Care accessed from all sectors

Dementia prevalence 1

Midlothian IRF work on dementia Data from the Midlothian Integrated Resource Framework shows:- Support for patients with dementia costs 5.5 times more per person than for those without Patients with dementia account for 5.4% of the population using health and social care, but for 24% of total spend In all subcategories the cost per person with dementia is significantly higher than for a person without dementia If we continue as we are, inpatient beds used by people with dementia are projected to more than double, with half directly attributable to dementia People with a dementia diagnosis are almost twice as likely to have a hospital stay.

Self-directed Support and people with dementia Pilot work in Ayrshire – up to 2012, succeeded by national “capacity building” work by Alzheimer Scotland From the final report: “Issues for people with dementia and their families are similar to the ones faced by other people. The main difference for people with dementia is the assumption…that SDS is not wanted or suitable for people with dementia.” Benefits of the SDS approach for people with dementia better outcomes for individuals carers felt important and valued the person with dementia was fully included and respected as a citizen with value “the majority of…people [involved in the pilot] now remain living in their own home instead of long-term residential care” Total cost of 6 direct payment packages: £880 per week. Total cost of residential care: £474 per person per week – ie £2,845 per week in total In other words…it works!

“Public service providers must be required to work much more closely in partnership, to integrate service provision and thus improve the outcomes they achieve... Experience tells us that all institutions and structures resist change, especially radical change. However, the scale of the challenge ahead is such that a comprehensive public service reform process must now be initiated, involving all stakeholders.” The Christie Commission Report Commission on the future delivery of public services, June 2011