@jitscotland JIT is a strategic improvement partnership between the Scottish Government, NHSScotland, COSLA and the Third, Independent and Housing Sectors Dr Anne Hendry National Clinical Lead for Integrated Care Creating an enabling political environment for health and social care integration

JIT is a strategic improvement partnership between the Scottish Government, NHSScotland, COSLA and the Third, Independent and Housing Sectors Outline 2 Understand, from experience in Scotland.... The what - health and care policy context, structures, legislation The when - political readiness for change, drivers and opportunities The how - creating the conditions, building a guiding coalition, person centred narrative, securing local ownership

Population 5.4 £12 billion budget 14 NHS Health Boards 32 Local Government bodies Universal healthcare coverage Integrated delivery system Free personal care for 65+

JIT is a strategic improvement partnership between the Scottish Government, NHSScotland, COSLA and the Third, Independent and Housing Sectors 79 Local Healthcare Cooperatives 1999 Recommendations of the Joint Futures Group 2000 Powers in the Community Care and Health (Scotland) Act 2002 NHS Reform (Scotland) Act Community Health Partnerships Collaboration and pooled budgets - Reshaping Care for Older People and Change Fund 2011 New legislation to integrate health and social care Previous reforms

JIT is a strategic improvement partnership between the Scottish Government, NHSScotland, COSLA and the Third, Independent and Housing Sectors 5

Scottish election 2011 Integration in manifesto of all parties Scottish National Party69 Scottish Labour Party37 Scottish Conservatives15 Scottish Liberal Democrats 5 Scottish Green Party 2 Other 1

“... effective services must be designed with and for people and communities – not delivered ‘top down’ for administrative convenience” The Christie Commission Report Commission on the future delivery of public services, June 2011

JIT is a strategic improvement partnership between the Scottish Government, NHSScotland, COSLA and the Third, Independent and Housing Sectors Principles for Public Services 8 Public services….. Are built around people and communities - their needs, aspirations, capacities and skills Work together effectively to deliver outcomes Prioritise prevention, reduce inequalities and promote equality Constantly seek to improve performance and reduce costs and are open, transparent and accountable

Public Service Reform

Public Finances – Fall in Government Expenditure

Projected % change in Scotland’s population by age group,

JIT is a strategic improvement partnership between the Scottish Government, NHSScotland, COSLA and the Third, Independent and Housing Sectors 9% 24% 41% 61% 84% Calendar year ’07 estimate P Knight Scottish Government

JIT is a strategic improvement partnership between the Scottish Government, NHSScotland, COSLA and the Third, Independent and Housing Sectors Creating the Conditions Co-produce a compelling vision to engage hearts and minds Develop a narrative and personal stories of current and future state Describe practical actions and steps towards realising the vision Recognise context and the power of place and local communities Build a social movement to empower people to be the change Create a guiding coalition to drive the change A clear framework and support for improvement Stick with it and sustain the progress

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

Current paradigmFuture paradigm System geared towards acute / single condition System designed around people with multiple conditions Hospital centredEmbedded in communities and their assets Doctor dependentMulti-professional and team based care Episodic careContinual care and support when needed Disjointed careWell coordinated integrated health and social care Reactive carePreventive and anticipatory care Patient as passive recipientInformed empowered patients and clients Self-care infrequentSelf management / self directed support enabled Carers undervaluedCarers supported as equal partners Low-techTechnology enables greater choice and control

Learning from successful integrated systems Four common characteristics: Plan for populations, not delivery structures Pool resources – money and people Embed clinicians and care professionals in service planning, investment and provision Strong local leadership

18 Structural solutions and payment reforms are insufficient Need policies and governance arrangements that enable health and social care to work together Organisational stability, leadership continuity and time to nurture new models of care Address professional, cultural and behavioural issues

Nicola Sturgeon, MSP, Deputy First Minister and Cabinet Secretary for Health and Wellbeing, Dec 2011 “We want to ensure that adult health and social care services are firmly integrated around the needs of individuals, their carers and other family members; that the providers of those services are held to account jointly and effectively for improved delivery; that services are underpinned by flexible, sustainable financial mechanisms that give priority to the needs of the people they serve rather than the organisations through which they are delivered; and that those arrangements are characterised by strong and consistent clinical and professional leadership.”

Start with a key concept – a single commissioner and budget Engage widely to explore and agree key principles: –Consistency of outcomes –Apply across councils and health boards –Statutory underpinning –Integrated budget –Clear accountable for delivery –Professionally led –Robust public /user /carer involvement

Involve political leaders and influencers Ministerial Strategic Group for Health and Community Care, chaired by the Cabinet Secretary and made up of local political and NHS leaders Bill Advisory Group, chaired by the Cabinet Secretary and made up of senior officials and professionals Expert working groups, - eg governance, finance, etc. Listening and dialogue

Public Bodies (Joint Working) (Scotland) Act People are supported to live well at home or in the community for as much time as they can and have a positive experience of health and social care when they need it All adult care groups +/- children’s services & criminal justice Principles for integrated health and social care Strategic and locality planning based on population needs Integrated governance : body corporate or lead agency Integrated budgets for health and social care Nine national outcomes for health and wellbeing Chief accountable officer has integrated oversight of delivery

Health and social care services should be planned for and provided so that they: 1.Are integrated from the point of view of service-users 2.Take account of the particular needs of different service-users 3.Take account of the particular needs of service-users in different parts of the area in which the service is being provided 4.Take account of the particular characteristics and circumstances of different service-users 5.Respect the rights of service-users 6.Take account of the dignity of service-users Principles of integration

Health and social care services should be planned for and provided so that they (contd.): 7.Take account of the participation by service-users in the community in which service-users live 8.Protect and improve the safety of service-users 9.Improve the quality of the service 10.Are planned and led locally in a way which is engaged with the community (including in particular service-users, those who look after service-users and those who are involved in the provision of health or social care) 11.Best anticipate needs and prevent them arising 12.Make the best use of the available facilities, people and other resources Principles of integration (slide 2)

Health and Wellbeing Outcomes 25

Getting to the Third Curve Time Performance Improvement Co-production, and personal Outcomes “In the next five years, let us ensure that Scotland is a person-centred country in the delivery of care and support to all citizens”. Deputy FM March 2015

28 From Personal to National Outcomes Source: Talking Points - Personal Outcomes Approach ( Points - Personal Outcomes Approach

“The whole point—indeed, the only point—of integrating health and social care is to improve people’s lives. Even as we debate the bill, our focus is on improving outcomes for people who currently use health and social care services across Scotland…” Alex Neil MSP, Cabinet Secretary, Scottish Parliament, February 2014

Cabinet Secretary for Health and Wellbeing Deputy First Minister Cabinet Secretary for Finance, Constitution and Economy Minister for Local Government and Community Empowerment Cross Government Political Leadership

Local Government Political Leadership 31

Local Flexibility and Choice Lead Agency v Body Corporate

Integrated Resources - Minimum to be delegated

A&E Outpatients Inpatients Day cases Deaths Prescribing Age/gender CHI Linked File SPARRA Social Care SIMD Linked Health and Social care file at an individual service user level (Activity & Costs) Partnership Access Via secure platform Linking data to understand people’s whole health and care journey

Keep it Local and Personal Locality Engine Room of Integration Where we will best engage and empower those who deliver and receive health and social care Where service changes can have a real and quick impact on outcomes Where we will build effective relationships and create local integrated networks of care and support

JIT is a strategic improvement partnership between the Scottish Government, NHSScotland, COSLA and the Third, Independent and Housing Sectors 37

JIT is a strategic improvement partnership between the Scottish Government, NHSScotland, COSLA and the Third, Independent and Housing Sectors 38

Focus on Outcomes What Matters to Me

JIT is a strategic improvement partnership between the Scottish Government, NHSScotland, COSLA and the Third, Independent and Housing Sectors Key Points 43 Understand local context and the wider reform agenda Learn from what worked / has not worked previously Use the current levers / drivers for change Create the conditions for transformation Build a guiding coalition Keep the focus on improving outcomes for people Listen, engage, involve and inspire Stick with it

Integration people-change-fund-building-on-progress-june-2015/ Integration people-change-fund-building-on-progress-june-2015/ 44 JIT is a strategic improvement partnership between the Scottish Government, NHS Scotland, CoSLA, the Third Sector, the Independent Sector and the Housing Sector