Integration A model for success Garry Coutts Chair, NHS Highland Convener, Scottish Social Services Council

Recessions I have known Early 1980s – Thatcher’s recession 5.8% drop in GDP Early 1990s – Major’s recession2.5% drop in GDP Late 2000s – Brown’s recession7.1% drop in GDP

How do we deal with recessions? Make cuts

Raise the bar

Increase charges

It’s pants!

This is different Length of time Banks not lending Size of deficit Few political alternatives being offered But Record levels of investment in the public sector over the last 20 years

– The majority of over-65s have 2 or more conditions – The majority of over-75s have 3 or more conditions Multimorbidity is common in Scotland

If we always do what we have always done we will get what we always got And it is not good enough So we need a different approach

Fatuous saying of the moment “We don’t need to work harder, we need to work smarter” Aye, right!

“Every system is perfectly designed to achieve exactly the results it gets” Don Berwick

So we need to change the system And support staff, providers, service users, carers and governors to become effective change agents

Changes in Highland Social Care staff to NHS Highland = 1,500 Health staff to The Highland Council = 250 Budget to NHS Highland = £90m Budget to The Highland Council = £8m Partnership agreement = 400 pages! Legislative and regulatory changes New management and governance structures

Family &Friends OT Care Home Day Services Acute Hospital Neighbours Home Carers Respite Care Physio GP Day Services Consultants Residential care Social Workers Pharmacy District Nurse Voluntary Community Hospital

Family &Friends Care Home Day Services Acute Hospital Neighbours Home Carers Respite Care Physio GP Day Services Consultants Residential care Social Workers Pharmacy District Nurse OT Voluntary Community Hospital Care Co- ordinator

Key questions to check if you have an effective system Does your system have single budgets? Does your system have single management? Does your system have single governance? Is there a process for service improvement and redesign? Do you have measures in place to monitor improvement? Are you involved in improvement?