Midlothian Joint Integration Board Strategic Plan 2016
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STRATEGIC MIDLOTHIAN HEALTH AND SOCIAL CARE PLAN JOINT INTEGRATION BOARD 2016 - 19 Working Together to Improve the Health and Wellbeing of the People of Midlothian Midlothian Joint Integrated Board –Strategic Plan 2016/19 Page 1 Throughout the document there are links to related national and local strategies. By pressing control and click on the link you can access these documents directly. These links look like this summarised version of plan Midlothian Joint Integrated Board –Strategic Plan 2016/19 Page 2 3.10 FUEL POVERTY .................................. 26 Contents 3.11 EMPLOYMENT ................................... 26 (Ctrl + Click to go to page) 3.12 HEALTH AND WELLBEING ................. 27 Contents (Ctrl + Click to go to page) .............. 3 4. RESHAPING PRIMARY CARE ...................... 27 Appendices Link: ............................................. 4 4.1 POLICY ................................................. 27 1. IMPROVING HEALTH AND WELLBEING ....... 5 4.2 NEEDS ASSESSMENT ........................... 28 WHY HAVE WE WRITTEN THIS PLAN? ....... 5 4.3 DELIVERY OF PRIMARY CARE .............. 30 1.2 REFORMING HEALTH AND CARE IN 4.4 SKILL MIX ............................................. 31 MIDLOTHIAN ............................................... 8 4.5 HEALTH AND WELLBEING ................... 32 1.3 THE MAIN CHALLENGES ...................... 10 4.6 PRESCRIBING ....................................... 32 1.4 WORKING IN PARTNERSHIP - KEY TO SUCCESS .................................................... 11 4.7 DENTISTRY........................................... 33 1.5 OUR KEY PRIORITIES FOR CHANGE ..... 13 4.8 OPHTHALMOLOGY .............................. 33 1.6 HOW WILL WE PROVIDE SERVICES 4.9 CONTINENCE SERVICE ......................... 33 DIFFERENTLY ............................................. 16 4.10 OUT OF HOURS ................................. 34 2. WORKING IN LOCALITIES .......................... 19 4.11 SEXUAL HEALTH and BLOOD BORNE 3. ADDRESSING HEALTH INEQUALITIES ........ 21 VIRUSES (BBVs) ......................................... 34 3.1 WHAT ARE “HEALTH INEQUALITIES”? . 21 4.12 HEALTH VISITORS AND SCHOOL NURSES ..................................................... 34 3.2 NEEDS ASSESSMENT ........................... 22 5. MAKING BETTER USE OF OUR HOSPITALS 36 3.3 HEALTH AND DEPRIVATION ................ 22 5.1 NEEDS ASSESSMENT ..................... 36 3.4 HEALTH, HOUSING AND HOMELESSNESS .................................................................. 23 5.2 ACUTE HOSPITALS ......................... 37 3.5 HEALTH INEQUALITIES AND DISABILITY 5.3. MIDLOTHIAN COMMUNITY HOSPITAL .................................................................. 24 (MCH) ........................................................ 39 3.6 VETERANS............................................ 24 6. SUPPORTING PEOPLE WITH LONG-TERM HEALTH CONDITIONS .................................... 40 3.7 LGBT (Lesbian, Gay, Bisexual, and Transgender) ............................................. 24 6.1 NEEDS ASSESSMENT ........................... 40 3.8 TARGETTED PARTNERSHIP WORKING IN 6.2 LIVING WITH A LONG-TERM CONDITION AREAS OF DEPRIVATION ........................... 25 .................................................................. 41 3.9 INCOME MAXIMISATION .................... 25 Midlothian Joint Integrated Board –Strategic Plan 2016/19 Page 3 6.3. SUPPORTING PEOPLE WITH 10.3 SUPPORT PLANNING ......................... 70 PARTICULAR CONDITIONS ........................ 42 10.4 GOOD HEALTH .................................. 71 6.4 PALLIATIVE CARE ........................... 45 10.5 BREAKS FROM CARING ..................... 71 7. ADDRESSING THE NEEDS OF PEOPLE WITH 10.6 ADVICE AND SUPPORTED SELF- DISABILITIES .................................................. 47 MANAGEMENT ......................................... 71 7.1 PHYSICAL DISABILITIES .................. 47 11. MAKING BEST USE OF OUR RESOURCES . 72 7.2 SENSORY IMPAIRMENT ................. 49 11.1 HOUSING ........................................... 72 7. 3.LEARNING DISABILITIES ...................... 51 See Housing Contribution Statement 8. PROMOTING MENTAL WELLBEING ........... 53 (appendix 6) .............................................. 72 8.1 PREVENTING MENTAL HEALTH 11.2WORKFORCE ...................................... 75 PROBLEMS AND PROMOTING WELLBEING 11.3 FINANCES .......................................... 77 .................................................................. 53 8.2. ENCOURAGING AND SUPPORTING 11.4 WORKING WITH THE THIRD SECTOR 80 RECOVERY FROM ALCOHOL OR DRUG 11.5 TECHNOLOGY ENABLED CARE .......... 80 MISUSE ...................................................... 56 Appendices Link: ........................................... 82 8.3 SUPPORTING PEOPLE WITH AUTISM .. 59 8.4 MEETING THE HEALTH AND CARE NEEDS OF OFFENDERS .............................. 60 Appendices Link: Appendix 1 Joint Needs Assessment 9. OUR AGEING POPULATION: THE CHALLENGES (Scott) ...................................... 62 Appendix 2 Summary of Feedback from Community Groups and Individuals 9.1 NEEDS ASSESSMENT AND NATIONAL Appendix 3 Strategic Planning Group POLICY ....................................................... 62 Membership 9.2 COMMUNITY SERVICES ....................... 63 Appendix 4 Localities and Map of Area 9.3 INTENSIVE SUPPORT INCLUDING Appendix 5 Related Strategies RESPONSES TO CRISIS ............................... 63 Appendix 6 Housing Contribution Statement 9.4 ADDRESSING ISOLATION ..................... 65 Appendix 7 Performance- Measuring the 9.5 CARE HOMES ....................................... 66 Impact of the Plan (to follow) 9.6 DEMENTIA ........................................... 67 10. UNPAID CARERS - OUR KEY PARTNER ..... 69 summarised version of this plan 10.1 NEEDS ASSESSMENT ......................... 69 10.2 EARLY IDENTIFICATION ..................... 70 Midlothian Joint Integrated Board –Strategic Plan 2016/19 Page 4 1.1.2 Understanding the Needs of 1. IMPROVING HEALTH People in Midlothian AND WELLBEING Midlothian is a small Local Authority, the second smallest in mainland Scotland in 1.1.1 A New Approach to the population terms. As a result of a major Delivery of Health and Social Care house building programme, the population is likely to rise from 81,156 to Scottish Government passed legislation in approximately 95,490 in 2020, continuing 2014 requiring health and social care to grow up to 2024 to a predicted level of services to become integrated. This is 99,136. Some estimates suggest even regarded as the biggest change in the higher growth with approximately 12,000 organisation of the National Health new houses projected to be built. Service since its creation in 1948. There are significant differences between A new Health and Social Care Partnership, communities within Midlothian in terms the Integration Joint Board (IJB), is now of their histories, resources and needs. responsible for planning health and care Our largest towns are in the region of services for the Midlothian population. 20,000 while there is a large, rural area to WHY HAVE WE WRITTEN THIS the south of the county. PLAN? Primary Care Services are based in local This Plan sets out how the Partnership will communities, however, other health and provide services over the next three years. care services are provided across It will be updated each year to take Midlothian and, in relation to some health account of changing needs and to take services, across Lothian. advantage of new opportunities to This plan takes an overview of Midlothian redesign services as they arise. and has been developed through: We need to strike the right balance learning about the needs of people in between long-term planning of services Midlothian - these are described in the and responding to new challenges. We Joint Needs Assessment (appendix 1) must make sure we are ready to maximise breakthroughs in medical science and take understanding the views of users and full advantage of new technology, whilst carers on our current services – see also responding to changes in the delivery appendix 2 “Summary of Feedback and funding of public services. For from Community Groups and example at the time of finalising this plan Individuals” the Government announced an additional £250m per year to address pressures in drawing on the issues raised by the social care in Scotland along with new public through the 16 Midlothian short term funding in both Primary Care Neighbourhood Planning Groups and Mental Health. Midlothian Joint Integrated Board –Strategic Plan 2016/19 Page 5 having conversations with staff in policies and strategies such as Reshaping health and social work and with Care for Older People, Caring Together voluntary and independent and the Road to Recovery (see appendix 5 organisations to understand their -relevant national and local strategies). views on how services could become Midlothian Council has elected to include more effective services for offenders in the scope of the We have also considered issues and IJB. This will strengthen the local approach planned service developments in our two to addressing their health and care needs localities, East and West Midlothian (see which are often the root causes of Section 2 and appendix 4), with a offending behaviour. Developing ways of particular focus on those communities reducing offending remains the remit of with high levels of deprivation. the Safer Communities Board. The Plan has been prepared by the While some children’s services such as Midlothian