Ayrshire and Arran NHS Board

Paper 11

Monday 21 May 2018

East Ayrshire Health and Social Care Partnership Strategic Plan 2018/21 Report

Author: Sponsoring Director: Erik Sutherland, Senior Manager, East Eddie Fraser, Director, East Ayrshire Health Ayrshire Health & Social Care Partnership & Social Care Partnership

Date: 30 April 2018

Recommendation

The Board is asked to: i. receive the report; ii. endorse on the draft the Strategic Plan 2018-21 (Appendix I) ; iii. edndorse the Workforce Plan 2018-21(Appendix II) ; iv. endorse the Property and Asset Management Strategy 2018-21(Appendix III); v. note the Service Improvement Plans (Appendix IV); vi. note that in meeting our duty to consult the Strategic Plan, Workforce Plan, and Property and Asset Management Strategy covering the period 2018-21 was presented to the East Ayrshire Strategic Planning Group on 18 April 2018; vii. note that the reports have been approved by the Integration Joint Board at the meeting on 26 April 2018; viii. note that the reports will also be presented to East Ayrshire Council on 10 May 2018 in line with the initial agreement between partners, ix. note the Chief Officer is instructed to commission services from NHS Ayrshire & Arran and East Ayrshire Council in line with the 2018/19 budget; x. note the Chief Officer is instructed to develop detailed Directions to East Ayrshire Council and NHS Ayrshire & Arran in line with the finalised budget as detailed in June 2018; and xi. otherwise comment on the report.

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Summary

The Public Bodies (Joint Working) (Scotland) Act 2014 places a duty on the Integration Joint Board to develop a Strategic Plan for the integrated functions and budgets under its control.

The Strategic Plan is the document setting out the arrangements for carrying out the integration functions and how these are intended to contribute to the achievement of the relevant national health and wellbeing outcomes for the Health and Social Care Partnership. Due to the expanded scope of the delegated functions to East Ayrshire Integration Joint Board, relevant outcomes in relation to Children and Young People and Justice are also included. The Workforce Plan and Property and Asset Management Strategy complement and support the Strategic Plan.

Glossary of Terms CIPD Chartered Institute of Personnel and Development HSCP Health and Social Care Partnership IJB Integration Joint Board

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1. Situation

The Integration Scheme establishing East Ayrshire Health and Social Care Partnership came into effect on 1 April 2015 with the Integration Joint Board formally meeting for the first time on 2 April 2015. The Strategic Plan is a key mechanism by which the Integration Joint Board will provide detail on the implementation of the Public Bodies (Joint Working) (Scotland) 2014, it is in effect the Business Plan for the Health and Social Care Partnership.

2. Background

The Public Bodies (Joint Working) (Scotland) Act 2014 places a duty on the Integration Joint Board to develop a Strategic Plan for the integrated functions and budgets under its control.

The Strategic Plan is the document setting out the arrangements for carrying out the integration functions and how these are intended to contribute to the achievement of the relevant national health and wellbeing outcomes for the HSCP. Due to the expanded scope of the delegated functions to East Ayrshire IJB, relevant outcomes in relation to Children and Young People and Justice are also included. The Workforce Plan and Property and Asset Management Strategy complement and support the Strategic Plan.

The remainder of this report outlines the content the Strategies and Plans for the next three year period.

3. Strategic Plan

The Integration Scheme establishing East Ayrshire HSCP came into effect on 1 April 2015 with the IJB formally meeting for the first time on 2 April 2015. At that inaugural meeting of the IJB, the Strategic Plan for 2015-18 was approved.

The Strategic Plan 2015-18 has been reviewed annually through the Strategic Planning Group and presented to partners through East Ayrshire Council and the NHS Board alongside the delegated budget.

A second Strategic Plan is now required covering the period 2018-21.

The Strategic Plan must have regard to the integration delivery principles:

Integration Delivery Principles

i. that the main purpose of services which are provided in pursuance of integration functions is to improve the wellbeing of service-users, ii. that, in so far as consistent with the main purpose, those services should be provided in a way which, so far as possible; iii. is integrated from the point of view of service-users, iv. takes account of the particular needs of different service-users, v. takes account of the particular needs of service-users in different parts of the area in which the service is being provided, vi. takes account of the particular characteristics and circumstances of different service-users,

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vii. respects the rights of service-users, viii. takes account of the dignity of service-users, ix. takes account of the participation by service-users in the community in which service-users live, x. protects and improves the safety of service-users, xi. improves the quality of the service, xii. is 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), xiii. best anticipates needs and prevents them arising, and xiv. makes the best use of the available facilities, people and other resources.

The Strategic Plan must also have regard to the national health and wellbeing outcomes and with the full scope of the delegated functions also include the National Outcomes for Children and Young People and Justice, detailed below:

National Outcomes for Children

Outcome 1 Our children have the best start in life.

Outcome 2 Our young people are successful learners, confident individuals, effective contributors and responsible citizens.

Outcome 3 We have improved the life chances for children, young people and families at risk.

Health and Wellbeing Outcomes

Outcome 4 People are able to look after and improve their own health and wellbeing and live in good health for longer.

Outcome 5 People, including those with disabilities, long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community.

Outcome 6 People who use health and social care services have positive experiences of those services, and have their dignity respected.

Outcome 7 Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services.

Outcome 8 Health and social care services contribute to reducing health inequalities.

Outcome 9 People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing.

Outcome 10 People who use health and social care services are safe from harm.

Outcome 11 People who work in health and social care services feel engaged with the work they do and are supported to continuously improve

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the information, support, care and treatment they provide.

Outcome 12 Resources are used effectively and efficiently in the provision of health and social care services.

National Outcomes Justice

Outcome 13 Community safety and public protection.

Outcome 14 The reduction of reoffending.

Outcome 15 Social inclusion to support desistance from offending.

Through our Annual Review process we have been able to recognise the increasingly challenging operational context and to further develop our Strategic Plan during 2017/18 to ensure a stronger focus on strategic commissioning for sustainable outcomes within a constrained resourcing envelope and strengthening partnership working in Localities to deliver on our priorities.

The Strategic Plan 2018-21 centres on the ‘triple aim’ of better care, better health and better value (Appendix I). As such it refocuses activity on a smaller number of core themes. These are:

 scaling up work on prevention and early intervention across all ages;  supporting New Models of Care;  building Capacity in Primary and Community Care; and  Transformation and Sustainability.

The Strategic Plan reviews progress over the last three years, sets out the programme of engagement agreed through the Strategic Planning Group and reiterates the vision and values that will guide our work. A refresh of the assessment of needs, assets and performance is provided in the Plan.

The four core themes are further described in the Plan, with a greater level of detail provided on Lead Partnership arrangements.

The Strategic Plan 2018-21 outlines the changing policy and legislative framework, including the Carers (Scotland) Act 2016, the national Mental Health and Dementia Strategies, the 2018 General Medical Services contract in Scotland and the Digital Health and Social Care Strategy. Linked partner Transformation Strategies for East Ayrshire Council and NHS Ayrshire & Arran are cited as is the health and social care regional planning work on the West of Scotland Regional Delivery Plan.

A Financial Framework section highlights the extent of the challenge facing public bodies in general and the implications of this for the Integration Joint Board as described in the Medium Term Financial Plan agreed at the 30th November 2017 meeting. This projects a demand and cost-pressure gap of almost £38M by 2021/22.

Strategic Commissioning Intentions are detailed in the Plan for the core themes outlined above.

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The Strategic Commissioning Intention related to Prevention and Early Intervention is focused on scaling up action on the main wellbeing challenges of alcohol, tobacco and obesity across all ages. The population and resource impact of this are quantified.

New Models of Care Strategic Commissioning Intentions sets out plans for more integrated, multi-disciplinary working in localities for older people and people with complex needs and long-term conditions. The impact of this and trajectories submitted to the Ministerial Strategy Group on ‘Measuring Performance Under Integration’ is quantified in the Plan.

The local impact of the national commitment to see investment in Primary and Community Care rising to more than half of frontline spending is described in the Strategic Commissioning Intention – Building Capacity in Primary and Community Care. This relates to the 2018 General Medical Services Contract, the new role for GPs as ‘expert medical generalists’ and the extended multi-disciplinary teams in Primary and Community Care. The approach to developing the Primary Care Improvement Plan in also set out.

Transformation and Sustainability is the fourth of the Strategic Commissioning Intentions in the Plan. This section highlights the projected financial gap set out in the Medium Term Financial Plan, links this to feedback from the engagement programme on making best use of relationships and resources, and to the transformational programmes of partners in East Ayrshire Council and NHS Ayrshire & Arran. The Transformation and Sustainability section of the Plan summarises the potential impact of the Commissioning Intentions to ‘closing the gap’ with appropriate agreement on mechanisms for resource release, invest to save programmes, and joint planning in relation to the ‘set aside’ budget.

Key enablers to the delivery of the Strategic Plan 2018-21 are set out in the final sections of the Plan covering workforce planning, information communication technology, premises and estates, ‘thinking differently’, housing contribution and leadership and improvement. Appendix I includes the full Strategic Plan 2018-21.

A public-facing version of the Strategic Plan will be produced together with an accessible Executive Summary and a Plan on a Page version.

4. Workforce Plan

The Chartered Institute of Personnel and Development (CIPD, 2010) provides a general working definition of workforce planning as: “A core process of human resource management that is shaped by the organisational strategy and ensures the right number of people with the right skills, in the right place at the right time to deliver short- and long-term organisation objectives”.

The Workforce Plan 2018-21 (Appendix II) has been developed in keeping with this working definition. It has been developed in light of our ambitious plans, aims and objectives which all centre on improving and sustaining wellbeing within our community and supporting people to live the healthiest lives possible.

The Workforce Plan recognises the significant challenges that face health and social care, including drivers for change such as population change, the demographics of our workforce, and financial uncertainty. The Plan identifies a need to look at new ways of working where prevention and enablement are at the forefront of our work. It is also located within the context of a need to transform service delivery to meet the needs of the people and not the organisations delivering them.

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To achieve this transformation, the Workforce Plan clearly prioritises investment in our single, most valuable resource, our workforce. The Plan aims to support and develop a dynamic workforce which is experienced, skilled, motivated and adaptive and is confident to challenge traditional boundaries and think outside the box to look at innovative ways of delivering our services.

The Workforce Plan is future-focused and has been developed using the ‘six step’ methodology of:

 defining the plan  mapping the service change  defining the required workforce  understanding workforce availability  planning to deliver the required workforce  implement, monitoring and refresh

The Plan reflects the national policy context, specifically the three-part ‘Framework for Improving Workforce Planning’ across the NHS, Social Care and Primary Care.

The Plan aspires to East Ayrshire being seen as an employer of choice, to ensure we can continue to attract and recruit the workforce of the future.

This Workforce Plan 2018-21 sets out key considerations over the planning period to ensure that we have the right people with the right skills in the right place at the right time to deliver sustainable and high quality health and social care services for the people of East Ayrshire.

A baseline position in relation to the current workforce is provided in the Workforce Plan, showing headcount across delegated services, the gender and contract type composition. Baseline detail is also provided by age-group and by salary.

The importance of partners, including independent and third sector partners, in delivering positive health and social care outcomes is fundamental to the Workforce Plan. The Workforce Plan is clear that health and social care integration encapsulates all partners and the wider workforce of the Third and Independent Sector, independent contractors and providers all of whom have a vital contribution to make to the wellbeing of East Ayrshire residents.

Summary workforce planning actions are set out in the Plan covering, unscheduled care, rehabilitation and enablement, models of care for older people and people with complex needs, Primary Care, Business Support, nursing, and children and justice services. An outline Action Plan is included covering Right People, Right Skills, Right Place, Right Time themes.

5. Property and Asset Management Plan

The Property and Asset Management Plan (Appendix III) complements the Strategic Plan and the Workforce Plan and aims to support these through making best use of the estate that health and social care services use, to enhance provision of health and social care in local communities and to rationalise the estate for reinvestment in frontline services.

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A set of Principles is contained in the Property and Asset Management Plan covering people-centred design, transparent allocation of resources, strategic fit with the vision of supporting people at home where possible, and manging assets in line with best value and the transformation programmes of partners.

The Property and Asset Management Strategy describes current and future plans to modernise and rationalise the property portfolio of the Partnership related to Mental Health Services, community-based rehabilitation and enablement, and Ayrshire Urgent Care Service.

Detailed use of NHS Ayrshire & Arran and East Ayrshire Council property, together with key strategic issues and emerging themes are set out in the Property and Asset Strategy for North, South and Kilmarnock Localities and for East Ayrshire-wide services and management.

6. Service Improvement Plans 2018/19

Service Improvement Plans are a key mechanism for setting out service level contributions to the delivery of the corporate objectives of the Health and Social Care Partnership’s integration parties in line with the Community Plan 2015-30. Service Improvement Plans describe the areas of responsibility, budget and structure for services alongside the policy and performance context. The Plans also detail improvement action, the performance framework and any key risks identified. (Appendix IV).

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Monitoring Form

Policy/Strategy Implications The Strategic Plan report supports in accordance with the legal requirement to prepare a Strategic Plan under the Public Bodies (Joint Working) (Scotland) Act 2014. The report provides assurance to NHS Ayrshire and Arran Board in compliance with reporting arrangements set out in the Integration Scheme.

Workforce Implications Human resource implications are considered through appropriate governance arrangements detailed in the Workforce Plan and Property and Asset Management Strategy. In addition management time will be require to be invested in developing detailed business cases and workforce plans for key areas of change.

Financial Implications The report has implications for the IJB in relation to both finance in relation to the need for the NHS Ayrshire and Arran Board to be assured that the indicative partnership budget is sufficient to deliver the outcomes and priorities set out in the Strategic Plan. Under Scottish Government guidance, developed by the Integrated Resource Advisory Group (IRAG), the Strategic Plan should incorporate a medium term financial plan for the resources within its scope. NHS Ayrshire and Arran and East Ayrshire Council delegate functions and make payments to the Integration Joint Board in respect of those functions. The IJB receives assurance from the Chief Financial Officer that those are sufficient to deliver on the priorities of the Strategic Plan.

The IJB, accordingly, has the responsibility for the planning, resourcing and operational delivery of integrated services.

The IJB sets direction and commissions the resultant integrated services from the NHS Board and Council through the HSCP.

Consultation (including Consultation has been wide ranging with employees, Professional Committees) stakeholders, third and independent sector and residents a programme in place between December 2017 and March 2018.

Risk Assessment Any strategic and financial risks will be identified through relevant governance routes and noted in the Partnership Risk Register.

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Best Value The Strategic Plan Report with accompanying - Vision and leadership Workforce and Property Plans fits with best value - Effective partnerships objectives and is aligned with the governance - Governance and arrangements to support the implementation within the accountability financial resources available. - Use of resources - Performance management

Compliance with Corporate The Strategic Plan Report with accompanying Objectives Workforce and Property Plans fits with the corporate objectives of caring, safe and respectful as well as quality ambitions and the effective use of resources.

Single Outcome Agreement The Strategic Plan Report aligns with Health and (SOA) Wellbeing themes within Community Plans and Local Outcome Improvement Plans

Impact Assessment A screening for equality implications has been carried out and a full Equality Impact Assessment will be completed in relation to the Strategic Plan.

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East Ayrshire Health & Social Care Partnership

Strategic Plan 2018-21

V016 – April 2018 Version Control Version Change/ Amendment Author Date V001 Initial kick-off draft structure Erik Sutherland 28/09/2017 V002 Needs, assets, performance section added Michael Byers 22/11/2017 V003 Locality section drafted Claire Kavanagh 22/11/2017 V004 Existing content drawn together Erik Sutherland 24/11/2017 V005 Messages from West of Scotland regional background papers added. West of Erik Sutherland 25/11/2017 Scotland ‘Position Paper’ added. Diabetes SPOG proposal summary included. Capita modelling added. Relevant local conversation presentation materials added. Survey added. V006 Foreword and Review Sections added. Partnership services section added. Erik Sutherland 27/11/2017 General content added throughout. Prof Sir Harry Burns review summary para. V007 Thinking Differently Section added. General content added throughout Claire Kavanagh 28/11/2017 V008 Lead Partnership Services added, HCS added, Revised Asset Mapping Section, Michael Byers 29/11/2017 Updated Demographic Stats, Updated Policy Context section, V009 Enabling Delivery Workforce section added. Content added throughout and Claire Kavanagh 29/11/2017 format edit V010 Independent sector contribution added to Assets Mapping. Enablers ICT and Erik 01/12/2017 Premises added. Housing Contribution section added. General edit. Sutherland/Margaret Phelps/ Claire Kavanagh V011 Final re-draft for consultation Erik Sutherland 02/12/2017 V012 Post-consultation re-draft – incorporation of engagement feedback as presented Erik Sutherland 30/03/2018 to IJB [highlighted]. Final ‘Lead Partnerships’ section added. Revision to add ‘Financial Framework’ section. New sections added for ‘Strategic Commissioning Intentions’. V013 Post-consultation re-draft – detail added to prevention and early intervention and Erik Sutherland 02/04/2018 models of care sections. Section numbering amended. Primary and community care strategic commissioning added. V014 Values graphic added. Minor textual changes made. Revised Lead Partnership Erik Sutherland 09/04/2018 content added. Leadership and improvement sections merged. V015 Final edit Erik Sutherland 10/04/2018 V016 Primary Care estimates added. Additional text re reinvestment in commissioning Erik Sutherland 11/04/2018 intentions added. Some reordering of sections. Indicative budget and set aside added.

Contents Foreword ...... 3 Review of 2015-18 ...... 4 Engagement ...... 6 Vision, Values and Strategic Priorities ...... 7 Partnership Services ...... 9 Policy Context ...... 18 Needs, Assets and Performance ...... 20 Finance, Activity and Commissioning ...... 23 Locality Planning ...... 31 Enabling Delivery ...... 32 Strategic Plan 2018/21 Consultation Survey ...... Error! Bookmark not defined.

Foreword Welcome to the Strategic Plan for East Ayrshire Integration Joint Board. This is our second Strategic Plan and it will set out our shared ambitions and priorities for health and social care in East Ayrshire for 2018-21.

We have much be proud of during the course of our last plan and the progress review section of this draft highlights many of those things. Moving into our second Strategic Plan we have strong ambitions. We will deliver on our vision of:

Working together with all of our communities to improve and sustain wellbeing, care and promote equity.

We will make a central contribution to the Wellbeing priority of East Ayrshire Community Plan 2015-30. We will focus on the National Outcomes and our aspiration that:

• Children and Young People, including those in early years, and their parents / carers are supported to be active, healthy and to reach their potential at all life stages; • All residents are given the opportunity to improve their wellbeing ,to lead an active healthy life and to make positive lifestyle choices; • Older people and adults who require support and their families and carers are included and empowered to live the healthiest life possible, and; • Communities are supported to address the impact inequalities has on the health and wellbeing of our residents.

We must continue to be driven by ambition for the people of East Ayrshire. To do so our Strategic Plan 2018-21 must be truly transformational. The needs assessment and finance sections of this draft Plan illustrate the challenges we face. Demand is increasing and resources are severely constrained. Our Partnership activity must therefore centre on the ‘triple aim’ of better care, better health and better value.

At ‘local conversations’ and ‘Big Plan’ days people have told us that prevention and early intervention are critical. This will be key in our approach to managing demand and making best use of available resources. During 2018-21 our plan is to focus on a number of core themes. These are:

• Scaling up our work on prevention and early intervention across all ages; • Supporting New Models of Care and building capacity in Primary and Community Care; • Ongoing partnership engagement about meeting challenges and creating opportunities, and; • Transformation to ensure sustainability – to tackle the financial gap which, if we continue as we are, is projected to be over £37.8M by 2021/22.

This will be supported by joint planning focused on the ‘set aside’ budget to develop support for people at home and prevent unnecessary hospital admission and make best use of Acute Services.

Our work over 2018-21 will be taken forward with the involvement of the workforce across all partners. The ideas, creativity and commitment of our workforce will be core to how we develop as a partnership.

I would urge all those with an interest in health, social care and the wellbeing of the residents of East Ayrshire to contribute to the delivery of our Plan and look forward to working with partners in this.

Eddie Fraser - Chief Officer

Section 1: Review of 2015-18 Organisational development • The Integration Scheme establishing the HSCP was approved by Scottish Ministers and Parliament for 1st April 2015. • East Ayrshire Integration Joint Board first met on 2nd April 2015 taking on the full range of delegated services. • Governance arrangements were put in place covering Chief Officer, Clinical and Professional leadership, Partnership Management, Audit and Performance, Health and Care Governance, Health, Safety and Wellbeing, Risk and Resilience, and Staff Partnership roles. • Lead Partnership arrangements were established with East Health and Social Care Partnership taking the lead role in Primary Care and health services in HMP Kilmarnock.

Tackling inequality • Contributed to the development of a set of Shared Equality Outcomes with a range of public bodies across Ayrshire and Arran. • Participated in a local Disability Inclusive: Confident Employers (DICE) encouraging employers to make the most of the opportunities provided by employing disabled people. • Endorsed the Stonewall Scotland –No Bystanders campaign and pledge. • Approved a Position Statement on Prostitution which seeks to challenge demand. • Further developed the ‘Know Who to Turn To...’ campaign signposting people to the right services.

Children & young people • Implemented Kinship Carer parity equalising eligible allowances with Foster Carers. • Continued to develop the role of the Children and Young People’s Strategic Partnership. • Launched supported accommodation provision for care leavers. • Increased recruitment of foster carers.

Preventing illness • Reviewed the level of investment in early intervention and prevention across the partnership. • Considered the implications for East Ayrshire of the Annual Report of the Director of Public Health in relation to challenges of alcohol, tobacco, obesity and mental health (ATOM). • Developed a new approach to eye care through ‘Eyecare Ayrshire’ to promote local optometrists as the first point of contact.

Care for older people • Worked with partners in Housing and Vibrant Communities to increase the number of people receiving minor equipment and adaptations, new housing units for varying need and the range of activities in supporting older people to live independently in the community.

Supporting people with long-term conditions • Contributed to reviews of pathways of care for people with long-term conditions as part of the Unscheduled Care Programme.

End of life care • Incorporated end of life care into the development of future Models of Care and Service Change and Transformation Programmes and to test local care home provision.

Community justice services • Contributed to partnership working in the transition year from the South West of Scotland Community Justice Authority to the Community Justice Ayrshire and to the production of the ‘Beginnings, Belonging and Belief’ plan.

Community engagement • Further developed locality arrangements and engagement with Community Planning Partners in Northern, Southern and Kilmarnock Localities. • Engaged with a stakeholder group including the Scottish Health Council, to support re-design and re-provision of Rowallan Ward at Kirklandside Hospital. • Held locality engagement events, including our Strategic Planning Group ‘Big Plan Day’ and our annual ‘Local Conversation’ events involving people in shaping our plans. • Co-produced our Carers Strategy, Local Eligibility Criteria and Carers Support Plans. • Prioritised tackling social isolation across the life course through Locality Planning process.

Choice & control • Redesigned our self-directed support and technology enabled care support teams into an integrated ‘Thinking Differently’ team. • Participated in Power of Attorney campaigns with local publicity, social media presence and a national television campaign.

Redesign of services • Developed Lillyhill Gardens supported accommodation. • Through the IJB, contributed to testing Participatory Budgeting in our communities.

Care close to home • Held ‘Ambitious for Ayrshire’ events setting out our vision for Primary and Community services and developing ‘cluster’ arrangements. • Taken forward the integration of Out of Hours Primary Care and Community Response services across Social Work, Primary Care and Community Nursing in a Ayrshire Urgent Care Service.

Technology enabled care • Established the WG13 community digital hub. • Published our plans for taking forward Technology Enabled Care (SmartSupports) over the next two years.

Workforce • In our first year organisational development work was taken forward to support integrated working within multi-disciplinary teams and safe and effective delivery of services continued. • Undertaken baseline assessments of our nursing, GP, care home, personal carer, social work, corporate parenting and community hospital workforce to inform workforce planning for the future. • Worked collaboratively to develop a General Practice Workforce and Contingency Plan which sets out the sustainability challenges and areas for development. • Successfully taken forward the ‘My Home Life’ leadership development programme in care homes, and other areas of service, with significant benefits in relation to collaborative working and quality of life • Implemented the Scottish Living Wage for care workers delivering direct care and support for adults in care homes, care at home and housing support.

Section 2: Engagement Our Plan is being developed by engaging with our workforce, partners and the communities we serve. Through them, we will understand the ways in which the Partnership can transform.

The programme of stakeholder engagement used to gather and understand local perspectives is shown in the table below. A summary report of engagement was presented to IJB. We will continue to build on this to improve communication and raise awareness across partners. Ongoing engagement will be core to developing and delivering consistent, targeted and accessible communications across all partners.

PROGRAMME Date/time Event Audience Location 31 August 2017 Strategic Planning Group Stakeholder , IJB and SPG CVO Belford Mill, Workshop Kilmarnock 14 September 2017 Integration Joint Board IJB members and officers WG13, West George Development Day Street Kilmarnock 26th October 2017 Locality Planning – Joint stakeholders, Dalmellington Area Southern area employees, communities Centre,

8th November 2017 – Providers Fora Independent Sector Auchinleck Resource Care Home. Centre 23rd November 2017 – Care at Home.

7th Nov to 5th Professional bodies- various December 2017 GP, Dental Optometry and Pharmacy 9 November 2017 Partnership Forum Employee representatives Kilmarnock Dec 2017- 18 Jan EAC Budget Joint stakeholders, Align where possible. 2018 employees, communities various 7th November 2017 Locality Planning – Joint stakeholders, various Northern area employees, communities

2nd November 2017 Locality Planning – Stakeholders, employees, various and 18th January Kilmarnock area communities 2018. 23rd November 2017 Stakeholder Forum People who use services and carers 24 November 2017 Local Conversation Employee , third sector and Grand Hall, local communities event Kilmarnock 1st December 2017 Consultative Draft All Online 18th January 2018 Third Sector Providers Third Sector/PN/Providers WG13 22nd February/ 16th Pre-publication Launch Employees and Senior Localities March 2018 Leaders

Section 3: Vision and Values

Vision and Values We developed a vision for how we would operate as a partnership in consultation with stakeholders prior to the establishment of the Integration Joint Board and the Health and Social Care Partnership.

This has driven our activity over the last three years and will continue to do so. Our vision is of:

Working together with all of our communities to improve and sustain wellbeing, care and promote equity.

We contribute to the Wellbeing objectives of Community Plan 2015-30:

Specific Health and Social Care Partnership values encompass partner values:

The long-term aim for health and social care in Scotland is for people to live longer, healthier lives at home or in a homely setting. The National Health and Wellbeing Outcomes, Children and Young People and Justice Outcomes guide our work. The aim is to have a health and social care system that meets with the Integration Principles:

• is integrated; • focuses on prevention, anticipation and supported self-management; • will make day-case treatment the norm, where hospital treatment is required and cannot be provided in a community setting; • focuses on care being provided to the highest standards of quality and safety, whatever the setting, with the person at the centre of all decisions; and • ensures people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

Section 4: Strategic Priorities The health and care system has been continually changing as new treatments, technology and service developments have emerged. Our health and social care system will always evolve to deal with society’s health challenges and to provide excellent care.

Scottish solutions have been found to the challenges faced which provide a solid foundation from which to build. There is a strategic focus on prevention, early intervention and developing better, more integrated care organised around the individual needs of people. Partners are working at a national, regional and local level to collectively plan to improve health and wellbeing, reduce inequalities and improve health outcomes. The extent of preventable illness is recognised as is the depth of health inequalities experienced in our communities.

Our Strategic Priorities are summarised below. More detail on activity to deliver these over the course of the Strategic Plan 2018-21 is set out in Section 9-12. These will provide greater focus to our work in recognition of feedback that we have been trying to change too many things at once in the context of pressure on services.

Early Intervention and Prevention There is a broad consensus across partners in in East Ayrshire that significant improvements in wellbeing result from tackling (undoing) the causes of ill-health rather than rather than treating the consequences (mitigation). The IJB commissioned a review of prevention and early intervention in 2016/17. Building on this, the intention is to make prevention a core focus of activity at the heart of health, social care and wellbeing during the course of 2018-21. We will scale-up prevention and early intervention across all Partnership work. There will be a focus on fairness, kindness and connectedness. This aligns with our prioritisation of social isolation across the life course.

New Models of Care Considerable work has been taken forward in designing and implementing new approaches to our provision of health and social care services for older people and those with complex conditions, which is aimed at supporting people in more homely and community-based settings and contributing to the management of unscheduled care in acute hospitals.

During the course of this Strategic Plan new models of care will be fully embedded across East Ayrshire. This involves implementation of multi-disciplinary partnership working in Localities where a range of professionals and partner agencies work together to ensure that people get the ‘Right Support, Right Place, First Time’. This includes developing models of care to support increasingly complex needs across partners.

Building Capacity in Primary and Community Care Within Primary Care we are widening the concept of the Practice Team to ensure that patients benefit from wider range of available support. Practices will typically consist of complementary teams of professionals lead by a GP but supported by highly-trained nurses, physiotherapists, pharmacists, mental health workers and social workers.

Transformation and Sustainability As a Partnership we have undertaken significant work to understand our challenges and how we can best meet these within a new financial context while continuing to strive towards our ambitions. We need to close the financial gap and transform how we work to achieve sustainability.

Ongoing engagement will be core. We will continue to improve communication and raise awareness across partners.

Section 5: Partnership Services Partnership services include the full range of community-based health and care services. These are fully detailed in the Partnership’s Integration Scheme.

Lead Partnership Primary Care and Out of Hours Community Response Lead Partnership arrangements continue to be in place across Ayrshire & Arran. The East Ayrshire H&SCP will continue to manage and deliver the following services on behalf of the North and South Partnerships.

. Primary Care (General Medical Services, General Dental Services, General Ophthalmic Services, Community Pharmacy) . Public Dental Services . Ayrshire Urgent Care Services . Contracting for GP services for settings such as Prison Service and Police Custody Services

The agreed vision for primary care services across Ayrshire and Arran is to achieve:

A strong local primary care service, supporting people in their day-to-day lives to get the best from their health, with the right care available in the right place when they need it. The overall theme is of partnership between individuals, communities, the health and social care and with partners.

The Ayrshire and Arran vision aligns to the Scottish Government’s vision for the future of primary care services, which is for multi-disciplinary teams, made up of a variety of health professionals, to work together to support people in the community.

In its Lead Partnership role, East Ayrshire is responsible for the development and implementation of the ‘Ambitious for Ayrshire’ programme of transformational change for Primary Care services. Good progress has been made in advancing the key priorities outlined in the this programme, which includes the development of GP clusters and supporting the development of multidisciplinary team working in and with GP Practices, increasing capacity to provide community-based services, improving workforce sustainability, improving primary care infrastructure and establishing an integrated Out Of Hours service.

Going forward our work will be informed by key Scottish Government policies including the new GP Contract 2018, ‘Achieving Excellence in Pharmaceutical Care – A Strategy for Scotland’, ‘Community Eyecare Review’, ‘Oral Health Improvement Plan’ and ‘Realising Realistic Medicine’ as well as addressing health inequalities.

This work is being delivered in partnership between communities, Primary Care, the three Ayrshire Health and Social Care Partnerships, Acute and Third Sector. These partners are committed to working collaboratively and positively to deliver real change in local health and care systems that support people to receive the right care at the right time.

General Medical Services

General practice provides continuing, comprehensive, coordinated and person-centred healthcare to the communities of Ayrshire and Arran. A strong and thriving general practice is critical to sustaining high quality healthcare, which is available to all and which can realise Scotland’s ambition to improve our population’s health and reduce health inequalities.

A new General Medical Services (GMS) contract has been agreed with GPs and will be implemented across Ayrshire and Arran from April 2018. The way in which General Practice will work in the future will change in line with the new contract, the guiding principles of which are to support:

. accessible contact for individuals and communities . comprehensive care of people - physical and mental health . long term continuity of care enabling an effective therapeutic relationship . co-ordinating care from a range of service providers

The benefits of the proposals is to develop partnerships between patients, their families and those delivering healthcare services work to provide care which is appropriate and based on an assessment of individual needs and values and improves wellbeing, demonstrates continuity of care, clear communication and shared decision-making.

What this will mean for local residents is that GPs will focus more on seeing patients who are unwell where a GP’s skills are required for diagnosis and developing a treatment plan as well as caring for those who have complex care needs. Other professionals such as Advanced Nurse Practitioners, Pharmacists and Community Link Workers or Connectors, Physiotherapists and Mental Health workers will work alongside GPs to assess and treat individuals in line with their own expertise. People often know what care they need and in future more people will be able to seek this directly, so that for example a person with shoulder pain may choose to see a Physiotherapist as a first point of contact, while individuals with minor ailments will increasingly find that Community Pharmacists can provide a range of treatment.

These new changes will be brought in over the next 3 years as part of a Primary Care Improvement Plan. East Ayrshire Integration Joint Board will have the responsibility to ensure the Plan is in place and delivered across Ayrshire.

Some of the first areas for change will be the way local people receive services such as vaccinations, repeat prescribing and medication reviews, community treatment and care services (e.g. minor injuries and dressings, phlebotomy, ear syringing, suture removal, chronic disease monitoring), urgent care and out of hours being supported by advanced practitioners (nurses and paramedics) including for home visits; physiotherapy, mental health services and more use of Community Connectors and Link Workers attached to GP practices.

The Plan will outline how these changes will be delivered before the end of the transition period at March 2021.

Community Pharmacy

The publication of ‘Achieving Excellence in Pharmaceutical Care – A Strategy for Scotland’ in 2017 by the Chief Pharmaceutical Officer for Scotland, provides an opportunity to review and align community pharmacy services with the Ambitious for Ayrshire vision for multi-disciplinary team (MDT) working in Primary Care. The Strategy makes a commitment to increase access to community pharmacy as the first port of call for self-limiting illnesses and supporting self-management of stable long term conditions, in and out of hours.

Through the Minor Ailment Service (MAS) community pharmacies are increasingly becoming the first port of call for eligible patients for a range of common clinical conditions and NHS Ayrshire & Arran has added to the range of common clinical conditions treatable by community pharmacists under the Pharmacy First Ayrshire

service. Women between 16 and 65 can now be treated for uncomplicated urinary tract infections and patients aged 2 years and over, can also be treated for impetigo. Both conditions previously required prescriptions through GP practices or OOH services.

We are also expanding the range of common clinical conditions that can be treated by community pharmacists for other skin infections and shingles, and intend to further expand the range of conditions that can be treated. Expanding the range of common clinical conditions treated will improve outcomes for patients and reduce the workload for GPs and other health and social care professionals.

A number of community pharmacists are qualified as Independent Pharmacist Prescribers (IPPs), providing clinics from their community pharmacy, in conjunction with local GP practices. These clinics include respiratory clinics, as well as hypertension and sexual health clinics. Further training and development of this workforce will unlock a further resource that can play a role in the MDT. Supporting patient self- management of long term conditions will improve outcomes for patients whilst reducing the workload of GPs and other health and social care professionals.

The recent changes to the GP contract and development of the pharmacotherapy service over the next 3 years provides us with an opportunity to introduce a serial prescription service to reduce the time spent in GP practices dealing with repeat prescriptions and to streamline the process at community pharmacies. If more patients have serial prescriptions in place this will allow a greater range of activities identified within the pharmacotherapy service to be carried out by the practice based pharmacists.

The development of GP practice based pharmacists also provides an opportunity for better joint working between GP practices and local community pharmacists. Their mutual understanding of one other’s issues will provide opportunities to provide better patient care and medicines management.

Optometry

The ‘Modern Outpatient Programme’ (2016) outlines the further need for a collaborative approach to health care. In Ayrshire and Arran accredited optometrists provide locally enhanced eye care services reducing the burden on secondary care. These include: Low Visual Aids (Visual Impairment); Bridge to Vision (Learning Disability); Post-Operative Cataract Surgery Assessment; Medical Contact Lenses and Diabetic Retinopathy Screening.

Launched in February 2017, the ‘Eyecare Ayrshire’ re-direction initiative aims to shift the balance of care for eye problems from GP practices and EDs to local optometry practices and promotes the use of the optometrist as first point of contact for eye problems, advising people that eye drops will be available free of charge dispensed from community pharmacists.

Where needed electronic referrals are made directly from optometrists to the hospital eye service. These referrals allow for images to be attached which further enhance the effectiveness of the triage/vetting process and patient care as a consequence. NHS Ayrshire and Arran attain approximately 80% referrals electronically which compares favourably to other Health Boards.

The Scottish Government Community Eyecare Review was published April 2017. The review considered care currently provided within community optometry and identified examples of good practice across Scotland that could be replicated. NHS Ayrshire and Arran was commended in the report for the locally developed initiatives and examples of care already developed within community optometry.

General Dental Services

The Scottish Government published the Oral Health Improvement Plan (OHIP) in January 2018. The plan sets the direction of travel for oral health improvement for the next generation and has a strong focus on reducing oral health inequalities, moving to a preventive based approach for NHS dentistry and meeting the needs of the ageing population.

The aims of the new plan are to focus on prevention, encouraging a more preventive approach to oral health care for patients of all ages to ensure that everyone can have the best oral health possible and that education and information sharing is specifically targeted at individuals and groups most at risk such as those who do not attend regularly for check-ups, communities in low income areas and particularly those people who either smoked or drink heavily. New approaches will also be introduced to make it easier for dentists to treat older people who live in a care home or are cared for in their own home and to enable those dentists with enhanced skills to provide services that would otherwise be provided in a Hospital Dental Service i.e. oral surgery, treatment under intravenous sedation and complex restorative services.

The aim of the NHS Ayrshire and Arran Oral Health Strategy 2013-2023, closely aligns with the new national Plan with the aim of ensuring the ‘best oral health possible for the people of Ayrshire and Arran’. The strategy covers stages of life (children and adults) and targets oral health promotion work for priority groups, such as the homeless and prisoners, people in care homes and those with specific care needs. We are currently progressing the NHS Ayrshire and Arran Oral Health Action Plan 2016-2019 and have completed the second year of the 3 year Plan and will continue to deliver oral health improvement activity over the remaining year of the Plan.

Ayrshire Urgent Care Services

NHS Ayrshire & Arran and East Ayrshire Health and Social Care Partnership has launched a new out-of-hours service which will bring together the skills, expertise and capacity of existing out of hours services to enable the citizens of Ayrshire to access the right person, with the right skills at the right time.

Launched in November 2017, the ‘Ayrshire Urgent Care Service’ (AUCS) brings together Primary Care and Social Work services into an ‘urgent care hub’, operating from the Lister Centre at University Hospital Crosshouse .This will be supported by local urgent care centres and the home visiting service as required. In partnership with NHS24 there will be continued promotion of self-care and redirection to the most appropriate service, for example local pharmacist. Ayrshire Urgent Care Service includes:

. Doctors and Advanced Nurse Practitioners . Out-of-hours district nursing service . Crisis Resolution Team; . Out-of-hours social work . East Ayrshire overnight emergency response personal carers . Service support staff

This redesign is in-line with national policy for urgent care services as set out in the report ‘Pulling Together: transforming urgent care for the people of Scotland, 2016’, which recognised the difficulty in sustaining GP involvement in out-of-hours services. The service will continue to test new ways of working to ensure a safe, high quality, effective and efficient out of hours service is delivered to the communities of Ayrshire

Ayrshire and Arran will continue to have an out-of-hours primary care service which will include Doctors and Advanced Nurse Practitioners working a part of a wider team to ensure that members of the public will see the most appropriate healthcare professional

Lead Partnership Mental Health The North Ayrshire H&SCP will continue to manage and deliver the following services on behalf of the East and South Partnerships.

Mental Health Inpatient Services NA HSCP leads on a wide range Mental Health Inpatient services across Ayrshire, including:

• Acute inpatient assessment for individuals experiencing functional and/or organic presentation • Low Secure male inpatient services • Intensive Psychiatric care provision • Generic and forensic rehabilitation services • Hospital Based Complex Continuing Care for individuals 65 and over on Ailsa site • Inpatient addiction service, offering inpatient detoxification programme, residential and day attendance rehabilitation programme

Also included within the inpatient portfolio of services are - • Community Forensic Team • Elderly, Psychiatric and Alcohol Liaison Services • Mental Health Advanced Nurse Practitioners • Acorn – service based at Ailsa offering structured activity, sheltered employment opportunity and supporting individuals who have/are experiencing mental disorder to develop a range of skills

Inpatient services are split between Woodland View on Ayrshire Central Hospital site in Irvine and on Ailsa Hospital site in Ayr, the majority of adult services being based at the new bespoke provision within Woodland View.

Crisis Resolution Team The Ayrshire Crisis Resolution Team offers a home based alternative to in-patient care for adults (aged 16- 65) experiencing acute and severe mental health crisis. The service offers short term support up to 21 days, in line with the national standards for crisis services.

Learning Disability Assessment and Treatment Service People with a learning disability have a significant, lifelong condition that affected their development and which means they need help to; understand information, learn skills, and cope independently. The Learning Disability Assessment and Treatment Service is a 16 bed inpatient admissions unit based at Arrol Park Resource Centre, Ayr. The unit provides access to specialist a range of specialist professionals and intensive multi-disciplinary services for all adults living in Ayrshire who have a learning disability.

The unit accepts both planned and unplanned admissions: • A planned admission to Arrol Park provides short-term intensive assessment and treatment. Where a planned admission is deemed appropriate, a pre-admission meeting will take place with the individual and family members and a range of support staff including; Community Learning Disability Team, designated Social Worker, and Third sector representatives • Emergency admissions to Arrol Park are facilitated by members of the Community Learning Disability Team. Admissions are agreed with a Responsible Medical Officer and members of the Community Learning Disability Team will be in contact with Arrol Park nursing staff to facilitate the admission process.

The following is a list of criteria for why an individual would be admitted to Arrol Park: • The person requires a period of complex nursing and therapeutic care which cannot be met elsewhere. • The person has severe emotional, behavioural or mental health difficulties which cannot be appropriately assessed or treated elsewhere. • The person requires a period of sustained specialist led support and rehabilitation. • Where risk evaluation indicates that hospital admission is most likely to reduce short and medium-term risks which are significant and likely to pose a hazard to the patient and/or others.

Psychology Services Psychological Services are provided across Ayrshire and Arran and are embedded within various specialist teams. Specialities covered are: . Child Psychology . Adult Mental Health . Older Adults, physical health and neuropsychology, and . Learning disability services The service deploys a range of staff within these specialist roles to undertake focused work, such as primary care mental health, community mental health and eating disorders.

Child and Adolescent Mental Health Service (CAMHS) The CAMHS service is available to young people aged 5 to 18 years old and offers short term treatments for those with mild to moderate mental health problems; to more complex treatments for children and young people experiencing more severe and complex problems. North Ayrshire shall deliver mental health services in line with the 10 year National Mental Health Strategy 2017-2027. This strategy aims to ensure that mental health problems are treated with the same commitment and passion as physical health problems. We will work to improve: Prevention and early intervention; Access to treatment, and joined up accessible services; the physical wellbeing of people with mental health problems; Rights, information use, and planning.

In addition North Ayrshire has lead responsibility for the following Early Years Services:

Child Immunisation Team In East and South Ayrshire, the HSCP Immunisation Team deliver all immunisation clinics, where in North clinics are delivered by both the Immunisation Team and many GP surgeries. The team is also responsible for the pupil immunisation programme in all Ayrshire schools.

Community Infant Feeding Service The community infant feeding nurse works across Ayrshire to provide a specialist service to families experiencing complex challenges with infant feeding. The service supports health visiting staff with advice and provides direct support to families via telephone, face to face discussions or home visits.

Child Health Administration Child Health Administration team co-ordinates, manages and supports the delivery of Ayrshire’s child immunisation programme and development screening programmes. The team maintains all records and information in relation to its remit and provides information to the Information Statistics Division (ISD) via nationally established data systems.

Over the next three years, the early years teams will support the implementation of the 3 year Vaccination Transformation Programme and will prepare for the replacement of the current Child Health & Community Health Index (CHI) system, expected by 2020.

Lead Partnership Allied Health Professionals The South Ayrshire H&SCP manages and delivers the following services on behalf of the East and North Partnerships.

Allied Health Professionals South Ayrshire HSCP leads on Allied Health Professional (AHP) services across Ayrshire. Within this remit are the following services: Dietetics, Orthotics, Occupational Therapy, Physiotherapy, Podiatry and Speech and Language Therapy. AHPs are a distinct group of specialist and sub-specialist practitioners who apply their expertise to diagnose, treat and rehabilitate people of all ages within both mental and physical health, education and social care and across acute and community settings. They work with a range of technical and support staff to deliver direct care and provide rehabilitation, self-management, “enabling” and health improvement interventions. The Active and Independent Living Programme provides a National Strategic framework for development of AHP services. Locally, four key work streams have been identified to ensure that teams have the necessary support and infrastructure to contribute to the development of services: Workforce; Staff support and development; Data for improvement and research and Development and evaluation

Falls Prevention A Falls Strategy Position Statement was developed in 2016 which outlined the local response to the national action framework for The Prevention and Management of Falls in the Community (Scottish Government, 2014). Key areas for future action by each of the Ayrshire Partnerships have been identified to both reduce the numbers of people who fall and improve the personal outcomes for those people who experience a fall. Further development of multi-agency, pan-Ayrshire falls pathways is required as well as improved access to community services and local supports that will improve individual’s ability to perform daily activity and reduce anxiety around falling.

Sensory Impairment Key priority areas have been identified by the Sensory Impairment service. A Pan-Ayrshire British Sign Language Plan is being developed and requires to be published by October 2018. Other key areas that will be prioritised include the development and provision of Sensory Impairment Awareness Training; the development of mechanisms to share service user’s confidential information across Council services; to improve access to service buildings; to provide a wider range of diagnostic procedures and specialist services in the community and to develop a structure where those with sensory loss are involved to improve services.

Continence The Integrated Continence Service promotes continence by empowering patients to self-manage through behaviour and lifestyle interventions. The objectives of the service are to offer intermediate clinics across Ayrshire and to offer an advisory service to patients, carers and voluntary organisations and educational service to NHS clinicians.

Technology Enabled Care (TEC) The Ayrshire and Arran strategy for TEC and Innovation outlines the need to harness the advances in technology and to develop the use of TEC across Ayrshire and Arran over the next three years. North, South and East Health and Social Care Partnerships and Acute Services are currently redesigning models of care and TEC will support and further enable services, the workforce and infrastructure transformational redesign.

Joint Equipment Store Officers from across the three Ayrshire Council’s and NHS Ayrshire & Arran have been in discussion about the feasibility of establishing a joint store for the provision of equipment to people living in the community. The equipment referred to is wide ranging and intended to enable people to live safely within their own homes.

Health Visiting (HV) The HVs and their teams support the universal services that improve the health and wellbeing of children. This is part of an integrated approach to supporting children and families within the wider multidisciplinary teams, supporting development and engagement with specialist services. The HVs work in partnership with public health, social care, paediatrics, education and the wider public services to safeguard children and families. HVs are key in ensuring robust systems are in place to identifying families that require further support, assessing need and delivering interventions.

Family Nurse Partnership (FNP) The Family Nurse Partnership (FNP) is a licensed programme where specially educated nurses work with first-time teenage mothers to develop their parenting capacity and support them to make positive choices for themselves and their children. The FNP aims to prevent damage a child's brain development, behaviour, learning, and long-term health by having a specially educated nurse visit the homes of first-time teenage mothers from early pregnancy (before 28 weeks) until their child is two years old. The programme has been shown to produce many benefits including improved early language development and academic achievement, reductions in children's injuries, neglect and abuse and fewer subsequent pregnancies and greater intervals between births.

School Health (SN) The school nurse (SN) role is a significant part of the school health service, which is a universally accessible service provided to children and young people, aged 5-19 years and their families. The role focuses on delivering consistent and efficient services across Scotland in order to deliver safe, effective and person- centred care based on the principles of Getting It Right for Every Child (GIRFEC) national practice model. Based on available evidence, policy direction and priorities, the role focuses on priority areas which include mental health and wellbeing, substance misuse, domestic abuse, homeless children and young carers.

Looked After and Accommodated (LAAC) Children who are looked after by local authorities can remain at home or be provided with accommodation away from their normal place of residence (i.e., kinship/foster/residential placement, respite care). The lead professional from the Health Board, is a key worker who assesses the individual needs of the child and liaises with the wider multidisciplinary team over the delivery of healthcare. This role supports Looked after children's nurses links to school nurses, health visitors and paediatricians have the capacity to refer to other services, identify health records and request them from the NHS Board in whose care they are held, provide a comprehensive health assessment. The role is essential in connection between the child protection processes and wider structural processes to support and plan services for vulnerable people.

Section 6: Policy Context

Why is this important? The wider policy context in relation to health and social care continues to evolve with developments being driven by wider economic, societal and technological changes.

Where are we now? The key policy developments that continue to shape and influence the delivery of services include: • The Palliative and End of Life Strategic • Health and Social Care Delivery Plan Framework for Action; • Realising Realistic Medicine (Report by • Report of the National Review of Primary Chief Medical Officer for Scotland) Care Out of Hours Services; • National Primary Care Vision • The Review of Public Health in Scotland • Self-Management Strategy for Long Term • A National Clinical Strategy for Scotland Conditions in Scotland • Social Services in Scotland: A shared vision • Children and Young People (Scotland) Act and strategy 2015-2020. 2014 • Healthier Scotland Conversation • Carers (Scotland) Act 2016 These policy and legal developments will shape our strategic and operational work during the planning period. Alongside this there have been developments at parent body, regional and UK level that need to be recognised in our activities: 3 Digital Health and Social Care Strategy Health and Social Care Making Care Better - A 2017-22 2 Standards: My support, A Fairer Healthier my life strategy for supporting The 2018 General Scotland; A Framework better care in Scotland Medical Services for Action 2017-22 2017–2022 Contract in Scotland 1

0 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec

-1 Welfare Reform – Mental Health Strategy Scotland's National Introduction of 2017-2027 Dementia Strategy Universal Credit -2 Review of Targets and 2017-2020 Achieving Excellence in Indicators in Health Pharmaceutical Care: A and Social Care in -3 Strategy for Scotland Scotland

NHS Ayrshire and Arran Transformational Change Improvement Plan 2017-2020: and associated Delivery Plan 2017-18. This is the local delivery plan for NHS services and includes delegated services. It describes how transformational change programmes will deliver improvements designed to meet the needs of the local population.

East Ayrshire Council Transformation Strategy 2: “Closing the Gap” sets out the Council’s proposals for transformational change in local authority services between 2017-2022. The strategy is currently being developed via engagement and consultation with partners and communities and continues the message of a definitive shift in spending towards outcomes based services built around people and communities, towards prevention and early intervention and a fundamental, innovative redesign of services to achieve financial and organisational sustainability.

West of Scotland Regional Delivery Plan for Health and Social Care: Scottish Government has commissioned the development of plans to encompass the whole system of health and social care in three regions; North, East and West. In the West Region, this means planning for a population of 2.7 million people by 5 NHS Boards, 16 Local Authorities, 15 Health and Social Care Partnerships as well as the Golden Jubilee Foundation. Implementation Leads have been identified to take this work forward across the country.

Welfare Reform: The implications of the Government’s Welfare Reform programme and the roll-out of Universal Credit in East Ayrshire will be significant. There are concerns that the reduction in welfare spending will impact negatively on income inequality, poverty and child poverty and on equality groups, including the impacts on women and people with disabilities.

It is projected that welfare spending in Scotland will be reduced by around £0.9 billion by 2020/21 as a direct result of these reforms, which equates to a loss per working age adult in East Ayrshire of £299 per annum. This reduction in incomes for individuals and families in receipt of benefits will likely exacerbate the already significant levels of poverty which exist across East Ayrshire and have a detrimental impact on the physical and mental health and wellbeing of those living in situations of poverty.

Addressing the impact of these reforms will be a further challenge for the Partnership over the life time of this Strategic Plan.

Where do we want to be? Our activities are planned, designed and delivered to achieve the positive outcomes described in local and national policy. We ensure connectedness across our integrated teams and systems so that we are all working towards the same goals.

How will we get there? • We will incorporate and align the key elements of these policy changes with our strategic and delivery plans. • We will work across financial inclusion partners to offset the impact of welfare reform in our communities, including participation in the ‘Menu for Change’ programme aimed at tackling food insecurity.

Section 7: Needs, Assets and Performance

Why is this important? Understanding the needs of our communities and the assets that they have to improve their outcomes is key to our approach to transforming the way we design and deliver our services. Our ability to manage performance at a strategic and operational level helps us to measure our progress towards improvement. Where are we now? Demographic Influences Our community is experiencing significant demographic change with extensive impact on current and future demand for services. Demographic change highlights why continuing to deliver health and care in the way we have done is no longer an option and why we need to focus on transformation.

• Demographic change is expected to result in an increase in the number of older people by over 30 per cent between now and 2026 and over 70 per cent by 2036. • Over the 2016-36 period the number of people with dementia in East Ayrshire is expected to increase by 35%. • The number of individuals aged 65 and over with one or more long term health condition is projected to increase from 14,411 to 17,360 in 2026 (an increase of 20%). • The number of emergency attendances is projected to increase by 2.4% in 2026 and by 3.6% by 2036. The percentage of emergency attendances involving patients aged 65+ is projected to increase from 22.8% (2016) to 27.8% in 2026 and 33.8% in 2036. • People living in the West of Scotland present to Emergency Departments at a rate which is 8 per cent above that expected from the population. Emergency admissions to hospital are 6 per cent higher than expected. • Four groups of people, accounting for 19 per cent of hospital admissions, used 69 per cent of bed days and made up 61 per cent of costs (complex cases, adult major injuries, frailty and end of life). • An expected rise in the number of children and young people living in low income families is expected to increase demand.

There has been significant focus on improving flow through hospitals with day-based care increasing and the length of stay in hospital reducing. However, there is a tendency for emergency admissions to hospital to increase.

This points to areas where effort must be concentrated to better support people in the community and to address unscheduled care.

Understanding the needs of our communities We use research, data and intelligence from a variety of sources to understand need. The Local Intelligence Support Team (LIST) provide analysis and data.

• Public health analysis of the population in the West of Scotland suggests that multiple deprivation and ageing within our communities are major drivers of demand, particularly for unscheduled care. • Life expectancy has a long-term tendency to increase, but indications are that this has slowed and that there is fall in life expectancy in some areas. This is a recent trend which seems to be the case for women and for older people in small towns and rural communities. • The reasons for this emerging trend are complex and linked to the impact of the economic crisis, lifestyle related ill-health, e.g., alcohol-related harm, smoking, unhealthy weight and diabetes.

• There is unexplained variation in the use of unscheduled care within and between communities which needs to be better understood and addressed where this results in inequitable distribution of resources. • Statistical modelling work has been completed to inform understanding of demand and capacity. Analysis shows that improvements have the potential to reduce occupied bed days in the unscheduled care system and to offset projected demographic pressures. • There is a relatively high rate of emergency admission for conditions where effective community care and case management could prevent hospital admission. • Analysis of Ambulatory Care Sensitive conditions (ACS) shows that individuals with certain conditions are admitted to hospital where they may have experienced deterioration or where provision of care in a community (or outpatient) setting could have resulted in their condition being managed more effectively. • Modelling indicates that there is potential to further increase the percentage of cases managed in this way.

A number of improvements with positive impact across the system are suggested including: improved access to senior decision-making at ED; rapid access clinics; improved ambulatory care pathways; work to reduce variability in length of stay; earlier discharge, and; high impact changes associated with community care capacity, intermediate care and multi-disciplinary working.

Asset Mapping Community assets are a key resource in the delivery of transformational change and in the strategic shift to focus on prevention, self-management and more effective use of community based services. In partnership with CVO East Ayrshire a range of asset mapping activity in our localities has taken place. This has added valuable information about resources in our communities, allowing us to build up an understanding of assets and activities within our communities that can contribute to wellbeing.

Through the ongoing development of the MyEastAyrshire online Community Directory and other digital resources, we will connect people in East Ayrshire with information and contact details for organisations, local groups, businesses and care providers who deliver a range of support. The Independent Sector is also working closely with the Partnership to develop and provide services that meet the needs of East Ayrshire residents. This has involved the Independent Sector utilising community

assets to provide services that support delivery of transformational change through provision of locally based step up/step down services, dementia friendly environments and specialist palliative care support. Performance We have developed a systematic approach to performance management, which links accountability to the National Health and Wellbeing Outcomes. Our approach provides information on our current levels of performance and helps identify shifts in performance trends over time. Through monitoring and analysis of our performance we can identify areas requiring improvement, which in turn informs strategic planning.

Our performance management focuses on the National Health and Wellbeing Outcome indicators. A combination of Statutory Performance Indicators, Wellbeing Delivery Plan local outcome indicators and local measures are included in Quality Assurance and Improvement Dashboards for Community, Health and Care Services, Primary Care and Out of Hours Community Response and Children’s Health, Care and Justice Services.

The core set of indicators developed by the Ministerial Strategy Group is a further component of performance. These measures help provide a whole system overview and focus on six key areas: emergency admission; unscheduled hospital bed days; emergency department (ED) attendances; delayed discharge bed days; the percentage of the last six months of life spent at home or in community settings, and; the balance of care between community and institutional settings.

We produce an annual performance report covering the breadth of performance and have published two reports; our first in 2015/16 the second for 2016/17 Annual Performance Report 2016/17. We recognise the importance of benchmarking to identify improvement and understanding of local performance against peer areas. Where do we want to be? We have robust and agreed needs, assets and performance information about our communities, initiatives and services that is used across partners to drive our transformation decisions. How will we get there? • Continue to develop our approach to asset mapping with partners. • Use local intelligence to direct improvement on an ongoing basis, e.g., identify and address unwarranted variation, or higher than expected emergency presentation at hospital. • Ensure that the implementation of new Models of Care takes into account the findings of system modelling work. • Promote on-line/digital resources that signpost community assets and sources of support in communities. • Implement the findings of the Burns review of “Targets and Indicators in Health and Social Care in Scotland1”.

1 The review suggests that indicators and targets should be based upon the principles of purpose, co- production, review and whole system relevance. The current system requires to be refocused on impact, improvement and contribution to wellbeing across the life course.

Section 8: Financial Framework

Why is this important? Scotland is in the midst of significant change in terms of the scale and composition of its public sector budget. This is the first time since the end of World War II that budgets have declined, in real terms, over an extended period. Reducing budgets are critical to our approach to transforming our activities and how we commission services.

Where are we now? The graph below shows the original predicted gap in funding of £39bn for public services in Scotland with budgets recovering from 2015-16 returning to the levels experienced before the economic downturn by 2025-26. Current estimates, shown as the red dotted line in the graph, are for a further spread in the funding gap with signs of any recovery delayed until 2021-22.

The Partnership’s budget is delegated to it by the Council and NHS. As financial settlements to partners reduce, the financial challenges of the Partnership increase.

Analysis and projections of cost pressures have been undertaken and the IJB approved a Medium Term Financial Plan on 30 November 2017. In summary, the Medium Term Financial Plan sets out a £37.881m indicative funding gap for the Partnership until 2021-22.

We fully recognise the unprecedented levels of savings required and in order to meet this challenge alongside the demographic and societal challenges outlined earlier, we need to deliver transformational change in the way health and social care services are planned, delivered and accessed in East Ayrshire.

Should current practice continue, early modelling work has suggested that NHS Ayrshire and Arran would need an additional 398 beds by 2035 to meet this demand.

The 2017-18 budget for the Partnership is £223.693m in respect of Council and NHS managed services is illustrated in the chart below.

The partnership has a responsibility, with our local hospital services at Crosshouse and Ayr, for planning services that are mostly used in an unscheduled way. The aim is to ensure that we work across the health and care system to deliver the best, most effective, care and support.

‘Set aside’ budgets relate to the strategic planning role of the Partnership. Key areas within this budget are: accident and emergency; inpatient services for general medicine, geriatric medicine, rehabilitation, respiratory and learning disability psychiatry, and palliative care services provided in hospital. The indicative ‘set aside’ budget for large hospital services which are used in a predominantly unscheduled way in 2018/18 is £19.3M for East Ayrshire.

This Financial Framework provides the context for our commissioning intentions over the course of the 2018-21 Strategic Plan. The commissioning implications of these priorities are set out in Section 9 – 12. This takes into account related system-wide change programmes.

As summarised in Section 4, our Strategic Priorities are:

• Prevention and Early Intervention; • New Models of Care; • Building Capacity in Primary and Community Care, and; • Transformation and Sustainability.

Our commissioning intentions over the 2018-21 period will focus on the ‘triple aim’ set out in the Health and Social Care Delivery Plan. The triple aim can be summarised as:

• ‘Better Care’ - improving the quality of care by targeting investment at improvement and delivering the best, most effective support; • ‘Better Health’ - improving health and wellbeing through support for healthier lives through early years, reducing health inequalities and focusing on prevention and self-management, and; • ‘Better Value’ – increasing value and sustainability of care by making best use of available resources, ensuring efficient and consistent delivery, investing in effectiveness, and focusing on prevention and early intervention.

Partnership working extends beyond our own services and includes close working with Education, Vibrant Communities, leisure and the Third and Independent sectors. The latter often support the delivery of innovative responses to need within our localities.

The indicative consolidated budget for 2018/19 is shown in the table below:

2018/19 2019/20 2020/21 2018/19 2019/20 2020/21 2018/19 2019/20 2020/21 Draft Indicative Indicative Draft Indicative Indicative Approved Indicative Indicative Budget Budget Budget Budget Budget Budget Budget Budget Budget HSCP HSCP HSCP Health Health Health EAC EAC EAC £m £m £m £m £m £m £m £m £m

Level One Core Adult Support and Protection 0.190 0.190 0.190 0.000 0.000 0.000 0.190 0.190 0.190 Learning Disabilities 14.587 14.587 14.587 0.507 0.507 0.507 14.080 14.080 14.080 Mental Health 4.961 4.961 4.961 2.071 2.071 2.071 2.890 2.890 2.890 Physical Disabilities 2.320 2.320 2.320 0.000 0.000 0.000 2.320 2.320 2.320 Older People 34.882 34.882 34.882 0.000 0.000 0.000 34.882 34.882 34.882 Addiction 1.310 1.310 1.310 1.123 1.123 1.123 0.187 0.187 0.187 Sensory 0.187 0.187 0.187 0.000 0.000 0.000 0.187 0.187 0.187 Community Nursing 3.413 3.413 3.413 3.413 3.413 3.413 0.000 0.000 0.000 General Medical Services 15.558 15.558 15.558 15.558 15.558 15.558 0.000 0.000 0.000 Health Improvement 0.307 0.307 0.307 0.000 0.000 0.000 0.307 0.307 0.307 Prescribing 25.678 25.678 25.678 25.678 25.678 25.678 0.000 0.000 0.000 Service Strategy (HSCP Management) 7.039 7.039 7.039 0.815 0.815 0.815 6.224 6.224 6.224 Transport 0.470 0.470 0.470 0.000 0.000 0.000 0.470 0.470 0.470 Integrated Care Fund 2.470 2.470 2.470 1.264 1.264 1.264 1.206 1.206 1.206 Resource Transfer 10.473 10.473 10.473 10.473 10.473 10.473 0.000 0.000 0.000 Total Level One 123.845 123.845 123.845 60.902 60.902 60.902 62.943 62.943 62.943 Level Two - Non District General Hospitals East Ayrshire Community Hospital 2.960 2.960 2.960 2.960 2.960 2.960 0.000 0.000 0.000 Kirklandside Hospital 1.187 1.187 1.187 1.187 1.187 1.187 0.000 0.000 0.000 Total Level Two 4.147 4.147 4.147 4.147 4.147 4.147 0.000 0.000 0.000 Level Three - Hosted Services Primary Care (Including Dental) 68.930 68.930 68.930 68.930 68.930 68.930 0.000 0.000 0.000 Prison and Police Healthcare 3.007 3.007 3.007 3.007 3.007 3.007 0.000 0.000 0.000 War Pensioner 1.224 1.224 1.224 1.224 1.224 1.224 0.000 0.000 0.000 Other Lead Services 0.318 0.318 0.318 0.088 0.088 0.088 0.230 0.230 0.230 Total Level Three 73.479 73.479 73.479 73.249 73.249 73.249 0.230 0.230 0.230 Level Four - Children's / Justice Services Children & Families / Women's Services 17.694 17.694 17.694 0.000 0.000 0.000 17.694 17.694 17.694 Outwith / Secure Placements 4.791 4.791 4.791 0.000 0.000 0.000 4.791 4.791 4.791 Health Visiting 2.278 2.278 2.278 2.278 2.278 2.278 0.000 0.000 0.000 Justice Services 1.875 1.875 1.875 0.000 0.000 0.000 1.875 1.875 1.875 Total Level Four 26.638 26.638 26.638 2.278 2.278 2.278 24.360 24.360 24.360

Partnership Total 228.109 228.109 228.109 140.576 140.576 140.576 87.533 87.533 87.533

Section 9: Strategic Commissioning Intentions - Prevention and Early Intervention We will scale-up universal prevention and early intervention work across Work, Alcohol, Tobacco, Obesity and Mental Health (WATOM). We will work with LIST analysts, public health and business intelligence to define where interventions can be most effectively targeted. From initial analysis and self-evaluation our focus will be:

• Early years outcomes as a result of child poverty and deprivation; • Potentially preventable ill-health; • Higher levels of premature mortality (Cardiovascular and Respiratory disease); • An ageing population and multiple long-term conditions.

Achieving this will require collaboration across Community Planning Partners and within Localities. This will involve leadership from the workforce at every level.

It is widely recognised that the early years of a child’s life are of crucial importance and can affect future health, wellbeing and life chances. Our approach is to identify and respond to strengths, and to empower people, families/cares and communities to be in control of their lives, with access to opportunities and services (where required).

This means shifting resources from crisis intervention to family and community support, which facilitates earliest possible identification of the need for additional support. Based on evidence of the challenges that our children and young people face in terms of poverty, safety, educational attainment and wellbeing, our priorities are:

• Youth Employment • Tackling child poverty • Alcohol and Drugs

In addition to these high level priorities, our Children and Young People’s Service Plan has developed priorities for further improvements, with a key focus on: raising educational attainment, particularly in respect of looked after children; improving emotional wellbeing, and; improving opportunities for looked after children.

Prevention and early intervention is a positive choice in the current resourcing context. With the embedding of prevention and earlier identification of need for support we can offset the need for more intensive or acute involvement at a later date. Prevention and early intervention assists with managing demand, releasing resources and improving outcomes in the longer term.

Part of this relates to stretch aims within the Children and Young People’s Service Plan. Specifically this includes the aim to reduce smoking and alcohol consumption in pregnancy and to increase exclusive breastfeeding rates.

The expected effect of these stretch aim areas over the planning period would be to:

• Reduce the number of women smoking in pregnancy from 300 to 226; • Reduce alcohol use during pregnancy from 397 to 196, and; • Increase the number of women exclusively breastfeeding at 6-8 weeks from 201 to 333;

A range of prevention and early intervention programmes is in place with many developed from tests of change under the former Integrated Care Fund. There are proposals to extend this, for example, a diabetes prevention and early intervention programme focused on evidence-based activity to target Type 2 diabetes and gestational diabetes through unhealthy weight in pregnancy.

Working together to reduce the impact of the main public health and wellbeing challenges in East Ayrshire arising from higher levels of alcohol related harm, tobacco use and obesity is expected to have the following impact over the course of the Strategic Plan:

• Reducing alcohol-related admissions from 970 to 910 per annum; • Reducing the number of adults smoking from 20,188 to 17,665; • Improving levels of physical activity to reduce overweight and obesity in the population from 69,600 to 65,600, and; • Reducing the number of unscheduled mental health bed days occupied in hospital from 20,545 to 18,901.

A programme of health literacy, self-management, supported self-management for people with long-term conditions is expected to result in:

• An increase from 500 to 1,500 people engaged in a health literacy programmes, and; • A reduction in the number of bed days used as a result of admissions related to the main long-term conditions from 9,500 to 7,600.

The estimated potential annual costs avoided to health and social care in East Ayrshire of action to achieve these Strategic Commissioning Intentions in Prevention and Early Intervention are £1.3M in the first year, rising to £3.3M by year three. While not all of these are cash releasing they do all represent real cost avoidance to the health and social care system and the public purse.

It is expected that planned interventions in alcohol, mental health and long-term conditions management could release resources of £0.708M by year three. Over the lifetime of the Strategic Plan 2018-21 it is expected that arrangements will be agreed to enable further release of these efficiencies across the system of health and social care through invest to save programmes. Joint planning in relation to the ‘set aside’ budget will be a key mechanism for achieving this.

During the 2018-21 Strategic Plan we will:

• Scale up our joint approach to preventing and tackling ill-health in our communities linked to wellbeing, alcohol, tobacco, obesity and mental health. • Ensure all staff working within the HSCP including independent and voluntary sector and are trained on inequalities, cultural competence, human rights, equality and diversity. • Tackling inequality through addressing health literacy and raising awareness and capabilities of our workforce, spreading the use of health literacy tools, supporting accessible self-management tools and deploying new technology solutions. • Ensure that ethical care commitments/charters are embedded in partnership practices. • Advocate for and highlight the key opportunities that address inequalities.

Section 10: Strategic Commissioning Intentions - New Models of Care We are designing and implementing new approaches to our provision of health and social care services for older people and those with complex conditions, which is aimed at shifting the balance of care from hospitals to more homely and community-based settings.

Taking forward the Strategic Commissioning Intentions – New Models of Care is expected to increase the integration of services, improve multi-disciplinary working within localities and further strengthen partnership working between professions, individuals and communities.

The effect of implementation of the New Models of Care workstreams includes trajectories submitted to the Ministerial Strategy Group in relation to the indicators for ‘Measuring Performance Under Integration’. Expected impact over the course of the Strategic Plan includes:

• A four per cent reduction in unplanned bed days from baseline of 103,808 to 99,656; • A nine per cent reduction in emergency department from 40,865 to 37,187; • A reduction from 4,157 to 3,120 (25%) in occupied bed days where people spend longer in hospital than necessary and could be better supported in another setting due to incapacity law; • An increase in the number of days in the last six months of life spent in the community rather than large hospital setting from 227,041 to 236,805; • The delivery of a Care of the Elderly Physician, Advance Care of the Elderly practitioner model; • Embedding multi-disciplinary Care Home Liaison; • Commissioning Adults with Incapacity intermediate care bed provision; • Development of pulmonary rehabilitation model; • A reduction in the number of people placed in care homes from baseline of 725 to 700, and; • An increase in reablement and redirection through the new ‘front door’ model resulting in reduced demand for formal support at home.

The estimated potential annual costs avoided to health and social care of action to achieve these Strategic Commissioning Intentions in New Models of Care are £5.1M in the first year, rising to £6.7M by year three. While not all of these are cash releasing they do all represent real cost avoidance to the health and social care system and the public purse.

It is expected that the implementation of New Models of Care Strategic Commissioning Intentions could release resources of £1.4M by year three. Over the lifetime of the Strategic Plan 2018-21 it is expected that arrangements will be agreed to enable further release of these efficiencies across the system of health and social care through invest to save programmes. Joint planning in relation to the ‘set aside’ budget will be a key mechanism for achieving this.

During the 2018-21 Strategic Plan we expect:

• Implementing the East Ayrshire Models of Care Programme for Rehabilitation and Reablement. • Continuing to redesign intermediate care at home services, modernising day hospitals and developing community based rehabilitation. • Implementing the East Ayrshire Models of Care Programme End of Life Care workplan. • Establishing and implementing locality based multidisciplinary service delivery models. • Reducing inappropriate referral, attendance and admission to hospital, better signposting to ensure the right treatment in a timely fashion, and reducing unnecessary delay in individuals leaving hospital. • Working together to reduce the levels of delayed discharges, ensure services are in place to facilitate early discharge and avoid preventable admissions in the first place. • Maintaining upper quartile performance in delayed discharge bed days occupied.

Section 11: Strategic Commissioning Intentions - Building Capacity in Primary and Community Care Within Primary Care we are widening the concept of the Practice Team to ensure that patients benefit from a wider range of available support. Practices will typically consist of complementary teams of professionals led by a GP but supported by highly-trained nurses, physiotherapists, pharmacists, mental health workers and social workers.

At a national level the intention is to see investment in Primary and Community Care rising to more than half of frontline spending in health services and an increasing shift of the budget towards investment in mental health, primary, community and social care. There is a national commitment to increase investment in Primary and Community Care by £500M by the end of the Parliament.

A new General Medical Services contract is in place, with a new funding formula, covering a transitional period of three years which aligns with the lifespan of this Strategic Plan. There is a longer-term plan for shifting responsibility for premises to NHS Boards alongside the new contract.

The 2018 General Medical Services Contract in Scotland envisages a new role for the GP as an ‘expert medical generalist’. This means GPs focusing on complex care, quality and leadership.

An extended Multi-Disciplinary Team (MDT) in Primary Care will cover a number of activities which are at present generally undertaken by GPs. This will include prescriptions, minor illnesses, and chronic disease management. Further developments relate to pharmacotherapy, and community treatment and care, e.g., phlebotomy, minor injury.

It is expected that investment across NHS Ayrshire and Arran will be around £3.3M for 2018/19 rising in line with the national commitment to increase investment in Primary and Community care described above on the basis of NRAC share.

During the 2018-21 Strategic Plan we expect:

• MDTs to expand to include pharmacy and prescribing support, physiotherapy, mental health support and community link workers. • The specifics of these developments to be set out in a Primary Care Improvement Plan which will be put in place from July 2018. • To work with National Boards to realise the benefits of developments, e.g., Scottish Ambulance Service and NHS24. • There to be one coordinated Primary Care Improvement Plan for Ayrshire and Arran, with a focus on local priorities and delivery where services are commissioned within the HSCPs based on population need. Supporting this, there will be three distinct sections for each of the HSCPs to deliver the local needs of each IJB. • Governance arrangements (structures and reporting processes) to provide a programme approach for working together across the three HSCPs, the NHS Board, the GP Sub Committee to jointly produce the Primary Care Improvement Plan and allow for ratification by the IJBs and LMC. • The Primary Care Improvement Plan to be progressed through Workstream Implementation Groups established to design and implement the required changes to meet priorities. These include: • Pharmacotherapy Service; • Primary Care Nursing Services (will include two sub groups for the delivery of vaccinations and Community Treatment and Care services); • Urgent Care, and; • Practice Based Multi-disciplinary Team (includes Community Link Workers).

Section 12: Strategic Commissioning Intentions - Transformation and Sustainability As a Partnership we have undertaken significant work to understand our challenges and how we can best meet these within a new financial context while continuing to strive towards our ambitions. We need to close the financial gap and transform how we work to achieve sustainability.

The Medium Term Financial Plan has identified a future financial gap of £37.8M by 2021/22 if we continue to deliver as we have. The financial gap is driven by increasing demand, cost pressures and a constrained resource envelope available for delegation to the IJB by partners.

If we are to deliver on our ambitions we need to close the gap and achieve sustainability. The Partnership has developed a range of actions to make more efficient use of our existing resource and is taking these forward through a Strategic Commissioning Board.

This is only part of the solution. Annual operational efficiencies within Partnership will not be sufficient. Scaling up prevention and early intervention, new models of care and building capacity in primary and community care – will be critical to truly transform how we work and achieve sustainability.

From engagement on this Plan feedback is that we need to transform what we do while continuing to deliver and this requires us to create ‘space and resources to develop good ideas and innovate’ across all partners. We need to take a ‘whole system’ approach across services to avoid ‘unintentional consequences’ where ‘change in one area could have a negative impact in another’.

In transforming we will build on strong relationships and further developed this by working with communities linked to Community Led Action Plans to support capacity and self-care. Feedback tells us that we must continue to ‘ask members of the community’, to fully involve individuals, families and communities in co-design so that transformation is ‘done at a pace set by those affected to ensure readiness’.

From engagement we recognise a need to respond proportionately, to avoid overprescribing support and creating dependency. We need to value our preventative activity – ‘keep it simple but value it’ is a key message in transformation. Also that some people just need ‘a listening ear’. Throughout our transformation and sustainability work we will keep in mind that ‘kindness is important. The small things make a difference...It’s not about loads of money’.

Health and social care transformation will be an integral part of partner transformation programmes in NHS Ayrshire and Arran and East Ayrshire Council.

Relevant NHS Ayrshire and Arran Transformational Change Improvement Plan 2017-20 workstreams are: • Unscheduled Care including Older People and People with Complex Care Needs; • Ambitious for Ayrshire; • Mental Health, and; • Planned Care: Improving Access – The Modern Out-Patient.

Relevant East Ayrshire Council workstreams are: • A fairer, kinder and connected East Ayrshire; • Workforce planning – culture change and service redesign; • A digitally connected East Ayrshire; • A vibrant and empowered East Ayrshire; • Property and estates rationalisation, and; • Income and commercialisation.

The chart below shows the potential impact of transformation and sustainability activity across the Strategic Commissioning priorities set out in the sections above. These are real cost-reduction actions which can contribute to demand management while also meeting the terms of the ‘triple aim’ of:

300 29.5 13.0 18.9 21.4 21.2 250 13.5 11.4 219.8 200 219.8

150

100

The chart illustrates the emerging gap set out in the Medium Term Financial Plan as a result of increasing demand and cost pressures. The potential impact from the Strategic Commissioning Intentions of prevention and early intervention, new models of care and building capacity in primary and community care are built in to this model. Scaling up prevention and early intervention across the main challenges to wellbeing, alongside a proportion of the additional investment committed to Primary and Community Care and plans taken through our Strategic Commissioning Board have significant potential to close the projected gap. This will require agreement on invest to save programmes and joint planning on the set aside budget over the course of the Strategic Plan period.

Section 13: Locality Planning

Why is this important? We know that working in an integrated way at locality level is central to making these improvements. Partnerships across Scotland are required to divide their areas into at least two localities and national guidance gives clear direction on the purpose of locality planning groups within these arrangements:

A group of people who play an active part in service planning for the local population, in order to improve outcomes... A mechanism for local leadership of service planning, to be fed upwards into the Partnership’s strategic commissioning plan…Localities must have real influence on how resources are spent in their area.

Where are we now? Community Planning Partners in East Ayrshire, has also been prioritised working in localities as one the ways to encourage involvement and engagement by local communities. The Partnership’s locality arrangements work as part of this broader picture.

At strategic level, localities mean a co-ordinated approach to how we work across and with different organisations on a geographical basis, for planning purposes we have aligned these to aggregated Multi Member Wards.

Since the Partnership’s inception, progress has been made through consultation and engagement to understand local priorities, improving data to better understand population needs and establishing defined locality areas within East Ayrshire. The three East Ayrshire localities established are:

• Northern Locality (Annick and Irvine Valley) • Kilmarnock Locality • Southern Locality (Ballochmyle, Cumnock and Doon Valley)

Operationally, localities will be the setting for Partnership employees, primary care contractors, third and independent sector and community partners to make decisions and deliver service improvements. It is recognised that GPs are key contributors to achieving quality improvement and as such clusters of General Practices have been established and these align to localities.

Locality Planning Groups are operating in each of the three areas to map local assets and plan and implement proposals to deliver improvements for the identified local priorities.

The development of Locality Plans and working with all partners in an integrated way at locality level is allowing us to maximise the contribution of local assets including the third sector, volunteers and existing community networks. Our Community Connectors have forged links across sectors and are engaging with GP practices to access supports best suited to individual needs. Locality Planning Groups regularly feed into the Partnership’s Strategic Planning Group to inform the Partnership’s strategic commissioning activities. In turn, the Strategic Planning Group reports to both the Partnership’s governing body, the Integration Joint Board and to the Executive Officers Group of the Community Planning Partnership. Feedback is then built into Locality Planning Group business, which forms a cycle of influence for service planning and use of resources. These arrangements are illustrated in the diagram below:

influence local evidence resources

Community Planning Integration Joint Exec Group Board

Strategic Planning Group

Northern Kilmarnock Southern LPG LPG LPG deliver plan services improvements

Locality Planning Groups have an agreed programme of meetings and events. Each locality will have a Plan in place by April 2018. Each Locality Plan will consider the needs and priorities of the area, understand the assets available to make improvements, identify any gaps that exist and put forward proposals.

One of the ways in which localities directly influence services and resources is in the use of participatory budgeting. For 2017/18, Council Vibrant Communities, together with the Partnership have secured £91k from the national Community Choices Fund to invest in a locality-focused participatory budgeting programme.

Where do we want to be? Our outcome for locality planning is:

• Our communities, through Locality Planning Groups, are key participants in designing and delivering initiatives that achieve improvements for their health and wellbeing.

Section 14: Enabling Delivery - Workforce

Why is this important? Our workforce is our single most valuable resource and we are committed to ensuring we have the right people with the right skills in the right place at the right time.

To deliver our vision, our workforce will be required to do things differently and work in new ways. They will be flexible, appropriately trained and qualified, and motivated to drive change forward. The success of any transformational change relies on having an experienced, skilled, innovative and adaptable workforce.

We have and will continue to place our workforce and workforce development at the core of how we deliver positive outcomes for individuals and communities. We recognise that our workforce extends across all sectors and partners and value all contributions to the wellbeing of our population.

To ensure we are able to attract and retain the best workforce we need to be viewed as an employer of choice, where we invest in training and development, involve our workforce in the shaping of our future services and encourage challenge to the status quo to work in new innovative ways.

Given the current local and national workforce challenges and all the foregoing case for change, workforce planning is all the more important. Detail is available in our Workforce Plan 2018-21 [Link].

Where are we now? • Our Initial Workforce Plan 2016-18 set out our workforce position, our workforce planning challenges and our action plan at that time. • EAHSCP has employed a dedicated resource for workforce planning. • Many areas across the partnership have benefited from workforce position statements being undertaken including the following services: GP Primary Care, Care at Home, Corporate Parenting, Care Homes, Social Work Services, Ayrshire Urgent Care Services and Intermediate Care and Enablement. • These statements provide key workforce data highlighting any immediate and potential workforce challenges, such as turnover and ageing workforce, which will help inform future workforce plans. • A number of areas of pressure have been identified, including recruitment and development within the third and independent sector.

Where do we want to be? • An employer of choice attracting, retaining and development the right people. • Have skilled, motivated and flexible workforce to deliver the transformational change programmes. • Delivering new, efficient and creative ways of providing our future services, harnessing creativity across all partners. • Develop career pathways by investing in our personal development review processes. • Provide opportunities which enable people to move into a career with health and social care at any stage of their career, from school leavers to those looking for a career change. • Develop our workforce skills, providing training and creating roles to meet changing needs in a person-centred way within an integrated context, e.g., frailty, dementia, self-management. • Prevention/early intervention must be at the forefront of everything we do – signposting to appropriate services e.g. TEC

• Work collaboratively across the extended workforce to prepare for and deliver on new models of care, including with our third and independent sector partners. • Engage with our education providers to ensure education pathways are robust and fit for purpose. • Promote health and wellbeing and invest in resilience approaches for our workforce. • Promote and support integrated working from senior level throughout the organisation across sectors as well as internally.

How will we get there? Across all years it is imperative we continue to work collaboratively with our NHS Ayrshire and Arran, North Ayrshire HSCP, South Ayrshire HSCP, third party and independent sector partners. We will work within the direction of our local plans including our Strategic Plan, People Strategies and Transformational Change Programme.

• Implement the National Health & Social Care Workforce Plan. • Develop EAHSCP Workforce Plan. • Develop a training plan across partnership to include prevention/early intervention. • Prepare and progress workforce plans for areas of transformational change e.g. Multi Disciplinary Team workforce in Primary Care setting to release GPs to deal with complex care, develop Ayrshire Urgent Care Service workforce plan. • Review personal carer workforce. • Engage with Education Providers to produce a robust pathway with generic focus to allow flexibility in the workforce and design and create opportunities in education for new roles. • Deliver a health, wellbeing and resilience programme with and for our workforce, taking into consideration the impact of demographic change on the workforce. • Optimise Recruitment and Retention. • Explore expansion of Modern Apprenticeships, graduate programme and work experience opportunities. • Conduct review of workforce with third and independent sector partners and develop flexible methods for developing the workforce. • Prepare and progress workforce plans for next areas of transformational change. • Prepare a holistic workforce plan inclusive of third and independent sector partners. • Include third and independent sector partners in recruitment initiatives where appropriate.

Section 15: Enabling Delivery - ICT

Why is this important? Developments in Information Communication Technology and other digital technologies present great opportunities to enhance how people are supported and how the workforce communicates.

At a national level there is a concerted effort to transform business systems using modern digital delivery. The aim is to automate processes, promote self-service and improved access to a single source of information. New technology will be used to improve personal experience, reduce processing, duplication, and free-up time to care. Software systems will be increasingly integrated covering HR, payroll, finance and data under a ‘Once for Scotland’ approach.

Part of this relates to the procurement of a Social Work Management Information System. East Ayrshire Health and Social Care Partnership the Social Work Service utilises a computerised management information system for the creation, management and storage of personal records to ensure that all contact with individuals who are referred to and use services is recorded effectively and appropriately. The system records information across the social work functions of Community Care, Children and Families and Justice Services. The system is also integral to the production of performance monitoring and operational management information.

Where are we now? A two year extension to the support and maintenance contract, for the Swift System was approved in August/September 2016. This contract expires in March 2019. This was to allow time for a specification of requirements to be developed in collaboration with all services within the Partnership. Following approval in late 2017, East Ayrshire Health and Social Care Partnership will tender within the Crown Services Commercial Services Framework to obtain a contract for a Social Work Management information System. This will be taken forward in 2018.

Where do we want to be? To support integration we will to ensure that the successful contractor’s system has the ability to integrate with Partner Agency Systems i.e. the AYRshare System which is a Pan Ayrshire System which allows secure sharing of information between NHS Ayrshire & Arran; East Ayrshire Council Education Services and Partnership Social Care Services in relation to the GIRFEC Principles. The system will have the ability to integrate with Health and Social Care Systems e.g. FACE and EMIS.

How will we get there? • Business Support Services will lead on the implementation of a new system with additional capacity invested in over the 2017 and 2018. • This will include Project Management to ensure progress against timescales, testing, training and implementation together with business support to enable the migration of data.

Section 16: Enabling Delivery - Premises and Estates

Why this is important? We need to ensure that our estates, the buildings used for delivering health and care in East Ayrshire, are used efficiently and are suitable for our current and future needs. Since the publication of CEL 35 (2010) it has been mandatory for all Health Boards in Scotland to have a Property and Asset Management Strategy (PAMS). There is a requirement for this to be updated annually, either as a full PAMS document or a highlight report, and submitted to Scottish Government Health and Social Care Directorate.

Where are we now? A PAMS Group has been created to collate data on behalf of NHS Ayrshire and Arran for inclusion in the Boards PAMS submission to Scottish Government. The PAMS Group are required to provide information as noted within the PAMS Guidance, issued by Health Facilities Scotland (2016). The East Ayrshire Health & Social Care Partnership is part of this group and the Partnership’s High Level List of Significant Projects has been agreed by the Partnership Management Team.

Where do we want to be? We want to have a sustainable estate that is ‘fit for purpose’, that Partnership services occupy efficiently. We want to deliver health and social care services from premises that support integrated working and the wellbeing of our workforce and communities. The aim is to complete the Partnership’s Significant Projects within the timescales contained within the PAMS. This is set out in our PAMS [Link].

How will we get there? East Ayrshire Health and Social Care Partnership will contribute to the delivery of the PAMS through a number of groups which are responsible for progressing the significant projects in line with timescales identified. These are:

• The Partnership Premises and Accommodation Group; • the Bentick and North West Kilmarnock Area Centre Steering Group, and • The Johnnie Walker Bond and Rothesay House Short Term Working Groups.

Section 17: Enabling Delivery - Thinking Differently

Why this is important? The number of people who require support from health and social care services continues to grow. Alongside this, there are more people with more than one long term health condition living in East Ayrshire meaning that they often need support from health and/or social care services.

East Ayrshire Health & Social Care Partnership is passionate about helping people to have a good life and reducing health and social inequalities. We are keen to think differently and more creatively about how best to use our resources and work alongside people who use our services in order to empower them and increase their independence.

In East Ayrshire, there is a number of key areas we have identified as important:

• People who use services and their families having more choice and control in setting goals and in designing services/supports to best achieve them. • Building confidence in using technology to support people to manage their own condition, become more independent and to make sure that people get the right support in the right way at the right time. • Recognising, empowering and supporting carers and young carers to improve their health and wellbeing and have a life alongside their caring role.

Where are we now? A Thinking Differently Programme Board is established to share learning and promote personalised and creative solutions. Dedicated Peer Support for Workforce to think differently and transform our services to meet future needs and outcomes. The number of people using technology to maximise their independence continues to grow. There is slow but steady increase in the numbers of children and young people using technology.

Where do we want to be? • Increased number of people using technology to manage their health condition at home. • Managing the transition from analogue to digital. • Empowering individuals and families to access mainstream technology to maximise independence and reduce need for formal supports. • More people will be getting the right support in the right way at the right time. • Dedicated Thinking Differently Resource to work alongside children, young people, their families and the multi-agency team around each child. • More individuals having choice and control • Implementation of our Carers Strategy • Increased confidence and permission to ‘think differently’ amongst the wider workforce

How will we get there? • Develop and implement East Ayrshire Carers Strategy 2018-2020. • Increase the number of people using be-spoke technology enabled care solutions. • Assess the impact of technology enabled care on digital inclusion. • Increase the number of people using SDS Option 1, 2 and 4. • Invest in a dedicated Thinking Differently Resource for Children, Young People and their families. • Roll-out a ‘Think TEC first’ campaign. • Integrated health and social care risk management response across East Ayrshire. • Embed the use of technology in the ‘front door’ point of contact for health and social care. • Consider the implications of and plan for the transition from analogue to digital. • Smart Technology Homes.

Section 18: Enabling Delivery - Housing Contribution

Why is this important? Housing Services in East Ayrshire play an important role in contributing to the outcomes and priorities identified within this Strategic Plan.

Where are we now? Housing Services work in partnership with health and social care services to support planning for future housing solutions and to deliver and enable services that support people to live independent lives and achieve their full potential. A Housing Contribution Statement has been produced and refreshed. The Housing Contribution Statement reinforces the strong linkages between housing, health and social care. The contribution made by East Ayrshire Council Housing Department towards achieving the nine national ‘Health and Wellbeing Outcomes’ is evidenced by the wide range of housing services delivered to support the health and wellbeing of our residents. These include an increase in the number of homes being built to wheelchair standard and for varying needs and the provision of bespoke housing solutions for people with learning and/or physical disabilities and for people with complex needs.

Where do we want to be? The aim is for everyone in East Ayrshire to have access to affordable quality homes that meet their needs and aspirations. Housing services contribute to the wellbeing of people through affordable, energy-efficient homes and through supporting people to live independently in suitable accommodation or with appropriate support where required. Realising the wider contribution of housing, including Registered Social Landlords (RSLs), to wellbeing in terms of the regeneration, re-provisioning of housing and the positive impact of this in creating strong, sustainable communities.

How will we get there? In the period 2018-2021 a number of joint projects will be undertaken by the Partnership and Housing Services to support people in East Ayrshire to live independent lives and achieve their full potential. These include; . Supported accommodation project in Hurlford that will promote independence for adults with additional support needs. . Supported accommodation project in New Cumnock providing an assisted living model. . Supported accommodation project in Kilmarnock where Registered Social Landlords will provide assisted living model for older people. . Supported accommodation project in Mauchline will be developed for assisted living model

The full Housing Contribution Statement is available here: East Ayrshire Housing Contribution Statement 2017

Section 19: Enabling Delivery – Leadership and Improvement The success of the strategic planning arrangements are underpinned by strong leadership across all sectors, working together within services, in hospital settings, with the third and independent sector and with partners in communities.

Our approach to leadership is based on shared values where individuals, families and carers are key partners in shaping and developing services focused on shifting the balance of power and creating equitable relationships.

The prevention and early intervention approach, working alongside residents in local communities to develop new community based activities, will support people to maintain their health and wellbeing and reduce reliance on services. This is the basis of transformation.

Transformation will require leadership from the whole workforce at all levels. To support this we will:

• Build leadership capacity to deliver on the transformation agenda set out in this Strategic Plan; • Develop leadership commitment to prevention and early intervention; • Deliver a consistent, targeted and accessible set of messages across partners promoting our vision, priorities and progress; • Create opportunities for creative and innovative ideas to be generated and harnessed; • Develop learning and development opportunities across the workforce in relation to prevention, early intervention, promoting wellbeing and self-management; • Support prevention and early intervention through case-finding/risk stratification methods to identify people at greater risk of experiencing reduced independence; • Maintaining the current level of investment in prevention and early intervention within the Partnership while identifying opportunities to increase this.

There is a range of ways used to ensure we can report and measure how we are doing and ensure we continue to improve. We engage in dialogue with people who use our services, families, partners in communities, third and independent sector. These include annual public events ’Local Conversation’, ‘BIG Plan Day’, the ‘Connecting to Change Group, Quality Checkers and the Stakeholder Forum.

During the course of this Plan:

• We will engage with national improvement support agencies such as the Improvement Service and Health Improvement Scotland’s Improvement Hub (iHub), Care Inspectorate, Scottish Social Services Council (SSSC) in relation to care delivery and system enabler programmes; • We will work to ensure that a culture of evidence-based, continuous improvement is supported with business intelligence, analysis, performance reporting and programme management; • We will collaborate with colleagues in North and South Partnerships and in Acute Hospital services to develop test quality improvements across the system and support new and sustainable models of care.

Locality Planning If you would like to get involved in Locality Planning, or would like more information, please contact us on: [email protected],

or Telephone: 01563 576000, asking for the Health and Social Care Partnership admin team, or by Textphone: 01563 576167

Our Voice ‘Our Voice’ is a national initiative with the purpose of engaging with people to improve health and social care. The HSCP will be building on locality engagement to develop the community network contribution to ‘Our Voice’.

Address: Our Voice, Delta House, Level 4, 50 West Nile Street, Glasgow G1 2NP

Visit: http://www.ourvoice.scot/our-voice

Email: [email protected]

Telephone: 0131 623 4503

Appendix II

Workforce Plan

2018-2021

Getting the right people with the right skills in the right place at the right time, to deliver sustainable and high quality health and social care services for the people of East Ayrshire

Our Workforce Delivering Our Future

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Message from the Director

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Contents

1. Why Workforce Planning? ...... 4 2. Our Demographics ...... 5 2.1. Our Local Population ...... 5 2.2. Our Current Workforce ...... 6 2.3. Partners ...... 9 2.4. Local Labour Market & Employability ...... 10 3. National Strategy ...... 12 3.1. National Health and Social Care Workforce Plan ...... 12 3.2. Safe Staffing Legislation ...... 12 3.3. NHS Scotland’s Everyone Matters - 2020 ...... 12 4. Drivers for Change ...... 12 4.1 Demographic change ...... 12 4.2 The Health and Social Care system ...... 13 4.3 Quality & efficiency ...... 13 4.4 Financial context ...... 13 5. Transformational Change ...... 14 5.1. Where are we now? ...... 14 5.2. What will we do? ...... 15 5.3. How will we do it? ...... 17 5.4. Risks ...... 17 6. Our People ...... 18 6.1. Our Values ...... 18 6.2. Organisational Development ...... 18 6.3. Human Resources ...... 19 6.4. Workforce Development ...... 20 6.5. Health, Wellbeing & Resilience ...... 20 6.6. Equality ...... 20 6.7. Trade Union/Partnership Working ...... 21 7. Defining the Required Workforce ...... 21 8. Pan Ayrshire Approach ...... 21 9. Conclusion ...... 21 Appendix 1 ...... 23

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1. Why Workforce Planning?

The East Ayrshire Health and Social Care Partnership Strategic Plan 2018-21 centres around the vision of the Partnership: ‘Working together with all of our communities to improve and sustain wellbeing, care and promote equity’.

We are responsible for delivery of the Wellbeing objectives of the East Ayrshire’s Community Plan 2015-30 along with our Community Planning Partners. These are:-

• Children and Young People, including those in early years, and their parents / carers are supported to be active, healthy and to reach their potential at all life stages; • All residents are given the opportunity to improve their wellbeing, to lead an active healthy life and to make positive lifestyle choices; • Older people and adults who require support and their families and carers are included and empowered to live the healthiest life possible, and; • Communities are supported to address the impact inequalities has on the health and wellbeing of our residents.

The long-term aim for health and social care in Scotland1 is for people to live longer, healthier lives at home or in a homely setting and have a health and social care system that:

In order to achieve this, a programme of transformational change is already underway.

At the heart of this is our single most valuable resource, our workforce. We are committed to ensuring we have the right people with the right skills in the right place at the right time, to deliver sustainable and high quality health and social care services for the people of East Ayrshire.

To make certain we are able to attract and retain the best workforce we will be viewed as an employer of choice, where we invest in training and development, we involve our workforce in the shaping of our future services and we encourage them to challenge the status quo and deliver services in new, innovative ways.

East Ayrshire Health and Social Care Partnership has, and will continue to place, workforce and workforce development at the core of how the partnership delivers on positive outcomes for individuals and strategic priorities.

1 Health and Social Care Delivery Plan – December 2016 4 Version 1.6 Draft

Our workforce planning requires to be integral not only to transformational change through the Integrated Joint Board but also the Transformational and Sustainability programmes of East Ayrshire Council and NHS Ayrshire and Arran.

To successfully deliver our transformational change programme our workforce will be required to do things differently and work in new ways. They will be flexible, appropriately trained and qualified, and motivated to drive forward change. We will rely on having an experienced, skilled, innovative and adaptable workforce doing new and different things.

Workforce planning is critical for success. It is dynamic, evolving and needs to be robust, whilst adaptable and affordable. Within the transformational change programme, individual services will develop their own bespoke workforce plans tailored to meet the workforce challenges relating to their contribution to delivery of the overall programme. These plans will link back to this plan to ensure an integrated and consistent approach.

This Workforce Plan outlines the main challenges we will face over the next 3 years, the key actions to be taken and the stakeholders involved to help address these. There are national and local policies and drivers that influence this plan which are referred to later in this plan. It is a work in progress and will remain flexible enough to support the continuing fluctuations within our service delivery.

2. Our Demographics

It is widely documented that Scotland’s population is ageing and the health needs of our older population is more likely to involve multiple complex conditions. This is reflected in our local population.

2.1. Our Local Population

National Records Scotland2 estimate from 2014 to 2039 the population in East Ayrshire will decrease by nearly 4%. Significantly the number of children (0-15) will decrease by 9%, those of working age will decrease by 11%, but pensionable age and over will increase by 21%. The number of people aged 75+ will increase by 77%. Chart 1 plots this change against Scotland and Ayrshire & Arran (A&A).

Chart 1 - Estimated Change in Population from 2014 - 2039 (Source: National Records of Scotland) East Ayrshire Scotland A&A

1% 1%21%28%21%77%85%82% -9% -11%-11%-13%

2 National Records of Scotland: Population Projections for Scottish areas (2014 based) 5 Version 1.6 Draft

The age range prediction for 2039 for A&A and EA as reported by National Records Scotland is shown in Chart 2. It should be noted that pensionable age projections take account of legislative changes3.

Chart 2 - Age Structure - EAC & A&A

Children (0-15) Working Age Pensionable Age & Over

A&A 2014 16.8% 60.2% 23.0%

A&A 2039 15.8% 55.0% 29.3%

EAC 2014 17.3% 61.9% 20.8%

EAC 2039 16.4% 57.4% 26.2%

A recent review of those aged 65 and older shows, whilst life expectancy in East Ayrshire is similar to the Scottish figures, table 1, the percentage of other key indicators are significantly higher within our population.

Table 1 - East Ayrshire Older Age Profile: Health, July 2017 East Ayrshire Scotland Ayrshire & Arran Male 76.1 76.5 76.6 Life expectancy Female 80.2 80.7 80.8

% of 65+ population with 1 or more long term health conditions 68.6% 66.7% 65.8% % of 65+ population physically limited by long term health conditions 58.2% 54.9% 53.2% % of 65+ population at risk of hospital admission / readmission (SPARRA score = >40) 10.4% 9.8% 8.2%

This shift in population will exert pressure on both health and social care services. The effect of the changing demographic is twofold, not only in relation to demand on services but also on the workforce, recognising that a significant proportion of our workforce is part of the local population and more people now choose or require to work past retirement age. This is this is one of the key reasons why prevention and early intervention is imperative, so we can help to keep people as well as possible.

2.2. Our Current Workforce

Headcount

3 By 2020 the pensionable age for women will rise to 65 and between 2024 and 2046 state pension age will increase to 68 for both sexes. 6 Version 1.6 Draft

At September 2017, 1742.23 whole time equivalent employees (wte), 2209 headcount, worked across 6 service areas (chart 3)4 within the Partnership. The majority, 56%, are employed within Community Health and Care Services. Chart 3 – Workforce Composition by Service Headcount WTE

1279 979.89

365 171 332.39 354 242.63 148.84 34 6 6.00 32.48

Business Childrens Community Directorate Planning & Primary Care Support Healthcare & Health & Care (H&SCP) Performance Services Justice Services Services

Personal Carers are the largest group of employees and comprise 23% of the total wte workforce. Social Workers and District Nurses are the next largest groups at 8% and 6% retrospectively.

Gender and Contract Type

Charts 4 and 5 show the workforce is largely female (87%) and part time (57%).

Chart 4 - Full/Part Time Split Chart 5 - Gender Split Fulltime Parttime Male Female

87% 57% 43% 13%

Chart 6 shows the split by service highlighting which areas have a predominately part time workforce.

Chart 6 - Gender & Contract type by Service Female FT Female PT Male FT Male PT 2% 4% 3% 3% 12% 7% 6% 19% 21% 6% 29% 33% 24% 15% 65% 56% 62% 53% 67% 62% 27% 26%

Business Support Childrens Community Directorate Planning & Primary Care Healthcare & Health & Care (H&SCP) Performance Services Justice Services Services

4 Does not include sessional or bank staff 7 Version 1.6 Draft

Age Profile

As already highlighted, the age profile of our workforce is a concern as there is a risk that as they leave the service it will be difficult to replace the skills and expertise we currently enjoy. Nearly half, 46% of the entire workforce is aged 50 years or more (chart 7).

Chart 7 - Age Split 16-49 50+

54% 46%

Each service has at least a third of its workforce in this age bracket (chart 8). Some groups have a higher proportion including Personal Carers (55%) and District Nurses (48%).

Chart 8 – Age Composition by Service 16-39 40-49 50-59 60+

Primary Care Services 25% 31% 34% 10% Planning & Performance 41% 18% 32% 9% Directorate (H&SCP) 50% 50% Community Health & Care Services 22% 28% 38% 11% Childrens Healthcare & Justice Services 36% 26% 31% 7% Business Support 44% 21% 27% 8%

Salary

The National Minimum Wage (NMW) is £7.05 per hour for those aged 21 and over, increasing to £7.50 for those 25 and over. Scottish Living Wage (SLW) is currently £8.75 per hour. The pay structure used in NHSAA consists of Bands (1 to 9) and in EAC contains Grades (1 to 16). The bands and grades which encompass NMW to SLW are up to and including Band 2/Grade 3. Chart 9 highlights over one third, 39%, of employees fall into this category.

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Chart 9 – Workforce within NMW/SLW Category Meeting Criteria for NMW/SLW Other

39%

61%

Sickness Absence

Sickness absence rates are recorded differently within NHS A&A and the Council. For 2016/17 the sickness absence for NHS A&A employees within the partnership was 5.35%, a decrease of 0.47% from 2015/16. The national target for sickness absence within the NHS is 4%.

In the Council there was an increase in 2016/17 of 0.44% from the previous year. Chart 10 shows the trend for each organisation.

Chart 10 – Sickness Absence NHS EAC

5.82% 5.35%

3.69% 4.13%

2015/16 2016/17

It is important we focus on and promote the health, safety and wellbeing of our workforce to support them to keep well.

2.3. Partners

Health and social care integration is not exclusive to Local Authority and NHS, true integration is much wider than these organisations and includes our independent sector colleagues such as Primary Care Service providers, Care Home Providers, Care at Home Providers and our many voluntary organisation partners who provide vital support within the community. All sectors are vital contributors to designing and delivering a sustainable and improved service and are very much viewed as equal partners in the delivery of our transformational change programme. Currently we have limited information regarding the workforce not employed by NHS A&A or the Council as it is essential to understand the workforce implications, capacity and ability as we transfer the balance of care from Acute (hospital) services to community services. We are committed to support our third and independent sector colleagues with workforce planning and are working with these partners to collate a full picture of the health & social care workforce within East Ayrshire to inform robust workforce plans. Some examples of which are:

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 Primary Care and Out of Hours Community Response

East Ayrshire Health and Social Care Partnership is the lead partner for Primary Care and Out of Hours Community Response services across Ayrshire and Arran. This includes independent services such as Dental Services, General Practice, and Pharmacy.

In light of difficulties replacing GPs we have successfully profiled the workforce within our A&A General Practices. The following key areas reflect the national picture:

• an ageing GP workforce – over one third of GPs are over 50 years old, with 6% being over 60 years • part time working prominent within GPs - two thirds of GPs are part time • an ageing practice nursing workforce - 52% aged 50 years or more (7% are 60 years plus) • majority of nurses are part time females - 1% are male, 78% are part time

This information allows us to proactively seek solutions and provide support to our General Practice Community including:

• Maximise Recruitment and Retention of GP trainees • Design and Delivery of an Advanced Nurse Practitioner Academy • Develop Multi-Disciplinary Team Working • Workforce Planning for Practice Nurses

 Care Homes

Our Care Home providers also face workforce challenges one of which is difficulties recruiting Nursing Staff.

We are working with these partners to obtain and analyse the workforce data. This will provide evidence to inform collaborative discussions with the Care Homes and with our Scottish Care colleagues around how we manage these challenges. This could involve developing a recruitment campaign encouraging entry to all nursing professions including Community Services, Care Homes, General Practice and Acute services, integrated training and development opportunities and liaising with our college and university partners to review the education pathway and links to all sectors.

Success of delivery of the partnership goals relies on all sectors working together to ensure we have a flexible, robust, fit for purpose workforce.

2.4. Local Labour Market & Employability

Economic inactivity considers individuals who may be inactive for a variety of reasons: long- term illness or disability, studying, staying at home to look after family, or retired. Although this group are not considered an active part of the labour supply, given how dynamic the labour market is with people continuously moving between different categories it is important to consider them as they include those who may make up the future labour supply and those who were part of the labour supply in the past.

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East Ayrshire has the third highest rate of inactivity in Scotland5, 28.2% and is 5% higher than Scotland as a total (table 2).

Table 2 - Inactivity Rate 2016 (16-64yr olds) 28.20% 23.20%

East Ayrshire Scotland

The actual unemployment rate for East Ayrshire is illustrated below and, although it has improved slightly in the last 12 months, it is the fifth highest in Scotland. Whilst this potentially provides an increased supply in the local labour market it takes no consideration of existing skills, qualifications or suitability within the local population.

Table 3 – Out of Work Benefit Claimant rates as at October 2017 (source: Office of National Statistics) Area Rate Number of Variance (%) claimants compared to (16 years +) Oct 16 East Ayrshire 3.1 2375 -0.1% North Ayrshire 3.7 3125 -0.4% South Ayrshire 2.2 1515 -0.3% Scotland 2.2 76970 0.0%

Employment is one of the most strongly evidenced determinants of health, the World Health Organisation notes that ‘unemployment puts health at risk’ and ‘unemployment has a direct bearing on the physical and mental health and even life expectancy for unemployed people and their families’. Unemployment therefore has a direct impact upon service provision and we must support employability across Ayrshire.

A key challenge is to maintain a skilled workforce to meet current demands, whilst adapting, supporting and growing this workforce to achieve the vision of the partnership. This needs to be done considering the following: • Meeting the needs of an ageing population with an ageing workforce; • The changing demand resulting from an increasing prevalence of complex long-term conditions and co-morbidities, dementia and frailty; • Meeting user expectations as they influence the care they receive; • Transformation that sees the person as the expert in their own care and a move towards supported self-management.

5 Annual Population Survey 2016, National Statistics 11 Version 1.6 Draft

3. National Strategy

3.1. National Health and Social Care Workforce Plan

Workforce Planning is already challenging in the current climate and is further complicated by incorporating multiple organisations and a commitment to a fast paced transformation programme. To help support integrated workforce planning across health and social care a National Health and Social Care Workforce Plan is currently in development:

• Part 1 – Framework for improving workforce planning across NHS Scotland, June 2017 • Part 2 – Framework for improving workforce planning for Social Care in Scotland, Dec 2017 • Part 3 – Framework for improving workforce planning in Primary Care - due early 2018

The intention is this will be an evolving document which will improve and strengthen workforce planning across the health and social care partnerships. A National Workforce Planning Group has also been created to consider issues and barriers that can’t be addressed locally.

3.2. Safe Staffing Legislation

In April 2017 the Scottish Government consulted on Safe and Effective Staffing in Health and Social Care. The proposal is to set out a Safe and Effective Staffing Bill which sets intention to legislate across the health and social care landscape to build on and strengthen existing mechanisms in place to ensure and assure appropriate staffing for high quality care and to enable further improvements in workforce planning.

3.3. NHS Scotland’s Everyone Matters - 2020

The Workforce Vision Plan 2018-20 from Everyone Matters continues to deliver an implementation plan for NHS boards in relation to 5 key workforce priorities:

 Health Organisational Culture  Sustainable Workforce  Capable Workforce  Workforce to Deliver Integrated Services  Effective Leadership and Management

4. Drivers for Change

Currently the drivers for change influencing the shape of the workforce are:

4.1 Demographic change (detailed in section 2) highlights our ageing population and workforce and increased complex conditions including dementia and frailty within our elderly population. Our workforce will design and adapt to new ways of service delivery for our users as they deal with more complex situations. We will move away from traditional ‘done to’ methods and educate and support our workforce to promote self- management, prevention and early intervention to keep our population well. Managing

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our users’ expectations will be challenging as we redesign our services. In addition as 46% of our workforce is over 50 and some likely to be affected by complex health conditions now or in the future, there may be implications on their ability to carry out their roles.

4.2 The Health and Social Care system focuses on Prevention and Early Intervention. The workforce will be able to support implementation of approaches and interventions which seek to improve health and reduce inequalities. This is a shared responsibility of the entire workforce across all sectors. New, integrated, innovate ways of working are already emerging across traditional boundaries such as multi-disciplinary teams and will continue to do so. We are encouraging our users and their families to be involved in decisions about their own health and social care journey which is a relatively new approach for many professionals where historically people would be told what treatment/care they would receive. Our workforce will be equipped to support this way of delivering care and have the appropriate skills and knowledge to ensure informed decisions are made inclusive of and to the benefit of the user.

4.3 Quality & efficiency is intrinsic to deliver better care, better health and better value. Traditional ways of delivering care will be challenged and redesigned to include new technologies and prevention techniques and to consider the whole system across all sectors. Any changes made will deliver improved outcomes and be financially viable which include changes to the workforce. We need to be able to measure the impact of the changes to ensure they provide an improvement and benefit to the users and to how we deliver our services.

4.4 Financial context – there is ongoing uncertainty regarding future funding and it will be essential to match our Strategic Plan and service delivery with the resources available to us. Taking account of a number of underlying assumptions around future cost and demand pressures, as well as future funding, the indicative scale of the financial challenge was set out in the Medium Term Financial Plan 2017/18 to 2021/22 which was approved by the IJB on 30 November 2017. To meet this financial challenge, delivering services in a more streamlined and effective manner will be essential, the following being key considerations:

• Full review of all elements of the budget. • Review of demand drivers and impact on future costs to identify relevant mitigating actions. • Identify operational risks associated with potential reduced service provision. • Deliver the ambition of the IJB and a safe level of service within delegated resources for 2017/18 and going forward. • Compliance with Health and Care Delivery Plan (December 2016) – focus on set aside budget.

It follows that new service implementation needs to be robust, cost effective and sustainable. This will inevitably impact the workforce at some level.

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5. Transformational Change

East Ayrshire Health and Social Care Partnership is delivering a transformational change programme that is designed to provide new and innovative approaches to the delivery of health and social care services.

Both partner bodies have plans, NHS AA - The Transformational Change Improvement Plan 2017-20, and EAC – Transformational Strategy 2017-2022, which describe the planned transformational change that will deliver health and social care designed to meet the needs of the local population. There will be significant changes which make a positive impact on service delivery and it is essential that our workforce and our partners are engaged and involved in these discussions and decisions including associated workforce planning.

Effective workforce planning will be influenced by the output from the various projects in the transformational change programme.

Figure 1 – Ayrshire Transformational Change Programme Governance Strategic Planning & Operational Group (SPOG) Programmes Unscheduled Planned Care Older people Mental Children’s Primary Care Care – & people Health Services Outpatients with complex needs Support Planning & Finance Info Management / Workforce Performance IT / Communications

Within the pan-Ayrshire programme (figure 1) the Partnership has lead responsibility for Unscheduled Care, Primary Care and due to interdependencies is heavily involved in older people and people with complex needs. Our colleagues in North and South Ayrshire Partnerships and Acute Services have responsibility for the other programmes, although there is a united approach from all partnerships for all programmes.

5.1. Where are we now?

Some of our key challenges are:

 Our population has more complex health needs than before. We have many unavoidable admissions to hospital because of a lack of investment in infrastructure and workforce in the community which also delays patient transfer from hospital;  Shifting towards prevention and early intervention and focussing on efforts to keep the population well, whilst working within a system where the effort is often in relation to health care service provision and treatment;  Our general practices are usually the first point of contact within the community and are integral to successfully shifting the balance of care from Hospital to Community. However, there is a national shortage of GPs and in A&A over two thirds are aged 50 plus. Current vacancies are difficult to fill and we know it will not be possible to replace all GPs who retire or leave over the next 10-15 years; 14 Version 1.6 Draft

 Our workforce is aging and it is difficult to attract younger people to certain roles;  It can be difficult to retain experienced social workers in rural areas;  Inability to attract and recruit certain groups such as nursing staff in Care Homes;  There are major financial pressures on the Partnership and we need to close the financial gap and transform working to achieve sustainability;  Re-thinking and redesigning services to be enabling, integrated and person-centred;  Discussions with trade unions and HR representatives with a view to fully integrating the Business Support Administration and IJB Finance Service teams;  Consideration of the impact the Living Wage will have on lower graded posts;  Improving current flows and processes in light of the introduction of digitalisation;  Working groups are established to introduce a replacement for our current Social Work Information System (SWIFT) – with a view to integrating with NHS electronic systems and manual processes.

5.2. What will we do?

Some of the key service improvements we will implement are summarised below:

Unscheduled Care

 Reduce admissions and improve the patient experience by shifting the balance of care closer to people’s homes;  Promoting early intervention and prevention to keep people well and reduce the need to attend hospital where possible;  Where hospital treatment is necessary, ensure care and support is in place in the community to allow patients to be discharged at the right time;  Review our palliative and end of life care approaches to support people’s needs and wishes – a national pilot is currently being undertaken in the south of East Ayrshire.

Rehabilitation and Enablement

 Recruit additional staff once investment becomes available to shift the balance of our activity to prevention of admissions;  Provide learning and education to the workforce to enable this to happen effectively and in a supportive manner.

Models of Care – Older People and People with Complex Needs

 Redesigning our ‘Front Door Service’ as a smart and efficient way of serving our communities, promoting independence and community engagement;  Design New Models of Care which support our older people and those with complex conditions in a more homely and community based setting;  Promote early intervention and prevention to tackle the causes of ill health rather than treating the consequences;  Promote and use Technology Enabled Care to support people to lead a more independent lifestyle with less dependency on carers;  Work with our partners including education design career paths and deliver a robust recruitment campaign to attract younger people into the care sector. Primary Care

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 Continually promote early intervention and prevention when people access our primary care services;  Continue our development of Advance Nurse Practitioners (ANP) through our ANP Academy;  Enhance our multi-disciplinary teams where people see the most appropriate professional within the practice, not necessarily the GP;  Promote Know Who to Turn To campaigns, encouraging people to attend for treatment by other professionals in the community such as Opticians for eye problems, Community Pharmacists for minor ailments and Dentists for oral health issues. This re-direction relieves pressure on the GPs allowing them time to see those with complex needs;  Design and deliver services in the community which were traditionally delivered in a hospital setting to relive pressure from hospital services and also provide a more proficient service to those attending hospital appointments.

New General Medical Services Contract 2018

 Change will be the way people receive services such as vaccinations, repeat prescribing and medication reviews;  Community treatment and care services (e.g. minor injuries and dressings, phlebotomy, ear syringing, suture removal, chronic disease monitoring), urgent care and out of hours being supported by advanced practitioners (nurses and paramedics) including for home visits;  Physiotherapy, mental health services and more use of Community Connectors and Link Workers attached to GP practices.

Children and Justice Service

 Implement the national approach in Scotland of ‘Getting it right for every child’ (GIRFEC) is about ‘improving outcomes and supporting the wellbeing of our children and young people by offering the right support at the right time by the right people. It supports them and their parent(s) to work in partnership with the services that can help them’;  Move further towards early intervention, prevention and the promotion of children and young people’s strengths through the medium of universal services, and shift resources from crisis intervention to family and community support;  Further embed the relational approach to practice, by supporting all practitioners who come into contact with children and their families / carers to meet the requirements of our Relationships Framework;  Build local capacity so that specific needs of children can be met (such as foster carers who can accommodate larger sibling groups, or reducing the number of children who are looked after in provision outwith East Ayrshire.

Transforming Nursing Roles

 To support new models of care, delivered by multidisciplinary, integrated teams, historical boundaries between services, settings and roles will become blurred;  Integrated community nursing teams will play a key role in planning and delivering care, building on current roles and best practice to meet the requirements of people with more complex health and care needs in a range of community settings;

Transforming Support Services Roles

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 Review current systems and processes to allow for multi-disciplinary teams to operate across the Partnership, including within Primary Care Improvement Programme;  A review of the current structure/roles/grades to integrate shared duties and responsibilities to take account of a number of Strategic Plan priorities as well as the Living Wage, the introduction of a replacement Social Work Information System and rationalisation of accommodation.

5.3. How will we do it?

As the transformation vision becomes reality, this will be a huge shift away from how we traditionally deliver services meaning new, innovative ways of working for our workforce.

We need to understand our current core workforce and model what our future core workforce will look like for example a shift to more enhanced roles such as Advanced Nurse Practitioners, Nurse Specialists and GPs with special interests combined with multi- disciplinary team working and more inclusive roles. Some of these resources are currently available, but limited, some skills gaps can be filled by upskilling the current workforce through training and development and other gaps will be filled by recruitment, apprenticeships, work placements etc.

We need to plan to ensure our workforce has the skills required to deliver our future services and is affordable and sustainable. This all needs to be done by:

 better understanding of workforce demand and supply;  cognisance of the integration of workforce, service and financial planning;  building a flexible workforce able to respond to future needs and demands  work in alignment with existing and developing legislation.

In order to fulfil our workforce transformation we need to:

 to encourage and support our current workforce to work to the top of their competency by ensuring they have the right skills and knowledge to do so;  look at the skills gaps within our current workforce and provide training and development opportunities to upskill our workforce to fill these and provide career progression opportunities;  maximise opportunities to attract a new workforce to the Partnership to fill any skills gaps through various methods including apprenticeships, work-placements and recruitment;  be guided by national, regional and local strategy/policy and influenced by external drivers for change such as understanding supply and demand;  be seen as an employer of choice where our workforce is motivated, committed and flexible;  have the right people with the right skills in the right place at the right time;  Consult with staff representatives across the Partnership and with all staff groups including in the form of focus groups.

5.4. Risks

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To achieve these ambitions it is vital we have the right people with the right skills in the right place at the right time however this won’t be easy in light of the challenges we face locally and nationally.

 Transformational change programmes are happening nationally, competition for qualified, trained and experienced staff is unavoidable;  There are shortages within certain groups of staff e.g. GPs, District Nurses, Personal Carers, Care Home Nursing staff;  Some workforce groups take time to be trained or achieve the necessary qualifications before they can take up post e.g. GPs, Social Workers, Nurses;  The financial pressures mean the workforce will require to be streamlined and roles redefined, some being more generalist to allow flexibility;  Staff will need to work across different boundaries and organisations which is a culture shift for many;  We have many volunteer carers, young and old, who are key contributors to our health and social care provision and we must retain this resource by providing support, respite and training where appropriate;  East Ayrshire is made up of many rural areas which can prove difficult to attract and retain staff.

6. Our People

As our single most valuable resource is our workforce there are various initiatives in place to support them. Both NHS A&A and East Ayrshire Council have developed and implemented a People Strategy6 and the partnership is committed to applying the principles of both of these, in order to become an employer of choice, which is able to attract and retain a highly qualified and skilled workforce.

6.1. Our Values

Our values encompass partner body values:

Empowering Supportive

Quality Safe Equality Caring Access Respectful Partnership

Seamless Inclusive

6.2. Organisational Development

An Organisational Development (OD) approach is adopted to ensure that Workforce Planning, Organisational Development interventions, Learning and Development provision and HR Policies and Procedures are fully aligned to support the aim of this strategy to have the right people with the right skills in the right place at the right time.

6 NHS A&A: ‘People strategy – People Matter’ and EAC People Strategy 2017-2022 ‘Performance through People’ 18 Version 1.6 Draft

By adopting a Business Partner approach all Services and Sections within the Partnership are supported to identify current and future development needs to equip our workforce with the skills, knowledge and attitude they need to deliver the outcomes of the Strategic Plan.

Each Service is supported by OD to have in place an OD Plan aligned to the Wellbeing Delivery Plan and their Service Improvement Plans. In addition, each professional discipline working within the Partnership has appropriate access to relevant learning and development and advice to ensure they are fully supported to deliver in their role now and in the future.

OD works with Chief Officers and Management Teams to support leadership development, leading change and building high performing teams in support of the delivery of transformation.

From inception there has been a commitment in a pan Ayrshire OD Strategy by each of the three Partnerships in Ayrshire to work together to adopt a consistency of approach, avoid duplication and increase collaboration where possible. This is supported through the Ayrshire Workforce Strategy Group (AWSG) which has representation at Chief Officer level from each of the four partner organisations, namely NHS Ayrshire and Arran, East Ayrshire Council, North Ayrshire Council and South Ayrshire Council. Each has distinct and differing needs and priorities but joint planning, development and delivery is undertaken wherever it is in the interests of our people and of efficiency to do so.

6.3. Human Resources

East Ayrshire Council and NHS Ayrshire and Arran remain the employer of the workforce and as such employees continue to adhere to their terms and conditions of employment. In addition within the Partnership it was recognised that a number of Senior Management posts required to be developed as joint appointments and as such have management responsibility for employees from both organisations.

A number of Pan Ayrshire protocols have been developed to support the workforce with integration, these include:

• Partnership Forum Terms of Reference • Joint Appointment Protocol • Definition of Joint Appointment • Joint Appointment Redeployment Process • Joint Appointment Admin Support

Human Resources provide a professional service and ensure the Partnership meets its legal obligations as an employer and progress towards the objective of being an exemplar employer and an employer of choice. As well as developing and maintaining responsive and supportive employment practices and processes in partnership with Staff Side and Trades Unions, the sections support the demands of an increasingly flexible workforce within the changing environment,

By adopting a Business Partner approach all Services and Sections within the Partnership are supported to identify current and future workforce requirements. Human Resources work with Chief Officers and are members of the management teams of the Partnership.

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6.4. Workforce Development

As our transformational change programmes progress our workforce will look very different, it will be integrated, engaged, motivated and empowered, where innovation and positive response to change is necessary. Our traditional working boundaries will become blurred with new ways of working such as multi-disciplinary team (MDT) working, across, not just health and local authority, but also with our third and independent sector partners.

As well as being skilled and appropriately trained in their role, the workforce will require to be competent to improve health and wellbeing.

We are committed to workforce development and by retaining ownership of their professional and personal development every employee will continue to be supported to be the best they can be through relevant training and development opportunities to ensure they are equipped to meet the new challenges ahead and be our workforce of the future.

Mandatory and statutory training remains a priority to ensure our workforce is meeting legislative and policy requirements. There are robust arrangements in place in both the Council and NHS A&A to identify and address current and emergent development needs through business partnering arrangements and to deliver and track completion of mandatory and statutory training.

For specialised roles, we continue to support employees to have necessary qualifications and accreditation. Many registered roles require an element of continuous professional development which the Partnership fully supports.

6.5. Health, Wellbeing & Resilience

Change can be an unsettling experience for many people, so it is imperative we have a flexible, responsive and adaptive workforce to deal with this. Health, wellbeing and resilience is a training priority to ensure our workforce is able to manage this change and delivery of wellbeing and resilience training for our workforce is underway.

Healthy Working Lives is a nationally recognised scheme which helps organisations to create healthier and safer workplaces by providing resources, information and opportunities to improve employee health and wellbeing, both at work and at home. Both East Ayrshire Council and NHS A&A have achieved the Gold Award.

6.6. Equality

Equality is also extremely important and our commitments within our Strategic Plan and our respective People Strategies are designed to engender a culture which promotes equality, values, diversity and protect human rights and social justice and tackles discrimination for our workforce and also our residents. Each Partner Organisation has agreed Shared Equality Outcomes 2017-2021 which are synergistic. Equality Outcome 4 is particularly relevant to this plan, ‘In Ayrshire, public bodies will be inclusive and diverse employers’.

All new policies, procedures and service changes are also the subject of an Equality Impact Assessment to ensure no protected group is disadvantaged by any change implemented

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6.7. Trade Union/Partnership Working

We are committed to ensure our workforce is supported to be the best it can be through the areas described and fully engage with our Trade Union and Staff Side representatives to ensure fairness and consistency across the full workforce.

7. Defining the Required Workforce

New roles will emerge as service models change and this will mean building and enhancing existing skills, and developing new ones for our current workforce.

The future characteristics of the Partnership workforce are designed to meet the needs of service users now and in the future. These characteristics can and must run in parallel to the transformational change programme. The workforce should be:

• Kind, compassionate and person centred; • Flexible and able to adapt to changing circumstances; • Confident, well-informed and value-driven – in ability to make decisions and act in their role, and in addressing inequalities and improving health where possible; • Creative and innovative – in service design and delivering for service users; • Integrated – a culture that values and trusts the skills and roles of others, not just in their immediate job family or organisation but across the partnership; • Able to have a clear picture of career progression, succession planning and development, taking mutual accountability for that development, with clear access as and when appropriate.

8. Pan Ayrshire Approach

Whilst local workforce planning is essential, it would be imprudent to ignore our partners within Ayrshire and Arran as already noted. A workforce planning group has been established to, where appropriate, take a collaborative pan-Ayrshire approach including NHS, local authorities and third and independent sector stakeholders. Initially this is predominately focussed on 3 areas:

• Employability schemes and encouragement of careers in health and social care; • Education programmes in partnership with further and higher education institutes (for the spectrum of generalist/specialist and registered/unregistered roles); and • Workforce planning and development for support worker roles across health and social care.

Some of the benefits of this collaborative approach include reduced duplication, shared learning, consistency of approach, developing fit for purpose learning opportunities, cost efficiencies and also provides opportunities to really explore the opportunities to develop our workforce.

9. Conclusion

In the current climate of various skills shortages, the long lead times in training and developing new staff, a declining working age population, changing demography health

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profiles and the current (and predicted) financial climate, it has never been more important for us to take a robust and strategic approach to workforce planning.

Proactive steps have been taken to date within Services and across the Partnership. This Strategy will continue to support a cohesive approach to identifying skills gaps and addressing these collaboratively to ensure we have the right people with the right skills in the right place at the right time across the whole Partnership.

The Action Plan at appendix 1 outlines in more detail some of the actions which will ensure we have the right people with the right skills in the right place at the right time, to deliver high quality health and social care for the people of East Ayrshire.

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Appendix 1 Workforce Action Plan 2018-2021

Aim Priority What will we do How will we do it Be an employer of • Promote East Ayrshire Health and Social • Robust recruitment advertising campaigns to attract choice Care Partnership as a career choice especially for difficult to recruit posts • Promote East Ayrshire as an attractive • Design career opportunities for those who wish to place to work and live progress within the HSCP • Provide flexible and agile working opportunities to attract a wide range of candidates • Engage champions/role models to share their experiences Engage a younger • Create opportunities for young people to • Improve accessibility of modern apprenticeships, work workforce join the Partnership through learning experience and foundation apprenticeship opportunities contracts • Collaborate with Ayrshire College to develop relevant • Attract school/college/university leavers qualifications and learning opportunities • Promote the Partnership as a career • Visit schools and colleges to promote the opportunities in choice the partnership and explain choices which best fit Attract returners to • Provide opportunities for career changers • Offer flexible learning opportunities to re-train the Partnership to come to the Partnership • Offer flexible working patterns to support training and work/life balance Be inclusive and • Ensure recruitment opportunities are • Refer to the Share Equality Outcomes 2017-2021 Right People diverse employers accessible to all groups document and ensure actions are undertaken within • Provide appropriate training and Equality Outcome 4. awareness raising of different equality areas Ensure workforce is • Ensure workforce planning is embedded • Conduct workforce review for each service fit for purpose, into Service Improvement Plans for each • Support managers to integrate workforce planning into sustainable and area of the Partnership everyday responsibilities affordable Work with our • Liaise with our third and independent • Work together to promote recruitment of professional roles partners to support partners to share expertise e.g. nurses appropriate staffing • Support our partners to produce workforce plans

• Share training and development opportunities

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to deliver and • Encourage our partners to plan forward to sustain services ensure appropriate skills and resources are accessible Value our Volunteers • Attract, recruit, train and support our • Publicise benefits and necessity of volunteers. volunteers • Provide training opportunities and support networks • Continue to recognise importance and • Link with and promote opportunities through Volunteer contribution of our volunteers Centre East Ayrshire, the EA Volunteer Framework and other volunteering routes. Develop a workforce • Promote values and behaviours of the • Incorporate values and behaviours into recruitment and aligned to the values Partnership at all opportunities selection process and behaviours of • Provide robust induction programme for all new starts the Partnership • Integrate into day to day service delivery e.g. team meetings • Lead by example and adopt values and behaviours Ensure workforce is • Ensure appropriate process is in place to • Undertake ongoing training needs analysis fully equipped to identify workforce needs • Promote learning and development opportunities for fulfil their role • Support training and development employees requirements • Ensure personal development discussions e.g.

• Encourage and support the workforce to EAGER/TURAS are implemented and monitored work at the top of their competency level Ensure workforce is • Ensure workforce are confident and • develop a programme of capacity building in line with the focussed on competent to seek and utilise public health skills and knowledge framework prevention and early opportunities to improve health and

Right Skills intervention reduce inequalities Encourage and • Ensure opportunities are available to help • Utilise flexible working policies provide people retrain or attain new qualifications • Support access to learning and development opportunities opportunities to to support Partnership growth internally and externally develop skills • Explore retraining opportunities in redeployment situations Promote and deliver • Develop a more efficient and effective • Review existing roles to determine where roles can be truly integrated workforce more generic/flexible working • Ensure workforce is appropriately • Engage with education providers to review courses being qualified and has the flexibility to move delivered across the partnership • Develop management teams who champion integrated working

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Continue to support • Ensure skilled and sustainable workforce • Enhance multi-disciplinary teams within primary care the shift of balance in community where it is needed setting of care to the • Consider benefits of teams working close • Ongoing recruitment of Personal Carer workforce community and together • Ensure workforce available to support services delivering locality working alternative options - ‘know where to go’ • Right Place Right Explore co-location opportunities Have a skilled • Plan ahead to ensure a resource is • Workforce plans within Service Improvement plans need workforce at the available to deliver service needs at the to consider lead times for training and development right time right time • Consider recruitment timescales • Succession planning and workforce planning embedded into management objectives

• Aligned to financial availability Support people to be • Ensure maximise all opportunities for • Improve workforce attendance e.g. sickness absence at work attendance by supporting the workforce • Provide resilience training to ensure the workforce are in line with policies and procedures prepared to deal with change • Ensure workforce is familiar with policies and procedures and responsibilities Right Time • Ensure managers are trained in implementing policies and procedures Plan for ageing • Consider the challenges and potential • Consider alternatives to retirement e.g. new roles, workforce solutions to address an ageing workforce mentorship roles • Utilise work/life balance policies to support continued employment

All of the above actions should be progressed in conjunction with both partner organisations where possible to ensure an integrated approach. At all times cognisance must be given to the policies and procedures in place within each partner organisation. Where it is possible, any developments from either EAC, NHSAA or the Partnership should be approached collaboratively to ensure the total workforce benefits and to support the integration process.

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Appendix III

East Ayrshire Health & Social Care Partnership

Property & Asset Management Strategy

2018 - 2021

1 1. INTRODUCTION AND CURRENT POSITION

The planning and delivery of Health and Social Care services requires alignment of Strategic Planning, Financial Planning, Workforce Planning and a Property and Asset Management Strategy. Just as the Strategic Plan of East Ayrshire Health and Social Care Partnership and services commissioned to deliver this sit within the wider Wellbeing agenda of East Ayrshire Community Planning Partnership then this Property and Asset Management Strategy for the HSCP sits alongside wider plans including, Strategic Housing Improvement Plan, Capital Planning for Primary and Acute Health, Leisure and Education, Commissioning of Care Home capacity from the Independent Sector and community capacity through local third sector and community organisations.

Together these plans set an environment to facilitate positive Wellbeing in our communities supported by access to high quality Health and Social Care services.

The Scottish Government’s Financial Planning Guidance for Health and Social Care Integration states that:

“The Chief Officer of the Integration Joint Board is recommended to consult with the Local Authority and Health Board partners to make best use of existing resources and develop capital programmes. The Integration Joint Board should identify the asset requirements to support the Strategic Plan. This will enable the Chief Officer to identify capital investment projects, or business cases to submit to the Health Board and Local Authority for consideration as part of the capital planning processes, recognising that partnership discussion would be required at an early stage if a project was jointly funded.”

East Ayrshire Council and NHS Ayrshire & Arran collectively own, lease or otherwise utilise a significant amount of property across East Ayrshire where health and social care functions are carried out. Following the establishment of the East Ayrshire Integration Joint Board (IJB) and the East Ayrshire Health and Social Care Partnership (HSCP), there is an opportunity and clear need to review the approach taken to strategic planning and utilisation of the estate available to the Partnership, to support the aims of integration and delivery of effective, efficient health and social care services in East Ayrshire.

A Premises and Accommodation Group has been established for the H&SCP, chaired by the Senior Manager Business Support, and attended by key stakeholders from the HSCP, East Ayrshire Council and NHS Ayrshire & Arran. The development of an agreed Property & Asset Strategy for the HSCP will inform the work of this group going forward.

2. OBJECTIVES

The key objectives of the Property & Asset Management Strategy are:

• To support the Strategic aims of the Integration Joint Board and the Community Planning Partnership. • To gain best value from our use of property; • To ensure that health and social care services are provided in and from fit- for-purpose, modern buildings; • To enhance provision of health and social care services in local communities; • To rationalise our estate in order to reinvest savings into frontline services;

3. PRINCIPLES A number of principles will be adopted in the implementation of the Property & Asset Management Strategy, namely:

1) Designing and delivering services to meet the needs of individuals, carers and communities Ensuring that decisions regarding the utilisation of property support delivery of the HSCP’s Strategic Plan, and that our services are delivered from fit-for- purpose premises.

2) Being transparent and demonstrate fairness when allocating resources; With significant decisions as to resource allocation being taken in the appropriate public forum - through either the IJB, Council or Health Board decision making structure and subject to a clear strategic or operational business need being articulated. This will include a focus on our localities and the specific needs of those communities.

3) Delivering services to people in their local communities; A fundamental aim of the Public Bodies (Joint Working) (Scotland) Act 2014 is to increase the amount of health and social care services delivered in people’s own homes and communities as opposed to institutional or residential settings. We ensure that our use of property is focussed on achieving that aim.

4) Making best use of the assets available to us We will effectively manage our assets, be engaged in the Transformation Plans of both East Ayrshire Council and NHS Ayrshire & Arran, and rationalise our estate where appropriate. For example, by co-locating health and social care services where this would be of benefit to patients, service users and carers.

4. STRATEGIC CONTEXT

Strategic Plan and National Policy

The East Ayrshire Health & Social Care Strategic Plan 2018 - 2021 states:-

“We want to have a sustainable estate that is ‘fit for purpose’, that Partnership services occupy efficiently. We want to deliver health and social care services from premises that support integrated working and the wellbeing of our workforce and communities”.

In addition, the National Health and Wellbeing Outcomes which the HSCP is required by statute to work towards includes:-

Outcome 9 - “Resources are used effectively and efficiently in the provision of health and social care services.”

It is within the context of both of these provisions that the objectives and principles of our Property & Asset Management Strategy have been developed, and within which decisions relating to use of property and assets will be taken.

5. LINKS TO PARTNER ORGANISATION STRATEGIES

The Property & Asset Management Strategy of the East Ayrshire Health & Social Care Partnership does not sit in isolation, and is linked closely to both East Ayrshire Council’s Transformation Strategy and NHS Ayrshire & Arran’s Property and Asset Management Strategy. Both of these strategies are focussed on making best use of the significant assets owned by the Council and Health Board, which is in line with the principles and objectives outlined in this document. Additionally the strategy takes cognisance of the Strategic Housing Investment Plan (SHIP), which sets out the priorities for investment in housing in East Ayrshire over the next five years (2018-2023) the SHIP is the housing investment delivery plan for East Ayrshire Council’s Housing Strategy including the development of the housing component of the social care and housing priorities. It is acknowledged that outwith this plan the Property and Asset Management decisions of partners in Third and Independent Sector also make an essential contribution to Wellbeing in East Ayrshire.

6. FUTURE PLANS

The long term vision of the HSCP Property & Asset Management Strategy is that the property estate available to the Partnership will be utilised across East Ayrshire for the provision of health and social care services, with those properties being modern, fit for purpose premises which are utilised to their maximum potential.

There is work already underway across East Ayrshire to rationalise and modernise our property portfolio, including:

4 • Funding of £0.265m from East Ayrshire Council’s Transformation Fund to enable the Partnership’s NHS North Locality Mental Health Services to be based in the one location, the North West Kilmarnock Area Centre.

• The IJB have approved the move to implement a community based rehabilitation model, subject to confirmation of funding, from the service currently provided at Kirklandside Day Hospital and Community Rehabilitation Centre.

• Progress to complete the co-location of all South Locality Mental Health Services by relocating the Mental Health Team currently based in Netherthird Clinic to Rothesay House.

• There has been Investment in the Lister Centre at Crosshouse Hospital to facilitate the Integration of pan Ayrshire Out of Hours Services.

7. GOVERNANCE

Overall responsibility for the implementation of the Property and Asset Management Strategy rests with the Premises and Accommodation Group chaired by the Senior Manager Business Support.

Financial governance of all matters relating to property is through the existing governance and capital planning arrangements of East Ayrshire Council and NHS Ayrshire and Arran, acting under direction from the Integration Joint Board.

As the IJB does not own property of its own, decision making with regards to decommissioning, capital investment etc. rests with East Ayrshire Council and NHS Ayrshire & Arran, albeit with appropriate reference to the needs of the East Ayrshire Health & Social Care Partnership and any specific directions made to either body. An annual report on implementation of the Property and Asset Management Strategy will be provided to the IJB.

8. MONITORING AND SCRUTINY

Monitoring and Scrutiny of the Health and Social Care Partnership’s Property and Asset Management Strategy will be primarily carried out by the IJB’s Audit and Performance Committee with reference to the full IJB where appropriate. Appropriate links will also be developed with the monitoring and scrutiny arrangements of East Ayrshire Council and NHS Ayrshire & Arran as necessary.

THE FOLLOWING SECTIONS CONTAIN THE LOCALITY AND EAST AYRSHIRE WIDE STRATEGIES

6 9. NORTHERN LOCALITY

INTRODUCTION

The Northern Locality utilises 3 NHS Ayrshire & Arran and 4 East Ayrshire Council properties, listed below.

Property Owned By H&SCP Services

Galston Clinic NHS Ayrshire & Arran District Nurses & Health Visitors

Hurlford Clinic NHS Ayrshire & Arran District Nurses & Health Visitors

Stewarton HC NHS Ayrshire & Arran District Nurses & Health Visitors

Ross Court East Ayrshire Council Older Peoples Day Service, Short Breaks Service & Moving On Service Stewarton Town East Ayrshire Council Office Accommodation for Community House Care Locality Team & Day Opportunities Service

KEY STRATEGIC ISSUES

The key strategic issues for the North Locality include:

H&SCP Presence in Galston Town Centre There are currently District Nurses, Health Visitors and Podiatrists located in Galston Town Centre within Galston Clinic and we are working with Council Corporate Services to look at the possibility of having a Wellbeing Centre within the new build in Cross Street in Galston or the use of the Library Building close to Galston Clinic.

Stewarton HSCP and Primary Care Service provision requires to be reviewed in light of the extensive house building in the area.

Primary Care Services, in particular GP services, require to be considered in respect of increasing house building and pressure on existing services and premises. More recently the need to consider Primary Care service delivery in Northern locality due to closure of GP surgery in Fenwick area. Within the Primary Care “Ambitious for Ayrshire” Programme, Stewarton has been a focus of joint working across Primary Care Contractors (GPs, Pharmacists, Dentists, Optometrists) and this also requires to be considered.

EMERGING THEMES

The key themes to be addressed in the Northern Locality:-

7 Investment HSCP Business Support staff will continue to liaise with NHS Ayrshire & Arran’s Estates & Capital Planning Services to identify building elements which need repair or replacement to support the planning for future work.

Impact of Regeneration Investment plans in health and social care buildings needs to take account of future house building and wider physical regeneration programmes so that we can continue to meet the changing demands caused by demographic changes. The population in Stewarton has increased as a consequence of major private housing developments. Further analysis of the potential impact of the housing development on the requirements for our services and buildings is needed so that we can plan effectively to meet the needs of the new populations.

10. SOUTH LOCALITY

INTRODUCTION The South Locality utilises 7 NHS Ayrshire & Arran properties, including one community hospital which is leased, and 11 East Ayrshire Council properties of which 1 is leased, listed below.

Property Owned By H&SCP Services

Cumnock HC NHS Ayrshire & Arran District Nurses & Health Visitors

Drongan RC NHS Ayrshire & Arran District Nurses & Health Visitors

East Ayrshire Community Leased from BAM Community Hospital Hospital Muirkirk Clinic NHS Ayrshire & Arran District Nurses & Health Visitors

Netherthird Clinic NHS Ayrshire & Arran District Nurses & Health Visitors & Mental Health Team Newmilns Clinic NHS Ayrshire & Arran District Nurses & Health Visitors

Patna RC NHS Ayrshire & Arran District Nurses & Health Visitors

Berryknowe East Ayrshire Council Housing Support Service

Boswell Resource Centre East Ayrshire Council Older People Day Service

Catrine Centre East Ayrshire Council Older Peoples Day Service

Dalmellington Area Centre East Ayrshire Council District Nurses & Health Visitors & Care at Home Team Ellisland Court East Ayrshire Council Older Peoples Day Service

Menzies Court Leased from Bield Community Health & Care Housing Office Base

8 New Cumnock East Ayrshire Council Older Peoples Day Service

Patna Day Centre East Ayrshire Council Older Peoples Day Service

Riverside Resource East Ayrshire Council Day Opportunities Service Centre Rothesay House, East Ayrshire Council Office Location for H&SCP Cumnock Services Sunnyside Children's East Ayrshire Council Children’s Residential House House

KEY STRATEGIC ISSUES

The key strategic issues for the South Locality include:

To co-locate the NHS Mental Health Team currently based in Netherthird Clinic to Rothesay House Mental Health Services Teams are currently located in 4 separate buildings within the EAHSCP and the aim is to reduce the office bases to 2, one in the North and one in the South of the Partnership and this relocation would result in one base for staff in the South of the Partnership. This relocation will also enable Netherthird Clinic to be declared surplus to NHS Ayrshire & Arran Estates & Capital Planning Services.

East Ayrshire Community Hospital The premises are leased from BAM and there is currently one ward not used. The HSCP is required to analyse the future requirement for this provision to enable a business case to be taken to the IJB for approval.

Primary Care Service Primary Care Service provision requires to be reviewed in localities with small branches in relation to GP Practice Sustainability.

EMERGING THEMES The key theme to be addressed in the South Locality:-

Investment HSCP Business Support staff will continue to liaise with NHS Ayrshire & Arran’s Estates & Capital Planning Services to identify building elements which need repair or replacement to support the planning for future work.

11. Kilmarnock Locality

INTRODUCTION

The Kilmarnock Locality utilises 4 NHS properties and 7 East Ayrshire Council Properties, listed below.

9 Property Owned By H&SCP Services

Central Clinic NHS Ayrshire & Arran District Nurses & Health Visitors

Kirklandside Day NHS Ayrshire & Arran Day Services & Community Rehabilitation Hospital Treeswoodhead NHS Ayrshire & Arran District Nurses & Health Visitors Clinic North West East Ayrshire Council Mental Health and Learning Disability Kilmarnock Area Services Centre Balmoral Road East Ayrshire Council Office Accommodation for H&SCP Teams & Day Opportunities Service Benrig Children's East Ayrshire Council Children’s Residential House House Montgomery East Ayrshire Council Children’s Residential House Place Children's House Rosebank East Ayrshire Council Older Peoples Day Service Resource Centre Sir Alexander East Ayrshire Council Day Opportunities Service Fleming Centre The Johnnie East Ayrshire Council Office Accommodation for H&SCP Teams Walker Bond

KEY STRATEGIC ISSUES

The key strategic issues for the Kilmarnock Locality include:

Kirklandside Day Hospital & Community Rehabilitation Centre The IJB have approved the implementation of a community based supported tenancy model subject to confirmation of funding. A Business Case is being developed which includes the relocation of the HSCP NHS employees with an office base at this location.

Co-location of East Ayrshire’s Health and Social Care Partnership’s NHS Mental Health Services Teams Currently located in 2 separate buildings within the North Locality and the aim is to reduce the office bases to 1 and alterations to the old Alzheimer’s Area in the NWKAC will enable the NHS Mental Health Services Team currently based at Lister Street in the Crosshouse Hospital Campus to relocate to the NWKAC resulting in one base for both EAC and NHS Mental Health Services Teams in the North of the Partnership. East Ayrshire Council’s Transformation Fund has allocated £0.265m from to meet the cost of reconfiguring the existing accommodation and providing appropriate IT infrastructure and equipment to allow the area to be maximised for staff use.

Co-location of Community, Health and Care Teams within The Johnnie Walker Bond This project will support the new Front Door Integrated Services Model being taken forward by Community Health & Care and improve and increase the multi-disciplinary team approach thus increasing re-enablements within the community and recognising local strengths and maximising people’s independence and skills.

10 Future delivery of Addictions Services from the Bentick Centre The HSCP's Bentick Joint Steering Group is looking at solutions due to the Bentick Centre not being fit for purpose of delivering clinical services.

Other East Ayrshire Council and NHS Ayrshire & Arran Accommodation As part of the drive to maximise efficiency and effectiveness, there will be an ongoing review of the accommodation needs and requirements across centrally managed services. This will be undertaken in the context of supporting integrated working and efficient working practices, such as agile working. This includes a review of existing offices.

Primary Care Service Primary Care Service provision requires to be reviewed in localities with small branches in relation to GP Practice Sustainability.

EMERGING THEMES

The key theme to be addressed in the Kilmarnock Locality include:

12. East Ayrshire Wide

INTRODUCTION

There are 6 properties used by East Ayrshire Wide Services, 3 NHS Ayrshire & Arran properties, 2 East Ayrshire Council, and 1 owned by the Scottish Prison Service, listed below.

Property Owned By H&SCP Services

Bentick Centre NHS Ayrshire & Arran East Ayrshire Addiction Services

Cross house NHS Ayrshire & Arran Office Base for Mental Health and Campus Addiction Services Teams & AHP Teams Lister Centre NHS Ayrshire & Arran Out of Hours Service and Crisis Mental Health Services Base London Road East Ayrshire Council HSCP Directorate Office Base

Civic Centre East Ayrshire Council HSCP Protection Team Office Base North HMP Kilmarnock Scottish Prison Service Justice Healthcare Services

11 KEY STRATEGIC ISSUES

The key strategic issues for East Ayrshire Wide include:

Future delivery of Addictions Services from the Bentick Centre The EAH&SCP's Bentick Joint Steering Group is looking at solutions due to the Bentick Centre not being fit for purpose of delivering clinical services.

Crosshouse Campus The co-location of Out of Hours Service and Mental Health services is underway as part of the development of the new Urgent Care Hub with East Ayrshire leading the pan Ayrshire implementation as part of the national pilot programme.

The Strategic Housing Investment Plan (SHIP) This sets out the priorities for investment in housing in East Ayrshire over the next five years (2018-2023) the SHIP is the housing investment delivery plan for East Ayrshire Council’s Housing Strategy including the development of the housing component of the social care and housing priorities. The SHIP was approved by East Ayrshire Council's Cabinet Committee on 29th November 2017 and includes plans for Social Care Housing Investment to promote independence for adults with additional support needs. These include:-

• Support Accommodation Project in Cessnock Road, Hurlford • Supported Accommodation Project in the Former Crown Hotel, New Cumnock • Supported Accommodation Project in Riccarton West, Kilmarnock • Supported Accommodation Project in Kilmarnock Road, Mauchline

H&SCP Management Team The team are currently located in various NHS Ayrshire and Arran and East Ayrshire Council Buildings across East Ayrshire and there is a plan to relocate the team to the top floor of the Civic Centre South Building in Kilmarnock Town Centre.

Primary Care Services

Ambitious for Ayrshire set out a clear direction for primary care within communities across Ayrshire recognising Primary Care is the front door and the first point of contact for communities when they access health and social care services. The pressures on primary health and social care include increasing demand for services combined with challenges relating to public sector funding and workforce recruitment and retention. The new GP contract and forthcoming Primary Care Improvement Plan (by 1 July 2018) will see a change in how the services are delivered with an increased focus on multi- disciplinary teams and wider primary care workforce supporting GP services

HMP Kilmarnock Her Majesty’s Inspectorate of Prisons (HMIP) inspected HMP Kilmarnock in November 2016 and the Healthcare Improvement Plan included the following property issues:-

12 CONCERNS ACTION

Healthcare physical infrastructure is Work in partnership with SERCO and hindering the ability to deliver core and SPS in formulating and submitting a specialist clinics. business case proposing renovations to existing Healthcare Department ensuring

that the space is fit for purpose to enable all services to be delivered effectively Due to the current lack of appropriate Work in partnership with SERCO to rooms progression of MH group work has ensure appropriate PCO cover to ensure been restricted group work can be progressed out of hours.

Triage room not fit-for- purpose Triage rooms will no longer be used for any clinical intervention. These rooms will

only be used for administration of medications. Due to the current lack of appropriate Review clinic room availability to allow rooms progression of Addiction group Addiction group work to be work has been restricted. accommodated

Day Services Day Services provide an important element of both social care and inclusion for those who access supports. East Ayrshire Council has invested significantly in the estate that supports Day Services in our Communities. These modern buildings are being considered as part of Transformation to ensure that they are utilised in a way that makes both maximises use of the facilities and the best outcomes for those who attend them.

Children’s services In October 2017 East Ayrshire Cabinet and in November 2017 East Ayrshire IJB were presented with a report “Looked After and Accommodated Children and Young People: Increasing Placement Capacity and Choice”.

The report sets out proposals to address the increasing placement capacity and choice in caring for looked after children and young people, specifically focusing on residential and intensive foster care including the provision by external providers and continued revenue funding for existing Supported Accommodation.

The report recognises there continues to be a shortage of internal residential provision. This is evidenced by a continuing need to purchase external placements (residential school or residential only) due to the induvial needs of the young person and experience confirms that flexible provision is required (smaller scale, intensive support). It is recognised that this is a costly provision.

The children and young people being supported have significant needs, requiring trauma informed approaches and services. The proposed plan enables an increase in internal placements, which along with the provision for care experienced young people in Supported Accommodation, will increase flexibility and placement choice.

An additional emerging need is for facilities that support contact and engagement with young people to ensure the supported accommodation and future support is sustainable to meet the young person’s needs.

EMERGING THEMES

Agile/Mobile working The introduction of agile and mobile working presents opportunities for the HSCP to optimise use of our buildings. Whilst the traditional layout of many of the buildings present challenges in adapting them to be agile-friendly and more open-plan the advantages to the HSCP in terms of efficiency, innovation, improved business continuity, and ultimately reduced property requirements. Work is underway to scope and deliver agile/mobile working across the estate, including the IT systems and connectivity to meet the hot-desking requirements of the various staff groups.

Record Storage Storage requires to be reviewed for NHS clinical records. There is a plan established to centralise all NHS Mental Health and Learning Disability Case Files as part of the co-location of Mental Health Services in Kilmarnock. All Social Work live case files have recently been back scanned and are now accessed electronically resulting in more efficient use of workers time and creation of additional space within our large office locations in Kilmarnock and Cumnock.

Other NHS Ayrshire & Arran and East Ayrshire Accommodation As part of the drive to maximise efficiency and effectiveness, there will be an ongoing review of the accommodation needs and requirements across centrally managed services. This will be undertaken in the context of supporting integrated working and efficient working practices, such as agile working. This includes a review of existing offices.

14 East Ayrshire Health and Social Care Partnership

Children’s Health, Care and Justice Service

Service Improvement Plan

2018/19

April 2018

Contents

SECTION 1: INTRODUCTION ...... 3 SECTION 2: SERVICE DESCRIPTION ...... 4 SECTION 3: POLICY AND CONTEXT ...... 9 SECTION 4: REVIEW OF PROGRESS 2017/18 ...... 13 SECTION 5: IMPROVEMENT PLAN ...... 14 SECTION 6: QUALITY ASSURANCE AND IMPROVEMENT DASHBOARD ...... 17 SECTION 7: PLANNED EFFICIENCIES ...... 19 SECTION 8: RISK ASSESSMENT/ MANAGEMENT ...... 20

SECTION 1: INTRODUCTION

This service improvement plan for Children’s Health, Care and Justice Services is set within the context of the East Ayrshire Community Plan 2015 – 30, the East Ayrshire Health and Social Care Strategic Partnership Plan 2018 – 2021 and the associated multi-agency strategic plans.

Service Improvement plans (SIPs) are a key part of the Health and Social Care Partnership’s performance management and improvement framework. This plan sets out our vision and priorities; our performance framework; risks and opportunities; improvement actions for 2018/19; and progress made in 2017/18.

The Children’s Health, Care and Justice portfolio includes child health services (health visiting and school nursing), social work services (children, families and justice) which are in turn made up of locality services and authority wide services, and the prison based health team (including police custody). The SIP is structured around these service areas, and focuses on ten high impact outcomes.

The Children’s Health, Care and Justice Management Team reviews progress against the service plan objectives at management team meetings, which also maintain an overview of performance and risk management.

SECTION 2: SERVICE DESCRIPTION

Children and Families Social Work

Keeping children safe is the highest priority for the Children and Families Social Work Service. Services are delivered within the context of an extensive range of statutory obligations, providing support to children, families and carers, with a focus on ensuring that our most vulnerable children and young people are cared for and protected. The service aims to give every child the best possible start in life, and maximises opportunities available to children and young people who are recovering from trauma, abuse and adversity.

The service is made up of two operational sections:

 Children and Families Locality Services (North and South)  Children and Families Authority Wide Services (Corporate Parenting and Family Support and Young People).

These two sections are augmented by a range of services purchased from external providers, including secure accommodation, residential accommodation / schools and fostering placements.

The 2018/19 budget for the Children and Families Social Work service is £17,994,000 (excluding out with placement budget).

The total staffing complement of the service is 205 full-time equivalents with services delivered from office bases located in Kilmarnock and Cumnock, and from our residential children’s houses in Kilmarnock and Auchinleck.

Child Health Services

The Early Years have a profound impact on an individual’s future experience of health and wellbeing. Evidence demonstrates the importance of prevention, early identification and intervention throughout the early years of life. Health Visitors have a vital public health role to play in supporting children and families in the first few years of a child’s life, while the role of school nurses is to promote positive health and wellbeing throughout a child’s educational experience. 4

The budget in 2017/2018 for Child Health Services is £2.278m.

The total staffing complement of the service is 63.95 full-time equivalents and services are delivered from office bases located across East Ayrshire.

Violence Against Women Services

Break the Silence Rape and Sexual Abuse Services (BtS) is funded by the Grants Committee until 2018. The contract value is £74,634 per annum. The aim of the service is to offer counselling and specialist support (including one to one and group work), advocacy and advice to adult survivors of rape and historical sexual abuse. The service also delivers awareness training programmes to support the East Ayrshire Violence Against Women Partnership. Additional services are offered through other funding routes, including complementary therapies which help service users to engage with the counselling process thereby aiding recovery.

East Ayrshire Women’s Aid (EAWA) is funded by the Grants Committee until 2018. The contract value is £258,380 per annum. EAWA provide information, support and safe refuge accommodation to women, children and young people who are experiencing, or have experienced, domestic abuse. The aim of the service is to support women, children and young people affected by domestic abuse to gain information, learn new skills and/or participate in group work programmes that provide individuals with social, educational and networking opportunities. Crisis and on-going interventions are offered through office-based and outreach services, including a sign posting service for males. The service also coordinates and delivers the East Ayrshire Violence Against Women Partnership Learning and Development Calendar. Awareness raising and prevention education activities are also delivered in communities throughout East Ayrshire. The Kilmarnock Women’s Centre provides a place for women to share their experiences, learn new skills and support one another.

Justice Social Work

The justice social work service discharges a range of functions, including:

 supervision of people in the community who have been sentenced by the courts;

 supervision of people who have been released from prison on statutory order or license;  provision of social work reports requested by courts;  management of serious violent and sex offenders in the Community;  provision of information, advice and support; and  Community Payback.

Specialist Justice services are delivered via the Ayrshire Justice Partnership arrangements and within the context of our partnership arrangements via Community Justice Ayrshire.

The Justice Social Work Services budget is almost fully supported by direct grant from the Scottish Government. The current budget is £1,875,000.

The total staffing complement of the service is 46, equating to 40.75 full-time equivalents and services are delivered from office bases located in Kilmarnock and Cumnock.

Prison and Police Custody Health Services

NHS Ayrshire and Arran legally assumed responsibility for the provision of health care to HMP Kilmarnock on 1 November 2011. This includes access to the full range of Primary and Secondary Care services available to the wider population of Ayrshire. A primary care practice was established to provide general medical services to prisoners and this practice operates from the Healthcare Centre within the prison. This service is delivered by five General Practitioners (GPs) under contract to the NHS. The police custody service is also provided via contracting arrangement, ensuring appropriate delivery of Forensic Medical Services.

The budget for the Prison and Police Custody Health Service is £3,007,000. The total staffing complement of the Prison Healthcare service (excluding the GPs) is 30.16, full-time equivalents and services are delivered from HMP Kilmarnock, which is located on the outskirts of Kilmarnock. The Police Custody service is provided by consortia of 8 Forensic Physicians (FP).

The indicative budget for the 2018/19 Children’s Health, Care and Justice Service is as follows:

Service Budget Children & Families / Women’s Services £17.694m Health Visiting £ 2.278m Outwith / secure placements £ 4.791m Justice Social Work £ 1.875m Prison and Police Custody Health £ 3.007m Total £29.645m

CHILDREN’S HEALTH, CARE & JUSTICE SERVICES

MARCH 2018

Health and Social Care Director

As Vice-Chair of Child Protection Child Protection Lead Committee Head of Service Officer (Children’s Health, Care & (Child Protection Committee) Justice Services)

Senior Manager Senior Manager (Social Work (Social Work Senior Nurse Senior Manager Children, Families Children & Families Manager for (Justice Healthcare and Justice Locality Authority Wide Children’s Services Services) Services) Services)

Service Service Service Service Service Service Manager Manager Manager Manager Manager Manager (Family Support (North (North (South (Justice (Corporate & Locality) Locality) Locality) Services) Parenting) Young People) 8

SECTION 3: POLICY AND CONTEXT

This SIP sits within the local context of:

The East Ayrshire Community Plan 2015-30 This is the sovereign and overarching planning document for the East Ayrshire area, providing the strategic policy framework for the delivery of public services by all partners. The Community Plan has been reviewed during 2017/18, and its vision is that:

“East Ayrshire is a place with strong, safe and vibrant communities where everyone has a good quality of life and access to opportunities, choices and high quality services which are sustainable, accessible and meet people’s needs.”

Strategic Priorities 2018-2021: The Council and Community Planning Partnership Board have agreed to focus on the following:  Improving outcomes for children and young people, with a particular focus on looked after children/young people and young carers;  Older people: adding life to years – with a particular focus on tackling social isolation; and  Community led regeneration: empowering communities - building community resilience.

Implementation of the Community Plan is through three thematic Delivery Plans, namely Economy and Skills, Safer Communities, and Wellbeing, which have been renewed as part of the Community Plan Review. The Health and Social Care Partnership has a lead role in taking forward the Wellbeing theme as well as being a key contributor in the delivery of the Economy and Skills and Safer Communities themes.

 Older people and adults who require support and their carers are included and empowered to live the healthiest life possible.  Communities are supported to address the impact that inequalities have on the health and wellbeing of our residents.

Wellbeing Delivery Plan- Local Outcomes:  Starting Well: Children have the best start in life.  Living Well: People are able to look after and improve their own health and wellbeing and live in good health for longer.

The East Ayrshire Strategic Plan 2018-21

The Partnership’s vision is of “Working together with all of our communities to improve and sustain wellbeing, care and promote equity.” Its focus over the course of the Strategic Plan 2018-21 is on early intervention and prevention, new models of care, building capacity in primary and community care, and transformation and sustainability.

The revised East Ayrshire Children and Young People’s Service Plan (2017-2020)

The revised plan, along with its associated action plans and performance framework, sets out a combined vision of the Children and Young People’s Strategic Partnership and the Child Protection Committee as:

“Children and young people are supported to be: Safe, Healthy, Achieving, Nurtured, Active, Responsible, Respected and Included.”

Therefore our commitment to children and young people, their families and carers is to provide them with the support they need, when and where they need it, in order to help them achieve their aspirations and potential at all life stages.

A number of other Integrated Strategic Plans that provide a context for the SIP include the Alcohol and Drugs Partnership Delivery Plan (Monitored by the Alcohol and Drugs Partnership); the East Ayrshire Violence Against Women Strategic Plan (Monitored by the Violence Against Women Partnership); and the Financial Inclusion Strategy (Monitored by the Financial Inclusion Group). In addition, at an

Ayrshire wide level, there is the Joint Child Health and Wellbeing Statement for Ayrshire and Arran (2015-2019); the Community Justice Plan for Ayrshire (Monitored by Community Justice Ayrshire); and a range of Health Improvement Plans.

All of these, in turn, sit within the national context, which includes:

 The Review of Public Health in Scotland  Healthier Scotland Conversation  Health and Social Care Delivery Plan  National Primary Care Vision  Public Bodies (Joint Working) (Scotland) Act 2014  Community Empowerment (Scotland) Act 2015  Children and Young People (Scotland) Act 2014  Carers (Scotland) Act 2016

These policy and legal developments will shape our strategic and operational work during the planning period. Alongside this there have been developments at parent body, regional and UK level that need to be recognised in our activities:

 East Ayrshire Council Transformation Strategy 2: “Closing the Gap” sets out the Council’s proposals for transformational change in local authority services between 2017-2022, with a shift in spending towards prevention and early intervention and a fundamental, innovative redesign of services to achieve financial and organisational sustainability.  Welfare Reform: The implications of the Government’s Welfare Reform programme and the roll-out of Universal Credit in East Ayrshire will be significant, and will likely exacerbate the already significant levels of poverty which exist across East Ayrshire.

National Outcomes – Health, Wellbeing, Children and Justice

A suite of 15 national outcomes frame the activity of the Health and Social Care Partnership. These are as follows:

SECTION 4: REVIEW OF PROGRESS 2017/18

During 2017 we underwent a successful Joint Inspection of Children’s Services. Throughout the process, we continued to implement the service’s vision for children and young people, while also further embedding our relationship based practice model; improving practice standards and designing and implementing new services. Progress against last year’s agreed SIP actions has been substantial, with all actions completed as planned. Of particular note, are:

 External foster placements have halved in number, bringing substantial financial savings;  Following considerable efforts to address the need for increased capacity of residential capacity for young people, funding has now been agreed to proceed with a sustainable plan;  Despite practical difficulties, most actions arising out of the HMIP improvement action plan in relation to prison healthcare have been implemented;  Implementation of a new model of school nursing is well underway, and we are ready for the next stages in national developments of the Named Person legislation. The Justice Service has continued to experience significant change during 2017, with the implementation of a new model for Community Justice in line with the newly introduced Community Justice (Scotland) Act 2016. While it has continued to provide services to the court, it is promoting a stronger focus on valuing people with convictions and developing approaches which reflect relationship based and recovery oriented ways of working. Initial tests of partnership approaches to the delivery of unpaid work with community and third sector services have proved to be successful.

SECTION 5: IMPROVEMENT PLAN

Action Area Expected Outcome Responsible Timescale Increase the number of targeted Increase in the % of older young Senior Manager (Social Work 31 March 2019 foster carers, particularly in people placed with internal foster Children & Families Authority (three monthly review of relation to: carers as opposed to external Wide Services) progress)  Small and large sibling groups; providers or residential care  Children displaying harmful (where assessed as appropriate). Service Manager (Corporate We meet a greater range of Parenting) behaviours; needs based on the specific  Enhanced support needs. needs of children accommodated at any given time. Increase children’s placement We meet a greater range of Senior Manager (Social Work 31 March 2019 choice and capacity. needs based on the specific Children & Families Authority (three monthly review of needs of children accommodated Wide Services) progress) at any given time. A reduction in the number of Service Manager (Corporate children placed in external Parenting) provision. Greater choice and flexibility over internally provided care and matching to individual need.

Action Area Expected Outcome Responsible Timescale To develop and implement the Improve service delivery Senior Manager (Justice 31 March 2019 HMIP Improvement Action Plan. arrangements, and achieve Healthcare Services) (three monthly review of improvements in prison progress) healthcare;

Improved prison healthcare Six monthly review of progress accommodation. (timescale dependent on external factors)

Action Area Expected Outcome Responsible Timescale Implementation of final phase of Relationship based support to Senior Nurse Manager for 31 March 2019 the Universal pathway for health parents in place for all new Children’s Services (three monthly review of visiting. parents. progress)

Contribution to national review of New local model for school Senior Nurse Manager for 31 March 2019 school nursing, and implement nursing, based on the national Children’s Services (three monthly review of local model within East Ayrshire. learning and responsive to local progress) need (emotional health and wellbeing).

Implement policy in accordance Improved policy and practice with Senior Nurse Manager for 31 March 2019 with the national guidance on regard to medicines Children’s Services (three monthly review of Supporting Children and Young administration in schools. progress) People with Healthcare Needs in Schools (which replaces the guidance on the Administration of Medicines in Schools)

Action Area Expected Outcome Responsible Timescale Implement improved Improved performance in respect Senior Managers (Locality) 31 March 2019 performance reporting of early decision making and (three monthly review of arrangements for permanency implementation of actions progress) planning.

Action Area Expected Outcome Responsible Timescale Implement and evaluate the Improved support for families to Senior Manager (Social Work 31 March 2019 impact of a family group reduce the number of children Children, Families & Justice (three monthly review of conferencing model being removed into care. Locality Services) progress) Improve the quality of practice Greater transparency to aid Senior Manager (Social Work 31 March 2019 recording across all services improved decision making Children, Families & Justice (three monthly review of Locality Services) progress) To design and implement a Improved standards and effective Senior Manager (Social Work 31 March 2019 practice improvement feedback arrangements with the Children, Families & Justice (three monthly review of programme in respect of national court. Locality Services) progress) standards and outcomes for Justice Services Service Manager (Justice Services)

SECTION 6: QUALITY ASSURANCE AND IMPROVEMENT DASHBOARD

NB The performance framework below is currently under revision, it is expected that indicators will be revised in-year, and subsequent progress reports will reflect changes.

Dashboard Theme Measure 2016/17 2017/18 2018/19 Goal Customers Number of complaints, baseline 2014/15. 37 TBC Reduce

Process Percentage of child protection decision making within 73% 72.8% 90% standard timescales (CP1s completed within 10 days) Community Payback Orders – percentage of First Job 75.7% 77.7% 95% Appointment within 7 days (Unpaid Work)

Percentage of re-registrations on child protection 5.6% 3.9% N/A register within 12 months

Outcome Percentage of Care Leavers recorded moving on to 100% 100% 100% positive living situations

Number of accommodated children in placements 180 TBC Reduce

Number of Foster Carers (including permanent, interim, 64 67 74 combined, short break)

Community Payback Orders – percentage % Level 1 69% 54.5% 80% Completed with 3 months (Unpaid Work)

Community Payback Orders – percentage Level 2 78% 70.7% 85% Completed with 6 months (Unpaid Work) Percentage implementation of health visiting universal 80% 90% 90% pathways

Dashboard Theme Measure 2016/17 2017/18 2018/19 Goal Rate of medication in prison healthcare 2 errors involving 3 6 errors involving 8 None staff staff % of relevant workforce with active EAGER, baseline 76% 50% 95% March 2016 People % of relevant workforce with e-KSF PDP/Review, 45% 41% 60% baseline March 2016 As at Jan 18 – new system coming into place Sickness absence – days per person (LA), baseline H1 0.92 0.65 0.67 per month 2015/16. Average over 11 months to Feb 2018 Sickness absence - lost hours as % of contracted hours. 4.86% 6.42% 4.0%

SECTION 7: PLANNED EFFICIENCIES

EAC NHS Total Management Action No Option Additional Comments £m £m £m or Consultation

10% budget reduction on Turning the Corner (Action Service was previously subject to a 10% 1 for Children) - Intensive Support as an alternative to (0.019) 0.000 (0.019) Management Action reduction Secure Care

Remodelling of Lisalanna Contract (Action for 2 (0.216) 0.000 (0.216) Report approved at IJB - 30 Nov 2017 Consultation Children)

Continuing commitment to reducing the 3 External Foster Care - planned reductions 2018/19 (0.060) 0.000 (0.060) Management Action use of externally purchased foster care

4 Self directed support (0.017) 0.000 (0.017) Budget Underspent in 2018/19 Management Action

Increased staff turnover in preference to 5 Staff turnover increase (6-7%) (0.124) 0.000 (0.124) Management Action deleting posts

6 Absorb additional demand - TBC 0.000 (0.080) (0.080) Absorb 3.5% indicative demography Management Action

Managed turnover to mitigate approved 7 Health Visitor budget – staff turnover (8.3%) 0.000 (0.191) (0.191) CRES target. This equates to 4.6 WTE HV Management Action posts.

TOTAL (0.436) (0.271) (0.707)

SECTION 8: RISK ASSESSMENT/ MANAGEMENT

The following high level risks are applicable across all services within the Children’s Health, Care and Justice portfolio.

Description of the risk Current measures in place that mitigate Failure to be sustainable  Maximise partnership working and the potential benefits of integration. That the reduction in public services funding, coupled  Transformational change programmes and service redesign that seek to attract with demographic pressures, means we are unable to additional investment, release capacity and recurring savings, or stop activity that no commission and deliver services which meet our longer delivers positive outcomes for children or in terms of community justice. strategic priorities or fulfil our statutory duties.  Anticipate demand and identify activity that will reduce demand for services. Failure to manage and support change  Ensure that work is appropriately delegated to managers/leaders. That, due to the scale and pace of change, and to the  Monitor impact of expanded portfolios for Heads of Service. ongoing impact of reductions in senior  Staff / team communication and learning opportunities. management/leadership, staff become disengaged from  Maximising opportunities for partnership connections, and supporting strong multi- the transformation agenda and our strategic priorities, agency partnership working. leading to poor morale, and in turn to increased staff  Engage with new Elected Members as part of their induction. absences and further pressures on meeting demand.  Clear priorities.  Shared leads for areas of development.  Regular review and timeline realignment where necessary.  Appropriate prioritisation of pan Ayrshire activity. Failure to meet standards of care  Codes of conduct. That, due to workforce development and planning issues  Robust governance arrangements; complaints procedures. (such as difficulties retaining experienced staff in rural  Supervision / EAGER etc areas), inconsistent practice across services,  Quality assurance measures (such as case file audits; Care Inspectorate inspections). inconsistent or poor practice mean we are not meeting  H&SCP Workforce Development Plan. children’s or communities’ needs i n a way that is safe for  Professional specific issues identified and action plans in place / adverse event review them, is of good quality, or that meets our own or groups; duty of candour. statutory standards.  Monitoring of specific issues eg maternity cover; retaining staff in the south of East Ayrshire.

Description of the risk Current measures in place that mitigate Failure to move to a more preventive and early  Maintaining existing relationships beyond the H&CSP and seeking to find more intervention delivery model effective ways to collectively improve practice and services. That we fail to sustain our models of care, meaning  Strong multi-agency partnership involvement in development and progressing the children and communities are no longer able to access Children & Young People’s Service Plan and the Community Justice Outcome appropriate support at an early stage, and so require Improvement Plan. more intensive supports, or that we fail to support  Robust progress reporting and performance framework to ensure implementation of preventable re-offending; and that in turn this contributes plans. to unsustainability of the health and social care system.  Improved co-ordination of planning & performance support. Failure to protect children & young people  Public Protection review in progress. That, due to the complexity of public protection, coupled  A robust Child Protection Team is in place supporting front line practice by developing with the increasing complexity of the needs we are appropriate policies and procedures meeting, implementation of the Children & Young People  Staff training and screening for risk (Scotland) Act 2014 and the associated readiness of our  Ayrshire Programme Board in place. multi-agency Named Person service are compromised,  Ayrshire Programme Manager appointed. meaning we are unable to ensure the safety of  Draft guidance developed. vulnerable children.  Multi agency training underway.  Multi-agency learning & development being planned.  MAPPA. Failure to respond to the Historic Abuse Enquiry  Strong focus on multi-agency partnership working to best support and respond. That we fail to properly support people who are affected  Learn from good practice in other areas. by the enquiry, and / or to anticipate financial  Monitor impact of additional demands on services. implications, contributing to pressures on demand for services or on the sustainability of the health & social care system.

In addition, there are Service specific risks to be considered;

Risk Mitigation Lack of appropriate accommodation within  Currently the healthcare team are maximising and prioritising the use of the rooms which are the prison for the provision of healthcare. available to deliver health interventions.  Consideration is being given to reviewing staff working hours, perhaps using consolidated hours to free up office space which is currently overcrowded.  Mental Welfare Commission and recent HMIP Inspection reports continue to highlight issues.  A proposed plan for the development of the accommodation has been developed. Risks of medication errors due to systems  There is a constant review of the processes involved in the prescribing and administration of issues and large scale operation across the medications along with review of the operational constraints in which the nursing staff prison. administer medications, in order to reduce the risk of medication errors.  There is ongoing work through the National Prisoner Healthcare Network to progress the implementation of electronic prescribing nationally to reduce many of the errors which currently occur.

Risk of Kinship Care Placement  Helping future focus assessment of Kinship Carers. Breakdown.  Improving the quality of assessments.  Explore funding potential for trauma team  Further engage key partners in the provision of support The inability to deliver the health visiting  Regular Review and monitoring of implementation plan. universal pathway due to the financial  Ongoing professional update with Director of Nursing/Associate Director of Nursing. savings requiring to be made within NHS  Regular professional updates with Health Visiting Staff. budgets. The potential risks associated with  Currently achieving Foster Carer recruitment targets and have converted a number of external managing the planned Council savings in Foster Care placements into Supported Carer arrangements for young people aged 18 years. respect of external fostering and external  Future savings will be dependent on an invest to save approach. residential child care, while also responding to demand pressures. The potential financial and service risks  Secured funding for 2 years for supported accommodation for 6 young people which will assist associated with the new continuing care with capacity. requirements.  Developed plans for increasing our internal children’s house capacity to address increased need associated with the new planning assumption that young people will “stay put” at least till they are 18 years or above. 22

The risks associated with managing  Encouraging foster carers to convert to Supported carers when young people in their care turn expectations; ensuring operational safety 18. and ensuring service delivery options in  The Children’s Houses registration has been increased up to age 19. extending the rights of care experienced  Recruiting supported carers. young people (e.g. Staying Put).  Developing Whatriggs Road with Blue Triangle.  Early Pathway planning. The risks to service delivery / business  Social Work Scotland professional view to inform approach continuity of failing to implement the NVP  Awareness-raising with staff in relation to the vetting process in order to dispel any myths. Vetting arrangements in respect of the  An approach in relation to this to be developed involving HR and legal services. 1 extended use of ViSOR (MAPPA).

1 ViSOR is the recognised national IT system for the management of people who pose a serious risk of harm to the public. It is Home Office owned and maintained and as such, it is the Home Office that sets the level of vetting required. In order to access and use ViSOR all staff (and other relevant Social Work Services) must be vetted to either Non-Police Personnel Vetting Level 2 (NPPV 2) or Non-Police Personnel Vetting Level 3 (NPPV 3), depending on an individual’s role within ViSOR. The process may be considered to be more intrusive than current PVG process which is required to be employed as a SW. Unions have advised their member not to comply with the vetting. It is acknowledged that over time if staff are not vetted the pool approved to access ViSOR will reduce and this may impact on service.

East Ayrshire Health and Social Care Partnership

Community Health and Care Service

Service Improvement Plan

2018/19

April 2018

Contents

SECTION 1: INTRODUCTION ...... 3 SECTION 2: SERVICE DESCRIPTION ...... 4 SECTION 3: POLICY AND PERFORMANCE CONTEXT ...... 7 SECTION 4: REVIEW OF 2017/18 ...... 13 SECTION 5: SERVICE IMPROVEMENT PLAN 2018/19 ...... 14 SECTION 5B: PERFORMANCE SCORECARD ...... 19 SECTION 6: PLANNED EFFICIENCIES ...... 20 SECTION 7: RISK ASSESSMENT/MANAGEMENT ...... 21

SECTION 1: INTRODUCTION This service improvement plan for Community Health and Care Services is set within the context of the East Ayrshire Community Plan 2015 – 30 and the East Ayrshire Health and Social Care Strategic Partnership Plan 2018 – 2021.

The SIP is structured around improvements in Community Health and Care Services as these contribute to creating positive local outcomes within the strategic planning context.

The Community Health and Care Management Team reviews progress against the service improvement plan objectives at management team meetings and also maintain an overview of performance and risk management.

The Service Improvement Plan covers the following:

 Service description;  Review of 2017/18;  Policy context;  Improvement plan;  Performance scorecard;  Planned efficiencies, and;  Risk.

SECTION 2: SERVICE DESCRIPTION During 2017/18, Community Health and Care developed its vision, which is:

“East Ayrshire communities have reached their potential for healthy, independent lives.” and developed common values, which underpin its work:

Community Health and Care services cover the following key elements:

 Locality Community Care Teams;  Purchasing budget;  Day services;  Commissioning and contracting of services for adults and older  Care at home; people;  Care homes;  Acute strategic liaison;  Physical disabilities;  Adult Support and Protection;  Sensory impairment;  Housing support;  District nursing;  Mental health services;  Frail elderly services;  Learning disability services;  Intermediate Care Team (East);  Alcohol and drugs services;  East Ayrshire Community Hospital;  Winter planning;  Kirklandside Community Hospital;  Unscheduled care.

The Organisational Structure of the service is shown below:

Head of Service: Strategic Adult Protection Programmes Community Health & Co-Ordinator Care Services Manager

Senior Manager Senior Manager Senior Manager (Locality Services) (Mental Health, (Locality Services) Northern & Alcohol & Drugs Southern and Learning Kilmarnock Disability)

Service Service Service Service Clinical Nurse Service Service Manager Manager Manager Manager Manager Manager Manager 5

The budget for the service for 2018/19 is shown below:

Service Budget (£M) Learning disabilities 14.587 Mental health 4.961 Addictions 1.310 Adult Support and Protection 0.190 Older people 34.882 Physical disability 2.320 Sensory impairment 0.187 Community nursing 3.413 Transport 0.470 Community hospitals 4.148 Integrated Care Fund 2.470 Resource transfer, administration 9.968 TOTAL 78.906

No specific “set aside” resource has yet been identified as part of the NHS Ayrshire & Arran budget setting process for 2018/19. Work is ongoing to finalise the sum to be allocated.

The “set aside” budget is for large hospital services, which are used in a predominantly unscheduled way. Service areas within the set aside budget are accident and emergency; inpatient services for general medicine, geriatric medicine, rehabilitation; respiratory and learning disability psychiatry, and palliative care services provided in hospital.

SECTION 3: POLICY AND PERFORMANCE CONTEXT The key policy developments that continue to shape and influence the delivery of services include:  The Palliative and End of Life Strategic  Health and Social Care Delivery Plan  Public Bodies (Joint Working) Framework for Action;  Realising Realistic Medicine (Report by (Scotland) Act 2014  Report of the National Review of Chief Medical Officer for Scotland)  Community Empowerment (Scotland) Primary Care Out of Hours Services;  National Primary Care Vision Act 2015  The Review of Public Health in Scotland  Self-Management Strategy for Long  Children and Young People (Scotland)  A National Clinical Strategy for Scotland Term Conditions in Scotland Act 2014  Social Services in Scotland: A shared  Carers (Scotland) Act 2016 vision and strategy 2015-2020.  Healthier Scotland Conversation

3 Digital Health and Social Health and Social Care Care Strategy 2017-22 2 Standards: My support, Making Care Better - A A Fairer Healthier my life strategy for supporting The 2018 General Scotland; A Framework better care in Scotland Medical Services for Action 2017-22 2017–2022 Contract in Scotland 1

0 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17

-1 Welfare Reform – Mental Health Strategy Scotland's National Introduction of 2017-2027 -2 Dementia Strategy 2017- Universal Credit 2020 Review of Targets and Achieving Excellence in Indicators in Health and Pharmaceutical Care: A Social Care in Scotland -3 Strategy for Scotland

Welfare Reform: the implications of the Government’s Welfare Reform programme and the roll-out of Universal Credit in East Ayrshire will be significant. There are concerns that the reduction in welfare spending will impact negatively on income inequality, poverty and child poverty and on equality groups, including the impacts on women and people with disabilities. It is projected that welfare spending in Scotland will be reduced by around £0.9 billion by 2020/21 as a direct result of these reforms, which equates to a loss per working age adult in East Ayrshire of £299 per annum. This reduction in incomes for individuals and families in receipt of benefits will likely exacerbate the already significant levels of poverty which exist across East Ayrshire and have a detrimental impact on the physical and mental health and wellbeing of those living in situations of poverty.

Everyone Matters – 2020 Workforce Vision Implementation Plan 2018-20 Everyone Matters (December 2017) is the fifth implementation action plan for the 2020 Workforce Vision. The Plan builds on previous success on embedding values, developing leadership, tackling inequalities and integration. There will be a continuous emphasis on the five priority areas of:  Healthy Organisational Culture  Sustainable Workforce  Capable Workforce  Workforce to Deliver Integrated Services  Effective Leadership and Management.

The 2018-20 implementation plan focuses on continuing and consolidating the good progress which has already been made over previous years through the implementation of the vision and values and a range of national and regional actions. Actions identified in previous implementation plans which have not been completed or superseded by others will also continue to be prioritised and progressed.

Self-Directed Support Strategy 2010-20 – Implementation Plan 2016-18: the Self-Directed Support Strategy Implementation Plan 2016-18 (November 2016) is the third phase of the ten year Strategy. The Implementation Plan for 2016-18 is about consolidation of the considerable progress made to-date in taking forward self-directed support. The Plan sets out key challenges driving action over the implementation period. These are grouped according to the outcomes of greater choice and control for supported people, confident and valued workers, flexible and responsive commissioning, and simplification of systems and processes.

The Modern Outpatient – A Collaborative Approach 2017-20: the Modern Outpatient Programme (December 2016) points to significant increase in high volume specialties such as gastroenterology, respiratory medicine and dermatology. The Programme is part of the transformation of services, shifting care closer to home, away from a hospital-delivered outpatient appointment and towards partnership between secondary care, primary care and community services to support self-management, anticipatory care and appropriate management of risk. The Modern Outpatient Programme aims to reduce hospital-delivered appointments and to free-up resources to be reinvested in community-based services. The Programme seeks to achieve this by making the most of e-health and digital technologies, developing care pathways and increasing the capacity of multi-disciplinary teams to support people in the community.

National Health and Social Care Workforce Plan- Parts 1 and 2: provides the framework for improving workforce planning across health and social care; to identify, develop and put in place the workforce they need to deliver safe and sustainable services within the context of wider health and social care reforms. Part 1 of the Plan focusses on NHS Scotland and Part 2 considers ways to address the challenges facing social care workforce planning post integration and is published jointly with COSLA. Part 3 of the Plan follows the conclusion of GMS contract negotiations and sets out thinking in relation to primary care. In this first year, this incremental approach will enable different systems to take stock and move together towards a second full Health and Social Care Workforce Plan in 2018, which will have greater capacity to address the size and diversity of the health and social care workforce, and its workforce planning needs.

National Outcomes – Health, Wellbeing, Children and Justice

The suite of 15 national outcomes frames the Partnership’s activities. These are as follows:

East Ayrshire Community Plan 2015-30

The East Ayrshire Community Plan 2015-30 is the sovereign and overarching planning document for the East Ayrshire area, providing the strategic policy framework for the delivery of public services by all partners. The Community Plan has been reviewed during 2017/18. The vision set out in the Community Plan is that: “East Ayrshire is a place with strong, safe and vibrant communities where everyone has a good quality of life and access to opportunities, choices and high quality services which are sustainable, accessible and meet people’s needs.” 10

Implementation of the Community Plan is through three thematic Delivery Plans, namely Economy and Skills, Safer Communities, and Wellbeing, which have been renewed as part of the Community Plan Review. The Health and Social Care Partnership (“the Partnership”) has a lead role in taking forward the Wellbeing theme as well a key contributory role in the delivery of the Economy and Skills and Safer Communities themes.

Strategic Priorities 2018-2021: The Council and Community Planning Partnership Board have agreed to focus on the following:

 Improving outcomes for children and young people, with a particular focus on looked after children/young people and young carers;  Older people: adding life to years – with a particular focus on tackling social isolation; and  Community led regeneration: empowering communities - building community resilience.

Community Plan Wellbeing Theme- Strategic Priorities:  Children and young people, including those in early years and their carers, are supported to be active, healthy and to reach their potential at all life stages.  All residents are given the opportunity to improve their wellbeing, to lead an active, healthy life and to make positive lifestyle choices.  Older people and adults who require support and their carers are included and empowered to live the healthiest life possible.  Communities are supported to address the impact that inequalities have on the health and wellbeing of our residents. Wellbeing Delivery Plan- Local Outcomes:

 Starting Well: Children have the best start in life.  Living Well: People are able to look after and improve their own health and wellbeing and live in good health for longer.

Health and Social Care Partnership Strategic Plan 2018-21

The Partnership’s vision is of: “Working together with all of our communities to improve and sustain wellbeing, care and promote equity.”

Strategic Priorities

The Partnership’s focus over the course of the Strategic Plan 2018-21 is on:

 Early Intervention and Prevention  New Models of Care  Building Capacity in Primary and Community Care  Transformation and Sustainability Community Health and Care Service Priorities

To contribute towards the Partnership’s Strategic Plan and the Community Planning Partnership’s Wellbeing Delivery Plan, improvements in Community Health and Care services over the course of the Service Improvement Plan 2018-19, are focussed on:

 Prevention and Early Intervention: o Mental Health o Maximising Independence and Reducing the Need for Formal Supports  New Models of Care: o Front Door and Multidisciplinary Services o Rehabilitation and Reablement o Unscheduled Care o Palliative and End of Life Care  Enablers o Technology o Workforce o Engagement  Transformation and sustainability cut across all the improvement areas.

SECTION 4: REVIEW OF 2017/18 Service improvements have been evidenced in a number of areas:

Preferred model for re-providing Delayed 73 admissions Red Cross Home Kirklandside ‘Code 9’ discharge bed avoided, from Hospital Hospital Services discharge bed days down 1,730 bed 1,716 people developed with days down 25.6%* days saved supported stakeholders 30.8%* People more Acute able to live well unscheduled bed day use down Intervention Front Door 2.4%* Minimised: at home ED conversions down 20.4%* 1.2% net iESE National Transformation reduction in Award Care at Home ‘Review of 24 hour

care: the right support, Workforce in the right way at the Developing Vision & Values Mental Health right time:’ established multidisciplinary created unscheduled bed governance, evidence * first 10 locality-based Shaping Our together day use down months of service delivery Future base & 8.7%* implementation plan 2017/18 (April model Together Engagement 17 - Jan 2018) compared to Programme baseline year Areas for improvement relate to:

 Performance in relation to supporting the workforce to achieve the “People” indicators within the Community Health and Care performance scorecard. 13

SECTION 5: SERVICE IMPROVEMENT PLAN 2018/19 Code Theme Service Priority Action Area Outcome(s) Responsible Timescale

1 Prevention & Mental Health Complete review of primary care mental health Services facilitate timeous access, minimise Senior Manager March Early services and begin implementation of new dependence on medication, promote Mental Health, 2019 Intervention service model. recovery and use minimum level of Alcohol & Drugs and intervention wherever possible. Learning Disabilities People get timely access to the right support.

Shift in balance of care/resources from formal services to community alternatives/self-management.

2 Prevention & Maximising Complete review of day opportunities services Day opportunities fit with policy and Senior Manager March Early Independence for adults and older people and begin resource context and opportunities for Mental Health, 2019 Intervention implementation of new service model. alternative service delivery models are Alcohol & Drugs and identified. Learning Disabilities People are supported in a way that is personal to them, close to home and maintains/improves their community connections.

Shift in balance of care/resources from buildings to community- based.

3 Prevention & Maximising Work with Children’s Services to finalise Service arrangements are in place to support Senior Manager September Early Independence pathway and implement arrangements that a managed transition from children’s to Mental Health, 2018 Intervention support smooth transition into adult services. adult services. Alcohol & Drugs and

People experience person-centred care that Learning Disabilities is integrated from their perspective.

Code Theme Service Priority Action Area Outcome(s) Responsible Timescale

4 Prevention & Maximising Continue to review provision of 24 hour Community based support makes best use Senior Manager March Early Independence packages of community based supports: the of Smart Supports and redesign Mental Health, 2019 Intervention right support in the right way at the right time. opportunities to maximise independent Alcohol & Drugs and living are identified. Learning Disabilities People are supported in the right way, in the right place at the right time.

Shift in balance of care/resources from care at home type supports to Smart Supports.

5 New Models of Maximising Implement programme of new models of Supported accommodation services are in Senior Manager March Care Independence supported accommodation in line with East place to enable independent living and Mental Health, 2021 Ayrshire Council’s Strategic Housing Investment appropriate risk taking with support. Alcohol & Drugs and

Plan. People with complex needs are able to live Learning Disabilities as independently as possible in the community.

6 New Models of Front Door & Further develop locality-based Front Door Services are aligned to and delivered as part Senior Managers March Care Multidisciplinary service model; multidisciplinary working and of published locality arrangements. 2019 Services business processes and implement approach in Business processes are in place to support sustainable services. adult mental health and learning disability services. Services operate to manage demand in line with financial sustainability and transformation objectives.

People are supported close to home in a way that; is personal to them, maximises their independence, improves their wellbeing and maintains/improves their community connections.

Code Theme Service Priority Action Area Outcome(s) Responsible Timescale

Shift in balance of care/resources towards community-based alternatives to formal supports.

7 New Models of Rehabilitation & Implement Phase 1 of redesigned Intermediate Multidisciplinary intermediate care is Senior Manager March Care Reablement Care Team model, pending new investment. embedded across community services. Locality Services 2019 (Northern and People are enabled to improve their health Kilmarnock) and wellbeing.

8 New Models of Rehabilitation & Implement preferred option for re-providing Rehabilitation model is embedded across Senior Manager March Care Reablement current Community Rehabilitation Centre appropriate community services. Locality Services 2019 services. (Northern and People received care closer to home. Kilmarnock)

9 New Models of Unscheduled Care Oversee delivery of the Unscheduled Care Programme is delivered to agreed outcomes. Head of Community March Care Programme, focussing on implementation of Health and Care 2019

top 3 strategic priorities.

10 New Models of Palliative and End Continue redesign as part of national palliative Learning from national pilot informs all Senior Manager March Care of Life Care care and end of life pilot. palliative care service redesign and Locality Services 2019 development programmes. (Southern) People are cared for in a way that; is personal to them, maintains their dignity and independence and maintains/improves their community connections.

11 Prevention & Maximising Develop and implement local dementia action Demand for support is understood and Senior Manager March Early Independence plan. effectively planned using an integrated Locality Services 2019 approach. 16

Code Theme Service Priority Action Area Outcome(s) Responsible Timescale

Intervention People receive the right support at earlier (Northern and stages, thereby avoiding hospital admission. Kilmarnock) and

People are supported close to home in a way Senior Manager that; is personal to them, maximises their Locality Services independence, improves their wellbeing and (Southern) maintains/improves their community connections.

Shift in balance of care/resources from acute to community services.

12 Enablers Technology Implement electronic scheduling systems pilot Services operate more effectively as a result Senior Managers March in care at home services. of efficient scheduling. 2019

13 New Models of Rehabilitation & Review pathways and medical model in East Reduction in variability of healthcare Senior Manager July 2019 Care Reablement Ayrshire Community Hospital and implement practice. Locality Services findings. (Southern) People are enabled to return home more quickly.

14 New Models of Maximising Continue to implement recommendations from Streamlined, efficient and effective provision Senior Manager March Care Independence Best Value Review of Adaptations. of adaptations across housing tenures. Locality Services 2019 (Northern and People are supported to live as independently as possible in their Kilmarnock homes/homely setting.

15 New Models of Maximising Support approved scoping exercise, with Equipment and minor adaptations are Senior Manager March Care Independence partners in South Ayrshire Partnership and NHS, delivered in a streamlined and effective way. Locality Services 2019

Code Theme Service Priority Action Area Outcome(s) Responsible Timescale

to inform decisions about future community People are supported to live as (Northern and equipment service modelling to address the independently as possible in their Kilmarnock needs of East Ayrshire communities. homes/homely setting.

16 Enablers People Implement Service Organisational Development The wellbeing of the workforce is improved; Head of Community March Plan thereby ensuring people are appropriately Health and Care 2019 motivated, engaged and skilled for work.

SECTION 5B: PERFORMANCE SCORECARD NB: The performance framework below is currently under revision, it is expected that indicators will be revised in-year and subsequent progress reports will reflect changes.

Customers

Measure 17/18 Result Baseline Target Aim 18/19 Result

Number of complaints (baseline total 2017/18) 45 45 N/A N/A Number of Older Aged Residents in Care Homes (baseline March 2018) 670 670 N/A N/A Number of Care at Home Service Users Aged 65+ (baseline March 2018) 1469 1469 N/A N/A

Outcomes

Measure 17/18 Result Baseline Target Aim 18/19 Result Bed days lost to delayed discharge for standard delays Data available May 2018 Number of delayed discharges number over two weeks 0 0 0 Minimise Referral to social work in week before fit for discharge Data available May 2018 50% Minimise % of delayed patients discharged within 7 days Data available May 2018 33% Maximise % of Emergency Attendances Converted to Unscheduled Admissions (baseline 32.3% 32.3% 30% Minimise 2017/18) Readmission to hospital within 7 days (baseline 2017/18) 5.4% 5.4% 4.3% Minimise Readmission to hospital within 28 days (baseline 2017/18) 11.1% 11.1% 9.2% Minimise

People

Measure 17/18 Result Baseline Target Aim 18/19 Result EAGER/PDP Review - % with EAGER in place (baseline March 2018) 76% 76% 95% Maximise PDR Percentage of PDRs completed & signed off by both parties at the end of the month for NHS 56% 56% 95% Maximise Employees (baseline Jan 2018) Sickness absence days per person (LA) (baseline March 2018) 0.72 0.72 0.67 Minimise Sickness absence - % of available days (NHS) (baseline March 2018) 7.09% 7.09% 4% Minimise

Process

Measure 17/18 Result Baseline Target Aim 18/19 Result

Recovery-focused drug treatment within 3 weeks (2017/18) 98.4% 98.4% 90% Maximise 19

SECTION 6: PLANNED EFFICIENCIES

The detail of planned efficiencies for the local authority parent body is set out in the Transformation Strategy 2017-2018, with periodic reporting on this provided through East Ayrshire Performs.

The detail of planned efficiencies for the Partnership in 2017/18 is set out in the published Financial Recovery Plan, with periodic reporting to the Integration Joint Board. Specific action to be taken forward during 2018/19 relates to:

EAC NHS Total Management Action or No Option Additional Comments £m £m £m Consultation

Revise policy on 24 hour Full year saving £0.817m approved by IJB (0.530) 0.000 (0.530) Management Action 1 care at home services 24/11/16

Review care at home Full year saving £2.874m approved by IJB packages to reduce overall (1.437) 0.000 (1.437) Management Action 2 24/11/16 by 10%

Partially absorb indicative demography 3% Older, 3 Absorb additional demand (1.224) 0.000 (1.224) 3% Mental Health, 4.2% Learning Disabilities Management Action £1.978m in total

4 Utilise ICF funding balance 0.000 (0.358) (0.358) Direct support to mitigate pressures in CHCS Management Action

Including cessation of ongoing redeployment at Kirklandside re-provisioning 0.000 (0.192) (0.192) Management Action 5 30/9/18 (permanency)

6 Managed turnover 0.000 (0.073) (0.073) Equates to 0.8% of CHCS staffing budget Management Action

TOTAL (3.191) (0.623) (3.814)

20 SECTION 7: RISK ASSESSMENT/MANAGEMENT Risk Assessment Mitigation Comments

Failure to be sustainable  Maximise partnership working and the If we were unable to sustain service That the reduction in public services potential benefits of integration. provision that meets people’s needs, the funding, coupled with demographic  Transformational change programmes and impact in East Ayrshire would be critical. pressures, means we are unable to service redesign that seek to attract additional The likelihood of this outcome with commission and deliver services which investment, release capacity and recurring current mitigating measures, however, is meet our strategic priorities or fulfil our savings, or stop activity that no longer delivers statutory duties. positive outcomes for people we support. low to moderate.  Anticipate demand and identify activity that Action should, therefore focus on will reduce demand for services. ensuring successful implementation of  Realise CRES savings the current mitigating measures to keep the likelihood of the risk low Failure to protect people  A robust Adult Support & Protection Team is If we were unable to ensure the safety of That the complexity of public protection, in place supporting front line practice by vulnerable people, the impact in East coupled with the increasing complexity of developing appropriate policies and Ayrshire would be critical. procedures the needs we are meeting, means we are The likelihood of this outcome with unable to ensure the safety of vulnerable  Self-evaluation. current mitigating measures, however, is and people at risk of abuse.  Staff training and screening for risk. low to moderate. Pending the outcome of the review of the public protection support function in East Ayrshire, action should focus on ensuring the continuing successful implementation of current mitigating measures to keep the likelihood of the risk low. Failure of external service providers  Contract monitoring and review officers. If we experience the failure of external That financial pressures, poor quality of  Care Inspectorate. providers (for any of the reasons care or poor leadership lead to the failure  Robust adult support & protection processes. mentioned), the impact in East Ayrshire of external service providers to meet  Contingency planning to provide emergency would be severe (rather than critical). contractual obligations, and consequently 21 mean we are unable to meet our strategic cover are in place across care homes The likelihood of this outcome with priorities or fulfil our statutory duties.  Risk registers in place with mitigations current mitigating measures is low to moderate. Action should focus on ensuring continued successful implementation of the current mitigating measures, and regular review of contingency plans, in order to keep the likelihood and impact of the risk low.  SSSC codes of conduct. If we fail to meet standards of care (due  Appropriate policies and procedures are in to errors or poor practice), the impact in place. East Ayrshire would be significant (rather  Duty of candour. than severe or critical). Failure to meet standards of care  Care plan audits. The likelihood of this outcome with That errors or poor practice mean we are not meeting people’s needs in a way that is  Clinical audits and improvement plans current mitigating measures is low. safe for them, is of good quality, or that  Supervision in place Action should focus on ensuring meets our own or statutory standards.  Incident reporting and learning. continued successful implementation of  Spot checks. the current mitigating measures, with opportunities for regular feedback and  Robust care governance in place learning, in order to keep the likelihood  Codes of conduct and impact of the risk low.  New Models of Care Programme. If we were unable to move to a Failure to move to a more preventive and  Invest in Vibrant Communities and Third preventive and early intervention model, early intervention delivery model Sector. the impact in East Ayrshire would be That we fail to re-balance our models of  Programme of service reviews that test for critical. care, meaning people are unable to access appropriate support at an early stage, and prevention / early intervention. The likelihood of this outcome with so become reliant on more intensive  Continuing the service change programme current mitigating measures remains supports and hospital admissions; and that (including FDS, ICT East, and management of high. in turn this leads to unsustainability of the supported tenancies). Given the critical nature of this risk, close health and social care system.  Improved co-ordination of planning & attention should be given to ensuing the performance support. mitigating factors are implemented, and 22 further consideration should be given to additional mitigation measures that could be put in place, (to reduce impact and / or to reduce likelihood).  Management and team development sessions. If we failed to manage and support  An effective OD programme that includes at change, the impact in East Ayrshire Failure to manage and support change least annual team development sessions would be critical. That staff become disengaged from the  Practice development. The likelihood of this outcome with transformation agenda and our strategic  Engagement and workforce development current mitigating measures, however, is priorities, leading to inconsistent practice across services and poor morale, in turn programme. low to moderate. leading to increased staff absences and  Healthy Working lives programmes Action should, therefore focus on further pressures on meeting demand.  Access to resilience building opportunities ensuring successful implementation of the current mitigating measures to keep the likelihood of the risk low.

23 East Ayrshire Health and Social Care Partnership

Primary Care and Out of Hours Community Response Service

Service Improvement Plan

2018/19

April 2018

Contents

SECTION 1: INTRODUCTION……………………… …………………………………………………………….....page 3 SECTION 2: SERVICE DESCRIPTION…………………………………………………………………………………page 4 SECTION 3: POLICY CONTEXT………………………………………………………………………………………...page 11 SECTION 4: REVIEW OF PROGRESS …………….…………………………………………………………………..page 20 SECTION 5: IMPROVEMENT PLAN 2018-2019……………………………………………………..………………..page 25 SECTION 6: QUALITY ASSURANCE AND IMPROVEMENT DASHBOARD……………………………………...page 27 SECTION 7: PLANNED EFFICIENCES………………………………………………………………………………...page 29 SECTION 8: RISK ASSESSMENT/MANAGEMENT…………………………………………………………………..page 30

SECTION 1: INTRODUCTION

Service Improvement Plans (SIPs) are a key part of the Health and Social Care Partnership’s performance management and improvement framework. This plan sets out our vision and priorities; our performance framework; risks and opportunities; improvement actions for 2018/19; and progress made in 2017/18.

This Service Improvement Plan covers the 2018/19 period and outlines how we will build on existing work to support the necessary improvements that are required across Primary Care. Our key aims for the forthcoming year remains fixed on supporting the wider transformation agenda within Primary Care, delivering improved levels of local care and building stronger, more sustainable and more integrated Primary Care services across Ayrshire and Arran.

Our Plan has been developed in a transformational period for Primary Care in Scotland and it continues to be guided by the national agenda on the modernisation of primary care to better deliver of safe, effective and person-centred healthcare services in line with key Government policies such as the ‘2020 vision’ and the ‘Health and Social Care Delivery Plan’.

Our focus for the forthcoming year has been influenced also by the requirement to implement the new General Medical Services (GMS) contract across Ayrshire and Arran from April 2018. The way in which General Practice will work in the future will change as a result of the new contract and our Plan outlines the activities that we will undertake to both implement the new contract and to deliver the required changes to meet the national priorities for Primary Care.

SECTION 2: SERVICE DESCRIPTION

The Service Area covers Primary Care and Out of Hours Community Response within East Ayrshire Health and Social Care Partnership.

Service coverage is as follows:

 Medical practices  Community pharmacies  Optometry practices  Dental practices  Public Dental Service  Ayrshire Urgent Care Service (formerly the Pan-Ayrshire Out-of-Hours Social Work Response Service)

Primary Care refers to the four independent contractors which provide the first point of contact for people with the NHS. These contractors are General Practitioners, Community Pharmacists, Optometrists and General Dental Practitioners. ‘Out of Hours’ refers to services provided beyond the common working pattern of 9.00 am to 5.00 pm and includes both Primary Care Health and Social Work out-of-hours services.

There are currently a total of 56 GP Practices across Ayrshire with a registered practice population of 385,007(as at April 2017). In addition to traditional General Medical Services, our practices deliver in excess of 30 Enhanced Services that deliver care to patients that would have otherwise have required a hospital visit.

General Practice General practice provides continuing, comprehensive, coordinated and person-centred healthcare to the communities of Ayrshire and Arran. A strong and thriving general practice is critical to sustaining high quality healthcare, which is available to all and which can realise Scotland’s ambition to improve our population’s health and reduce health inequalities.

The benefits of the proposals is to develop partnerships between patients, their families and those delivering healthcare services to provide care which is appropriate and based on an assessment of individual needs and values and improves wellbeing, demonstrates continuity of care, clear communication and shared decision-making.

GP clusters were introduced in Scotland as part of the 2016/17 GMS agreement between the Scottish GP Committee and the Scottish Government. GP Clusters have a mandate to improve quality in the wider health and social care system, including the use of secondary care, and to ensure that the focus on quality improvement work is responsive to local needs and locally determined. In Ayrshire and Arran a total of 11 clusters have been established across the three Health and Social Care Partnerships.

Community Pharmacy Across Ayrshire and Arran there are 98 community pharmacy outlets and these are also providing 15 enhanced services to meet local needs. In addition, 64 dental practices are offering general dental services (5 of which are orthodontic practices) and 57

optometry practices are offering a range of optometry services across the area. Clinical Leadership arrangements are also well- established across contractor groups.

Community Pharmacy, through its national contract, provides a range of services for patients over and above the dispensing of medicines, taking full advantage of the skills of a pharmacist. These include four new NHS pharmaceutical care services, which have been introduced since 2006. These services are the Minor Ailment Service (MAS), Public Health Service (PHS), Acute Medication Service (AMS) and Chronic Medication Service (CMS). Across Ayrshire and Arran these new services are involving pharmacists in the community more in the provision of direct patient-centred care as part of the wider primary care team.

In addition, the Pharmacy First initiative is enabling community pharmacists to treat "uncomplicated UTIs in women and impetigo in children" without a prescription. In Ayrshire and Arran 97 of 98 pharmacies provide this service. Patients can self-refer to community pharmacies providing the Pharmacy First service and they can also be referred by GP practices in hours and OOH services/NHS24 out of hours.

Community optometrists provide a comprehensive eye examination service model to care for an aging population. The eye examination is universally funded and therefore free of charge to all eligible patients. In Ayrshire and Arran accredited optometrists provide locally enhanced eye care services reducing the burden on secondary care. These include: Low Visual Aids (Visual Impairment); Bridge to Vision (Learning Disability); Post-Operative Cataract Surgery Assessment; Medical Contact Lenses and Diabetic Retinopathy Screening.

Optometry Community optometrists provide a comprehensive eye examination service model to care for an aging population. The eye examination is universally funded and therefore free of charge to all eligible patients. Geographical access to eye care at optometrist practices across all HSCPs in NHS Ayrshire and Arran is good.

The ‘Eyecare Ayrshire’ re-direction initiative was launched in 2017 and aims to shift the balance of care for eye problems from GP practices and EDs to local optometry practices. The public campaign promotes the use of the optometrist as first point of contact for eye problems, advising people that eye drops will be available free of charge dispensed from community pharmacists.

Dental Services Dental services are provided by the General Dental Service and the Public Dental Service which includes Oral Health Promotion and actions across all ages including increasing dental registration, promoting equity of access and ensuring effective referral pathways to acute care.

The NHS Ayrshire and Arran Oral Health Strategy 2013-2023 is closely aligned with the new national Oral Health Improvement Plan and aims to ensure the ‘best oral health possible for the people of Ayrshire and Arran’. The strategy covers stages of life (children and adults) and targets oral health promotion work for priority groups, such as the homeless and prisoners, people in care homes and those with specific care needs. The NHS Ayrshire and Arran Oral Health Action Plan 2016-2019 is being progressed and we have completed the second year of the 3 year Plan and will continue to deliver oral health improvement activity over the remaining year of the Plan.

Governance and decision making structures of Primary Care services in Ayrshire. The East Ayrshire Integration Joint Board and the Primary Care Programme Board are the main bodies with responsibility for shaping and influencing the development of Primary Care services across Ayrshire and Arran. The Primary Care Programme Board currently oversees the Primary Care Programme – Ambitious for Ayrshire. The original terms of reference of the Board are being revised to reflect its role as the governance group overseeing the implementation of the GMS contract, which it will co-chair with the GP Sub Committee. Membership will also be revised to reflect the leadership roles of GPs, HSCPs and the NHS Board in this process.

These arrangements, set out overleaf, mean that the three Ayrshire HSCPs, the NHS Board and the GP Sub Committee will share responsibility in producing the three year joint Primary Care Improvement Plan.

Due to the complexity and scale of the Programme, a Primary Care Programme Steering Group has also been established as a forum for project leads, service leads and HSCP colleagues to come together and discuss operational actions and any issues.

Also highlighted overleaf is an organisational structure chart for Primary Care highlighting key areas of service responsibility.

Primary Care – Governance and Oversight Structure

The draft budget for the service for 2018/19 is shown below:

Service 2018/19 Budget (£000) East Ayrshire Prescribing 25,678 East Ayrshire GMS 15,558 Ayrshire and Arran Primary Care (including dental) 68,930 East Ayrshire Standby (including Community Alarms) 209

3. POLICY CONTEXT National Strategic Context

2020 Vision for Health and Social Care

The national 2020 vision for health and social care continues to be a key driver in influencing the Primary Care Service Improvement Plan 2018-19.

This ambitious vision for health and social care has been set out by the Scottish Government to respond to the twin challenges of the growing number of people with complex health and social care needs and continuing financial constraints in relation to public sector budgets/both the Health Service and Local Government.

This vision envisages that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting and, that we will have a healthcare system where:

. We have integrated health and social care . There is a focus on prevention, anticipation and supported self-management . Where hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm . Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions . There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission

National Clinical Strategy for Scotland

The Strategy sets out a framework for the development of health services across Scotland for the next 10-15 years. It gives an evidence-based high level perspective of why change is needed and the direction that change should take. The Strategy sets out the case for: planning and delivery of primary care services around individuals and their communities; planning hospital networks at a national, regional or local level based on a population paradigm; providing high value, proportionate, effective and sustainable healthcare; transformational change supported by investment in e-health and technological advances.

Health and Social Care Delivery Plan

The Health and Social Care Delivery Plan brings together a range of separate policy strands into one coherent plan and sets clear milestones that focus on four major programmes of activity:

 Health and social care integration  The National Clinical Strategy  Public health improvement; and  Reforming NHS Boards

The Delivery Plan sets out a series of key actions for government and local health and care services to deliver better patient care, better population health and better value. It also signals the need to look at services on a population basis and to plan and deliver services that are sustainable, evidence based and outcomes focussed. The overarching aim of the Plan is to deliver high quality services, focused on prevention, early intervention and supported self-management.

The key principle at the heart of the Delivery Plan is that better patient outcomes and more efficient, consistent and sustainable services for citizens can be achieved through NHS Boards, Integration Joint Boards and other partners working more collaboratively and effectively to plan and deliver services.

National Primary Care Outccomes

NATIONAL OUTCOMES We live longer healthier lives Our people are able to Our public services are high quality, Our children have the best start in maintain their independence continually improving, efficient and life and are ready to succeed as they get older responsive We start well We live well We age well

PRIMARY CARE VISION Our vision is of general practice and primary care at the heart of the healthcare system. People who need care will be more informed and empowered, will access the right person at the right time and will remain at or near home wherever possible. Multidisciplinary teams will deliver care in communities and will be involved in the strategic planning of our services.

HSCP OUTCOMES People can look after their own health People can live at home or in Positive experiences of Services improve quality a homely setting services of life Services mitigate Carers are supported to People using services are safe Engaged workforce is Efficient resource use inequalities improve their health from harm improving PRIMARY CARE OUTCOMES Our primary care services better contribute to Our experience as patients in primary care is We are more informed and empowered when improving population health enhanced using primary care Our primary care workforce is expanded, more Our primary care infrastructure – physical and Primary care better addresses health integrated and better coordinated within digital – is improved inequalities community and secondary care

The Scottish Government’s vision for the future of primary care services is for multi-disciplinary teams, made up of a variety of health professionals, to work together to support people in the community and free up GPs to spend more time with patients in specific need of their expertise.

In order to inform this vision and provide strategic guidance for the transformational work which is ongoing across Primary Care the Scottish Government has developed 6 primary care outcomes. These are highlighted in the diagram above.

Other important policy and legal developments will shape our strategic and operational work over the coming year. These include;

West of Scotland Regional Delivery Plan for Health and Social Care Scottish Government has commissioned the development of plans to encompass the whole system of health and social care in three regions; North, East and West. In the West Region, this means planning for a population of 2.7 million people by 5 NHS Boards, 16 Local Authorities, 15 Health and Social Care Partnerships as well as the Golden Jubilee Foundation.

Everyone Matters – 2020 Workforce Vision Implementation Plan 2018-20 Everyone Matters is the workforce strategy for NHS Scotland. This is the fifth implementation plan for NHS Boards, Scottish Government and others to deliver the 2020 Workforce Vision. The Plan builds on previous success on embedding values, developing leadership, tackling inequalities and integration. There will be a continuous emphasis on the five priority areas of:

 Healthy Organisational Culture  Sustainable Workforce  Capable Workforce  Workforce to Deliver Integrated Services  Effective Leadership and Management.

National Health and Social Care Workforce Plan- Parts 1 and 2 The Plan provides the framework for improving workforce planning across health and social care; to identify, develop and put in place the workforce needed to deliver safe and sustainable services within the context of wider health and social care reforms. Part 1 of the Plan focusses on NHS Scotland and Part 2 considers ways to address the challenges facing social care workforce planning post integration and is published jointly with COSLA. Part 3 of the Plan follows the conclusion of GMS contract negotiations and sets out thinking in relation to primary care. In this first year, the incremental approach will enable different systems to take stock and move together towards a second full Health and Social Care Workforce Plan in 2018, which will have greater capacity to address the size and diversity of the health and social care workforce, and its workforce planning needs. Local Strategic Context

Community Plan 2015-30

The vision set out in the Community Plan is that:

The Council and Community Planning Partnership Board have agreed to focus on the following three strategic priorities over the period 2018-2021;

. Improving outcomes for children and young people, with a particular focus on looked after children/young people and young carers; . Older people: adding life to years – with a particular focus on tackling social isolation; and . Community led regeneration: empowering communities - building community resilience.

Implementation of the Community Plan is through three thematic Delivery Plans, namely Economy and Skills, Safer Communities, and Wellbeing.

Wellbeing Delivery Plan

The Health and Social Care Partnership has a lead role in taking forward the Wellbeing theme as well a key contributory role in the delivery of the Economy and Skills and Safer Communities themes. Strategic Priorities under the Wellbeing Theme of the Community Plan are as follows:

 Children and young people, including those in early years and their carers, are supported to be active, healthy and to reach their potential at all life stages.  All residents are given the opportunity to improve their wellbeing, to lead an active, healthy life and to make positive lifestyle choices.  Older people and adults who require support and their carers are included and empowered to live the healthiest life possible.  Communities are supported to address the impact that inequalities have on the health and wellbeing of our residents.

Health and Social Care Partnership Strategic Plan 2018 – 21

The Health and Social Care Partnership has recently published its second Strategic Plan, which sets out the shared ambitions and priorities for health and social care services in East Ayrshire for the period 2018 to 2021.

The new Strategic Plan is focused on delivering transformational change so that we are able to meet the increased levels of demand for health and social care services in East Ayrshire during this period of financial restraint.

We continue to be driven by our ambition for the people of East Ayrshire and as a result the activities which will be undertaken over the next three years will centre on the triple aim of better care, better health and better value.

The Plan will focus on a four core themes, these are;

. Scaling up our work on prevention and early intervention across all ages . Supporting New Models of Care and building capacity in Primary and Community Care . Ongoing partnership engagement about meeting challenges and creating opportunities, and . Transformation to ensure sustainability

Ayrshire and Arran vision for Primary Care

As highlighted in the diagram overleaf, the vision for primary care services across Ayrshire and Arran is to achieve:

The Ayrshire and Arran vision aligns to the Scottish Government’s vision for the future of primary care services, which is for multi- disciplinary teams, made up of a variety of health professionals, to work together to support people in the community.

This work will be delivered in partnership between communities, GP Practices, the three Ayrshire Health and Social Care Partnerships, Acute and Third Sector. These partners are committed to working collaboratively and positively to deliver real change in local health and care systems that support people to receive the right care at the right time.

NHS Ayrshire and Arran Transformational Change Improvement Plan 2017-2020: and associated Delivery Plan 2017-18.

Services in NHS Ayrshire and Arran will need to change substantially over the next two decades: in the way that they work, where services are provided and by whom. In recognition of this the Transformational Change Improvement Plan describes NHS Ayrshire and Arran programmes of transformational change and sets out the Boards intention for the period of transformation from 2017 to 2020. The Plan is aspirational and seeks to make deliberate, sustainable improvement in the way health and care services are delivered in Ayrshire, in order to ensure better outcomes for the people who use these services.

SECTION 4: REVIEW OF PROGRESS 2017-18

During 2017/18 we have taken forward a considerable amount of work to deliver against the objectives outlined in the Primary Care ‘Ambitious for Ayrshire’ Programme and to progress the vision for Primary Care Services in Ayrshire and Arran. Our key achievements and performance highlights in this period are outlined below.

Service Highlights 2017-18

Primary care at the heart of H&SCPs . We have continued to develop a bottom up approach to cluster improvement work and our clusters, through localities, are linking directly into locality planning arrangements.

. We have established a virtual Cluster Support Team to enhance our approach to using data to measure improvement and make improvements.

. We have provided strong support to those GP practices experiencing pressures and work has taken place on a practice by practice basis to ensure sustainability and high quality care to patients.

. A significant training programme commenced for front line reception/ administration staff in GP Practice to support care navigation.

Increased capacity in community

. We expanded the range of services in community pharmacies and 95 of 98 pharmacies in Ayrshire and Arran have signed up and are providing treatment for UTIs and impetigo under the Pharmacy First umbrella. . Since the introduction of the Eyecare Ayrshire initiative in 2017 over 1000 items have been dispensed.

. The first phase of the Stewarton Redirection Programme was rolled in December 2017 to support the redirection of patients to other, more appropriate services.

. We saved approximately 3900 GP appointments over the last year as a result of the initiative to employ Advanced Practitioner Physiotherapists as first point of contact for patients presenting with an MSK condition.

Investigate and address health inequalities . Workforce and contingency planning . The Primary Care Advanced Nurse Practitioner Academy has been established with the first cohort of 14 nurses completing the initial set of modules.

. We continued to recruit and train pharmacists and technicians to work in GP practices with 100% of year 2 cohort target reached.

. All of the new cohort of pharmacists recruited in 2017-18 have now started their induction and training and have been allocated to GP practices

. Implementation of a range of initiatives to attract and retain GPs and enhance GP career development in Ayrshire and Arran Improve primary care infrastructure . We collated information from each of the Ayrshire Health and Social Care Partnerships on their premises, risks and future plans for developments, which have been developed into a Primary Care Premises Vision Document.

Integrated and sustainable out-of-hours services . Out-of-hours services successfully participated in the NHS24 Model Office project and the system is now being rolled out nationally.

Areas for Improvement 2018-19

Improvement actions for 2018/19 include;

. Introduce new approaches to make it easier for dentists to treat older people who live in a care home or are cared for in their own home . Introduce new approaches to enable dentists with enhanced skills to provide services that would otherwise be provided in a Hospital Dental Service . Expanding the range of common clinical conditions treated by community pharmacists

. Review and align community pharmacy services with the Ambitious for Ayrshire vision for multi-disciplinary team (MDT) working in Primary Care . Create a more streamlined referral process from Optometrists to GP for patients who require checks for Diabetes/Hypertension. . Develop shared care pilot for the management of patients with ophthalmic conditions in community optometry . Create options to move simple oral surgery treatments from a secondary to primary care setting. . Increase number of GPs utilising Telehealth pathways and integrating Technology Enabled Care within multidisciplinary teams . Utilise research findings to develop and introduce wellbeing initiatives in targeted local areas

Performance 2017-18

Primary Care has access to a wide range of quality data to enable the service to better understand performance across all the key areas of the service and the Primary Care Management Team has developed a suite of measures to better understand the primary care system in a balanced way and to provide improvement support.

In 2017/18, the service met or exceeded its targets in a number of key areas.  Our 2017-18 rate of 0.36 for level of GP complaints exceeded our target rate of 0.38 for complaints per 1000 of the population.  Exceeding our target figure of 82%, in 2017-18 86% of patients were successfully triaged within one-hour by the out-of-hours service (AUCS) home visiting service.

 Also in 2017-18, we exceeded our target figure of 82% with 96.5% of patients being successfully triaged within 30 minutes by the out-of-hours service (AUCS) at the two urgent care centres at University Hospital Ayr and Ayrshire Central Hospital.  The percentage of Ayrshire GP practices signed up to the Scottish Patient Safety Programme in 2017/18 increased slightly to 92.73% of practices, from 92% of practices in 2016/17.  The service also successfully met its target in relation to the percentage of people on one or more disease register, with 38.6% of the Ayrshire population being on a disease register in 2017/18.  The number of Optometry Practices in Ayrshire and Arran who underwent inspections in 2017/18 totalled 17.  In 2017-18, all of the Dental Practice Inspections that were due were carried out successfully, representing 100% completion of all inspections due.  In 2017/18, 2729 items were dispensed by community pharmacists as part of the Pharmacy First initiative.  As a result of the Advanced MSK Physiotherapist initiative, in 2017-18 66.19% of patients assessed by a primary care Physiotherapist were seen as a first point of contact with 72.38% of patients assessed being provided with the tools to self- manage their problem  As part of the Eyecare Ayrshire initiative in 2017-18, over 11,000 signed orders were presented at pharmacies in Ayrshire and Arran.  In 2017-18, 85% of relevant NHS staff within the H&SCP had completed an e-KSF PDP/Review. This was significantly ahead of the 80%target figure.  68% of relevant local authority staff within the H&SCP had completed an EAGER, significantly adrift of the 95% target.  In respect of 4C prescribing and ADOC 1-hour triage, in both instances targets were narrowly missed in 2016/17

SECTION 5: IMPROVEMENT PLAN 2018/19

Following the agreement to implement the new GP contract in January 2018, the service undertook a review of the existing Ambitious for Ayrshire Primary Care Programme. As a result of this review a decision was taken to align all of the projects within the original programme to the priorities set out in the Memorandum of Understanding for the new contract.

It was also agreed that the content of this Service Improvement Plan (SIP) will unambiguously reflect the direction of travel set out in the 3 year Primary Care Improvement Plan (PCIP) and that we would consolidate the number of workstreams in the SIP into four, again to reflect the priority areas as set out in the MoU.

The overall outcome being sought by the Programme in shaping the activities outlined in this SIP remains the achievement of “Sustainable, Safe, Effective and Person Centred Primary Care Services”.

The content of the Improvement Plan 2018-19 (see overleaf) will be populated following completion of the project and implementation plans, currently being developed by the collaborative Writing Team. This will be completed by June 2018.

Each of the following workstreams and associated actions are planned to be significantly progressed in 2018/19.

Workstream 1 Expected Outcome Responsible Timescale Pharmacotherapy Service

Workstream 2 Expected Outcome Responsible Timescale Primary Care Nursing Services

Workstream 3 Expected Outcome Responsible Timescale Urgent Care

Workstream 4 Expected Outcome Responsible Timescale Practice Based Multi-disciplinary Team

SECTION 6: QUALITY ASSURANCE AND IMPROVEMENT DASHBOARD

Primary care has developed a quality assurance and improvement dashboard. Primary Care management will continue to review and develop this dashboard in order to use data overtime to identify areas requiring support and quality improvement.

The overall dashboard is being utilised by the Primary Care Management team with GP Practices having full access to their own data as ownership of the data by professionals, practices and services is key to driving improvement. From this dashboard, whole system Ayrshire and Arran figures are reported for a few core measures as key performance indicators for the Health and Social Care Partnership Dashboard.

These core measures are linked to the Primary Care Workstreams and reflect national Health and Wellbeing Outcomes. The key measures, which make up the Primary Care quality assurance and improvement dashboard, are set out overleaf. These are set around balanced themes of Customer, Outcomes, People and Efficiency with goals being established for each of the measures.

Customers

Measure 17/18 Result Baseline (2016/17) Target Commentary

GP Complaints (per 1000 pop) TBC 0.28 (2016/17) Reduce GMS 0.28 complaints per 1000 patients

Outcomes

Measure 17/18 Result Baseline Target Commentary (2016/17) Disease Registers 38.6% 38.2% (2016/17) 38% % of people on one or more disease register

4C Prescribing (per 1000 patients) TBC TBC Reduce 4C Prescribing: Co-amoxiclav, Clindamycin, Clarithromycin, Cephalosporin. Scottish Patient Safety Programme – GP Practices 92.7% 90.7% (2016/17) 90% % of GP Practices signed up to SPSP.

No. of Fluoride Varnish Applications to children aged 2 year - 5 year 6,718 6,320 (2016/17) Increase All nursery children and majority of primary school 11 months children (20,000 children) in Ayrshire participate in the Childsmile Toothbrushing Programme.

Eyecare Ayrshire - Count of medications supplied by community 1,170 627 570 The ‘Eyecare Ayrshire’ service was launched on 1st pharmacy from signed optometry order February 2017.

People

Measure 17/18 Result Baseline Target Commentary (2016/17) GP Vacancies by Practice 25% 21.1% Reduce Practices with vacancies as % of all practices.

EAGER Completed 48% 92% 95% % of relevant workforce with active EAGER, which has been completed. eKSF/PDP 86.32% 88.69% 80% % of relevant workforce with e-KSF PDP/Review

Efficiency

Measure 17/18 Baseline Target Commentary Result (2016/17) Optometry Inspections 100% 100% 100% Practice Inspections - % due inspection that were inspected

AUCS Home Visits triaged as one-hour category, seen AUCS - Home visits within 1 hour 86.3% 90.3% 82% within one hour.

AUCS PCTC triaged within 30 minutes. Indicator recorded AUCS - PCTC within 30 minutes 96.7% N/A 95% from April 2017 onwards, therefore no baseline available.

SECTION 7: PLANNED EFFICIENCIES 2018/19 A significant element of the overall primary care budget is exempt from CRES (Cash Releasing Efficiency Saving) due to GP expenditure being protected nationally and most of dental funding being Scottish Government ring-fenced funds.

Primary Care and Out of Hours Services Proposed Cash Release Efficiency Savings 2018-19

EAC NHS Total

Area £m £m £m

Primary Care contracts budget realignment 0.000 (0.023) (0.023)

Community Pharmacy 0.000 (0.003) (0.003)

Public Health Dental 0.000 (0.015) (0.015)

General Dental 0.000 (0.015) (0.015)

Out of Hours Review 0.000 (0.305) (0.305)

TOTAL 0.000 (0.361) (0.361)

SECTION 8: RISK ASSESSMENT/ MANAGEMENT

Primary Care Risk Register 2018-2019

Code Risk Internal Controls Matrix Score

PCRISK01 Aims of Primary Care Programme surpassed Effective strategic management and programme governance by demographic and demand driven growth. allied with ongoing and regular engagement with all key stakeholders.

PCRISK02 Clinical resistance to the developing model Full engagement with contractors to develop primary care from independent contractors. services and collaborative leadership across contractors.

PCRISK03 Resistance to moving activity from an acute Collaborative leadership and full engagement with clinicians, model to community and primary care. contractors and partners to aid the transition towards community and primary care.

PCRISK04 Failure to integrate primary and community Establish principle of collaborative leadership across clinical services effectively within practices and contractors to support cluster and locality working. Ongoing clusters. monitoring and reporting of cluster development

PCRISK05 Reductions in the budgets of critical services Ensure monthly reporting on the delivery of CRES and service as a result of CRES savings targets. change proposals through routine performance reporting to the NHS Board and IJB

PCRISK06 Inability to develop and recruit alternative Implementation of structured approach to design and delivery workforce to support primary care activity. of learning and training opportunities.

PCRISK07 Establishing effective programme and Effective leadership, collaborative working and team project management support. development to ensure effective support across the Primary Care programme.

PCRISK08 IT and ICT lead times Resources allocated to minimise IT and ICT lead times and to develop primary care IT infrastructure and support.

PCRISK09 Estate limitations. Allocation of additional resource by the SG to address service gaps and pressures in primary care and effective programme governance to ensure resource efficiency.

PCRISK10 Limitations in rural areas i.e. effective Commitment of SG funding to improve rural broadband broadband connection. connectivity together with other locally based initiatives to improve connectivity, will support efforts to increase the use of Technology Enabled Care (TEC)

PCRISK11 Inability of AUCS to respond to OOH Development of new multi-disciplinary model of working and demand. joint working with NHS24.

PCRISK12 Ineffective engagement with key stakeholder Comprehensive stakeholder engagement strategy to be groups developed and implemented.

PCRISK13 Failure to recruit to GP vacancies Establish calendar of local events to engage with local trainees Establishment of Primary Care Contingency and locums and to expedite networking opportunities for the Group with the LMC / GP Sub. local GP community.

PCRISK14 Failure of IT infrastructure in general Development of a business case to address infrastructure practices, particularly in relation to branch requirements. Ehealth to work with individual practices to surgeries experiencing extremely slow maximize current infrastructure and practice contingency. connections.