Subject: FOI-18-1038

From: Foi Enquiries Sent: 08 August 2018 14:50 To: ' Subject: FOI-18-1038 - Age Policies Attachments: V2 - Further Information - Right to Review & Appeal.pdf; FOI-18-1038 - aberdeen-city-hscp- strategic-plan-2016-19.pdf; FOI-18-1038 - JCS_FINAL_April_2013_with_web_links.pdf

Dear

Thank you for your information request of 10 July 2018. Aberdeen City Council (ACC) has completed the necessary search for the information requested.

1. Does the council have a strategic plan or policy in place for making their local authority area: i: age-friendly (such as an Older Person’s strategy) ii: dementia-friendly (such as a Dementia strategy) Please see response below.

2. If so, what work has been done to implement these policies? Please see response below.

3. Is this strategy, or policy document, publicly available, and if so where? Please see response below.

4. We would also be grateful if the local authority could send us a copy of any such strategy or policy document if possible. Aberdeen City Health & Social Care Partnership has a strategic plan which is available on the website at: https://www.aberdeencityhscp.scot/globalassets/strategic-plan.pdf. The Strategic plan covers all services. Dementia is mentioned within the strategy but it is not a strategy specifically about making the City age or dementia friendly. Provided is the latest document in relation to this strategic plan: please see attached FOI-18-1038 – Aberdeen City HSCP Strategic Plan 2016-19.

Aberdeen City Health & Social Care Partnership also has an Ageing wi Opportunity in Aberdeen City Strategy – A consultation document on the future Joint Commissioning Strategy for Older People 2013-2023 which has been provided for reference. The strategy is in the process of being refreshed and the current strategy is attached: FOI-18-1038 – JCS FINAL April 2013 with web links.

Work is ongoing to develop a Living and Aging Well Framework for the City. It is anticipated that this Framework will identify different “tiers” of living and aging well, from living well (self-management and prevention), through to those who require more intensive support as a result of complex conditions related to aging. The Framework will identify priority activities attached to each of these “tiers”. The Framework will align with key partnership and national strategies including the partnership’s Strategic Plan and the national Dementia Strategy 2017 - 2020.

We hope this helps with your request.

Yours sincerely,

Anna Buchan Information Compliance Officer

file:///O|/...to%20Information/FOI/Case%20Files/2018/FOI-1001-1100/FOI-18-1038%20-%20Age/FOI-18-1038%20-%20Age%20Policies.htm[09/08/2018 10:21:53] INFORMATION ABOUT THE HANDLING OF YOUR REQUEST

ACC handled your request for information in accordance with the provisions of the Freedom of Information (Scotland) Act 2002. Please refer to the attached PDF for more information about your rights under FOISA.

Information Compliance Team | Customer Feedback|Customer Experience Aberdeen City Council, Business Hub 17, 3rd Floor North, Marischal College, Broad Street, Aberdeen, AB10 1AQ Tel 03000 200 292 Email [email protected]

www.aberdeencity.gov.uk

*03000 numbers are free to call if you have ‘free minutes’ included in your mobile call plan. Calls from BT landlines will be charged at the local call rate of 10.24p per minute (the same as 01224s).

file:///O|/...to%20Information/FOI/Case%20Files/2018/FOI-1001-1100/FOI-18-1038%20-%20Age/FOI-18-1038%20-%20Age%20Policies.htm[09/08/2018 10:21:53]

Aberdeen City Health and Social Care Partnership Strategic Plan 2016-19.

Foreword.

I warmly welcome the publication of the Aberdeen City Health and Social Care Partnership’s first Strategic Plan showing how we will develop and deliver integrated health and social care services for the benefit of the citizens of Aberdeen and other residents in Grampian also.

The publication of this Strategic Plan marks the ‘Go Live’ date for the integration of our health and social care services in Aberdeen. Many colleagues from across the health, care, third, independent and housing sectors have been working closely over the past few years to ensure the success of our integration transition. This Strategic Plan reflects their collective endeavours and I would like to thank them for their respective contribution.

We strongly believe that working with our citizens and their communities to develop their resilience and increased capacity for self-management will greatly contribute to their health and wellbeing as will the development of person centred, integrated, locality based services.

We recognise the demographic and financial challenges that we face and we recognise that we will have to do things differently however we are confident that proposals outlined will help improve the health and wellbeing of our local population and reduce the health inequalities that still exist in our city.

These are exciting times and I look forward to sharing with you news of our future developments and achievements.

Cllr. Len Ironside, CBE (Chair)

Aberdeen City Health and Social Care Partnership Integration Joint Board

Integration Principles.

The Health and Social Care Partnership is required by the Scottish Government to take into account the national integration principles when preparing both the Integration Scheme and the Strategic Plan.*

These principles, stated below, clearly state that the main purpose of integrated services is to improve the wellbeing of our citizens and these services should be provided in a way in which, so far as possible:

 Is integrated from the point of view of recipients  Takes account of the particular needs of different recipients  Takes account of the particular needs of recipients from different parts of the area in which the service is being provided  Takes account of the particular characteristics and circumstances of different service users  Respects the rights of service users  Takes account of the dignity of service users  Takes account of the participation by service users in the community in which service users live  Protects and improves the safety of service users  Improves the quality of the service  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)  Best anticipates needs and prevents them arising  Makes the best use of the available facilities, people and other resources

* The Integration Scheme is the legal agreement between Aberdeen City Council and NHS Grampian to establish the Aberdeen City Health and Social Care Partnership and the arrangements for delegating certain adult health and social care functions to the partnership. The Strategic Plan outlines how these delegated functions will be set out to meet the national health and wellbeing outcomes.

3 i) The planning and delivery of good quality health and social care in the city of Aberdeen embraces the principle of equal opportunities, as set out in the respective partners’ Equalities Schemes.

This means that the partners will strive to encourage equal opportunities and diversity, responding to the different needs and service requirements of people regardless of sex, race, colour, disability, age, creed, marital status, ethnic origin, sexual orientation or gender re-assignment.

An Equality Impact Assessment has been undertaken and is detailed in Appendix 1. ii) To ensure the effectiveness and fairness of the decisions that we will make we have completed a Health Inequalities Impact Assessment to help us think about how this plan and its ambitions might affect the people of Aberdeen.

A Health Inequalities Impact Assessment has been undertaken and is detailed in Appendix 2. iii) Health and social care language can often be complex and unfamiliar. We have attempted to minimise the use of jargon in order to make this document as accessible and understandable as possible.

A Glossary of key words and phrases is set out in Appendix 4.

If you require further information about any aspect of this Strategy please contact:

Aberdeen City Health and Social Care Partnership Community Health and Care Village 50 Frederick Street Aberdeen AB24 5HY

Website: https://aberdeencityhscp.scot

Twitter: https://twitter.com/HSCAberdeen

This document is also available in large print, other formats and other languages, on request.

Please contact the Aberdeen City Health & Social Care Partnership on 01224 625729

Contents

1. Introduction.

1.1. This Strategic Plan. 1.2. Our Vision and Values. 1.3. Our Strategic Priorities.

2. Our Caring Partnership.

2.1. Our Aberdeen. 2.2. Our Partnership. 2.3. Our Carers. 2.4. Our Resources. 2.5. Our Strategic Connections.

3. Working Together with Our City Communities.

3.1. Our Localities. 3.2. Our Communities and Localities. 3.3. Locality Planning. 3.4. Developing a Community and Locality Based Approach. 3.5. Helping People Stay at Home and Prevent Unnecessary Admission.

4. To Enable People.

4.1. Our Personalised Approach. 4.2. Our Self-Management Principles and Supports. 4.3. Our Improvement Principles and Ambitions. 4.4. Whose Risk Is It Anyway?

5. To Achieve Healthier and Fulfilling Lives and Wellbeing.

5.1. Our Intentions.

6. How Will We Know We Are Making A Difference?

6.1. Our Performance Framework. 6.2. Where Do We Want To Be in 2019?

Appendices.

1. Equality Impact Assessment. 2. Health Inequalities Impact Assessment. 3 Housing Contribution Statement. 4. Glossary.

1. Introduction

1.1 This Strategic Plan. What is integration? This Strategic Plan outlines our ambitions for those adult health and social care functions and services The Scottish Parliament which will be delegated by Aberdeen City Council and passed the Public Bodies

NHS Grampian to the Aberdeen City Health and Social (Joint Working) (Scotland) Care Partnership. Act in 2014. It requires It reflects the many conversations we have had with the local authorities and people of Aberdeen and our professional colleagues health boards to work across all sectors and services about what health and social care integration will mean to them and the together and integrate services that they value highly. certain adult health and

social care services and to We strongly believe that integration will offer us many different opportunities to reflect on what we currently do set these out in a legal and to think about what we could and should be doing agreement called an to benefit the local citizens and the communities in Integration Scheme. which they live. Our integration authority We cannot afford to be complacent. As part of our is called the Aberdeen consultation on the draft strategic plan we asked the City Health and Social City Voice forum to indicate whether they were satisfied or dissatisfied with their recent experiences of using our Care Partnership and it is health and/or social care services. More than half of responsible for the respondents (59%) indicated they were satisfied with planning and delivery of this experience but 1 in 7 (15%) reported being dissatisfied. We want to be part of a partnership that those integrated services the citizens of Aberdeen and our professional from 1st April 2016. We colleagues are proud to identify with and be a part of. are committed to

There are fundamental themes throughout this strategic improving the health and plan that can be read as the Integration Joint Board’s wellbeing of the local statement of intent and which are applicable to all our population, delivering current activities and our future intentions. They include: quality services and becoming recognised as Our focus will always be on improving, where possible, the health and wellbeing of our citizens one of the highest and seeking to reduce the health inequalities that performing partnerships. exist in our city. in Scotland. 7

We will be challenged however by the increasing demand for our services and the likelihood of decreasing financial resources so we must accept that we will have to configure and deliver our services differently. Delivering our services as we have traditionally done so will be ineffective in meeting that increasing demand. However we do want to reassure that desirable service change should not in itself mean service disruption.

As citizens, we must all take greater responsibility for our own health and wellbeing and in doing so be a part of the new solutions that we seek to develop. We will develop a stronger preventative emphasis to our activities and interventions to minimise the cumulative impact of an increasing population with a number of long term conditions.

We will also support and develop our communities and localities so that they can help shape priorities and implement their own solutions within the framework of this strategic plan. We want to see innovation flourish in our localities.

Improving the quality of all our services will underpin everything we do. We are committed to improving the personal experiences of everyone who uses our health and social care services and improving their personal outcomes.

The primary purpose of health and social care integration is not to save money. Integration in itself will not result in cost savings but we do anticipate that efficiencies will be achieved through identifying duplication of services and resources and eradicating these.

We are determined to be recognised as a partnership that works closely with our staff, unpaid carers and our partner agencies in the third, independent and housing sectors to fulfil the vision and ambitions of this strategic plan.

We are ambitious to be seen as an employer of choice and one of the leading and innovative health and social care partnerships in Scotland.

Given the impending demographic and financial challenges, delivering our health and care services as we have previously done is not an option for us. To achieve the required improvement in our health and wellbeing, improvement in our experiences of using services, and our personal outcomes, will require us all to take greater responsibility and interest in our own lives and wellbeing by improving our lifestyles, and where appropriate, managing our long term conditions better.

Our plan will demonstrate the strength of our commitment to improving the personal experiences of our local citizens when they use our health and care services, and our

commitment to improving their personal outcomes. We will show how we hope to develop our community connections and activities to complement the care and support that is offered, as locally as possible to enable people to live at home, or in a homely environment, for as long as is reasonably possible.

We will deliver integrated health and care services that support the people of Aberdeen to remain as well as possible for as long as possible. We will seek to ensure that people are only admitted to hospital when that is the best place for them to be, and that they stay in hospital for only the minimum time that is clinically required.

The integration of our health and care services will offer us significant opportunities to shift the balance of care towards preventative, locality based services that work in partnership with individuals, families, and communities. We are very aware though, that we must continue to deliver existing services on a day to day basis until such time as we are ready to implement our plans and support this transformation to happen. Service change will not mean service disruption.

Our Strategic Plan will outline and support the transformation of our integrated services. It presents a three-year vision for our adult health and social care services and:

 Provides an overview of the health and social care system in Aberdeen City and seeks to establish a shared understanding of our challenges and priorities.  Provides the strategic framework for the future development of the local health and social care system so that needs and demands can be met more effectively within available resources.

 Sets out high level actions on how these issues and priorities will be addressed by the joint partners, and shows how progress will be monitored, and impact evaluated.

1.2 Our Vision and Values.

Our strategic vision outlines our ambitions and is a pivotal reference point that helps frame all our discussions and suggested developments. The vision has been developed through integration conversations and workshops involving staff from the health, social care, third, independent and housing sectors and members of the shadow Integration Joint Board.

Our vision is:

“We are a caring partnership working together with our communities to enable people to achieve fulfilling, healthier lives and wellbeing”

There is a strong civic pride in Aberdeen. People are proud to identify themselves with the city and these bonds of association will be very helpful in developing our common purpose that good health and wellbeing is everybody’s business. This is something that cannot be sustained in isolation, as it needs our social connections and wider participatory activities to flourish. Our caring partnership is a mix of family, friends, neighbours and our colleagues from across the health, social care, third, independent and housing sectors working together to shape the activities and the interventions that matter to us.

Our values are the pillars that shape the identity of the partnership and help explain why we do the things we do; they underpin all our intentions and are evident in all our activities.

 Caring  Person centred  Enabling

Our values shape the development of our relationships with one another. Promoting responsibility and choice will be key factors in encouraging our citizens and our colleagues to feel that the development of the partnership and the role that it plays in our lives is not just for those periods of ill health and need, but is instead a more enduring relationship.

1.3 Our Strategic Priorities.

The population of Aberdeen is, like the rest of the country, living longer. Increasing life expectancy is a good thing but it can be associated with greater demands for health and 10

social care. Our overall health profile is better than the Scottish national average however we know that within the city, there are significant differences in health and wellbeing, with some communities reporting greater levels of health problems than others.

People having multiple long term conditions (also known as multi morbidity) is increasingly prevalent and it is affected by wider social factors, in that it is more common and occurs at a younger age as social and economic deprivation increases. We also know that increasing multi morbidity can have a significant impact on the number of unplanned admissions, length of stay and potential for delayed discharge in our hospital services.

To address these challenges and achieve our desired outcomes, our strategic priorities for the next three years are:

 Develop a consistent person centred approach that promotes and protects the human rights of every individual and which enable our citizens to have opportunities to maintain their wellbeing and take a full and active role in their local community.  Support and improve the health, wellbeing and quality of life of our local population.  Promote and support self-management and independence for individuals for as long as reasonably possible.  Value and support those who are unpaid carers to become equal partners in the planning and delivery of services, to look after their own health and to have a quality of life outside the caring role if so desired.  Contribute to a reduction in health inequalities and the inequalities in the wider social conditions that affect our health and wellbeing.  Strengthen existing community assets and resources that can help local people with their needs as they perceive them and make it easier for people to contribute to helping others in their communities.  Support our staff to deliver high quality services that have a positive impact on personal experiences and outcomes

We are very aware that these are high level priorities but they do capture very well our intentions to work closely with our citizens, the communities they live, work and socialise in, our carers and our workforce to improve our individual and collective health and 11

wellbeing.

Our consultation on these proposed priorities in our draft strategic plan showed some significant variation in ranking of these priorities primarily in relation to respondent age and gender.

 Working age respondents and particularly those aged less than 35 years were more likely than those aged older than 65 years, to highlight the importance of reducing health and wider social inequalities that affect health and wellbeing.  Older respondents were generally more likely to highlight the importance of promoting self-management and independence, and supporting unpaid carers.  In relation to gender, males were more likely to highlight the importance of improving the health and wellbeing of our local population, while females were more likely to highlight the value of developing person-centred services.

Our emphasis will be on the health and wellbeing of the individual, the resilience and capacity of communities to engage with and support its residents, investment in our carers, focus on prevention, working collaboratively with all our partner organisations, developing flexible, high quality services and achieving positive outcomes.

To fulfil our vision and our strategic priorities, we must develop integrated services that have individuals, families and communities at the centre of all their activities. We want everyone to have seamless and enhanced positive experiences of using our services, no matter what these are and what sector they are from.

We recognise that the best health and care systems are proactive in maintaining and improving health and wellbeing, not only reactive to problems once they have occurred. We want to deliver locally based services that have a positive impact on the health and wellbeing of all individuals, families, and communities.

Addressing our strategic priorities will offer us the opportunity of fulfilling the interdependent “Triple Aim” that improves our experiences of using health and social care services, improves our health and wellbeing, and reduces wastage and duplication in the costs of care and treatment.

2. Our Caring Partnership. Integration Joint 2.1 Our Aberdeen. Board (IJB).

Aberdeen is a significant regional and national From the 1st April 2016, business centre and is a popular place for people to live, work and socialise. The city's geography, cultural the IJB is responsible for activities, two universities and regional college the planning and delivery combine to form a proud identity and a mostly positive of adult health and care and enduring quality of life. services in Aberdeen. The 2014 Good Growth for Cities index, by Price The IJB consists of four Waterhouse Cooper, (PWC) named Aberdeen as the local councillors and four best city in Scotland in which to live and work, and the second top city in the UK. members of NHS Grampian health board and It is a city that projects an image that it is at ease with itself and the rest of the world however we know that also the Chief Social Work Aberdeen's affluence is not uniformly distributed Officer, a GP, consultant, across the city and that where you live has an impact nurse, staff on your health and wellbeing. representatives, third Aberdeen City and Aberdeenshire is the most sector representation and economically productive region in the UK, outside Inner London. It is however, heavily reliant on the oil individuals representing and gas sector, and as such the current downturn is people who use our having a significant impact. services and their carers.

 Aberdeen City has historically had one of the Our Chief Officer is lowest unemployment rates in Scotland, but the number of out-of-work benefit claimants has accountable to the IJB for risen sharply over recent months, and in the effective delivery of November 2015 was 58% higher than in our integrated services in November 2014.  The average annual gross wage in the city is line with the 9 national around £5,700 more than the Scottish average health and wellbeing (£33,408 in Aberdeen City, £27,710 in outcomes. Scotland).  Aberdeen City has one of the most unequal pay structures in the UK, fuelled predominantly by the oil and gas industry. The high wages paid in the industry have increased the divide between high and low earners.

 There is a significant gender pay imbalance in Aberdeen City, with male full-time workers earning, on average, around 13% more per hour than female full-time workers.

There is a shortage of affordable housing in the City. House prices are high, and private rents in the city are the highest of all major Scottish cities. The lack of affordable housing makes the recruitment and retention of key workers, such as teachers, social workers, emergency services and health professionals, difficult. The downturn has not, as yet, improved this.

Aberdeen’s booming economy in recent years has placed the city’s infrastructure under significant pressure and that infrastructure is now struggling to keep pace. This has increased the cost and ease of doing business in the city. Significant investment, such as the recently agreed City Region Deal is required to improve the infrastructure to ensure that the city remains an attractive and competitive place to do business.

Aberdeen’s population is rising and expected to reach almost 289,000 by 2037. The growth in the under 64s (21%) is mainly in the 0-15 age group, but the biggest growth is predicted in the over 65s (49%).

Figure 2.1 Grampian Population 1981-2037.

Source: NRS

Whilst Aberdeen tends to have an overall health profile that is better than the Scottish average, the health experience amongst the population varies. For example, people living in the most deprived parts of Aberdeen have a 100% increased risk of being admitted to hospital with angina or heart attack, and a 590% increased risk of being admitted as an emergency for chronic obstructive airways disease.

Socio-economic inequalities affect health outcomes in that those who are best off financially do best on health outcomes, with the converse true for the poorest. It is known locally, but perhaps not so nationally, that our city has a mix of both significantly deprived and significantly affluent neighbourhoods. Just under one third of the Aberdeen population live in areas that are amongst the 40% most deprived in Scotland, whereas just over half of our population live amongst the 40% least deprived areas in Scotland.

Three-quarters of Aberdeen’s population report that they are in ‘good’ or ‘very good’ health, but there is a negative correlation with deprivation and with age. Those from more deprived backgrounds and older people are less likely to perceive that their general health is ‘good’ or ‘very good’. Generally, people living in more deprived areas are more likely to suffer a premature death.

Generally, people from more deprived areas of the City are more likely to attend Accident & Emergency. The more disadvantaged members of our community are the most likely to be admitted to hospital as an emergency, and are more likely to have repeat emergency admissions. The over 65 population group account for more than a third of emergency admissions to hospital in Aberdeen City.

Long term physical illness is often associated with accompanying psychological strains and this combination of physical and mental ill health has a strong association with health inequalities and poor outcomes for individuals and their families.

Almost 15% of the City’s population are prescribed drugs for a mental health condition (anxiety, depression or psychosis) and this has been increasing over the past 5 years. The recent economic downturn, and the resultant job losses and instability, will likely have a detrimental effect on the health and wellbeing of those affected, particularly middle-aged men and young people and single parents with no family support networks. A lack of accessible and suitable support groups and decent housing will challenge any continuity of care.

Alcohol and drug misuse is a significant concern that not only impacts on the individual’s health and wellbeing but also that of their families and communities. This is reflected in indicators such as emergency hospital admissions and criminal justice statistics. In 2014, there were 35 probable suicides in the City. Men in their 40s and 50s are the most likely group to commit suicide, and the most common method used is hanging. 18

Aberdeen City has a consistently higher rate of pregnancy terminations that the national rate, and has been one of the worst performing areas in Scotland over the past decade. There is a link between deprivation and termination rates. There is also an association between deprivation levels and breastfeeding, with children born into the most deprived communities the least likely to benefit from being breastfed. Women living in Northfield, Cummings Park, Torry and Mastrick are the least likely to breastfeed.

There is an obesity crisis in the Grampian area, as indeed there is in Scotland. and again the link with deprivation is evident as people from more deprived communities are less likely to eat a health balanced diet than those from less deprived areas. A range of inter- related interventions that reflect the complexity of this issue such as access to healthy food options, practical cooking skills and licensing of food outlets is required to address the situation.

Physical activity can help in the fight against obesity, but again those from more deprived areas are the least likely to achieve recommended activity levels with a relatively low awareness of what these even are. Better communication of the importance of a good diet and regular physical activity will not necessarily in itself result in improved health and wellbeing; targeted support to particular population groups will however be more appreciated and beneficial. Physical activity can help individuals across all ages and client groups to reduce stress, improve wellbeing and positively impact on those with long term conditions.

At the time of the 2011 Census, 75% of Aberdeen’s population reported Scotland as their country of birth and 15.9% was born outside the UK. More than 60% of those born outside the UK had been living in the UK for less than 5 years, compared to 40% in Aberdeenshire and 44% in Scotland.

In Aberdeen city, approximately 0.1% of the population recorded ‘Gypsy Traveller’ as their ethnic grouping, this equates to approximately 223 individuals1. Within this community there is a belief that poor health and pain must be tolerated. Another feature is a fatalistic attitude to health ('what will be, will be'), resulting in a view that illness is inevitable, and therefore seeking treatment is pointless. Fear of certain illnesses, including cancer and other terminal illnesses, combined with this fatalism, mean that many Gypsy/Travellers may avoid health screening. Our system wide service design and provision may sometimes lack the required cultural awareness and accessibility to improve matters, leading to a reliance on a particular service in a particular area.

The ‘Scotpho’ profiles (www.scotpho.org.uk) contain information on 56 associated topics that can be used to inform our investment in improving the health and wellbeing of the

1 Figure 3: White ethnic groups by council area, Scotland, 2011. www.scotlandscensus.gov.uk

local population and reducing health inequalities. Aberdeen’s profile shows that we are statistically worse than the national average in relation to:

 alcohol related hospital stays  drug related hospital stays  patients hospitalised with Chronic Obstructive Pulmonary Disorder (COPD)  patients hospitalised with coronary heart disease  road traffic casualties  people aged 65 and over with high levels of care need who are cared for at home  crime rate  domestic abuse  drug crimes recorded  population within 500 m of a derelict site  child dental health in p7  immunisation uptake at 24 months (5 in 1)  immunisation uptake at 24 months (MMR)

We also recognise the significant detrimental effects on our health and wellbeing that is directly caused by isolation and loneliness. The increasing impact on the demand for our pressured services caused by this modern public health concern is preventable through a cohesive, early intervention and prevention approach that says challenging loneliness is everyone’s business.

We need to have a cultural shift that looks not only at the adult population in its entirety but also our families, so that our children in turn become healthier adults. We need to focus our policy on disengaged groups and ask why is it that our health and care services are not working for them as well as we might wish. The life course issues that we need to be mindful of include: alcohol and smoking related diseases, unemployment, domestic abuse, higher accident rates, mental health issues and substance misuse issues. It is often the case that the vulnerability of individuals within these groups is heightened by a lack of appropriate support networks so additional, enhanced support is not just beneficial, but necessary.

2.2 Our Partnership.

The scope of our partnership’s activities has been formally outlined in our Integration Scheme2 and consists of services from the health, social care, third, independent and housing sectors which are all committed to providing high quality integrated services to our citizens.

2 http://www.aberdeencityhscp.scot/contentassets/47a823b8be3c4f26830d11200cb644a1/ aberdeen-city--integration-scheme.pdf 20

These sectors provide valuable care, support and treatment to adults of whatever age, who may have a physical health difficulty or disability, dementia, a mental health difficulty, autism, a learning disability, a substance misuse problem or any combination thereof.

Our partnership will host the Older People and Rehabilitation hospital-based services at Woodend Hospital and the Links Unit of behalf of Aberdeenshire and Moray IJBs. These services include:

 Inpatient services for people at Woodend Hospital which are part of the Grampian Specialist Rehabilitation service for elderly people.  Stroke rehabilitation.  Neurology rehabilitation.  Horizons – ‘one stop shop’ for health and social care service provision for community based clients across Grampian with complex neuro disability.  Craig Court – transitional community based neuro rehabilitation for acquired brain injury; complex stroke and spinal cord injuries.  Mobility and Rehabilitation Service (MARS) - includes Wheelchair, prosthetics and orthotics services.

We will continue to host, within Aberdeen City, the Sexual Health Services based at the Community Health and Care Village.

It is proposed that each IJB will take responsibility for the planning and delivery of healthcare within the police custody suites situated within their respective areas. Aberdeen City IJB will take the lead responsibility for the planning and delivery of Forensic Medical services across Grampian as well as the overall strategic leadership for all Police health matters.

Further discussions will take place during the course of 2016 about the hosting of in patient mental health and learning disability services based at Royal Cornhill.

Children’s services are not within the scope of this Strategic plan as they are not being delegated by the local authority and health board to the integration joint board, but even so it is very important that we are mindful of the health and wellbeing of children and our interactions with them. Strong collaboration with the Integrated Children’s Services will be critical to our longer term strategy if we are truly going to transform our activities and provision to a more preventative and anticipatory model.

2.2.1 A defining feature of our partnership will be the involvement of all partners in the planning, design and delivery of services, and we will seek to strengthen the trust between all partners and support the development of collective confidence in all partnership activities. We recognise that partner involvement must include individuals, families and communities also.

A significant number of integration conversations have taken place across these sectors, discussing the potential benefits and challenges that may arise from the integration of our health and care services. We recognise that there is a desire to understand structures and processes and where we all fit into those, but we will place greater value on the relationships that exist across all sectors and how these can always be used in the best interests of the individuals who use our services, their carers and their communities.

We want to be judged not only on what we do but how we do it, and so we will seek to demonstrate through our attitudes and our behaviours, that we are a caring partnership that shows compassion to the individuals who use our services, their carers and family, and our workforce. We will be very visible in our local communities and will work with our residents to plan and deliver services that make best use of the assets and resources that are available in our local communities.

A significant proportion of our services are delivered by our partners in the third, independent and housing sectors. We recognise the positive relationships that many organisations in these sectors have with the people who use their services and their carers, and the wider connections that they have with our local communities. We

recognise that further work is needed so that organisations in these sectors truly believe that they are seen and valued as our partners in delivering on our ambitions.

The Housing Contribution Statement (see Appendix Three) sets out the role of social housing providers in Aberdeen City to achieve outcomes for health and social care. The provision of good quality housing to support a range of needs will play a key role in achieving outcomes in relation to supporting people to be able to live, as far as is reasonably practicable, independently and at home:

 Increase housing supply to meet housing need and demand.  Improve housing conditions in both the public and private sector.  Ensure continued supply and access to affordable housing.  Continue to provide information and advice to improve housing conditions in the private housing sector.  Ensure there is a supply of particular needs housing of the right type to meet future requirements.  Improve energy efficiency in both the public and private housing sectors and alleviate fuel poverty.

2.3 Our Carers.

Anyone looking after a person with an illness or disability, whatever their circumstances and living arrangements, is considered a carer. Carers look after someone without pay or financial reward. They are sometimes known as 'informal' carers or more frequently as ‘unpaid’ carers.

The “formal” health and social care services provided a range of different sectors can be readily “counted”: we have a good idea of who is doing what and how much it costs. In contrast however, much of the “unpaid” care provided by people in our communities can go unrecognised, although one report, ‘Valuing Carers’ suggests that in 2015 in Aberdeen £326m worth of care per annum was being delivered by unpaid carers.3

According to the 2011 census there are self-identified 15,571 carers in Aberdeen but in reality there are probably as much as 10% of the local population, roughly 25,000 people who are fulfilling this role in one way or another. It is important that we have a greater certainty about how many unpaid carers are providing care and support to their family member, friend or neighbour, and perhaps reducing the need for them to currently access “formal” health and care services. The circumstances of the cared for individual or carer can change at any time causing services to be urgently required and delivered, possibly at a higher level of intervention than would otherwise be the case.

3 Valuing Carers 2015, The Rising Value of Carers’ Support; Carers UK. 23

It is a good thing to recognise and support the vital role that “unpaid” carers fulfil: they are, in many respects the experts. One test of a caring society is the readiness with which we agree to be an unpaid carer should the circumstances of our relative, friend or neighbour require this. It may be that we need to reposition our attitudes to the unpaid caring role.

Given that our health and care services could not function as well as they do were it not for the contribution of our unpaid carers, we will ensure that the support offered to all carers is targeted at their specific and individual outcomes, as well as the specific and individual outcomes of those being cared for. We recognise that there are a variety of outcomes which are unique to carers such as the need for time to themselves and for relief from challenging circumstances,. We are also very aware that carers typically may not be aware of what is available to them. We need to rectify this and at the same time, promote across all our sectors and services, with high expectations regarding carer engagement.

Case Study: Kate is 55yrs old. She works part time at the City Centre Branch of the Royal Bank of Scotland. She has a son and a daughter. Her daughter is married with two children and lives several miles away. Her son lives at home and since losing his job, has suffered from depression and anxiety making it difficult for him to leave the house. Kates’ elderly parents live in sheltered housing some distance from her, on the other side of the City. Her father has recently been diagnosed with dementia and her mother has mobility problems since suffering a stroke a few years ago.

Kate does what she can to support her family but is finding it increasingly difficult to keep asking for time off work to attend hospital/GP appointments with her son and parents, and give the practical/emotional support they rely on her to provide. Kate enjoys her job but feels that she might have to give this up as her family responsibilities increase. If asked the question, Kate would not describe herself as a carer.

We anticipate that our integrated approach will benefit Kate in the following ways:

 Kate and other carers and the essential role that they fulfil will be identified on first contact with partners or as soon after as possible.  Kate and other carers will be given advice about their rights. The partnership will promote awareness about carers’ rights at every opportunity.  Carers typically may not be aware of what is available to them. We will ensure that our staff receive Carer Awareness Training. When undertaking Adult Carer Support Planning our staff will have the knowledge of local sources of support where carers can find further help to meet their needs. Better joint working will bring a greater understanding of the role that Kate fulfils. 24

 We will ensure that Kate and other carers are fully included and supported when the person they care for has need of Health and Social Care Services.  By encouraging partnership working with Carers at all levels of care from the individual to overall service planning.  Our staff will recognise Kate as expert in the care of her son and parents.  We will ensure that a range of Carer Support services is available to Kate and other carers.  We will ensure that the support offered to all carers is targeted at their specific and individual outcomes.  We recognise that there is a need for Kate and other carers to have time to themselves and for relief from challenging circumstances.  We will improve access to more flexible support and short breaks.

2.4 Our Resources.

2.4.1 Our staff groups across the health, social care, third, independent and housing sectors will be pivotal to the success of our integration endeavours. We know that our health and care workforce is getting older putting additional pressures on our recruitment and retention activities and costs across all sectors. It is a legitimate question to ask of ourselves ‘What do we have to do to recruit our future generations of social workers, GPs, nurses, care managers and other professionals?’

There was a clear message from our consultation on the lack of staff in certain sectors and service because of low wages and lack of affordable housing, and how this impacted on the quality of service provision. Concerns were expressed that even when staff were available they are not given enough time to do what is needed and so have a task focussed instead of person centred approach to their relationship with the individual who is receiving the service. We recognise that providing individuals with a good quality of care needs, amongst other things, continuity and consistency of staffing.

We are very aware that the integration of health and social care services is a complex undertaking and that we need to consider many cultural issues relating to all our partner organisations and professions. This journey will not be risk free and not all benefits will be immediately apparent however, we believe that being part of something new that delivers improved personal outcomes and experiences will appeal to all colleagues across all sectors.

We accept that reconciling these different cultures will require different professions and staff groups to understand each other’s roles, responsibilities and perspectives more fully. We are not taking anything for granted but we think that empowering our staff to do the right thing from a person centred perspective, (‘what we permit, we promote’) will be advantageous for everyone. 25

We want our staff to be very clear about what is expected of them so that they can play a full part in encouraging people to engage with this plan’s ambitions. Our emphasis on providing support at home or in a homely environment will require us to work more closely with our communities and to work in partnership with individuals especially with regards to those with long term conditions.

New working practices will be needed as we move towards preventative and re-ablement approaches with all staff responsible for identifying issues affecting health and wellbeing recording and acting upon the information received. Cherry picking behaviours and disabling models are not compatible with the quality of service that will be the hallmark of our partnership.

We know that there is a strong relationship between people’s experiences of using our health and social care services and the experiences of staff who deliver those services and that positive outcomes are unlikely to happen to one without the other. We recognise that we cannot keep asking our staff to deliver more in shorter timescales without any extra resources, so we will work towards improved experiences being recognised as an essential outcome of our integrated activities.

We recognise that engaging with staff at all levels particularly our front line practitioners, is important. Knowing what matters to them and what works will be necessary to convince all our colleagues across all organisations and sectors of the credibility and feasibility of our intentions and activities. We will support our staff and provide them with the education and training necessary to provide high quality services. We will answer whatever queries they may have and listen to their concerns. We will respect existing staff support structures and mechanisms. We will recognise individual and service achievements and celebrate our successes together however we will never forget the responsibilities and the personal and professional accountabilities that we must always fulfil.

Case Study:

Current circumstances:

 You are employed by Aberdeen City Council as a Care Manager within the Older People’s Service  You are on an ACC salary grade, terms and conditions of employment and work to ACC policies.  You are based at Marischal College working primarily with ACC colleagues.  You have regular contact and liaison with a range of professionals, stakeholders, supported people and their carers/families.

 You report into a Service Manager responsible for Older People’s Services, who is also based at Marischal College.

Future circumstances:

 You are employed by Aberdeen City Council as a Care Manager  You continue to be on an ACC salary grade, terms and conditions of employment and work to ACC policies.  You are based within a locality ‘Hub’.  You are co-located with a range of colleagues both ACC and NHS Grampian undertaking a range of health and social care / work roles to form a multi-disciplinary team within the locality.  Care staff from the Third and Independent sectors have access to a ‘touch down’ desk within your workplace.  You report into an Operations Manager responsible for providing a range of health and social care services (including social care) within your locality.  Your line manager is an NHS Grampian employee, on NHS terms and conditions of employment.  Your line manager does not have a social work or social care background but is from a nursing background.  You will have regular 1 to 1 meetings with your line manager on your workload.  You will also receive professional leadership from a Social Care Service Manager at regular supervision sessions.

2.4.2 Our Integrated Budget.

The total Health and Social Care partnership budget is derived from the budgets delegated to it by Aberdeen City Council for Adult Social Care and by NHS Grampian for Community Health services.

In 2015/16 the cost of social care and NHS services in our scope of integration totalled approximately £250m. It will be an ongoing and significant challenge for us to ensure that we manage all these resources appropriately and that it gives us the necessary sound platform for future investment in line with this plan’s ambitions.

Increases in health and social care costs are strongly associated with increasing age and it is widely projected that the care of the very old will account for an increasing proportion of our health and social care budgets in the future. We need to respond to the population and social changes ahead by doing things differently or we will face projected increases in both scheduled and unscheduled hospital admissions as well as admissions for care

home places that will significantly impact upon people’s quality of life. This is neither desirable nor affordable. We recognise that time is not on our side to make the changes that we need to make to meet the future anticipated demand for our services. In order to produce effective and transformational change in the coming years we will require our financial management processes to support a shift in resources towards our preventative locality-based services. Only by doing this will our changes be enduring and sustainable.

The City Council revenue budget for 2016/17 was set at its meeting on 25 February 2016, and on 2 March the Full Council meeting agreed the total budgets to be delegated to the Integration Joint Board of £88.2 million.

The Scottish Government’s Local Government Finance Settlement provided Local Authorities with details of their revenue and capital funding for 2016/17 only. Previous settlement details have included indicative figures for future years, but this information is unlikely to be available until the Comprehensive Spending Review is provided, probably in Autumn 2016.

Likewise, the NHS funding settlement only covers 2016/17. On 3 March 2016 the NHS Grampian Board agreed the total budgets to be delegated to the Integration Joint Board of £163.5 million. At this stage the NHS Grampian Board figures do not reflect budget uplifts for 2016/17 for pay awards, national insurance and GP Prescribing, nor an allocation for out of area referrals. They also exclude non-recurring funding sources which have yet to be notified by the Scottish Government.

Table 2.2 shows the approved budgets for the delegated services in 2015/16 and indicative budgets for each of 2016/17, 2017/18 and 2018/19 subject to the caveats outlined above.

Table 2.2 Aberdeen City IJB Budget

2015/16 Aberdeen City IJB Budget Budget aligned 2016/17 2017/18 2018/19 to Integration Indicative Indicative Indicative services Budget Budget Budget £m £m £m £m

Community Heal h Services 36.999 33.885 34.495 35.116 Learning Disabilities 28.368 28.868 27.793 26.483 Mental Health & Addictions 17.849 17.783 17.733 17.435 Older People & Physical and Sensory Disabilities 70.809 72.417 72 522 70.577 ACC Administra ion & Management & Criminal Justice 0.200 0.794 0 936 0.998 Primary Care Prescribing 38.302 38.334 39 024 39.726 Primary Care 35.110 33.476 33 811 34.149 Additional Capacity Funding 5.729 9.625 9 884 10.147 Provision for NHS pay & price increases 2016/17 0.000 5.800 5 904 6.010 Hosted Services Intermediate Care 8.620 8.553 8.707 8.864 Sexual Health Services 0.828 0.822 0 837 0.852 Marie Curie Nursing 0.289 0.289 0 294 0.299 Heart Failure Service 0.116 0.108 0.110 0.112 Continence Service 0.273 0.273 0 278 0.283 Diabetes MCN 0.367 0.367 0 374 0.380 Chronic Oedema Service 0.092 0.092 0 094 0.095 HMP Grampian 1.022 0.934 0 951 0.968 Police Forensic Examiners 0.271 0.271 0 276 0.281 Primary Care Contracts Team 0.248 0.282 0 287 0.292 Other Hosted Primary Care Budgets 1.037 1.037 1 056 1.075 GMED 3.618 3.489 3 552 3.616

Total 250.147 257.499 258.916 257.758

The Integration Joint Board will also have strategic planning influence over the budget for Large Hospital services. The set-aside budget for 2016/17 totals £46.7m.

In order to provide an estimate of the budgets that will be delegated to the IJB for each of the 3 years covered by this Strategic Plan a range of assumptions have been made as follows:

 An estimate of budget uplifts for 2016/17 for pay awards, national insurance and GP Prescribing.  An estimate of growth in future year’s budgets to allow for the effects of staff pay awards and contractual obligations, price inflation on contractual arrangements and implementation of the Scottish Government commitment to paying the living wage.  Ongoing impact of service options and budget savings agreed to achieve a balanced budget in 2016/17.

solutions across our health and social care sectors. We need to be clear about what we want our integrated services to do and then look to the IT solutions that can support this. We recognise that there is already an enthusiasm to discuss how we can share assessments, client/patient records and anticipatory care plans (ACPs). We need to be clearer about the opportunities for individuals, families and communities that can be realised through the greater use of technology.

2.5 Our Strategic Connections.

2.5.1 We recognise the importance of many different client group policies and plans to the respective partner agencies. The vision and aspirations set out in this Strategic Plan are consistent with those policies and plans to ensure a continuing quality of experience and satisfaction for the individuals who use our services and their carers.

The national transformation of public services shares many common themes with our thoughts about what needs to be done to make integration successful at an individual, service, and organisational level. Key themes include:

 Outcomes focussed, that is, what actually needs to happen from the individual’s point of view.  Person centred and co-produced in order to ensure that people and communities are fully involved in the design and delivery of services.  Assets and strengths based, building on the strengths of individuals and communities, and developing their resilience.  Focussed on prevention and early intervention.  Evidence led to support performance improvement and innovation.  Empowering staff to work in partnership and in innovative ways

The Christie Commission4 identified the need to redesign public services and in response to the Commission's recommendations, the Scottish Government emphasized the four pillars of public service reform as:

 A decisive shift towards prevention.  A greater focus on 'place' to drive better partnership, collaboration and local delivery.  Investing in people who deliver services through enhanced workforce development and effective leadership.  A more transparent public service culture which improves standards of performance

4 http://www.gov.scot/About/Review/publicservicescommission 31

These pillars will underpin the transformational change of our services and in doing provide a first level response to the question ‘What are we going to do’? We recognise that in order to maintain trust and confidence levels there needs to be a strategic cohesion between our ambitions and actions so that we can explain, in a straightforward manner, what we are proposing to do, including why and what we hope to achieve.

2.5.2 Two national strategies underpin the ambitions and priorities of this Strategic Plan. The ‘Social Services in Scotland: a shared vision and strategy 2015-2020’5 outlines its vision as:

‘a socially just Scotland with excellent social services delivered by a skilled and valued workforce which works with others to empower, support and protect people, with a focus on prevention, early intervention and enablement’.

Similarly, the 2020 healthcare vision6 is that ‘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  If 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 making sure that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission’

These strategies recognise the complexity of the transformational change that will accompany the integration of our health and social care services. They will no doubt challenge our workforce but are both very clear about their desired impact on the people who use our services and their carers.

2.5.3 The ‘Concordat’ (2007)7 between local and national government emphasises the central role of community planning and single outcome agreements in delivering valued services and tangible benefits to our communities.

This Strategic Plan contributes to the following national single outcome agreement outcomes:

5 http://www.gov.scot/Resource/0047/00473374.pdf 6 http://www.gov.scot/Topics/Health/Policy/2020-Vision 7 http://www.gov.scot/Publications/2007/11/13092240/concordat 32

 We live longer, healthier lives.  We have tackled the significant inequalities in Scottish society.  We live in well-designed, sustainable places where we are able to access the amenities and services we need.  Our public services are high quality, continually improving, efficient and responsive to local people’s needs respectively.  Our people are able to maintain their independence as they get older and are able to access appropriate support when they need it.

Our Integration Joint Board will be a statutory partner in the city’s Community Planning Partnership and will seek to exert a strong influence on its conversations that impact on the health and wellbeing of the local population. Effective community planning arrangements will support our integration activities and increase our focus on prevention and continuous improvement in order to achieve better services and better outcomes for our citizens and communities.

The Aberdeen City Single Outcome Agreement will set out our coherent, multi-agency ambitions to make Aberdeen a better place to live and work in. It will be a significant influence on the implementation of this strategic plan and our progress towards fulfilling the national health and wellbeing outcomes.

2.5.4 Strategic Planning for Acute Services.

Strategic planning of the acute sector services below is being delegated to IJBs because of the significant proportion of unplanned admissions that they experience.

 Accident and Emergency services provided in a hospital.  Inpatient hospital services: o General medicine o Geriatric medicine o Rehabilitation medicine o Respiratory medicine o Palliative care o Mental health o Psychiatry of learning disability

It is proposed that Aberdeenshire IJB will take the overall lead in hosting the strategic planning of these services on behalf of Aberdeen City and Moray IJBs. This will include taking lead responsibility for the strategic planning process associated with the services and working with NHS Grampian to ensure that there is a consistent and comprehensive planning process for all acute services.

A series of workshops have been held to understand our strategic planning requirements in the context of the pathway of care overseen by each service. A number of common themes emerged including:

 Healthier populations who are independent for longer – prevention, self- care/management and managing expectations  Individualised care with positive risk taking  ‘One Team Approach’ – better co-ordinated care with a key contact for patients/carers  Integrated planning at locality level based on population needs and available resources  Rapid access to services and decision making as and when it is required  Supporting carers needs  Education accessible and where appropriate joined-up for all appropriate professionals  Reducing avoidable admissions – right care in the right place and at the right time  Improving communication – accessible electronic records to support professional to professional communication but also requirement to consider how we improve professional/patient communication

These themes have been factored into the development of this strategic plan and will also feature heavily in the service specific planning process within the acute sector and also the development of the Grampian Clinical Services Strategy.

What does this mean for the residents of Aberdeen?

A new organisation, the Aberdeen City Health and Social Care Partnership will have responsibility for the planning and delivery of adult health and social care services as of 1st April 2016.

Social Workers, Community Nurses, Allied Health Professionals, GPs and colleagues from other services in the health, care, third, independent and housing sectors will all be working more closely together to offer an improved ‘seamless’ service to individuals and their carers.

“Unpaid” carers are an integral part of our Partnership. We could not do what we do without their contribution and support.

3. Working Together with Our Communities. What is co-production? Our Strategic Plan recognises the value of an asset Co-production has been based approach to developing effective and sustainable defined as: models of care that focus on health and wellbeing and maximise the assets of both individuals and “Delivering public services communities. in an equal and reciprocal relationship between We want to move away from traditional ‘Deficit’ models professionals, people using that focus on identified problems which require services, their families and professional interventions to resolve them, and which do communities. not support the active involvement of local residents and Where activities are co- communities. We recognise though, that moving away produced in this way, both from these models will be a challenge as they are services and communities commonly used as the basis of our statutory become far more effective interventions, but this will be necessary if we are to be agents of change.” successful in empowering and promoting independence, A co-production approach rather than continuing to reinforce dependence. includes the following key characteristics: In practical terms, this will mean moving away from a point of view that statutory authorities should Recognising people as commission services for all the needs of a community to assets. one that encourages and supports individuals and Building on people’s communities to take more responsibility for their own existing capabilities. health and wellbeing. Promoting mutuality and We want to promote and develop the resilience of our reciprocity. communities by increasing opportunities for the people Developing peer support who live in these communities to shape their own lives networks. and take part in local decision making. This means that we: Breaking down barriers between citizens,  Start with the assets and resources in our professionals and services. communities and identify opportunities and Facilitating rather than strengths. delivering.  See people as having something valuable to contribute and support them to develop their potential in adding social value to their Co-production will be a key communities.  Focus on communities encouraging and adding social valueinteg at every ated a opportunity ti ities. This will not be without its challenges. The single person household will likely be the most common household type in years to come and that living without the immediate

support of family members, combined with the increasing prevalence of chronic conditions such as diabetes, asthma, chronic obstructive pulmonary disease, heart failure, arthritis and dementia, will challenge our vision of a healthy, resilient interconnected community.

3.1 Our Localities.

The Public Bodies (Joint Working) (Scotland) Act 2014 requires us to divide Aberdeen’s geographical area into at least two localities to enable the effective planning and delivery of our integrated services.

Localities should be large enough to offer sufficient scope for service improvement but small enough to feel local and real for those people who live there. The main purposes of localities are to assess need, prioritise and plan how all resources are used in pursuit of delivering the outcomes of the strategic plan in the locality. The partnership is also required to involve representatives of a locality in any decisions or planned changes that are likely to significantly affect service provision in that locality. Our intended locality approach will be wholly in line with these integration principles below:

 integrated from the point of view of recipients  takes account of the particular needs of different recipients, and from different parts of the area in which the service is being provided  takes account of the participation by service users in the community in which service users live  makes the best use of available facilities, people and other resources  and 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.)

We are proposing to base our localities on the four existing GP cluster areas that have existed for a number of years so that we can take advantage of established relationships and activities. Our localities will be:

 Aberdeen North  Aberdeen Central  Aberdeen West  Aberdeen South.

Figure 3.2 Our Localities.

We are very aware that drawing lines on a map should not define the experiences and activities of the local population. They will however, provide us with a definable set of areas from which to administer local delivery and evidence the impact of our integrated activities.

Localities must be well organised, with sufficient structure to co-ordinate their input to strategic planning. Each locality is required to have a locality lead, and this position will be identified formally through the ongoing reorganisation of the partnership.

We will develop an integrated management structure that will give sufficient balance to, and support the delivery of our strategic and operational responsibilities. Our senior managers in their new roles will lead discussions and consultations on what functions and services should be aligned to the locality model. We will then work with appropriate Organisational Development colleagues to develop and support integrated, multi-disciplinary teams across the localities.

As the partnership matures we anticipate that the identities of the localities will become more visible and robust and their activities more effective. Even so, we are very clear that co-operation not competition will define the operation of our localities especially since, for example, we know that some individuals will live in one part of the city but be registered with a GP practice in another. Information, good practice and access to activities and/or services will all continue to be shared across locality boundaries. We will not remove professional or service silos only to see them emerge in another form in another part of the partnership’s operations.

It is important not to underestimate the significance of the role of localities in our partnership model. They are intended to be the engine room of integration, bringing together individuals, carers and professionals from the health, social care and housing sectors to plan and help redesign services. If this approach is to be successful, localities and their leadership teams must have the information they need about the nature of the communities they serve and must be empowered by the partnership to make the appropriate decisions that will deliver the desired outcomes.

3.2 Localities and communities.

We all have different thoughts and different answers when asked ‘What are the things that make life meaningful, provide a sense of wellbeing, and keep us healthy?’ Very few of us live, work and socialise solely in one part of Aberdeen. Work patterns, leisure interests, shopping habits and technological advances mean that our connections and relationships across different areas of the city (and beyond) can be mapped in a way that makes perfect sense to each individual.

Our development of localities will therefore reflect that citizens will naturally associate themselves with communities rather than necessarily by the “locality” within which they geographically reside, the boundaries of which are set for administrative purposes rather than necessarily being meaningful to local residents.

“Natural Communities” refer to the communities of place that people call their own. People form associations and local groups around natural communities, but will also

relate to larger geographical areas. For example, someone living in Torry will associate themselves with that area and form associations and groups (for example, a parent may associate with other parents of children attending the same school.) The person living in Torry may also associate themselves with the wider Aberdeen City geographical area, and identify that they live in the South of Aberdeen.

Our citizens are very clear about what their lives would be like were it not for the informal activities they participate in or support as volunteers. Each and every community has different connections and relationships and it is through these that we will tackle head on the scourge of loneliness and isolation which is the root cause of much of the increasing demand for our services.

3.3 Locality Planning. Localities will be critically important from a planning perspective as they will enable us to understand the health and wellbeing of the populations in these areas. We will seek to use these localities to develop local solutions within a cohesive framework. We will start small by testing our proposals, understand the impact of their implementation and then, where appropriate, seek to develop them further on a sustainable basis .

Some communities in Aberdeen already have established networks or planning groups, and where these are in place it is intended to seek to utilise this existing community asset infrastructure. Examples of this would be the Tillydrone network, and the Northfield Total Place Board and wider Stakeholder Engagement Group. In communities where there are limited or disparate networks, we will work with these communities to grow appropriate networks and build community assets. A bottom up approach will be taken rather than placing a community or neighbourhood structure down onto a community in order to increase the likelihood for sustainability.

We are supporting the creation of new Locality Leadership Groups – in the South area, the Cluster Integration Group has agreed that they will develop and diversify membership to become the Leadership Group for the South Locality. Discussions are planned with the North and other Cluster Integration Groups.

We will liaise with all our Community Planning colleagues to ensure that there is a strong strategic coherence in terms of the engagement that we undertake with our citizens and communities, developing our understanding of our local communities and populations and agreeing our joined up actions.

It is our intention that the four localities should plan and develop services on the basis of what we know about the health and wellbeing of the local population and what assets and resources are available locally. We are mindful though that this locality planning in itself should not increase health and social inequalities and create a postcode lottery of access to services.

All our activities will be co-ordinated through the partnership in line with this strategic plan but we recognise that localities may want to pursue some different approaches given their identified priorities. Mature and trusting relationships in and between the localities and the partnership as a whole will help ensure that these local emphases are within the parameters of this strategic plan. We do not have all the answers as to how locality planning will work across all client groups, patient pathways and service models but it will always be the basis of our discussions that are seeking to improve our health and wellbeing, our personal experiences and our personal outcomes.

There is an opportunity in particular for our specialisms and hospital based services at ARI, Cornhill and Woodend to look at our emerging localism and see what connections can be made with these initiatives and developments to improve service delivery and individual outcomes, in a way that does not diminish their professional identity or expertise, but instead opens that to a wider audience.

3.4 Locality Plans.

We will develop locality profiles that illustrate our understanding of the local communities including the health and wellbeing of the local population. These profiles will map the assets and resources and also highlight particular challenges. We will use these profiles to underpin the development of the locality plans which will detail the local services that we intend to develop.

Each locality plan is required to include:

 A list of all the services under the management of the Integration Authority of which the locality is a part;

 Identified priorities for each locality under each of the service headings  Planned expenditure for the identified priorities showing how resources are shifting towards preventative and community-based health and care services.

Our locality plans will be credible and achievable. They will provide the commissioning detail of what integrated health and social care services will be aligned to the localities and how these will function in the best interests of the individuals who use our services, their families and communities.

3.5 Developing a Community and Locality Based Approach.

We strongly believe that those living, working and volunteering locally are best placed to assess identified need in terms of issues relating to health and social care; to suggest how these needs might be addressed; to prioritise the needs on the basis of what is most important to the local community; and reflect all of these within an agreed action plan for the community. It is important to recognise again that some individuals may, at any given time, be isolated or unconnected within a community. This does not mean that they are not part of that community, but that there remains an opportunity to create and develop rich connections.

We are very aware that our colleagues from across all sectors and professional disciplines want to know what the locality model will mean for them and the way that they work. We are clear that our four locality model will not necessarily be the prescriptive delivery model for the services that we commission and deliver across all sectors however our pragmatism should not be mistaken for a lack of ambition about the improvements we intend to deliver in the best interests of the people who use our services, their carers and families and our workforce.

If we are serious about the people who use our services having an improved, seamless experience then we need better communication and improved co-ordination within the health service itself (primary care, secondary care and the acute sector) as well as with and between the social care, third, independent and housing sectors.

We also need real time information and good decision support provided to our front line practitioners so that other appropriate options can be sourced for individuals to reduce our ‘social admissions’ (admissions which are not clinically necessary but are the most practicable at that time due to the absence of other options i.e. social care).

We need to develop integrated, multi-disciplinary, community based services that will have an increased focus on early, preventative interventions and less reliance on formal support. We want the formation of these teams to result in fewer avoidable hospital admissions, A&E attendances and care home admissions, and for them to be focussed on the best interests and outcomes of individuals such as Jean whose story below is not that different from many others across the city.

Case Study: Jean is 78 and lives alone. She has chronic obstructive pulmonary disease, arthritis and high blood pressure. Her family live nearby and help when they can. She is not confined to the house but does struggle to walk long distances or stand for any length of time. She is scared of falling but is adamant that she wants to remain in her own home. Reshaping our services will offer Jean and her family the following:

 Better coordination of care with a single point of contact for Jean and her family  One concise, integrated care plan that addresses all her needs and informs Jean and her family what to do if she is unwell  Less duplication of assessment and less need to repeat information  More community based support helping to reduce the need for hospital admissions  Information to Jean and her family to help them understand more about her conditions and how she can manage her health to live more independently.  More joined up service and greater continuity of care  More advice and support for those who care for Jean.  More linking up to community activities that support Jean being an active member of the community in areas of her own choice.

We also anticipate these professional outcomes;

 Better joint working and greater understanding of the roles of others  Shared knowledge and ownership of issues  Greater awareness of resources, enabling more effective choice.  Greater shared risk management and more creative responses to need.  Much faster access to all relevant information 42

 A proactive rather than a reactive service  Better development of skills and knowledge  Breaking down barriers and silo based working practices in the best interests of the individual

The objective of enabling Jean and others like her to remain safely in their own homes is a key policy ambition of the Public Bodies Act but we know that there are significant numbers of people, who for different reasons, are not known to services. These individuals, however, will be known to their family, friends and communities and maybe it is our services that are hard to reach. We need to change this.

3.5.1 Integrated Community Hubs.

Most people want to receive their primary care services either at their local GP surgery or, if circumstances warrant, their own home and ideally at a time convenient to them given their other commitments and the perceived necessity of the treatment.

A new model of integrated care would develop our community infrastructure and focus much more on preventing ill health, supporting self-management, enhancing primary care, providing care in people’s homes and the community, and increasing coordination between primary care teams and specialists in secondary care.

We believe that having our multi-disciplinary teams responsible for service provision in smaller geographical hubs could potentially facilitate better continuity of care as a result of local strong alignment of key professionals including GPs, Care Managers, Nurses, Allied Health Professionals, Pharmacists as well as appropriate colleagues from the third and Independent sectors.

There is also the potential for this alignment to be supplemented with significant contributions from, for example, community geriatrician consultants (and other acute sector consultants) and clinical psychologists to ensure that individuals are being seen by the right professionals with the right set of skills at the right time in the right place.

Providing appropriate support to the decisions made by other colleagues across the “Hub” will reinforce the continuity of care experienced by all individuals. We will link much better into assets within our communities to help those individuals with complex needs and there will be better links with our hospital-based services with the result that our admission and discharge planning will be better co-ordinated.

Colleagues from across this “Hub” will meet regularly to discuss those individuals who have recently been discharged from hospital, had contact with out of hours, or were screened and appropriate interventions agreed. Other conversations will explore how greater links with the community and third and independent sector groups can be

established to increase community capacity for improving the health opportunities of older people and reconnect people with their own communities.

Given this, a key question is how can we build effective teams and supporting infrastructure in our localities to help us care, support and treat individuals in their communities. This alignment of service and close collaboration across professional disciplines will enable us to explore opportunities that will benefit individuals.

 Workloads that reflect professionals’ skillsets, have colleagues working to the top of their ‘licence’  Free up GP time to care for the complex patients in their own homes  GP beds in each locality  Increased use of technology ie Skype or email consultations  Improved access and longer appointment times where appropriate  Greater collaboration re home visits to decide who is the most appropriate professional to visit  Collaboration between hubs to promote initiatives/best practice and also to provide sickness/holiday cover  New ways of working and the training of Advanced Nurse Practitioners and Physicians Associates, Pharmacists and Links Workers to supplement teams in the community.

3.5.2 Helping People Stay at Home and Prevent Unnecessary Admission. In Aberdeen we are committed to only admitting people to hospital when they need to be there and that they stay in hospital for only the minimum time that is clinically required. Aberdeen City has had, and continues to have, a high rate of people being admitted to hospital unnecessarily and remaining in hospital too long There are a number of reasons for this, which may include the lack of available care at home service provision and availability of suitable housing options.

Given the choice, people often say they want to remain at home, and so we will develop a hospital at home service to prevent unnecessary hospital admission by providing acute care at home. The benefits of this model include: shorter duration of hospital-equivalent treatment, fewer procedures, reduced complications, improved activities of daily living, and better satisfaction as well as providing an opportunity to assess a person’s home environment. The development of this model will incorporate the following themes:

 An increase in services around prevention of admission; building on and developing existing community services to provide acute care at home at a time of crisis.  Home to assess as the guiding principle.

 A comprehensive assessment applying a re-enablement approach to determine and reduce long-term health and social care needs.  A consistent approach to risk management taking a more risk enabling approach.  Consideration of what services are best delivered at city-wide, locality or at GP practice level and how we can work better together with communities and third sector partners to support people at home.  A single point of access for health and social care to mobilise services.  Improvement in communication and documentation, to be person centred, standardised, and shared.  Medication management and pharmacy support embedded as part of the service model.  Telecare and telehealth solutions embedded as part of the service model.  Transport links that support service provision.  Enhanced links to housing services.

A key next step is to establish what elements that already exist could be reshaped to work more effectively, and also to identify any gaps that we need to provide as part of the new model.

What does this mean for the residents of Aberdeen?

We will use the people, organisations and communities that sit within this locality model as the basis for all our engagement with our residents and communities in the city.

We will seek to use and build on the strengths and assets of our local communities in supporting and facilitating an individual’s important contribution to their own community and their own health and wellbeing

We will seek to develop integrated health and care services that are aligned with the four localities and add social value to the communities in these localities.

4.1 Our Personalised Approach.

A strong aspiration of the partnership is for our What does ‘person personalised approach to be evident in all our centred’ mean? activities and for the individuals and their carers to truly believe that they have choice and control, as far Being person centred as is reasonably practicable, over the care and treatment that is offered to them. means treating everyone with dignity, respect and Our approach means services are tailored to the compassion. It means requirements of the individual rather than a ‘one size fits all’ approach. It also encompasses the provision offering personalised of improved information and advice, investment in care, support or preventive services to reduce or delay people's need treatment that is tailored for care and the promotion of resilience and interdependence among individuals and to the needs and communities. aspirations of each individual, not With improved choice and control comes responsibility and we accept that more work is standardised to their needed to inform and support many people about the condition. appropriate use of certain services, for example GP surgeries and the Accident & Emergency department, and what other alternatives may be more suitable for them given their circumstances. Being person centred

means seeing individuals An older population affects our need for healthcare services. For example, if we had tomorrow’s as assets not burdens and population today, we might expect emergency working with them so that admissions in the over 65s to increase from 5300 to they can recognise and 8100 per year. develop their own The growth in our older age population is an resourcefulness and opportunity as well as a challenge for the partnership. capabilities. Aberdeen has, until recently been recognised as doing well in the social and economic factors that underpin good health, and we can use our vibrant neighbourhoods and communities to minimise the need for health services. Many older people are active members of the place where they live and positively contribute to the local health economy by volunteering and providing informal social care. A 5% increase in self-care could reduce demand for

professional care by 25%, while a 10% decrease could increase demand for professional care by 50%.

4.2 A key element of our personalised approach is the promotion and availability of ‘self-directed support’. Self-directed support enables people to have more informed choice and flexibility over their care and support and provides the opportunity for more people to commission and control their own care through the use of individual budgets or direct payments.

The individuals who use our services and their carers will require consistent and accurate information that clearly, without the use of jargon, explains the options and opportunities that are available to them.

Personal outcomes are defined as what matters to individuals and their carers as well as the end result or impact of activities. Outcome based approaches are inherently person centred as they require meaningful engagement with individuals as an essential first step. Focusing on outcomes for individuals will challenge the partnership to move away from any tendency towards service led approaches and to think and act in a person centred way drawing on the individual’s own assets, strengths and capacity.

Ensuring that personal, organisational and national outcomes are linked in a coherent manner is central to the successful implementation of an outcomes focused approach and our commissioning framework. We will ensure that review and feedback is linked through the different levels however we will always seek to emphasise the core personal outcomes underpinning all our activities.

4.2 Our Self-Management.

Most adults under 65 are independent with little or no contact with our health and social care services. We mostly expect to live longer and healthier lives and to have more choice and control over the support we might need to maintain our independence as we age. For that to happen, we must plan now for new ways of providing services that deliver the outcomes for health and wellbeing that people will need and expect. However, we know that there is going to be an increasing demand for our services, and our resources are unlikely to grow at the same rate, if at all.

We need to spend less on some of the things we currently do and find different, and more efficient and effective ways of delivering services in the future. Many people with long term conditions make decisions, take actions and manage a broad range of factors that contribute to their health on a day-to-day basis. It makes sense that practitioners should support people to manage their health as effectively as possible.

Individuals are clear that their respective health conditions should not define nor dictate their lives. They do however want to understand their long term conditions, develop the 46

skills or attributes necessary to manage them better, and develop appropriate informal and formal support relationships.

Self-management means moving away from a model where individuals are passive recipients of care and treatment to a more collaborative relationship where they are active partners. To achieve this, it will be very beneficial for individuals to develop their knowledge, skills and confidence to make informed decisions and adapt their health- related behaviours. They need to have access to the necessary expertise to support them in making informed decisions, achieving their goals and overcoming barriers.

Achieving optimal physical, emotional and social health is an important self- management outcome. We need to be very clear about which other self-management outcomes are considered important by the individuals, their carers and families, and appropriate professionals, to guide the commissioning and design of future self- management services.

Self-management has received growing attention as an effective approach for long- term condition management. We recognise that this is not an option for every individual to pursue as there are some individuals who perhaps are not going to get better or who are always going to need some form of health and social care provision. We do not consider self-management to be a substitute for the appropriate provision of health and care services, but instead is part of the complementary range of supports and services that we wish to develop and offer.

4.3 End of Life Choices

Offering a person- centred approach that respects choices is brought into sharp focus when it is an individual’s end of life choices that are being contemplated. The percentage of people who die at home in Grampian has not changed in the past 20 years. Given that people say they want to die at home, we need to be better at providing and promoting the services that are required in these challenging circumstances, such as Roxburghe House.

As a partnership we need to get better at having difficult or enlightening conversations and we need to be mindful of the language that we use in those conversations. Anticipatory Care Plans have an important role in understanding the person not the condition(s) but we must make sure that they reflect the individual’s current thoughts and choices. We must also make sure that those expressed choices are informed choices, as there can be difficulties in accessing appropriate services with people telling us that they don’t know who to turn to. Carers will have a crucial role in supporting the cared for individual with these conversations and the choices that arise from them.

Continuing supportive care means that there is ongoing assessment and support for those people whose end of life is imminent. Their circumstances will be a test of how well we are doing in improving the co-ordination between services, how responsive our communities based services are, and whether we are actually improving individual experiences.

4.3 Whose Risk Is It Anyway?

We will have a robust and transparent approach to risk management that respects individual choices and keeps people safe from harm. We recognise that individuals need to be supported to live the lives they want and not the lives we think they need however we also need to spread the word that adult support and protection is everyone’s business.

We are very aware that within the health and social care sectors there are different attitudes to risk, and because of this, our workforce will need continuing support and reassurance about how best to manage expectations and support choices. Through the development of our clinical/care and staff governance structures and processes we will ensure that professional leadership and guidance continues to inform and influence our attitude to risk.

Our IJB’s outlook is captured in our risk appetite statement which says:

The IJB recognises that it is both operating in, and directly shaping, a collaborative health and social care economy where safety, quality and 48

sustainability of services are of mutual benefit to local citizens, to stakeholders and to organisational stakeholders. It also recognises, as a newly-established organisation, that its appetite for risk will change over time, reflecting a longer- term aspiration to develop innovation in local service provision based on evidence of benefits and on a culture of continuing, planned engagement with the public and other stakeholders, including those involved in service delivery. As a result the IJB is working towards a mature risk appetite over time.

It recognises that achievement of its priorities will involve balancing different types of risk and that there will be a complex relationship between different risks and opportunities. The risk appetite approach is intended to be helpful to the board in decision-making and to enable members to consider the risks to organisational goals of not taking decisions as well as of taking them.

The board has identified several broad dimensions of risk which will affect the achievement of its strategic priorities. These are: financial risk; regulatory compliance risks; risks to quality and innovation outcomes; risk of harm to clients and staff; reputational risk.

The IJB will set a level of appetite ranging from “none” up to “significant” for these different dimensions. It will have zero tolerance of instances of fraud. It will accept no or minimal risk in relation to breaches of regulatory and statutory compliance. Similarly, it will accept no or minimal risks of harm to service users or to staff. It will accept low to moderate risk in relation to financial loss and to quality and innovation outcomes which predict clearly identifiable benefits and can be managed within statutory safeguards. It will accept moderate to high risks to reputation where the decision being proposed has significant benefits for the organisation’s strategic priorities. Higher levels of all risk types may be accepted if specific and effective controls are demonstrably in place and there are clear advantages for integration objectives.

The IJB has an appetite from its inception to take decisions which may expose the organisation to additional scrutiny and interest where there is evidence of confidence by key stakeholders, especially the public, that difficult decisions are being made for the right reasons. This is most likely to be evident in relation to innovation where there is a perceived need to challenge relationships, standards and working practices and/or where the IJB considers there are identifiable, longer-term benefits of greater integration of systems and technology.

A Risk Management Framework incorporating our risk management policy, risk appetite statement and both strategic and operational risk registers will be developed.

We will support, in the best interests of the individuals who use our health and care services and their carers, a positive culture of risk enablement that is underpinned by evidence-based decision making, based on accurate and appropriate information.

Case Study:

Sarah is a young woman with a moderate learning disability who lives in supported accommodation. Whilst Sarah had support and access to staff within her accommodation, she also goes out to her own activities and work placement – using public transport unsupervised. This worked well for Sarah, as she had a degree of independence, alongside the ‘back up’ of her support team when she needed assistance.

Recently, however, the staff at her work placement (run by a third sector organisation) had become more concerned as Sarah appeared more withdrawn and appeared to no longer want to buy her lunch as she usually did. Sarah confided to the work placement staff that a ‘boyfriend’ was now regularly meeting her on the bus on her way to work and asking rather forcefully for ‘a loan’ via the cash machine. Sarah felt scared and didn’t want to give him the money, but also didn’t want to upset him.

The work placement reported the situation to the Adult Protection Unit who commenced an inquiry with social work staff working alongside the Police, the supported accommodation, the work placement and the local learning disability community nurses to find out what happened and make sure Sarah was safe. Working jointly, a protection plan was put in place that

supported Sarah to travel safely to her activities; protected her bank account; confronted the man targeting her; and worked with her to ensure she was able to have a better understanding of what a healthy relationship is and is not.

 The sphere of Public Protection is already one of the areas where the various organisations who work with vulnerable individuals work exceptionally closely together.  Legislation already places duties to ensure the good cooperation of Social Work and health staff (alongside other agencies). Local multi-agency arrangements have implemented this to good effect.  Integration will help embed and deepen these existing good links and will also further aid in the management of the most complex and detailed public protection cases.  Integration will also further integrate the third and independent sectors into public protection frameworks via the embedding of joint referral and commissioning arrangements.

4.4 Improvement Principles and Ambitions

We are committed to improving the experiences of the individuals who use our services and their personal outcomes. We are also committed to the continuing improvement of all our services so that they are recognised as being effective, person centred and high quality.

Managing public expectations about where these services are and what they do is a critical element of our improvement agenda and will require continuous engagement and transparent decisions.

The commissioning of services will be one of the most important functions undertaken by the partnership as it seeks to ensure that all services enhance the quality of life for the individuals and their carers now and in the future. We recognise that it will be most effective if it is done in partnership with citizens, families, communities and other agencies that have an interest in the continued wellbeing of our local population.

We recognise however that not everybody has the time, energy and inclination to participate in these discussions, however, we will aim to include as many people as possible. We want the citizens of Aberdeen to value the health and care services that we are proposing to develop and in a wider context, identify with and support the broader ambitions of the partnership.

The vision and aspirations set out in this Strategic Plan are consistent with the ambitions and expectations of the National Care Standards and the NHS Quality Strategy. We will commission outcomes-focussed services that deliver high quality care and support and can evidence a positive quality of experience for the individual 51

and their carer. We will develop a quality-driven approach that promotes and protects human rights and seeks the appropriate involvement of people and their carers in the commissioning process. We will challenge discrimination, intended or otherwise and will ensure that we will manage and mitigate against risk appropriately.

What does this mean for the residents of Aberdeen?

We will be person centred in all our activities and will always consider

the best interests of the individual and the communities in which they live.

There will be more emphasis on people taking responsibility for their own health and wellbeing, self-managing their long term condition(s) and self-directing their care. We need to be realistic however, about what is expected and what can be afforded.

We will expect continuous improvement to be a defining feature of the services that we commission, and for this to be always evident to the people who use those services and their carers.

5. To Achieve Healthier and Fulfilling Lives and Wellbeing.

5.1 The majority of people remain healthy and active into old age without the need for services. Although What do we mean by health problems generally increase with age, ill health health and wellbeing? and disability should not be an inevitable consequence of growing older in Aberdeen City. We The World Health want to focus on the promotion of health and wellbeing Organisation (WHO) and strengthen early intervention and prevention. offers a positive

At the same time, we want to make sure that people definition of health which have access to the right treatment, care and support includes our social and services when they need them, in ways which are personal resources as well effective, personalised and empowering. We need to recognise the essential asset of life experience and as our physical capacities create opportunities for people to be more in control of as ‘a resource for their health and wellbeing and the management of any everyday life, not the health problems. objective of living’.

To achieve our strategic objective of optimising the independence of people at home we need to look at A sense of physical, how we manage our resources to deliver the best mental and emotional value for all people and their carers and their communities. In the next few years, health and social wellbeing is a key care budgets will most likely reduce in real terms while attribute that reflects the demand for services will increase. the multi-dimensional and

We are committed to making the best use of our positive aspect of health. resources to deliver best value in improving outcomes for people. We will have to make difficult decisions WHO also make the point about future priorities and how we meet them, through that “the enjoyment of the process of joint commissioning. We may however, need to stop or reduce investment in some services to the highest attainable release resources to commission other or different standard of health is one services to address our known challenges and fulfil our of the fundamental rights strategic priorities. of every human being”. 5.2 The Scottish Government has identified nine national health and wellbeing outcomes that the partnership must work towards. We have taken our focus on individuals, communities and the partnership and applied it to these outcomes showing some ideas that we think will address some of the challenges that we have outlined in this plan.

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

 What does this mean for individuals? That people develop their resilience and interdependence so that they are able to accept responsibility for their own health and wellbeing, with support where needed and continue to contribute to their communities.

 What does this mean for our communities? They are a safe place to live; residents feel that they are listened to, that their opinion ‘counts’ and believe that there are positive opportunities for developments that will enhance their lives and the life of their community.

 What does this mean for the Partnership? Our personalised approach will promote self-directed support and self-management and support the prevention of ill health. We will support our local communities by adding social value wherever possible and seek public participation in all our activities.

 How are we going to do this? o We will support and develop our Wellbeing activities that promote good health and participation in appropriate activities. o We will invest in telecare and telehealth solutions to enable people to monitor their health and alert the appropriate services to any changes. o We will target our interventions towards those population groups whose vulnerability, behaviours and wellbeing requires additional support for them to attain optimal health and wellbeing. o We will put in place the necessary supports to develop high health literacy rates and self-care/self-management skills o We will adopt a consistent ‘Making Every Opportunity Count’ approach to support individuals to be as independent as possible.

 How will we know we are making a difference? o Percentage of adults able to look after their health very well or quite well. o Premature mortality rate.

o Emergency Admission Rate.

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

 What does this mean for individuals? We should have easy access to understandable information and advice and access to ‘low level supports’ to help us continue to live independently. We should be supported to develop self-care and self-management skills and to be able to contribute to our communities in ways we value.

 What does this mean for our communities? Communities will be more aware of the difficulties that people face, and increasingly will be more able to respond so that individuals feel listened to, valued and a have greater sense of belonging and connectedness that contributes to their wellbeing and the wellbeing of their community.

 What does this mean for the Partnership? We will promote ability not disability and respond appropriately to what people are telling us. We will communicate with other services and providers to make sure that our delivery of service is as holistic as possible and we will provide extra help to those who struggle to navigate the system to stay in control of their care.

 How are we going to do this? o We will invest more resources in early intervention and re-enablement to ensure that people have the best opportunity to remain independent o We will promote the uptake of Anticipatory Care Plans and make sure that they always reflect the current thoughts and opinions of the individuals and their carers and that all relevant staff have access to, and take cognisance of them. o We will always involve the people who use our services and their carers in the planning and delivery of our services.

o We will develop a hospital at home service so that appropriate individuals can receive acute hospital care at home. o Increase use of risk tools, falls education and proactive multi-disciplinary team working to improve early intervention with frail, older individuals. o Increase options for palliative care in localities.

 How will we know we are making a difference? o Percentage of adults supported at home who agree that they are supported to live as independently as possible. o Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided. o Emergency admission rate. o Emergency bed day rate. o Readmission to hospital within 28 days. o Proportion of last six months spent at home or in a community setting. o Falls rate per 100,000 population aged 65+. o Percentage of adults with intensive care needs receiving care at home. o Number of days people spend in hospital when they are ready to be discharged per 1,000 population. o Percentage of health and care resource spent on hospital stays where the patient was admitted in an emergency. o Percentage of people admitted to hospital from home during the year who are discharged to a care home. o Percentage of people who are discharged from hospital within 72 hours of being ready. o Expenditure on end of life care

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

 What does this mean for individuals?

Individuals will be treated with respect and dignity at all times and will be given the necessary information to make informed choices. They will be listened to and their views, and where appropriate, those of their carers and families will be taken into account by all colleagues who have an involvement in their life.

 What does this mean for our communities? Residents have clear expectations of the range and purposes of the services and support available in the community and are clear about how to access them. They have confidence in the care and treatment that is provided to them irrespective of who is providing them.

 What does this mean for the Partnership? A commitment to ‘continual improvement’ in leadership, governance, and organisational culture, behaviours, personalisation of service delivery, active listening and communicating, a growing confidence in multi-professional, multi-agency roles and responsibilities.

 How are we going to do this? o We will demand high levels of positive engagement between staff and the individuals who use our services. o We will develop a single point of contact for individuals to enter our health and social care system and for their journey to be supported and co-ordinated as appropriate. o We will record and act upon all feedback received on a continual basis to ensure ongoing improvement throughout our systems and processes. We will have robust feedback systems putting individual experience at the heart of improvement and change.

 How will we know we are making a difference? o Percentage of adults supported at home who agree they had a say in how their help, care or support was provided. o Percentage of adults supported at home who agree that their health and care services seemed to be well co-ordinated. o Percentage of adults receiving any care or support who rate it as excellent or good. o Percentage of people with positive experience of the care provided by their GP practice o Readmission to hospital within 28 days. o Proportion of last six months spent at home or in a community setting. o Proportion of care services graded ‘good’ or better in Care Inspectorate inspections.

o Number of days people spend in hospital when they are ready to be discharged per 1,000 population. o Percentage of people who are discharged from hospital within 72 hours of being ready. o Expenditure on end of life care

Outcome Four: Health and social care services are centred on helping to maintain or improve the quality of life of service users.

 What does this mean for individuals? People should feel supported and confident in maintaining independent living, feel valued and included in their community, feel they have influence in and with the services that they access and that are important to them..

 What does this mean for our communities? health and social care service improvement will centre on strengthening community services supporting and seeking to add social value at every opportunity so people can find what they need close to where they live.

 What does this mean for the Partnership? Our health and social care services will be locally designed and delivered in partnership with citizens and community and voluntary organisations, in order to increase people’s access to the assets and resources in their local communities. We will facilitate people’s access to local community assets and resources that support good health, self-care and self-management in ways which encourage a sense of belonging to the communities in which they live.

 How are we going to do this? o We will develop integrated health and social care services on a locality basis. o We will develop Integrated Community Hubs across our Localities providing significant multi-disciplinary resource so that individuals are able to be supported at the right time in the right place by the right person.

o We will develop strong, meaningful partnerships with all our partners across the third, independent and housing sectors and ensure that they are involved in the planning and delivery of services.

 How will we know we are making a difference? o Percentage of adults supported at home who agree that their services and support had an impact in improving or maintaining their quality of life. o Emergency admission rate. o Emergency bed day rate. o Falls rate per 100,000 population aged 65+. o Number of days people spend in hospital when they are ready to be discharged per 1,000 population. o Percentage of health and care resource spent on hospital stays where the patient was admitted in an emergency.

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

 What does this mean for individuals? People want to see improving health for themselves and their families, and believe they have a realistic prospect of achieving that.

 What does this mean for our communities? Making better use of everyone’s assets to achieve better outcomes, create an integrated web of support across communities and agencies to support people to have increasing opportunities for improved outcomes.

 What does this mean for the Partnership? We will put reducing health inequalities at the heart of everything that we do and will seek to develop inequalities-sensitive practice at every level of the partnership.

 How are we going to do this?

o Localities will be encouraged to establish informal, desirable supports i.e. self-management groups, peer support groups, carer support groups that our citizens and communities value o We will support and develop our understanding and implementation of health inequality impact assessments tools. o We will complete a health inequality impact assessment for this Strategic Plan and will do this for all subsequent health and social care policies and strategies. o Locality plans will prioritise reducing health inequalities in those communities that experience the poorest levels of health and wellbeing.

 How will we know we are making a difference? o Premature mortality rate. o Emergency Admission Rate. o Readmission to hospital within 28 days.

Outcome Six: People who provide unpaid care are supported to reduce the potential impact of their caring role on their own health and wellbeing.

 What does this mean for individuals? Individuals can be reassured that the significant role of unpaid carers will be recognised, that their views will be included and respected in the development of all strategic and operational plans for themselves and the people they provide care to. The health and wellbeing of the carers themselves and the impact of their carer role is hugely valuable and appropriate support must be blended throughout all our systems.

 What does this mean for our communities? Carers are a vital cog in the life of communities and barriers will be reduced to enable carers to stay active in their communities to increase their sense of belonging and developing social connections that actively support them in their role in meaningful ways.

 What does this mean for the Partnership? The Partnership values the contribution that carers make and will endeavour to nurture and protect their rights, their sense of belonging and their supportive links throughout our health and social care systems will enhance the engagement with unpaid carers by all partner sectors and organisations and at all levels.

 What are we going to do this? o In response to what we have been told by carers, we will continuously improve access to more flexible support and short breaks. o We will continue to invest in the involvement of carers as equal partners in the planning and delivery of community based health and social care supports and services. o We will implement in full the legislative requirements of the Carers Support Act 2016 and also work towards attaining the Carers Positive accreditation.

 How will we know we are making a difference? o Percentage of carers who feel supported to continue in their caring role.

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

 What does this mean for individuals? Adults at risk of harm are supported and protected by their families, communities and network of supports.

 What does this mean for our communities? Communities are aware and confident that systems are in place for the identification, reporting, and prevention of harm.

 What does this mean for the Partnership?

We have a culture which places the safety and wellbeing of the individuals that we work with at the centre of everything we do. We are confident that our evidence-based practice, clear and robust governance arrangements, and commitment to continuous service improvement minimises the risks of harm to them.

 What are we going to do this? o We will continue to promote the key message that adult support and protection is everyone’s responsibility. o We will develop a robust clinical and care governance framework that protects the people who use our integrated health and care services. o We have robust systems in place for the reporting and investigation of harm/suspected harm and we will ensure that all staff are fully aware of their professional responsibilities. o We will ensure through appropriate consultation that individuals and communities feel confident to use our robust protection systems and are aware of any risk in their locality that could impact on the safety of themselves their family and friends and their community and are given appropriate advice and support to tackle any concerns they might have.

 How will we know we are making a difference? o Percentage of adults supported at home who agree they felt safe. o Emergency admission rate. o Emergency bed day rate. o Falls rate per 100,000 population aged 65+. o Percentage of health and care resource spent on hospital stays where the patient was admitted in an emergency.

Outcome Eight: People who work in health and social care services are supported to continuously improve the information, support, care and treatment they provide and feel engaged with the work they do.

 What does this mean for individuals?

People have clarity over what is expected of them and are motivated to come to work, feel supported by colleagues and management, and are valued by colleagues and people for whom they provide high quality care and support,

 What does this mean for our communities? All partnership staff belong and contribute to their own communities, we will reflect this in our contractual obligation to allow one hour of volunteering per month for all staff to ensure and encourage a work life balance.

 What does this mean for the Partnership? Clear recruitment and retention strategies, training provision, particularly during change implementation, clear lines of accountability and reporting, feedback mechanisms, ability to participate in decision-making, provision of necessary equipment and infrastructure to undertake roles, fair reward, adequate staffing levels and a recognition that all staff must have a work/life balance.

 How are we going to do this? o Ensure staff are equipped to promote health and wellbeing as part of a targeted approach. o We will develop the Partnership’s organisational structure and behaviours and will seek to harmonise, where possible, our activities and the processes that support these so that we become a more effective, agile and efficient agency. o We will offer the workforce appropriate opportunities to participate in robust multi-disciplinary working arrangements where good practice can be shared and skillsets developed. o We will do our best to support our workforce at all times including when they themselves are experiencing episodes of ill health or have become a carer themselves. o We will support our partner organisations across all sectors to work towards attaining Healthy Working Lives accreditation. o We will seek to develop a social care campus that will provide individuals who are seeking employment in the health and care services with appropriate levels of training and (linked) affordable housing options.

 How will we know we are making a difference? o Percentage of staff who say they would recommend their workplace as a good place to work.

Outcome Nine: Resources are used effectively in the provision of health and social care services, without waste.

 What does this mean for individuals? People will understand how health and social care organisations make their decisions, people will be confident that public funding is being used cost effectively.

 What does this mean for our communities? Understanding of how health and social care organisations make decisions, confidence that public funding is being used to best effect, communities collaborate with organisations to identify where local assets can be used to help meet health and social care needs.

 What does this mean for the Partnership? Decision-making processes that are consistent, fair, accountable and transparent, ensuring that the right people with the right skills and knowledge participate in decision-making groups which have timely access to up-to-date health intelligence and evidence of effectiveness and cost-effectiveness.

 How are we going to do this? o We will seek to shift the balance of care to community based models that are valued by individuals and which strengthen our communities. o We will review our bed based services with a view to developing appropriate intermediate models of care delivery such as step up or step down. o We will improve outcomes for service users and carers by developing easier access to health and social care in the right place and at the right time. o We will develop fully integrated teams that will work across sectors and pathways to ensure that the individuals and their carers who use our services have more positive experiences and outcomes on a continual basis. o We will develop strong, collaborative relationships with the acute sector so that our mutual challenges can be addressed to fulfil our shared strategic objective.

o We will develop our planning function to give us a better understanding of the health and wellbeing of the local population, their unmet needs and the evidence of what works so that this can shared more fully with our communities and localities.

 How will we know we are making a difference? o Percentage of adults supported at home who agree that their health and care services seemed to be well co-ordinated o Readmission to hospital within 28 days. o Proportion of last six months spent at home or in a community setting. o Falls rate per 100,000 population aged 65+. o Number of days people spend in hospital when they are ready to be discharged per 1,000 population. o Percentage of health and care resource spent on hospital stays where the patient was admitted in an emergency. o Percentage of people who are discharged from hospital within 72 hours of being ready. o Expenditure on end of life care.

6. How will we know we are making a difference?

6.1 Performance Framework.

One of our key ambitions is for our partnership to be recognised at a local and national level as a high performing partnership. As such, we will show how we are improving personal experiences, improving personal outcomes and fulfilling our strategic priorities.

As can be seen in Chapter 5 there are a core suite of indicators provided by the Scottish Government that are aligned with the national outcomes. However, given what we have said about our personalized approach, the views of individuals and their carers about the quality of their experience when using our services will be an essential indicator of whether our partnership is progressing in the expected manner or not. Similarly, knowing that we have an engaged and motivated workforce across all sectors and organisations will also be an important barometer of the partnership’s own health and wellbeing.

Colleagues from across the health, social care, third, independent and housing sectors will continue to work together to establish an integration platform that offers us the best opportunity to reshape our health and care services. No single activity will produce the outcomes that we desire, instead we will require planned and co- ordinated interventions across a number of areas including:

 Focus on population health and adding social value to our communities  New improved ways of delivering our care and support  Technological advances making people’s lives easier  Quality and efficiency improvements  Active cost management

We recognise the strengths of the single system frameworks that have previously evidenced the performance of services therein. The services that are to be delegated to, or hosted by, the IJB, are highly complex. Therefore, there is a self- evident business critical need that we work collegiately with all our sector partners to develop a performance management framework that is acknowledged as being appropriate, easy to understand, and fit for all purposes.

We will be consistent in the manner in which we evaluate all our new initiatives and developments, and we will have high expectations of the engagement and consultation that will take place. Our locality based, participatory approach to the planning and delivery of services will offer different opportunities to fulfill our priorities and meet the national outcomes. Our strategic coherence will be evident in the development of all these opportunities.

6.2 Where do we want to be in 2019?

As part of the consultation on our draft strategic plan, we asked respondents to tell us what would integrated health and social care partnerships look like in 2019. Their answers can be summarised as:

 The integration of adult health and social care services has progressed smoothly and the partnership is established and known throughout the city.  There are high satisfaction levels from those individuals who use our health and social care services.  Carers feel better supported than previously was the case.  Staff are busy (that hasn’t changed) but they are engaged with our transformational activities and morale on the whole is good.  Staff feel empowered to address the underlying issues impacting on health and wellbeing.  Our partner organisations in the third, independent and housing sectors feel valued for the contribution they are making to the planning and delivery of services.  IT systems are more joined up than they were previously.  People feel empowered to look after own health in their own communities.  Greater focus on prevention and early intervention.  No more falling through cracks, less disengagement distress and crisis.  The locality model is up and running across the city with there being subtle differences in how the four localities are addressing some of their own priorities  Improved resilience in the communities  Better connections amongst staff individuals and community resources.  Multi-disciplinary working is accepted as the natural order of things; workers are confident, know the communities in which they work, know where to link in with wider partnerships and have clear systems and processes in place so everyone knows what is expected of them.  People are getting more confident in knowing where to go for help/support when it is required but also confident that when they are sick or have high support needs those needs will be met for the most part in their own homes and that they will be involved in decisions about their lives.  Improved understanding of support of range of disciplines in the community

What does this mean for the residents of Aberdeen?

We will be judged on the differences and improvements that we make to the health and wellbeing of the people of Aberdeen and its local communities. We will improve this.

We are very clear about the mutually supportive and consultative relationships that we want with our localities and communities.

There will be a strong and consistent partnership ethos across all professions, sectors and services.

”Ageing wi’ Opportunity” right support right place right time

Foreword

Our vision is to work with you to make Aberdeen a great place to grow old and flourish by maximising choice and promoting independence.

Ageing wi’ Opportunity in Aberdeen city

Ageing wi’ Opportunity is Aberdeen City’s first Joint Commissioning Strategy for older people. It is based on a whole system approach that places older people and their carers at the heart of our plans. It provides a high level description of how Aberdeen City Council and NHS Grampian, in partnership with older people and their carers and our Change Fund partners in the third sector (also referred to in this document as the voluntary sector), represented by Aberdeen Council of Voluntary organisations (ACVO), and the independent sector, represented by Scottish Care, will deliver services that meet the health and social care needs of older people in the next 10 years. Throughout the Strategy, we recognise the importance of the wider contribution of services such as housing and environment, leisure, and education, to the wellbeing of older people.

We celebrate older people as an asset and not a burden and recognise that they contribute a wealth of experience, knowledge and energy to our communities. In developing this Strategy we consulted widely with older people and their carers who told us that they would like services to be more flexible, better coordinated and more focused on helping them to remain well and living independently at home for as long as possible. We know that we will achieve these outcomes only by working together.

We all aspire to live longer and healthier lives and to have more choice and control over the type and level of support we might need to maintain our independence as we age. We know that we must plan now for new ways of providing services or supports that deliver the outcomes for health and wellbeing that people will need and expect. However, we must recognise that resources are unlikely to grow with demand as the population of older people increases and we cannot continue to do more of the same. We need to do things differently, spend less on some of the things we do now and find more efficient and effective ways of delivering services in the future. So as well as building on the excellent examples we have of joint working in Aberdeen City, we will give more emphasis to people taking responsibility for their own health and directing their care and to building capacity for wellbeing in communities .

The Strategy outlines the main challenges, opportunities and priorities for health and social care, based on what older people and their carers, staff and citizens have told us during our consultation, together with what we already know from our Joint Strategic Needs Assessment. Throughout the Strategy we have linked our commissioning priorities with our current Single Outcome Agreement and the Scottish Government’s objectives for a Scotland that is healthier, safer and stronger, wealthier and fairer, smarter and greener. These themes are currently under review and we will amend future versions of this document to reflect this.

Joint Commissioning Strategy 2013 - 2023 Page 4 ”Ageing wi’ Opportunity” right support right place right time

In taking forward this Strategy, we will develop a system that promotes: preventative services and anticipatory care ; proactive care and support at home ; effective care at times of transition ; best use of hospital and care homes; and investments that support all partners to work together and to make the most of individual and community resources to promote health and wellbeing. By focusing on these five broad themes, we will improve the ways in which services are commissioned and delivered and achieve our strategic aim of “optimising the independence and wellbeing of older people at home or in a homely setting.”

……………………………… ………………………………

Valerie Watts Richard Carey Chief Executive Chief Executive Aberdeen City Council NHS Grampian

……………………………… ………………………………

Joyce Duncan Stephen Cowie Chief Executive Local Representative ACVO Scottish Care

Joint Commissioning Strategy 2013 - 2023 Page 5 ”Ageing wi’ Opportunity” right support right place right time

Section 1 - Introduction

This Joint Commissioning Strategy sets out our ten year vision and outlines our commissioning intentions for health and social care in Aberdeen over the next three years. This will be supported by an implementation plan, for 2013 to 2016, which will define our short to medium term actions and commissioning priorities and a one year investment plan detailing the use of the 2013-14 Change Fund for Reshaping Care for Older People, worth £3.14m. This meets Scottish Government’s expectations for the development of joint commissioning.

In our Strategy we have focused on securing the best range and quality of health and social care provision to meet the needs of older people into the future. Our commissioning priorities are based on delivering better outcomes within available resources, by prioritising needs, providing joined-up services that give value for money and ensuring fair access within all localities in Aberdeen City. By addressing health and social care inequalities, our Strategy is consistent with the community planning outcomes in our Single Outcome Agreement (SOA).

In this section we will set the scene that informs our Strategy. 1.1 Our Vision

The vision that underpins this Strategy is:

“To Work with you to make Aberdeen a great place to grow old and flourish by maximising choice and promoting independence .”

In agreeing our vision we were guided by the recognition of the tremendous amount of work done by older people and their carers in promoting their own health and wellbeing and the commitment of statutory, voluntary/third and independent sector providers to work together.

How will we achieve the vision?

We will work together to plan and develop more integrated services to meet the needs of all older people, to ensure that older people:

 are supported to live as independently as possible in their own home for as long as they are able and want to, through a range of home based services;  are given opportunity and support to take an increased responsibility for their care and wellbeing at home;  have access to health care which is close to home, responsive, flexible, with no professional or organisational boundaries;  have access to hospital and specialist health care and will be admitted to and stay in hospital only for the time they need;

Joint Commissioning Strategy 2013 - 2023 Page 6 ”Ageing wi’ Opportunity” right support right place right time

 have a choice of good quality housing within a range of options including ownership, private rented and social rented (local authority or housing association) that can meet changing needs and support independence for as long as possible;  feel safe in their home and in their community;  have opportunities for activity, social stimulation and to maintain their wellbeing;  are able to take a full and active role in their local community as citizens of Aberdeen; and  are able to get information about those services that are available quickly, easily at a time convenient to them.

Underpinning our vision is a commitment to work together with the carers of older people to provide the support they need to maintain their caring role, and to promote the health and wellbeing of people before retirement so that they can maximise the opportunities of later life. 1.2 About Aberdeen City

Aberdeen is Scotland’s third biggest city. Although the City’s economy is predominantly driven by the oil and gas industry, Aberdeen is also a premier centre for business, higher education, life sciences research, retailing, leisure and culture 1. The City benefits from a low level of unemployment, 2.2% compared to the Scottish average of 4.4 % 2, and though this brings prosperity to many, it results in difficulties in attracting people into some occupations, such as support roles in NHS Grampian and social care work in Aberdeen City Council and the Independent sector.

Although Aberdeen is relatively affluent, there are a number of localities with significant social and economic challenges: for example, in the 2012 Scottish Index of Multiple Deprivation (SIMD) 3, 22 areas (datazones in SIMD) in the City fall into the15% most deprived areas in Scotland. Similarly in the health category, 48 areas of the city fall into t he 15% most deprived areas in Scotland . We know that someone living in a disadvantaged area in Aberdeen is more than twice as likely to have a long term medical condition as someone living in an affluent area, and is more likely to be admitted to hospital because of their condition . Addressing the inequalities associated with deprivation will be a key focus of our joint efforts.

Population Profile 4

The 2010 population estimates show that there are about 220,420 people living in the City, with 32,354 people (14.6%) aged 65 or over. This includes 4,232 people aged 85 or older, (1.9% of the total population). In our recently published Joint Strategic Needs Assessment (JSNA) and the Director of Public Health Report 2012 (DPH) 5 we reported that, across the age range, the population of the City is projected to increase over time but with a disproportionate increase in the older population. As shown in Table 1, from 2010 to 2035, the number of people aged 65 to 74 years is expected to grow

Joint Commissioning Strategy 2013 - 2023 Page 7

”Ageing wi’ Opportunity” right support right place right time older people is c£76m (gross). Of this, c£42m (gross) is spent on the purchase of care home and care at home services from the independent sector.

A significant amount of work has been done by NHS Grampian to identify and disaggregate the direct patient care spend on older peoples care in Aberdeen from universal budgets. There is still much more work to be done particularly from an NHS Grampian perspective in order to have a full analysis on the expenditure on older people within mixed patient groups for GP services, prescribing, dental services and acute hospital services. .

(See JCS Financial Framework, Appendix 3 for further information) 1.5 Current Performance

Shifting the Balance of Care

Shifting the balance of care from hospital and care homes towards community based provision and increasing the number of people in receipt of intensive care at home (over 10 hours a week) to meet growing need is a priority. Aberdeen ranked 31 out of 32 Councils 6 in its use of care homes in 2010-11. However, from 2011 through 2012, the use of permanent nursing home places reduced by 10%, though the use remained the same for residential care, and the number of people receiving care at home increased by 16%. Whilst this shift was in part the result of a temporary shortage of care home places, more people are being supported to remain at home by greater availability of community based services, for example, short stay, residential rehabilitation at Rosewell House, home-based reablement and direct-delivery community nursing teams. There is more to be done to establish a trend towards care at home, particularly to reduce reliance on residential care, which is mainly providing for people with dementia for whom care at home is no longer feasible or safe. More investment will be needed in home care, telehealthcare systems, respite breaks, and alternative use of care home provision such as intermediate care to reduce time spent in hospital. A shift in the balance of spend from permanent care home placements of only 5% over three years would release £3m for re-investment in care at home, at the 2012- 13 budget level.

Delayed Discharge

Since the Scottish Government set a discharge standard of 6 weeks in April 2008, Aberdeen City has been meeting this with very few exceptions. The standard will reduce to 4 weeks from April 2013 and whilst we were committed to meeting this in advance of April, our efforts are being challenged

Joint Commissioning Strategy 2013 - 2023 Page 12 ”Ageing wi’ Opportunity” right support right place right time by a shortage of care at home provision in the City. The investments we have been making in discharge support, care at home and enablement services along with good integrated working across health and social care will help us towards the 4 week standard in 2013, moving toward a 2 week standard in 2015. 7

Emergency bed days for people over 75

Reducing unplanned admissions of older people to hospital is a national performance measure (HEAT 12) 8. The number of bed days resulting from emergency admissions for people over 75 in Aberdeen had been steadily rising to June 2012, when they began to reduce (see Appendix 1). It is too soon to know whether this downward trajectory will continue but it may be that the introduction of Anticipatory Care Plans, with over 2000 completed through GP practices from December 2011 to September 2012, is beginning to impact on admissions. Nonetheless, there is a great deal more to be achieved as admissions for older citizens in Aberdeen remain higher than for the rest of Grampian. More analysis by GP practice is being undertaken to understand the reasons for admissions and how they might be prevented by alternative provision.

1.6 Policy Context

The Scottish Government’s “Reshaping Care for Older People: a Programme for Change 2011-2021” 9 sets out the framework within which we are developing our joint commissioning strategy. This does not sit alone, but builds upon a range of local and national strategies that have informed our thinking. Some of these are shown in Figure 4 (Further details are included in Appendix 4).

Joint Commissioning Strategy 2013 - 2023 Page 13

”Ageing wi’ Opportunity” right support right place right time communities and other agencies that have an interest in the wellbeing of older people and their carers.

Our Strategy, “Ageing wi’ Opportunity”, will provide a framework for jointly commissioning services in Aberdeen that focus on delivering good outcomes for older people. Our priorities for commissioning include provision for:

 people who are active and may remain so into late older age;  people who have health challenges or long term conditions; and  people who have complex health and social care needs

We want to deliver good outcomes by matching people’s needs to appropriate types and levels of treatment, care and support. Section 2: Consultation - What People have told us 2.1 Our Consultation - “Ageing wi’ Opportunity”

Our consultation was set against the context of what we already know about population challenges, existing needs and service provision. We asked people what our commissioning priorities should be, what they thought of our proposals and if they agreed with them and, critically we wanted to know, if our commissioning priorities will enable us to deliver our strategic objectives.

We linked our strategic outcomes to the Single Outcome Agreement (SOA) themes - Healthier, Safer and Stronger, Wealthier and Fairer, Smarter and Greener – to recognise the wider influences on the health and wellbeing of older people and their carers. We asked people how we could make best use of our resources.

The formal consultation ran between 28 September 2012 and 9 November 2012. Extended consultation with specific groups of interest continued into December.

2.2 How we consulted

We hosted a series of stakeholder events to explain the process and discuss each of the themes shown below. At these events we asked people to tell us if our proposals will help deliver a better outcomes for older people and their carers and asked participants to give us their views on the changes to service provision that are needed in order to meet future demand and expectations.

Over 2,000 printed copies of the consultation document were circulated through Council and NHSG sites, ACVO distribution, libraries, GP practices, sheltered housing and mailing lists. The document was also published on the Partners’ websites (see Appendix 5) and on the Chamber of Commerce

Joint Commissioning Strategy 2013 - 2023 Page 15 ”Ageing wi’ Opportunity” right support right place right time website along with a questionnaire that we had developed to assist with shaping the final strategy. The questionnaire was available in paper format and on Survey Monkey.

Our consultation reached a wide range of people in the City; with over 400 responses:

 117 questionnaires returned;  285 face to face via focus groups, meetings and public consultation events. 2.3 Feedback and emerging themes

The results from the questionnaire and feedback from the consultation events have been analysed and used to refine the final version of our Strategy.

Below are some summaries of what people told us:  We want to remain at home and have access to services which are closer to home, responsive, flexible, with no organisational boundaries.  We want to be able to live in the accommodation of our choice with support when we need it.  Services should be more flexible to meet our needs.  Older people and their carers need information and advice on what’s available for them, including benefits, equipment and adaptations, and respite from caring.  We want opportunities for social interaction.  It is important for us to be able to travel safely to the venues of our choice.  We want to contribute to our communities and be valued for this.  We should receive care and treatment from someone who is competent to deal with our level of need and is sensitive to our culture.

A link to the full list of the responses is available in the technical appendices that supplement this document (Appendix 5). Section 3: Delivering Outcomes for Older People

Our consultation reinforced the importance of taking a whole system approach to deliver the health and social care people need and expect in Aberdeen. Our aim will be to deliver health and social care provision, without duplication of resources and with coordination and timely transfer of care between sectors or services. Where possible we will support and encourage older people and their carers to take more responsibility for their care and wellbeing. We will work more closely with the voluntary/third and independent

Joint Commissioning Strategy 2013 - 2023 Page 16 ”Ageing wi’ Opportunity” right support right place right time sector providers to improve outcomes and make best use of our joint capacity and resources

The section below describes some of the opportunities and challenges we face in order to meet local needs and future demands.

3.1 Opportunities and Challenges

We have used the information available in our Joint Strategic Needs Assessment (JSNA) and Stats and Facts to inform this section and to provide an overview of the some of the opportunities and challenges we face. If you would like more in-depth information please see Annex 1 and Appendix 1

Population Change

Projected population changes 4 offer both a challenge and opportunity to the health and social care system in Aberdeen City. We can be proud that many people are living longer, healthier lives and our aim is to ensure this for more people in the future. A key issue is whether people will spend these years in good physical and mental health, or with illness, distress and loss of independence. It is not just increased life expectancy that is of importance but years of healthy life expectancy.

Our consultation highlighted some specific challenges with our changing population.

Long Term Conditions (LTC): We know that the numbers of older people living with long term conditions such as diabetes, respiratory disease, hypertension (high blood pressure), arthritis, heart failure, stroke, obesity, dementia, and depression are projected to increase. 10, 11 . . In Aberdeen, 21% of households include someone aged 60 to 69 who has a long term condition or disability, rising to 33% in the over 70 age group. There are clear links between long term conditions, deprivation and lifestyle factors. People with long term conditions use over 60% of hospital bed days and are twice as likely to be admitted to hospital and to stay longer. Around 80% of all GP consultations concern a LTC and they account for 60% of deaths.

Our challenge is to make sure that people with a long term condition are supported to meet their needs by fostering good self management of the condition and providing high quality specialist services when they are needed. As important is a preventive approach to tackle the factors that lead to LTC.

Dementia is a range of progressive disorders that affect memory, thinking, behaviour and the ability to perform everyday activities. Alzheimer’s disease is the most common type of dementia. It mainly affects older people, although there is a growing awareness of dementia before the age of 65. After age 65, the likelihood of developing dementia roughly doubles every five years. There

Joint Commissioning Strategy 2013 - 2023 Page 17

”Ageing wi’ Opportunity” right support right place right time social isolation 14 . Untreated depression also shortens life and it is the leading cause of suicide among older people.

Social Isolation and loneliness 15 , are often triggered by loss of family, friends, mobility or income, to which older people are particularly vulnerable. This can have damaging effects on physical health and mental wellbeing and make access to health and social care services more difficult. There was an estimated 11,570 people aged 65 and over living alone and at higher risk of social isolation in Aberdeen City in 2010, and this is projected to rise by 43.5% to 16,600 in 2035.

We intend to provide more supportive social opportunities to combat some of the causes of depression. Befriending services, volunteering opportunities and community involvement should be encouraged. Building capacity through the use of volunteers, including older people themselves, can reduce the impact of social isolation.

Alcohol 16 is one of the leading causes of ill health worldwide. The Scottish Health Survey estimates that 1 in 6 older men and 1 in 15 older women are likely to be drinking enough to harm themselves, with approximately a third of older people developing problems for the first time in later life. In Aberdeen City about 10% of all hazardous and 7% of all harmful drinkers (see explanation in glossary)are aged 65 years and over and the number is likely to increase.

Failure to tackle alcohol misuse in older people could result in an increase in alcohol related conditions including hypertension, heart disease and strokes, placing strain on acute, primary care and social care services. Our challenge will be to promote a positive relationship with alcohol to reduce harm and to provide more care and support for older people who may develop later onset alcohol problems. This requires partnership working across a range of agencies including health, social services and the voluntary sector.

End of Life Support (palliative care) 17 is a particularly sensitive issue. Many individuals and families express a preference for end of life care to be provided at home. Our response will be to develop a coordinated approach to support people at the end of their life to access palliative care services in the setting of their choice.

Support for Carers 18 ,19 is vital to enable them to sustain their caring role and support older people to have a good quality of life and remain independent. We know that there are around 7,760 people aged 50 and over providing unpaid care in Aberdeen, including 3.5 % of people aged 85 and over. Over 3,000 of these carers are providing between 20 to 49 hours of informal care each week. Alzheimer Scotland estimates that 1 in 9 carers is looking after someone with dementia. The number of carers, including older carers, will increase.

Joint Commissioning Strategy 2013 - 2023 Page 19 ”Ageing wi’ Opportunity” right support right place right time

Carers often struggle on, feeling unsupported in their efforts, and are not always effectively involved by professionals. Some carers may feel forced to give up work to care and their own health and financial security can suffer as a result. We recognise the need for practical, emotional and financial help and that more needs to be done to identify and support carers. We are investing 20% of the Change Fund towards this. We will produce a local response to the National Carers Strategy, setting out further our aims for support of carers.

3.2 Common themes

During our consultation a number of common themes that impact on the planning and delivery of services were highlighted and we take account of these in developing our Joint Commissioning Strategy.

Access to information, advice 20 and the importance of advocacy services were cited many times during our consultation as both an area of concern and strength. Whilst we have areas of good practice, we need to ensure clear, consistent information and advice across all services is available, to enable older people to identify and access support at the right time. Everyone has a role to play in this, including key services such as GPs, housing, libraries, community resources and frontline staff. In response a joint strategy for information and advice and advocacy will be developed.

Technology 21 will play an increasingly important role in ensuring that older people have electronic access to information and resources and are supported to maintain their independence and safety through the benefit of telehealthcare.

The Government’s move towards a “digital society” 22 , where access to benefits and information will be available mainly on-line poses a challenge. Many older people have told us they either cannot or do not want to access computers and this could lead to a knowledge gap. Others are embracing opportunities to learn new skills and this is an area where we are encouraging intergenerational activities 23 . For our future older population that will be more accustomed to technology, we need to ensure that we make full use of advances and ensure accessibility 23 .

The Self-Directed Support Bill 24 , due to be enacted in April 2013, will provide an opportunity to expand the use of personal budgets to self-directed care for everyone eligible for ongoing social care. Among older people, take up of the existing opportunity for a Direct Payment has been low and we must ensure that self-directed support offers user-friendly access to services, with well-informed staff to support this.

Accessible transport is something that older people often tell us is important to reducing isolation and enabling access to leisure opportunities, social support networks and health services. Although public transport in Aberdeen

Joint Commissioning Strategy 2013 - 2023 Page 20

”Ageing wi’ Opportunity” right support right place right time

and specific services on a ‘clinic’ basis, for older people and their carers.  We will offer training and support to unpaid carers in the use of telecare and equipment that will improve safety and independence.  We will offer a 6 week reablement programme as an outcome of all community care assessments where likely benefit to the older person is indicated.  We are caring for more people outwith hospital at the end of their life and we will roll out the Living and Dying Well project which aims to improve quality of care in all ca re settings.  To m eet the wishes of more people to be cared for at home we will establish a joint, specialist service for end of life care. Effective care at times of transition  We will reduce further inappropriate admissions to hospital and improve cont inuity of care by making Anticipatory Care Plans available to NHS 24, Scottish Ambulance and Out of Hours services.  We will extend the Rapid Response service to include evening and weekend cover, with improved links to care at home and respite services and access to aids and equipment.  We will consider ongoing investment in a Scottish Ambulance Service ‘See and Treat’ initiative that is showing early results in keeping people out of hospital.  We will increase the availability of specialist clinical advice for community teams to avoid the need for referral to hospital.  We will develop alternatives to emergency admission, including use of non -hospital facilities.  We will develop options for care to support earlier discharge, including use of care homes and v oluntary and community resources.  We will support people to return to their own home before any decision is made about the need for admission to a care home, wherever possible.  Hospitals and Care Homes  We are redesigning services delivered from Woodend Hospital to increase opportunities for rehabilitation prior to discharge.  We will enhance provision of occupational therapy, physiotherapy and home care to prevent admission at the Emergency Care Centre and support return home.  We will put robust plans i n place to meet new delayed discharge standards.  We will extend specialist geriatrician support to all care homes in the City.  We will plan for a level of care home provision to meet future need.  We will support planned diversification of care options by care homes where this will prevent admission or support discharge from hospital.

Joint Commissioning Strategy 2013 - 2023 Page 24

”Ageing wi’ Opportunity” right support right place right time

Ensuring more choice and control  We will ensure that people understand what services will be funded by the public s ector and what they may fund themselves and we will maximise the take -up of benefits.  We are promoting personalisation of provision and planning for the implementation of self -directed supp ort for older people, to improve effectiveness of care and give mo re control and choice.  We will continue to invest in the involvement of service users and carers in the planning and delivery of community based health and social care services. Their involvement in decisions about priorities will be essential.

Building community capacity  We will develop strategies to assist service providers with the transition to the new, joint commissioning model.  We will work with the providers to consider potential alternative uses for care homes as we shift the balance of care.  We will build capacity within the voluntary and community sectors to make better use of resources, including knowledge, skills and assets by promoting collaborative working to achieve commissioning outcomes.

Developing the workforce for new challenges  We ha ve begun to focus jointly on the training needs of staff to equip them with the knowledge and skills necessary to meeting individual health and social care needs and working in more integrated ways.  We have begun working with the Scottish Government, DWP, and service providers to tackle issues of workforce recruitment and retention and to make the care sector a more attractive career option.  We must offer flexible employment opportunities to staff who wish to work beyond retiral age, to retain their expert ise.  We will support interested unpaid carers to make the transition to paid work in social care.  We will implement a joint organisational development plan for the workforce, to ensure we have the right skills to deliver evolving models of joint working.

Developing alternative models of service delivery  A number of alternative delivery models are being developed in Health and Social Care including the Health Village, Cluster Working and the Local Authority Trading Company for Adult Social Care. Further d etails on these are given in Section 4.3  We will explore opportunities for new ways of working based in communities and building on community assets and capacity of local people and resources.

Joint Commissioning Strategy 2013 - 2023 Page 33

”Ageing wi’ Opportunity” right support right place right time

career option.  We will use contractual agreements to ensure that care at home workers are paid at least the ‘living wage’.  We will develop generic posts to deliver aspects of health and social care.  We will offer opportuni ties for more flexible working arrangements to improve recruitment/retention and enhance or extend service delivery.  We will base joint training on competencies required to deliver outcomes rather than profession boundaries and will include the voluntary /third and independent sectors where appropriate.  We will provide training to support personalisation in services and self directed support, based on learning from initiatives already in place in adult services.  We will offer training opportunities to dev elop the nursing support workforce to take on new responsibilities.  We will offer a range of training opportunities, leading to SVQ 2 qualification, to interested unpaid carers who wish to enter the social care workforce.  We will develop a Joint Organisat ional Development Plan to ensure that the learning needs of staff are met in relation to integrated working and that professional and cultural boundaries are not a barrier to better outcomes.

4.2 The Housing Contribution

Older people are more likely to remain at home and retain their independence if they live in housing that is suitable to their needs. The contribution of housing is crucial to shifting the balance of care. In Aberdeen the majority of older people live in ordinary housing and 7 out of 10 are owner occupiers. This has implications for demand for housing adaptations and for alternative housing. The Council’s housing modernisation programme and the housing association sector (Registered Social Landlords or RSLs) business plans have been anticipating the demand for adaptations in social rented housing. For private housing Disability Adaptation Grants may be available.

An alternative option for older people is to consider sheltered or very sheltered housing, which provide an integrated housing warden, telecare and home care service.

In Aberdeen we have a relatively high level of sheltered housing provision of 2,602 units and a lower level of very sheltered or extra care units,280, for rent. A further 322 properties are available in the private sector where housing support is provided on site. A new team of Housing Needs Assessors is ensuring that Council house allocations are appropriate to people’s needs and make best use of resources.

Joint Commissioning Strategy 2013 - 2023 Page 35

”Ageing wi’ Opportunity” right support right place right time

4.3 Alternative Delivery Models

The Development of Cluster Working in Aberdeen City

Aberdeen Community Health and Social Care Partnership have established groupings of GP Practices known as “Clusters”, working together as a source of engagement and communication. Each cluster has around 7 or 8 practices, with populations ranging in size from approximately 52,000 to 66,000 people. There are four clusters in the City, which are based around geographical areas of North, South, Central North and Central South. Clusters will be the local vehicle for the Integration of Health and Social Care.

The development of clusters is based upon a model of multi-disciplinary working, with aligned health and social care staff and voluntary sector involvement within each cluster. A recent Rapid Improvement Workshop looked at using an ‘accelerated cluster’ to develop this concept further and provide leadership to front line staff to develop new ways of working together. Patients/service users, clinicians and social care staff will be fully involved in service redesign.

The proposal will be to develop a joint commissioning approach to services development and delivery at City and cluster levels. This will be consistent with current local and national plans.

The Aberdeen Community Health and Care Village NHS Grampian and the Scottish Government approved a Business Case for the construction of the new Aberdeen City Community Health and Care Village in March 2012. Construction is underway and the project is due to go- live by the end of 2013.

The Health Village will become the main hub in the City for a range of services led by Allied Health Professional (AHPs). When completed, it will host services that are currently delivered from Denburn Health Centre and some of the services currently provided at Woolmanhill Hospital including: dietetics, physiotherapy, podiatry, and speech and language therapy, providing out-patient clinics, rehabilitation classes and education sessions for people from across Aberdeen. In addition the Health Village will have a shared information resource run by Healthpoint and a carers information point.

Joint Commissioning Strategy 2013 - 2023 Page 37

”Ageing wi’ Opportunity” right support right place right time

The allocation of funding will be led by the Change Fund Working Group, which includes representatives from the NHS, Council, independent and voluntary/third sectors.

Exit strategy and ongoing investment

A condition of time-limited funding from the Change Fund has been that initiatives demonstrate an exit strategy that ensures there is no expectation of ongoing mainstream funding unless this is specifically identified. The question remains as to how successful initiatives, without this commitment but that might warrant ongoing support, can be funded. The Partnership will consider the whole system impact of the Change Fund to identify these initiatives and options for future funding.

As the Change Fund is available only until 2015, it is imperative that the Partnership creates opportunities to disinvest in certain areas in order to provide the funding to continue new ways of working. A potential area for release of funding will be the acute hospital sector, as more people are successfully cared for in community settings and unplanned admissions are reduced.

As any consideration of disinvestment there will need to be planned on a Grampian basis, a joint group of senior managers across three Councils and the NHS is meeting. The work of this group will contribute to an Aberdeen City disinvestment plan, to be developed in 2013/14.

Section 6: Performance Management

6.1 Governance Arrangements

The Aberdeen Partnership Agreement for Reshaping Care for Older People 2010-2013 provides the overarching context for this Strategy. NHS Grampian and Aberdeen City Council are signatories to an existing Joint Governance and Accountability Framework. Figure 6 shows the current governance arrangements, accounting for the Joint Commissioning Strategy and Change Fund.

These arrangements will be subject to change with the Integration of Health and Social Care and the establishment of a new Partnership body, under which Joint Commissioning arrangements will be determined. This work will be a priority in 2013.

Joint Commissioning Strategy 2013 - 2023 Page 41 ”Ageing wi’ Opportunity” right support right place right time

Community Planning Partne rship Aberdeen

NHS Grampian Board Aberdeen City Council /Social Care & Wellbeing Committee

Aber deen City CHSC Partnership

Aberdeen City CHSC Executive Group

Integrated Operational Management Group

Change Fund Group and PROPOSED Joint Commissioning Joint Commissioning Reference Steering Group Group (linked to wider older people network)

Figure 6: Current Partnership Governance Arrangements

It is proposed, as part of the governance arrangements, that a Joint Commissioning Reference group is established (see Figure 6) to involve older people and their carers in the work of implementing the strategy. The consultation process gave people the opportunity to express an interest in being involved in this work.

6.2 Performance and Evaluation Framework

Throughout the Strategy we have emphasised our commissioning aim of delivering good outcomes for older people and their carers, by working together to provide services that maximise independence and improve wellbeing, while enabling people to take increased responsibility for their own health. To realise this objective we intend to develop a performance management framework that will monitor progress towards the objectives set for each commissioning priority, allow identification of areas of concern and inform investment and disinvestment decisions.

Joint Commissioning Strategy 2013 - 2023 Page 42

”Ageing wi’ Opportunity” right support right place right time year change fund investment plan by September 2013. Further work will be done to develop our commissioning intentions for years four to ten.

Aberdeen City Council, NHS Grampian, ACVO and Scottish Care are committed to working in partnership with older people, and their carers to deliver this Joint Commissioning Strategy. In 2013 we will establish the Partnership arrangements to support Joint Commissioning.

Joint Commissioning Strategy 2013 - 2023 Page 44 ”Ageing wi’ Opportunity” right support right placeright time

Section 7 - References and Bibliography

1. Aberdeen City and Aberdeenshire Strategic Forecasts for 2006-2031 http://www.aberdeencity.gov.uk/nmsruntime/saveasdialog.asp?lID=12340&sID=332 (accessed October 2012)

2. Aberdeen City Council’s Stats and Facts, http://www.aberdeencity.gov.uk/tourism visitor attractions/tourists visitors/statisti cs/stt home.asp (accessed October 2012)

3. Scottish Government 2012, Scottish Index of Multiple Deprivation (SIMD) http://www.scotland.gov.uk/Topics/Statistics/SIMD/ (accessed October 2012)

4. Scottish Government 2011, National Records of Scotland Population Projections http://www.gro-scotland.gov.uk/files2/stats/council-area-data-sheets/aberdeencity-factsheet.pdf (accessed October 2012)

5. NHS Grampian 2011, Director of Public Health NHS Grampian Report 2011www.nhsgrampian.org/grampianfoi/files/DPH annual report 2011 final.pdf (accessed December 2012)

6. Information Services Division (ISD) 2012, Care Home Census 2012. http://www.isdscotland.org/Health-Topics/Health-and-Social-Community- Care/Publications/2012-10-30/2012-10-30-CHCensus-Report.pdf?73028200865 (accessed January 2013)

7. Information Services Division (ISD) 2012, Delayed Discharges http://www.isdscotland.org/delayed discharges/ (accessed December 2012)

8. National Performance Framework, Scotland Performs, 2008, HEAT Targets http://www.scotland.gov.uk/About/Performance/scotPerforms (accessed December 2012)

9. Scottish Government 2011, Reshaping Care for Older People: a Programme for Change 2011 – 2021 http://www.jitscotland.org.uk/action-areas/reshaping-care- for-older-people/ (accessed June 2012)

10. Scottish Government 2009. Long Term Conditions Collaborative, Improving Complex Care, http://www.scotland.gov.uk/Resource/Doc/263175/0078713.pdf (accessed November 2012) (accessed July 2012)

Joint Commissioning Strategy 2013 - 2023 Page 45 ”Ageing wi’ Opportunity” right support right place right time

11. Scottish Executive (2005) National Framework for Service Change in the NHS in Scotland – Care of Older People. Edinburgh: Scottish Executive . http://www.sehd.scot.nhs.uk/nationalframework/Documents/DRIVERSFORCHAN GE.pdf

12. Alzheimer Scotland 2012, Delivering Integrated Dementia Care: The 8 Pillars Model of Community Support http://www.alzscot.org/pages/policy/delivering- integrated-dementia-care.htm (accessed January 2013)

13. Scottish Government 2009, Towards a Mentally Flourishing Scotland: Policy and Action Plan 2009 – 2011 http://www.scotland.gov.uk/Publications/2009/05/06154655/0 (accessed October 2012)

14. NHS Choices, 2013, Clinical Depression, Causes http://www.nhs.uk/Conditions/Depression/Pages/Causes.aspx (accessed January 2013)

15. Karen Windle, Jennifer Francis and Caroline Coomber, SCiE 2011 Preventing loneliness and social isolation: interventions and outcomes http://www.scie.org.uk/publications/briefings/files/briefing39.pdf (accessed January 2013)

16. Alcohol Focus Scotland 2013 http://www.alcohol-focus-scotland.org.uk/ (accessed December 2012)

17. NHS National End of Life Programme (2012) Improving end of life care http://www.endoflifecare.nhs.uk/ (accessed December 2012) (accessed October 2012)

18. Carer Information Scotland 2012 Can I get Carer Support http://www.careinfoscotland.co.uk/can-i-get-help-with-caring.aspx (accessed October 2012

19. Scottish Government 2010 Caring Together: The Carers Strategy for Scotland 2010 – 2015 http://www.scotland.gov.uk/Publications/2010/07/23153304/0 accessed October 2012 (accessed October 2012

20. Dunning A 2006 Information, advice and advocacy for older people: Defining and developing services The Joseph Rowntree Foundation http://www.jrf.org.uk/system/files/185935372x.pdf (accessed October 2012

21. Beech R and D Roberts 2008 Assistive technology and older people Research Briefing 28 http://www.scie.org.uk/publications/briefings/files/briefing28.pdf (accessed December 2012)

Joint Commissioning Strategy 2013 - 2023 Page 46

”Ageing wi’ Opportunity” right support right place right time

This document is also available in large print, other formats and other languages, on request.

Please contact Aberdeen City Council on 01224 522132 or NHS Grampian's Corporate Communications Department on 01224 551116 for a copy

Joint Commissioning Strategy 2013 - 2023 Page 58