Services for Older Adults in Lochaber
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Services for Older Adults in Lochaber Mid Highland Community Health Partnership DRAFT Service Plan Proposal 5th DRAFT, 25th January, 2006 1 Contents 1. Introduction and Background 2. National Context 3. The Need for Change 4. Process to Date 5. Service Plan for the Future 6. Skills for Health 7. Well being and Health Improvement 8. Staff Governance 9. Resources 10.Next Steps Appendices 1. Rapid Re design methodology 2. Condition of Glencoe Hospital 3. Operational Policy for Intermediate Care 4. Draft Role, Remit and Membership of Implementation Group 5. Draft Action Plan 6. Bibliography 2 1. Introduction and Background This paper will describe proposals for changes in service provision for older people in Lochaber, that are in keeping with the „Delivering for Health‟ principles of more emphasis on care in the community, support for self care, anticipatory, proactive care and avoidance of hospital admissions. The building of a modernised community infrastructure will facilitate the shift in the balance of care away from hospital, into local communities and in people‟s own homes. Evidence from elsewhere has demonstrated that through timely interventions and support in the community, hospital admissions can be avoided. This shift has been part of the agenda for NHS and Partner agencies for some years and has been reinvigorated through the work of Professor Kerr, Delivering for Health and the 21st Century Social Work Review. There has been a gradual move to disinvest in NHS continuing care beds and, in Lochaber, there is a need to do so in Glencoe Hospital so that the resource can be re invested in a range of community based services which will provide for many more people than can be accommodated in a hospital building. Very few people now require to be in hospital long term as their needs can be met in other, more homely care settings as residential and nursing homes have progressed and developed the services that they offer. The proposals rely heavily on partnership working with the Local Authority, Voluntary and Independent Sectors and on building community capacity and resilience in order to meet the care demands of the future. 2. National context – Delivering for Health In November 2005 the Scottish Executive Health Department (SEHD) published “Delivering for Health”, its response to the Kerr report which had been released earlier in the year. “Our vision for the NHS is to reapply its founding principles with vigour to meet the needs of the people of Scotland. Delivering for Health means a fundamental shift in how we work, tackling the causes of ill-health and providing care which is quicker, more personal and closer to home.” This theme runs throughout the document and is a cornerstone for all Health Boards to review the ways in which they deliver services to their local populations. 3 The key principles are:- Improving health and well being As local as possible, as specialised as necessary Predominantly community rather than hospital focused Better access to local diagnostic care and treatment Whole systems, integrated care through networks, and use of technology Supported self care Care at home where possible Ambulatory care, day case admissions Team based Enhanced roles of all team members Existing model Evolving model of care . Geared towards acute . Geared towards long-term conditions conditions . Hospital centred . Embedded in communities . Doctor dependant . Team based . Episodic care . Continuous care . Disjointed care . Integrated care . Reactive care . Preventative care . Patient as passive recipient . Patient as partner . Self care infrequent . Self care encouraged and facilitated . Carers undervalued . Carers supported as partners . Low tech . High tech 4 Community Health Partnerships have been given specific actions as part of the implementation of „Delivering for Health‟:- • Easing access to primary care services • Systematic approach to long term conditions • Anticipatory care • Supporting people at home • Avoiding hospital admission • Local diagnosis and treatment • Enabling appropriate discharge and rehabilitation • Improving health and tackling inequalities • Improving specific health outcomes These have been taken into account as part of the Review and Planning for new and improved services in Lochaber. This service change proposal demonstrates the implementation of „Delivering for Health‟ in the Lochaber area through shifting the balance of care from hospital to community, adopting a team based, multi disciplinary and multi agency approach. It acknowledges the need for better management of long term conditions, supports self care and carers. When the community infrastructure is in place, supported by the development of rehabilitation services, there will be a reduction in our reliance of hospital and care beds. The proposal is also in keeping with the Review of Nursing in the Community. 21st Century Social Work Review The 21st Century Review and Implementation Plan reflect the need for change and for all Partners to work together with communities and individuals to promote well being, self care support, engaging people as active participants and to work in new ways to plan and deliver high quality services. “Doing more of the same won‟t work. Increasing demand, greater complexity and rising expectations mean that the current situation is not sustainable.” The Review states that tomorrow‟s solutions will:- “…Involve professionals, services and agencies from across the public, private and voluntary sectors in a concerted and joined-up effort, building new capacity in individuals, families and communities and focusing on preventing problems before they damage people‟s life chances irreparably.” This is in keeping with the proposals contained in this document. 5 3. The Need for Change Building and Health Service Fit for the Future – A National Framework for Service Change in the NHS in Scotland, (Kerr Report) clearly sets out the challenges facing the NHS in Scotland, and, in particular highlights the likely demands of an ageing population unless new and better forms of delivering health care are put in place. The report points out that many of the care needs of frail older people are social rather than medical and that a lack of integrated and preventive care can lead to crises that result in unnecessary hospital admissions. It calls for “ A proactive and supportive approach to the care of frailer older people, based on „whole system‟ re design of health and social care…” There is an overwhelming need to establish multi disciplinary, multi agency teams with the ability to respond within 24 hours and provide coordinated packages of care and rehabilitation so that older people can remain in their own homes. The population of Lochaber is ageing, and there is a projected significant increase in those over the age of 65 in the next 20 years (see table below). This is compounded by a lower birth rate. The consequences of this are that there will be more people in the community who have complex needs and who will require care, but fewer younger carers, both formal and informal. There will be fewer tax payers and therefore reduced ability to invest in health services at the level currently enjoyed. Lochaber health and social care community services are already stretched and this, inevitably, leads to unnecessary hospital and care home admissions. We know that it is better and safer in many instances for people to be cared for in their own homes, and, indeed, that this is also their preferred site of care. Unless there is a significant change in the way we plan and deliver services, we will be ill prepared and unable to cope with future needs. Lochaber Locality is already well funded, in Highland terms, in that it uses more than its fair share of both Health and Local Authority resource. There is therefore little opportunity to attract new investment and re design is essential. The hospital admission rates and length of stay in Lochaber, standardised for the population, are already higher than the Highland average. There is an overwhelming need to disinvest in buildings and beds and to re invest in services and people. There are opportunities to do this. In the medium term, planning for the future Belford Hospital as a Rural General Hospital, integrated with extended primary care services, and providing an expanding range of specialist services, will be a crucial component of our service development plan. In the shorter term, there is potential to develop Belhaven Unit as a specialised assessment and rehabilitation service for the whole of Lochaber. The physical unsuitability of Glencoe Hospital, its limited access by the Lochaber population, and its high running costs present an immediate opportunity to use the associated resources more effectively and efficiently. This would ensure sustainable community based care in Nether Lochaber but also allow similar services to be extended 6 to the wider Lochaber population. It would also enable the further development of Belhaven. Projected* population changes Lochaber 2004-2024 Population % Change 2004 2024 䦋 0-15yrs 3,585 ㌌2,824 -21 ㏒ 16-64yrs 11,999 10,385 -14 䦋 65+yrs 3,205 좈5,264 +64 䦋 75+yrs 1,317 琰2,604 +98 All ages 18,759 茞18,473 -2 䦋 䦋 Ü 4. Process to Date The Lochaber Local Health Partnership, part of the Mid Highland Community Health Partnership, has led a review of services for older people in Lochaber, in partnership with other public, and voluntary sector agencies. The most recent phase of the review, which incorporated extensive public engagement, has been progressing since June 2006. There has been significant community involvement through meetings, workshops, and face to face contact with individuals. There were also focus groups and fireside chats with older people themselves, culminating in a two day whole system planning event that had a wide invitation list and was attended by approximately sixty five people. Demographic, epidemiological and financial information is contained in the appendices. The outputs from all of the above were encapsulated in a Consultation Document that has been widely circulated and followed up with community meetings.