Argyll and Bute HSCP
What does the future look like for Argyll & Bute’s health and social care services?
Stephen Whiston Head of Strategic Planning and Performance
working together with you Our Vision
People in Argyll and Bute will live longer, healthier, happier, independent lives
working together with you
A&B HSCP Strategic Plan Drivers for Change
People/Users – tell us Quality Epidemiological Workforce Want to stay at home in We relentlessly pursue the community. Want to More people living with one Some key professions will or more long term condition imminently have significant highest quality of care – choose and have more eliminate harm, waste and from middle age or younger gaps in workforce information variation
Demographics Ageing and falling population Reasons why we have to Clinical increasing complex health change NHS and Social Increasing numbers of and social care needs Care Services in new treatments and Argyll and Bute drugs Financial Short to medium term funding of public service will be extremely challenging
Culture working as a single Technological Major Shifts in Legislative health and care service, Opportunities re information Health & Care policy e.g. Children’s Act, focus on person centred recording – shared IT systems, e.g. personalisation, early Community Empowerment, care, meeting need, Telecare and Telehealth intervention, prevention, Self Directed Support Public expectations co-production Future Shape of Services
• A single Health and Social Care team will provide more services in your Community 24/7 (Adults and Children's)
• You will only need to contact one person for all Health and Social care in your community.
• We will prioritise investment for Health Improvement and healthy lifestyle programmes, to keep you healthy.
• We will become used to using technology to support care at home, by allowing remote monitoring of your condition remote consultations with trained staff
• Your local hospital will continue to co-ordinate and deliver emergency medical care, with fast access to Glasgow hospitals when necessary.
Future Shape of Services
• GP and other 'front-line' services will continued to be provided locally. However we expect that, through mergers and federations, there will be fewer GP practices. This will provide a greater choice to patients – e.g. a male or female doctors and offer you a range of GPs and nurses with special interests and training.
• Most hospital treatments will not require a stay in hospital, with hospital beds being used only for those needing more continuous nursing. – Less hospital beds
• With more care delivered in the home, and with more support for carers (especially family and friends), nursing- and care-home beds will be used for those who need a higher level of care.
The fundamental transformational change required is shifting of our services and resources (workforce and money) to ones which prioritise:
• anticipatory care • preventative measures • maintenance of health and wellbeing.
This means spending less money on acute care, disinvesting and transferring this money to prevention and anticipatory care services in the community
A&B HSCP Financial Plan
The table below provides the detail of the partnership budget position and the resulting gap across the three year period of the Strategic Plan.
2016-17 2017-18 2018-19 £m £m £m Baseline Budget 249.162 264.499 272.393 Pay Increase Cost 2.447 1.793 1.808 Non Pay Inflation & Cost/Demand 12.890 6.101 5.153 Pressures Total Forecast Expenditure 264.499 272.393 279.354 Total Estimated Funding (256.001) (257.294) (258.638) Budget Gap (Cumulative) 8.498 15.098 20.716 Budget Gap (In-Year) 8.498 6.601 5.617 Strategic Plan 2016-2019 Consultation feedback
❶ Keep Services Local ❷ Better Patient Transport ❸ More Public & Patient Participation ❹ Increased Focus on Mental Health Services ❺ Communication between NHS and Social Work ❻ More Health Promotion Information & Services ❼ A Higher Quality, Better Paid Care Worker
Argyll and Bute HSCP
What does this mean for Island Health and Care Services?
Will doing the same work in the future? working together with you
Island GP practice population by Age
GP Practice by Age band April 2016
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Bute Islay Jura Colonsay Mull & Iona Tiree Easdale GP
00-15 16-24 25-34 35-44 45-64 65+
Age Group Bute Islay Jura Colonsay Mull & Iona Tiree Easdale GP 00-15 809 507 29 9 490 125 101 16-24 588 285 23 10 216 57 76 25-34 613 339 19 6 300 69 56 35-44 569 346 27 11 373 77 76 45-64 1952 982 72 42 1024 224 376 65+ 1806 817 44 46 760 157 323 Total 6337 3276 214 124 3163 709 1008 Source: NHS Information Services Division Change in Island GP population 30%
25%
20%
Jura 15% Coll
10% Mull and Iona Colonsay 5% Tiree Easdale GP 0%
(% of population in 2006) in population of (% Islay 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Bute
-5% Difference between population in 2006 2006 in population between Difference
-10%
-15% Year
Source: NHS Information Services Division Census data – general health Island Communities General Health of Population
100%
80% Very bad health Bad health 60% Fair health Good health 40% Very good health
20%
Percentage of Population of Percentage 0%
Island Island All people Very good health Good health Fair health Bad health Very bad health Bute 6,498 2,860 2094 1085 356 103 Islay 3,228 1597 1035 449 116 31 Jura 196 115 51 21 8 1 Gigha 163 85 39 27 9 3 Colonsay 132 64 45 19 3 1 Mull 2819 1485 905 323 89 17 Iona 177 107 57 10 3 0 Coll 195 110 54 24 7 0 Tiree 653 341 200 89 17 6 Easdale 59 37 21 1 0 0 Luing 198 91 63 35 7 2 Lismore 192 94 58 34 5 1 Seil 551 301 164 56 26 4 Source: Scottish Census 2011 Crown copyright Islanders with a Long term health problem or disability
Long-term health problem or disability
100%
90%
80% Day-to-day activities
limited a lot 70%
60% Day-to-day activities limited a little
50% Day-to-day activities 40% not limited
30% Percentage of Populationof Percentage
20% Source: 10% Scottish
0% Census 2011 Crown copyright Island Number and % of people with common diseases at each GP practice
Disease Profile
25%
20% Hypertension
15% CHD Diabetes 10%
5%
Percentage of Population Population of Percentage 0% Bute Islay Jura Colonsay Easdale GP Mull & Iona Coll Tiree IslandCoronary Heart Island Hypertension Disease (CHD) Diabetes Bute 1396 425 430 Islay 665 149 203 Jura 32 6 8 Colonsay 20 14 6 Easdale 178 52 47 Mull & Iona 508 139 141 Coll 30 8 11 Tiree 144 30 44 Source: NHS Information Services Division It costs more per • How do we make best use of scarce and skilled workforce? head to provide services in remote • How do we reconcile the and rural areas, is opportunity cost of low volume this sustainable? services?
• How do we release funding to invest in care at home?
• How do we manage expectations?
• How do we ensure best value for money?
• How do we really achieve mutuality in decision making? Workforce Workforce Recruit & retain -local higher retention, career Shared working – what is pathway, roles in that ? – TEAM sustained community, local training to 7 days a week by ensuring support skills retention and basic level of intervention development and reduce duplication of visits,
Workforce Workforce
Common Skill sets Community team skills developed and agreed - patient/carer review and across health and care anticipatory support for our complex cases - hands-on care Visit to review reablement Workforce potential, tissue viability, manual handling Workforce Single point of contact equipment and practises, rd with person - carer and 3 sector input Underutilised workforce - e.g. 'ready One practitioner visit to etc & waiting' for work like radiology, GPs triage/do a basic general and nurses on islands- locality role in assessment, provide basic Anticipatory care, prevention etc equipment, walking aids and care planning Person Centred Care – it’s a TEAM approach
Can we expect people to work in isolation any longer?
What attracts and keeps people working in health and care in Argyll and Bute?
What are they and how do we respond to emergencies? Isles of Eigg Muck & Rhum
Rural Support Team • No resident GP or Nurse on Small Isles or Acharacle • Multi professional Team • GP input from Skye 2 days a week • Community Resilience – First responder – Fire, Coastguard, community – Community Health and care worker (Nuka Model)- 4 posts – Tele health, diagnostic support Use and build on all of our Workforce
How do we ensure we have a sustainable Health and Care service for our island communities?
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Further Information
If you would like to be kept up to date on the changes or would like further information please contact:
Stephen Whiston – Head of Strategic Planning and Performance [email protected]
working together with you