Shifting the Balance of Care Policy and Health Board SBC Leads Network Notes of Meeting – 2 April 2009 Scottish Health Service Centre, Edinburgh

Attendees Apologies

Members Members Jean Hendry, NHS Ayrshire and Arran Vicky Irons, NHS Fife Jackie Morton, NHS Borders Dr Les Bissett, NHS Fife David Whipps, NHS Forth Valley Brenda McFall, NHS Fife Joe McGhee, NHS Forth Valley Dr George Crooks, NHS 24 Tony Fitzpatrick, NHS Lanarkshire Linda Kirkland, NHS Highland Brian Durward, NES Mandy Yule, NHS Ayrshire and Arran Wendy Peacock, NHS Health Scotland Joan Pollard, NHS Dumfries and Paul Currie, NHS Lothian Galloway Martin Moffat, QIS Jack Stuart, NHS Grampian Jackie Morton, NHS Borders Elaine Brown, NHS Grampian Eleanor Cunningham, Edinburgh Council Sandy Dustan, NHS Grampian Tricia Campbell, Edinburgh Council Manju Patel, NHS Grampian Rab Murray, Midlothian Council Catriona Renfrew, NHS GGC Janice Turner, NES Linda Kirkland, NHS Highland Jane Douglas, Scottish Borders Council Brian Montgomery, NHS Lothian Simon Bokor-Ingram, NHS Shetland Scottish Government Mary Allison, NHS Health Scotland Kathleen Bessos, Shifting the Balance of Andrew Wemyss, SAS Care Dr Anne Hendry, NHS Lanarkshire Sylvia Wyatt, Shifting the Balance of Care Dr Ciara Catchpole, Shifting the Balance of Scottish Government Care Jackie Britton, Shifting the Balance of Marilyn Barrett, Health Workforce Care June Wylie, Allied Health Professions Fiona Grant, Remote & Rural Dr Sarah Mitchell, Allied Health Professions Bette Francis, Adult Care and Support Margaret Whoriskey, Joint Improvement Team Susan Bishop, LTC Collaborative Grant Hughes, Joint Improvement Team Brian Kerr, Joint Improvement Team Jane Arroll, Joint Improvement Team Moira MacKenzie, Joint Improvement Team Catherine Rainey, Social Care Workforce Stephen Sandham, Housing Support

1. Update on SBC progress Kathleen Bessos welcomed the participants to the meeting and provided an update on the SBC Improvement Framework.

• High level support for SBC: KB said that the Health and Community Care Ministerial Strategy Group, which looks at the ‘big picture’ strategies across

1 Health and Well Being, supported the SBC approach, as did the Health Management Board. The Improvement Framework will be considered by Health Chief Executives shortly, where the key message will be that SBC is a non- negotiable direction of travel and progress will be discussed during the annual review process. • Better joint use of resources: Referring to the 8 SBC improvement areas, she noted that the 8th improvement area (Better joint use of resources) is different, in that it is an enabler of changes. She emphasised the need to consider how much work is practically possible. • HEAT targets for 2010/11; The Director of Delivery (John Connaghan) is keen for HEAT targets to evolve to support SBC and put more emphasis on care outside acute hospital. • Improved SBC website: She drew the Group’s attention to the SBC website (www.shiftingthebalance.scot.nhs.uk) which is being added to very rapidly and includes a lot of current thinking, including the minutes of the SBC Delivery Group. One of the functions of the SBC Delivery Group is to “challenge” Scottish Government policy leads about how well aligned they are with the SBC Improvement Framework, and how their policies support and inform the direction of travel. So far, E health, Long Term Conditions and 18 week RTT policy leads have attended the Delivery Group. The two areas of policy to be considered at the next meeting in June are Care at Home and End Of Life Care. • Partnership working: She emphasised that the SBC Delivery Group (and SBC Leads Group) are partnership groups, and include representatives from Local Authorities and other associated bodies, as well as from the NHS and from Special Health Boards (particularly QIS, NES, Health Scotland and SAS). • Aligning resources to support SBC: The financial envelope for Boards and Local Authorities is particularly tight, so there is a need to realign existing resources, rather than relying on new ones. The development of the resource mapping work of activity and cost of services provided across health and social care will make resource use more transparent so it will be clearer what has to shift. The SG Director of Finance has issued a questionnaire inviting comments on the benefit of the Cost Book – and the Group members are invited to respond.

2. Support for SBC by Special Health Boards Staff of QIS, NES, and Health Scotland attended the meeting with a view to exploring how best to align their work with the 8 improvement areas in the SBC Improvement Framework. The following activities are in progress: • Two workshops were held by NES, QIS and Health Scotland on 23th March and 6th April; during these sessions they discussed areas that need support from special Health Boards. Presentations from these events are available on http://www.shiftingthebalance.scot.nhs.uk/news-and-events/events/.

• QIS have undertaken a Delphi survey to find out what support Health Boards and CHPs would like. The output includes:

1) Patient journey/flow – between Primary, Secondary and Social care

2) Barriers between Primary and Social care

2 3) Quality-assuring good practice (particularly in community hospitals, MCNs and small practices), and sharing ideas for good practice

4) Supporting CHPs to deliver outcomes

5) Tackling health inequalities

• Marilyn Barrett noted that SBC is a strand under workforce improvement, and that a new national workforce planning group has recently been established in order to drive priorities at a national level.

3. Extending the role of non medical practitioners – changing the musculoskeletal pathway by allowing self referral and by providing specialist AHP led services

Dr Sarah Mitchell gave a detailed presentation on a new musculoskeletal model that will enable:

• Self-referral into musculoskeletal services. • A community musculoskeletal service utilising advanced practitioners to screen all orthopaedic referrals.

The main discussion points were as follows:

• Such changes in the care pathway in Glasgow for self referral to their back pain service have been successful. • Engagement with GPs is key to successful implementation, and support will need to be acquired from GPs. It was suggested that RCGP support would be beneficial. • Lanarkshire and Highland, Ayrshire and Arran are interested in taking this work further; NHS Borders have been providing a joint service and were interested in implementing the change locally.

• This change supports many policy changes (including 18wks RTT, getting people back to work quickly, making good use of non medical skills), and should be shared; marketing strategies should be considered. Self referral and non medical screening could also be used in many other areas: pain, mental health etc.

The presentation and accompanying paper are available on http://www.shiftingthebalance.scot.nhs.uk/improvement-framework/high-impact- changes/rehabilitation-and-re-ablement-to-enable-people-to-maximise-their- potential/

4. Mainstreaming telecare – results of evaluation of telecare in Scotland

Sylvia Wyatt introduced the discussion on telecare, showing the Group a DVD called ‘Telecare Supporting Scotland’, produced by JIT (copies of this are available – contact [email protected]). The increasing number of older adults will affect the need for telecare in the future. Main discussion points were as follows:

3 • The results of the evaluation of telecare were published in February 2009 (available at http://www.jitscotland.org.uk/action-areas/telecare-in- scotland/telecare-publications/). This demonstrates that telecare is cost effective. Telecare can have big financial benefits when the difference between its use (approx £6/person/week) and the cost of inpatient hospital or care home stays are compared.

• Telecare is being mainstreamed in some Boards, and the national funding is helpful. However, the cost for individuals needs to be considered too, as this might, on occasion, be a barrier.

• Implementing tele-health-care for people with dementia is important but has some key issues:

o How much passive monitoring can we do, and how can informed consent be obtained? o How can we adapt housing using telecare initiatives so that more people can stay at home for longer? o Getting a good response to telecare alarms is difficult. We currently have 3 or more service response systems – NHS 24, SAS and Community alarms – how can these response services be integrated and streamlined to ensure the best use of resources?

• North Lanarkshire has linked tele-care to personalisation, looking at individual need. Borders are working on getting telecare mainstreamed into their service, and getting care managers to think about it.

5. Prioritising and mainstreaming SBC changes

NHS Boards, CHPs and their partners need to decide where to focus their efforts so that they deliver a limited number of changes. Various aspects need to be considered in order to arrive at local priorities. This prioritisation process needs to take into account the following:

• The need for partners to understand what they are trying to shift, what size of shift is required, and within what time-frame. • That the real challenge, after deciding where to prioritise, is shifting/realigning the balance of resources (e.g. staff). • A request that LDPs should make the areas in which SBC progress is expected more explicit; this information was requested too late for the current round but will be expected in future. • It is a struggle to identify individuals with a specific lead role for SBC in Local Authorities who could be involved in the network. • Measuring change in the priority areas and then adding changes across all 8 SBC improvement areas together into the cumulative change for SBC is difficult, but important.

4 6. Dates of future meetings (sandwich lunch provided at all) SW invited comments from members of the Group on the best use of time in the future meetings schedule (see below) – any suggestions should be directed towards her in the first instance.

• Fri 15 May 2009 9.30am-1pm • Thurs 9 July 2009 9.30am-1pm • Mon 14 Sept 2009 9.30am-1pm • Thurs 19 Nov 2009 9.30am-1pm • Wed 6 Jan 2010 9.30am-1pm

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