Health and Social Care Integration Steering Group

Health and Social Care Integration Steering Group

Localities Proposal for Shetland

1.0National Context

Within the introduction of the Public Bodies (Joint Working) (Scotland) Act 2014 there is a requirement for each partnership to work in at least 2 localities.

1.1In July 2014 Shetland NHS Board (the Board) and Shetland Islands Council (the Council) approvedthe Body Corporate as the preferred model for Health and Social Care Integration (H&SCI)in Shetland under the terms of the Public Bodies (Joint Working) (Scotland) Act 2014 (the Act).

“Locality Planning, Community Empowerment and Community Capacity are all strands of Scottish Government policy which are coming together through Health & Social Care Integration. Commissioning should deliver the right number of properly trained staff in each locality to ensure the capacity of that locality to deliver the whole range of community services. The locality team and the specialist team will clinically determine those patients who will benefit from specialist care. When that status changes and they will no longer benefit from specialist care, they need to be returned to the care of the community team. In this model the locality is built up from General Practices coming together to form a natural team for them and their patients. This is essential to develop full accountability and responsibility for the decisions the locality makes. We must make best use of our clinical teams’ time and I think this is best done by concentrating on their complex clinical decision making process with full input from patient and carers. It requires a basic honesty and openness from everybody. It also allows a democratic accountability in each locality. In management terms, we can build up these natural groupings to whatever size is needed or wanted but they must have collective ownership of their clinical and therefore financial patterns.” “The best outcome indicator of good integrated community care was found to be the percentage of over 65 patients at home on any given day.”[1]

1.2Over time the intention is to develop a better, population based understanding of need at individual patient / client and community level (including unmet need), so that, as we strengthen Locality Planning, this feeds into service planning and informs service change and redesign.The aim is to change where the workforce works towards more proactive preventative work in the community in order to reduce the need for hospital beds and care in other institutional settings.

1.3There will be a requirement for each new Health and Social Care Partnership to clearly identify a minimum of two localities within their partnership boundary and to develop a delivery model and service planning approach that engages all the clinical and professional practitioners, partners, stakeholders, and populations within each locality in planning and delivering for a suite of specified national outcomes.

1.4 The Public Bodies (Joint Working) (Scotland) Act requires that every Partnership works in at least two localities and that these localities will be the “spaces” that professionals and communities utilise to help shape delivery and planning to suit the local circumstances and to feed directly into the strategic planning and commissioning process.

1.5 Partnerships will be given flexibility to develop the arrangements for localities to match their local needs and circumstance, but will be required to involve and consult with a wide range of stakeholders, including, specifically, GPs, social workers, nurses, AHPs, pharmacists, third and independent sector, service users and carers in their development and on-going operation. The obligations for public sector organisations set out in the Community Empowerment (Scotland) Bill mirrors this approach.

2.0Local Context

2.1It is important to be clear what a locality is for, and how planning in this way will make a positive difference to a population. Furthermore, how services are delivered to that population is key.

2.2The boundaries for a locality need not be based around geography, but on natural divides such as demography, socioeconomics and morbidity.

2.3Shetland has a comparatively small population compared to most other local authority and health board areas. However, a significant portion of the population is dispersed in some of the more remote areas of Shetland, and this in itself begins to create some defining features of similarity for different groups of residents.

3.0Challenges

3.1Creating more than one locality in a population of 23,000 appears at first to be somewhat self defeating. Often organisations talk about the diseconomies of scale that the small economy in Shetland experiences, which makes some of our costs look extremely high when compared to other local authority/health board areas.

3.2Some of the service delivery units are small, and in some cases single handed where we have specialist staff. In these cases any dividing of resources between populations becomes more difficult.

3.3Strategically planning services for too small a population risks losing sight of Shetland wide issues.

4.0Opportunities

4.1There is a long history of joint working between social care and health services, with a well established Community Health and Care Partnership.

4.2There are now a number of joint appointments who work across council and health board services, and teams that consist of council and health board staff.

4.3A decision was reached earlier this year to move to a Body Corporate model for community health and social care services, and a Community Health and Social Care Partnership exists with a jointly appointed director.

4.4Strategic planning for community health and care services is well established, with a historic CHCP Agreement which has been updated yearly, setting out how services will be delivered and developed.

4.5Shetland has a strong Community Planning Partnership, and there is a willingness and enthusiasm for organisations across Shetland to work together for the benefit of local residents. Community Councils are established across Shetland, and while recent elections highlighted the need to invigorate community interest in these groups, nonetheless Shetland has a good history of engagement between public services and the community.

5.0Aspirations

5.1We aspire to provide the best services possible, within the available budget, that are of high quality, that meet need, and support residents to maintain as much independence as possible.

5.2When people require healthcare, a hospital admission should only happen when necessary, and where that care could not be given in the community. Where someone requires hospital admission, their stay in hospital should not be any longer than necessary, and early supported discharge back to the community setting should be the standard approach.

5.3Better use should be made of technology, and services that are based in one venue in Shetland should adapt to increase access throughout Shetland.

5.4 We should aspire to enable each community to achieve its full potential, working in partnership where particular needs are well recognised. This may result in resources needing to be targeted at particular areas, and this will be transparent and understandable to all.

6.0 Engagement on a locality model

6.1 In order to begin drawing conclusions on what a locality model for Shetland might be, a number of groups have been engaged with to gather views and comments about locality working. The list is not exhaustive but designed to demonstrate the range of people who have contributed to this.

• GPs at a dedicated protected time for learning event
• Team Leaders from across health and care at Directorate Team meetings
• Public at meetings with targeted invites arranged to discuss strategy development and localities
• Discussions at Social Services and CHP Committee
• Health and Social Care Integration Steering Group meetings
• Association of Community Councils (6 monthly meeting)
• Specific service team meetings
• Directorate operational management team meetings

6.2 Further engagement events are planned, including public meetings, to

continue building on the work carried out to date. This further engagement

will take account of the decision from the Steering Group on the preferred

option.

7.0Options

7.1Doing nothing is not an option. The demographic information tells us that we have an ageing population. Financial challenges face both the Council and the Health Board. Residents rightly expect high standards from services.

7.2Having a dedicated focus on a smaller population, whilst being mindful of not losing sight of the broader issues, can only be a good thing where that populations needs are better understood. At the same time, having enough resource to be able to flex and prioritise is critical, otherwise services become powerless to adapt and meet changing needs.

7.3There are 7 historical planning localities in Shetland, which are broadly co-terminus with services based in each locality, such as care centres and GP Practices. 7 localities would allow an in-depth analysis to be completed, in much the same way that the population needs in Hillswick for example was analysed a year ago.

7.4There are a number of services that are based in Lerwick, but where provision is for the whole of Shetland. Services need to describe how they will deliver services in localities, and create a visibility for the service to each population.

7.5A number of services that have smaller numbers of staff, and work across Shetland from one central base, will need to link staff to localities and focus primarily on those populations, gaining a better understanding of particular variations and needs in those communities. There will be a requirement for services to engage in co-production in localities.

7.6The requirement in the legislation is to work in localities. Rather than focusing on management structures, services will need to demonstrate how they are measuring and meeting outcomes in each locality. An outcomes focus will be the driver for change. The locality team will be the staff working there; the third sector and the community, with leadership coming from

those working and living within that locality.

7.7 The alternative is to focus on management structures, dividing existing small teams into 2 or more smaller teams, and providing services from 2 or more distinct teams to a defined population.

7.8There will be a need to review arrangements over time, and any model agreed on should be adapted and refined as the process progresses.

8.0 Proposal

8.1 The work that has been carried out over the last few months looking at how a locality model would work best for Shetland has elicited a range of views. There is a desire from clinicians and practitioners to focus on the needs of communities, and to build upon the positive joint working already happening within the localities that exist.

8.2 How we meet the needs of communities is what is important. The

management structure is seen as something that supports service delivery;

provides expertise that would otherwise be diluted through generic portfolios;

and will be subject to review over time. The work on strategy development

(Primary Care; Older People and Dementia) will help to inform how we can

best meet the needs of the population.

9.0 Recommendation

9.1 That the Health and Social Care Integration Steering Group RESOLVE to agree:

• That planning will revolve around a number of localities in Shetland, being at least 2 and up to a maximum of the 7 planning localities.
• Services will need to plan around the needs of each locality, and a plan for each locality will describe how services will deliver to and connect with that locality.

Edna Mary Watson

Chief Nurse (Community)

Simon Bokor-Ingram

Director Community Health and Social Care

22 October 2014

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[1] briefing to CEs from Alastair Noble March 2014