A meeting of the Clackmannanshire and Stirling Integration Joint Board will be held on Wednesday 24 February 2016 at 2.00-4.00, in Castle Suite, Forthbank Stadium, Stirling, FK7 7UJ
Please notify apologies for absence to [email protected]
AGENDA
1. NOTIFICATION OF APOLOGIES For Noting
2. NOTIFICATION OF SUBSTITUTES For Noting
3. DECLARATION(S) OF INTEREST For Noting
4. URGENT BUSINESS BROUGHT FORWARD BY CHAIRPERSON
5. MINUTE OF THE CLACKMANNANSHIRE & STIRLING INTEGRATION JOINT BOARD MEETING HELD ON 26 JANUARY 2016 For Approval
6. MATTERS ARISING
7. CHAIR AND VICE CHAIR INTEGRATION JOINT BOARD For Discussion
8. STRATEGIC PLAN For Approval (Paper presented by Shiona Strachan)
9. STRATEGIC NEEDS ASSESSMENT For Approval (Paper presented by Shiona Strachan) (Presentation by Chris Sutton and Dr Oliver Harding)
10. INTEGRATION JOINT BOARD DEVELOPMENT SESSION OUTPUT For Noting (Paper presented by Morag McLaren)
11. DELAYED DISCHARGE PROGRESS REPORT For Noting (Paper presented by Kathy O’Neill and Val de Souza)
12. PARTICIPATION AND ENGAGEMENT STRATEGY For Approval (Paper presented by Chris Sutton)
13. PARTNERSHIP FUNDING For Noting and Approval (Paper presented by Ewan Murray)
14. INTERNAL AUDIT For Approval (Paper presented by Ewan Murray)
15. EXTERNAL AUDIT For Approval (Paper presented by Ewan Murray)
16. PROGRAMME WORKSTREAMS UPDATE For Noting (Paper presented by Lesley Fulford)
17. ANY OTHER COMPETENT BUSINESS
18. DATE OF NEXT MEETING
Tuesday 22 March 2016, 2.00-4.00, Boardroom, Alloa College
Clackmannanshire & Stirling Integration Joint Board
24 February 2016
This report relates to Item 5 on the agenda
Minute of Clackmannanshire & Stirling Integration Joint Board meeting held on 26 January 2016
For Approval
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Minute of the Clackmannanshire & Stirling Integration Joint Board meeting held on Tuesday 26 January 2016, at 3.00pm, in Boardroom, Forth Valley College, Alloa Campus.
Present: Alex Linkston, Chairman (Chair) Councillor Les Sharp, Council Leader (Vice Chair) Councillor Donald Balsillie Councillor Johanna Boyd, Council Leader Stewart Carruth, Chief Executive Joanne Chisholm, Non-Executive Board Member Val de Souza, Chief Social Work Officer Councillor Scott Farmer John Ford, Non-Executive Board Member Graham Foster, Executive Board Member Fiona Gavine, Non-Executive Board Member Tracey Gillies, Medical Director Jane Grant, Chief Executive Tom Hart, Staff Representative Shubhanna Hussain-Ahmed, Unpaid Carers Representative Morag Mason, Service User Representative for Stirling Natalie Masterton, Third Sector Representative Teresa McNally, Service User Representative for Clackmannanshire Elizabeth Ramsay, Unpaid Carers Representative Abigail Robertson, Staff Representative Pamela Robertson, Staff Representative Councillor Graham Watt
In Attendance:
Phillip Gillespie, Assistant Head of Social Services Helen Kelly, Director of Human Resources Stephanie McNairney, Project Administrator, NHS Forth Valley (Minute) Elaine McPherson, Chief Executive Ewan Murray, Chief Finance Officer Kathy O’Neill, General Manager, CHP’s Shiona Strachan, Chief Officer Susan White, Housing Development and Regeneration Team Leader Gregor Wightman, Private Sector Housing Manager
1. APOLOGIES FOR ABSENCE
Apologies for absence were intimated on behalf of:
Councillor Kathleen Martin Wendy Sharp, Third Sector Representative Councillor Christine Simpson Elaine Vanhegan, Head of Performance Management, NHS Forth Valley Angela Wallace, Nurse Director
2. NOTIFICATION OF SUBSTITUTES
• Councillor Graham Watt substituted for Councillor Kathleen Martin Page 2 of 6
3. DECLARATION(S) OF INTEREST
There were no declarations of interest.
4. URGENT BUSINESS BROUGHT FORWARD BY CHAIRPERSON
There was no urgent business brought forward.
5. MINUTE OF MEETING HELD ON 17 SEPTEMBER 2015
The minute of the meeting held on 11 December 2016 was approved as an accurate record, subject to the following clarification:
• Jane Grant should be recorded as present rather than in attendance
6. MATTERS ARISING
Shiona Strachan had sought clarity from Alison Taylor at Scottish Government, who confirmed that accountability of IJB decisions lies with voting members.
It was also noted that IJB meetings were now held in public and the papers and minutes are now uploaded onto the internet site.
http://nhsforthvalley.com/about-us/health-and-social-care- integration/clackmannanshire-and-stirling/integration-joint-board-meetings-and-papers
7. CHANGE IN MEMBERSHIP
Jane Grant confirmed that following the recent appointment of a new non executive and the re-evaluation of commitments, Joanne Chisholm would become a member of the Clackmannanshire & Stirling IJB, and that James King would stand down as a member.
The Integration Joint Board noted the change in membership and welcomed Joanne to the Board
8. DOUNE HEALTH CENTRE
Morag Farquhar provided some background to the proposed new build health centre at Doune as part of a wider programme of primary care developments. The project was also in line with Strategic Plan priorities.
The provision of health centre facilities had been a capital investment priority for some time, and a new build was identified as the preferred way forward.
A summary of the procurement and approval processes was provided which included submission to the Scottish Government’s Capital Investment Group if approved by the Integration Joint Board. If approved to proceed, the Full Business Case would be brought back to a future meeting of the Integration Joint Board.
The Integration Joint Board noted the position and next steps. Page 3 of 6
9. DELAYED DISCHARGE PROGRESS REPORT
Phillip Gillespie provided an update on the status of Delayed Discharges.
A summary of people delayed at the census point in December 2015 was provided as well as an overview of the management actions being taken. An improvement on the previous period was noted. Both Clackmannanshire and Stirling were performing well when benchmarked against the rest of Scotland and the work of the services to sustain this performance was acknowledged by the Board.
There was a query around whether patients from Fife, if delayed, impacted on Forth Valley performance. Phillip advised that these delays to discharge would be recorded against the Fife partnership’s figures .
The Integration Joint Board noted performance and acknowledged the management actions undertaken.
10. PARTNERSHIP FUNDING
Ewan Murray provided a verbal update to the Board in relation to partnership funding. An evaluation of the use of Delayed Discharge and Integrated Care Funds was being undertaken, overseen by the Reshaping Care Strategy Group and Joint Management Team. Funding of services should be in line with the Strategic Plan priorities. Details would be brought back to the Integration Joint Board alongside the Strategic Plan.
The Integration Joint Board noted the evaluation of Partnership funding and agreed that a further report should be provided to the Board..
11. WORKSTREAM OUTPUTS
11.1 INTEGRATED WORKFORCE PLAN
Helen Kelly provided a summary of the workforce plan which had been developed to support the Strategic Plan. It had been developed through an inclusive approach with valuable contributions from the Joint Staff Forum.
The workforce was noted as the single most important resource, and the importance of creating a workforce fit for the future was key to deliver change. It was an ambition of the Integration Joint Board to ensure high standards of care and that staff are engaged and rewarded in their work.
Natalie Masterton asked about the application of the workforce plan to the third and independent sector staff groups.
Helen Kelly confirmed that the Plan applied to all sectors in terms of the approach and principles and that it contained the proposals for further work over the life of the Plan to develop the wider workforce
The Integration Joint Board approved the Integrated Workforce Plan
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11.2 JOINT STAFF FORUM UPDATE
A Joint Staff Forum had been established and meets bi monthly. Its constitution has now been agreed by all members.
The Integration Joint Board noted the establishment of the Joint Staff Forum.
12. CHIEF SOCIAL WORK OFFICER’S REPORT
Val de Souza advised of the statutory requirement for local authorities to appoint a Chief Social Work Officer to provide professional guidance and leadership for social work/care services. The Chief Social Work Officer also provides an annual report to the the local authority and this was now being presented to the Integration Joint Board as part of what will form part of the annual clinical and care governance report.
The Integration Joint Board noted the report.
13. DRAFT HOUSING CONTRIBUTION STATEMENTS
Susan White introduced the draft Housing Contribution Statements, which have been developed as part of the Strategic Plan and will link to the local housing strategies.
Councillor Boyd asked if the Stirling Multicultural Partnership was still active . Susan confirmed that she was not aware of the contact with the group.
There was no Equality Impact Assessment in the draft Housing Contribution Statement, however such assessments were routinely undertaken and would be included within the final version of the Strategic Plan, of which the Housing Contribution Statement was a part.
Natalie Masterton suggested that a statement be included around safe, affordable housing and the impact on health and wellbeing, as well as the impact of fuel poverty, particularly in rural areas.
It was noted that the multi agency Strategic Planning Group had developed the draft Strategic Plan and that the Housing Contribution Group had fed in their work to the Strategic Planning Group.
The Integration Joint Board approved the draft Housing Contribution Statement for public consultation.
14. AIDS AND ADAPTATION SERVICE SCOPING
Susan White provided an overview of the paper which included the housing functions which must be delegated to the Integration Joint Board by 1 April 2016. Work was underway to identify the budgets attached to these functions.
A Service Level Agreement was to be developed in line with Strategic Plan priorities and performance indicators to be put in place.
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The possibility of unpaid carers involvement in the review of Registed Social Landlords [RSLs] was raised. The Chair and Vice Chair agreed to raise this at their Integration Joint Board Chairs Meeting during the coming week.
The Integration Joint Board agreed the report and the development of the SLA
15. AUDIT SCOTLAND REPORT
Shiona Strachan advised that the report presented had been published in December 2015 and was the first of three planned Audit Scotland reports on integration and social work services. The Audit Scotland report highlights some generic risks for all partnerships and the recommendations from the report along with a statement of the mitigating actions being taken by the services was presented to the Board for consideration.
Alex Linkston confirmed the importance of the Audit Scotland report and sought confirmation from members that they were satisfied with the local actions.
The Integration Joint Board noted the content and recommendations arising from the Audit Scotland report and the partnership activity as detailed within the appendix of the report submitted by the Chief Officer.
16. ANY OTHER COMPETENT BUSINESS
There was a request not to use acronyms within reports, and also to use common language across agencies.
17. DATE OF NEXT MEETING
Wednesday 24 February 2016, 2.00-4.00, Forthbank Stadium, Stirling
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Clackmannanshire & Stirling Integration Joint Board
24 February 2016
This report relates to Item 7 on the agenda
Chair and Vice Chair of Integration Joint Board
Paper presented by Shiona Strachan
For Discussion
Approved for Submission by Shiona Strachan, Chief Officer Author Lesley Fulford, Programme Manager Date: 8 February 2016 List of Background Papers: • Public Bodies (Joint Working) (Integration Joint Boards)(Scotland) Order 2014 • Clackmannanshire & Stirling Integration Scheme • Clackmannanshire & Stirling Integration Joint Board Standing Orders
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Title/Subject: Chair of Integration Joint Board Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 24 February 2016 Submitted By: Lesley Fulford, Programme Manager Action: For Discussion
1. Executive Summary
1.1 The Integration Joint Board requires to identify and appoint a new Chair and Vice Chair by 1 April 2016.
1.2 The Public Bodies (Joint Working)(Scotland) Act 2014, the Integration Joint Board Order, Integration Scheme and the Boards Standing Orders all refer to this change.
2. Recommendations
The Integration Joint Board is asked to discuss and agree:
2.1. Clackmannanshire Council and Stirling Council agree which Council will nominate a Chair of the Integration Joint Board (for a period of 2 years) and advise the Integration Joint Board who the nominee is before 1 April 2016.
2.2. NHS Forth Valley nominate a vice Chair from their current non executive director voting members of the Integration Joint Board (for a period of 2 years) and advise the Integration Joint Board who the nominee is before 1 April 2016.
3. Background
3.1. The Clackmannanshire & Stirling Integration Scheme states: • The Chairperson and Vice Chairperson can only be appointed from the voting membership of the Integrated Joint Board. • NHS FV may only nominate as Chairperson or Vice Chairperson a voting member of the Integrated Joint Board who is a Non-Executive Director • The initial Appointing Period for the Chairperson and the Vice Chairperson shall be up until 31 March 2016. Thereafter the Appointing Period shall be 2 years. • NHS FV shall appoint the Chairperson for the initial Appointing Period. • The Parties have agreed that the Chairperson from 1 April 2016 shall be nominated by one of the Local Authorities.
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• The Parties have agreed that the Vice Chairperson from 1 April 2016 shall be nominated by NHS FV. • If NHS FV nominate the Chairperson, the Vice Chairperson must be nominated by one of the constituent Local Authorities and vice versa in accordance with Article 6 of the Integrated Joint Board Order. • The appointment of the Chairperson and consequently the Vice Chairperson must alternate between NHS FV and a constituent local authority. • Nominations for Chairperson and Vice Chairperson can only come from the voting membership of the Integration Joint Board and subject to the further proviso that NHS FV may only nominate a voting member who is a Non-Executive Director. • A Party may change the person appointed by that Party as Chairperson or Vice Chairperson during the Appointing Period.
3.2. The Clackmannanshire & Stirling Integration Joint Board Standing Orders:
• The Chairperson appointed to serve from 1 April 2016 for a period of two years shall be nominated by one of the Local Authorities and the Vice Chairperson shall be appointed by NHS FV to serve for the same period. • The appointment of subsequent Chairpersons and Vice Chairpersons must alternate between NHS FV and one or other of the Local Authorities in accordance with Article 6 of the Integrated Joint Board Order. In each second alternating appointing period the appointment of a Chairperson shall alternate between Stirling Council and Clackmannanshire Council. All appointments under this Standing Order 7.3 will be for a period of two years.
4. Conclusions
4.1. Clackmannanshire Council and Stirling Council agree which council will nominate a Chair of the Integration Joint Board and advise the Integration Joint Board who the nominee is before 1 April 2016.
4.2. NHS Forth Valley nominate a vice Chair from their current non executive director voting members of the Integration Joint Board and advise the Integration Joint Board who the nominee is before 1 April 2016.
5. Resource Implications
5.1. The nominated Chair and Vice Chair would be invited to attend pre agenda meetings in advance of the Integration Joint Board meetings to review agenda and papers from 1 April 2016.
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6. Impact on Integration Joint Board Outcomes, Priorities and Outcomes
6.1. Nomination will ensure the Board comply with commitments set out in:
• Public Bodies (Joint Working) (Integration Joint Boards)(Scotland) Order 2014 • Clackmannanshire & Stirling Integration Scheme • Clackmannanshire & Stirling Integration Joint Board Standing Orders
7. Legal & Risk Implications
7.1. The nominations will ensure the Integration Joint Board meet their obligations as set out in the Integration Scheme.
8. Consultation
8.1. The governance leads in each partner organisation have been consulted in the drafting of this paper.
9. Equality and Human Rights Impact Assessment
9.1. This paper does not require an impact assessment
10. Exempt reports
10.1. No
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Clackmannanshire & Stirling Integration Joint Board
24 February 2016
This report relates to Item 8 on the agenda
Strategic Plan
(Paper presented by Shiona Strachan)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Lesley Fulford, Programme Manager Chris Sutton, Service Manager Strategy Robert Stevenson, Senior Planning Manager Date: 24 February 2016 List of Background Papers: 2015.10.27 Clackmannanshire & Stirling IJB - Strategic Plan & Strategic Needs Assessment Update Appendix 1 – Draft Strategic Plan Appendix 2 – Draft Easy Read Strategic Plan Appendix 2 – Consultation & Engagement Report Appendix 3 – Staff Engagement Report Appendix 4 - EQIA
Title/Subject: Strategic Plan Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 24 February 2016 Submitted By: Lesley Fulford, Programme Manager
Action: For Approval
1. Executive Summary
1.1. As set out by the Public Bodies (Joint Working) (Scotland) Act 2014 the Partnership must prepare and publish a Strategic Plan prior to 1 April 2016.
1.2. This paper provides the revised draft Strategic Plan to the Integration Joint Board for approval to publish pending final financial resource information.
1.3. In addition this paper provides information on engagement and consultation work undertaken to revise and develop the draft Strategic Plan.
2. Recommendations
The Integration Joint Board is asked to:
2.1. Approve the draft Strategic Plan (appendix 1) which has been revised following a period of public consultation.
2.2. Approve the revised draft easy read Strategic Plan (appendix 2) which has been revised following a period of public consultation.
2.3. Approve the consultation & engagement report for (appendix 3) publication.
2.4. Approve the staff engagement report (appendix 4) for publication.
2.5. To note the ongoing work in relation to the quantum of resources to be transferred to the IJB.
3. Strategic Planning Group
3.1. The membership of the Strategic Planning Group is prescribed in the Public Bodies (Joint Working) (Membership of Strategic Planning Group) (Scotland) Regulations 2014, which came into force on 12 December 2014.
3.2. These stakeholders must be fully engaged in the preparation, publication and review of the Strategic Plan, in order to establish a meaningful co-production approach. They are as follows: • health and social care professionals • users of health and social care • carers of users of health and social care
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• commercial & non-commercial providers of health care • commercial & non-commercial providers of social care • non-commercial providers of social housing • third sector bodies carrying out activities related to health care or social care.
3.3. The Strategic Planning Group has been established and is meeting monthly. At the meeting on the 24 January 2016 feedback was sought on the revised draft Strategic Plan and this has been incorporated within the version presented with this paper.
4. Strategic Plan Working Group
4.1. A small working group was been established to draft the Strategic Plan based on input and direction from the Strategic Planning Group.
5. Strategic Plan
5.1. As set out by the Public Bodies (Joint Working) (Scotland) Act 2014 the Partnership must prepare a Strategic Plan that: • Sets out the arrangements for carrying out the integration functions over the period of the plan • Sets out how those arrangements are intended to achieve, or contribute to achieving, the national health and wellbeing outcomes and the Partnerships local vision and outcomes • Sets out the separate arrangements for carrying out the integration functions in relation to each locality area • Has due regard to the effect which any arrangements may have on services, facilities and resources. • Has regard of the integration delivery principles • Has regard of the national health and wellbeing outcomes & local outcomes • Includes other material as considered fit
5.2. The Strategic Plan was developed based on discussion and engagement at a series of events held throughout the year.
• A range of fora were attended during January 2015 during consultation on the integration scheme • Staff engagement events held in May and June 2015 • Public Engagement Event May 2015 • Public Engagement Events September & October 2015
5.3. Integration Joint Board Members are asked to approve the draft Strategic Plan in appendix 1 for publication.
6. Strategic Needs Assessment
6.1. The Strategic Needs Assessment is covered in a separate paper.
6.2. Housing Contribution Statements are covered in a separate paper.
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7. Consultation & Engagement
7.1. The consultation and engagement report attached in appendix 3 provides the detail of engagement work to develop the draft Strategic Plan and consultation undertaken.
8. Financial Plan
8.1. The UK Spending Review published in November 2015 and the subsequent Scottish Draft Budget set out the short to medium outlook for public finances of year on year real term reductions in overall public expenditure until 2020. This financial settlement is set against the demographic pressures outlined within the Strategic Needs Assessment and the need to redesign services to meet our vision and outcomes. The Integration Joint Board will require to ensure that all of the redesigned and commissioned services are aligned to the eight priorities within the Strategic Plan through a process of both review and alignment of the existing redesigns already underway within the partner agencies during 2016/17.
9. Conclusions
9.1. The Partnership have a statutory requirement within the Public Bodies (Joint Working) (Scotland) Act 2014 to publish a Strategic Plan no later than 1 April 2016. This report provides an update on progress and presents a final draft Strategic Plan for the Integration Joint Boards approval to publish pending final financial resource information.
10. Resource Implications
10.1. Chief Finance Officers across all three partners are refining budget papers and will be presenting budget information to the 22 March 2016 Integration Joint Board.
11. Impact on IJB Outcomes, Priorities and Outcomes
11.1. The final draft Strategic Plan incorporating the financial statement and the Housing Contribution Statement will be presented to the Integration Joint Board in March 2016. Failure to agree the Strategic Plan would mean that the budget and associated functions would not be delegated prior to the statutory required date of 1 April 2016.
12. Legal & Risk Implications
12.1. If the Integration Joint Board do not approve the draft Strategic Plan at the 24 February meeting there will be one further opportunity to do so at the 22 March meeting prior to the legislative deadline.
13. Equalities and Human Rights Assessment
13.1. The strategic Plan is subject to an Equalities Impact and Human Rights Assessment and equalities data is part of the Strategic Needs Assessment to inform the Page 4 of 6
Strategic Plan. The equalities impact assessment is being finalised and will be brought forward to the March Integration Joint Board meeting.
14. Exempt reports
14.1. No
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Appendix 1 – Draft Strategic Plan
See separate file
Appendix 2 – Draft Easy Read Strategic Plan
See separate file
Appendix 3 – Draft Consultation & Engagement Report
See separate file
Appendix 4 – Draft Staff Engagement Report
See separate file
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Strategic Plan
DRAFTDRAFTClackmannanshire and Stirling Draft Final Strategic Plan
2016 - 2019 Health and Social Care Partnership
Clackmannanshire and Stirling Strategic Plan
DRAFT
Clackmannanshire and Stirling Strategic Plan
Contents
Foreword ...... 2 Background to Health & Social Care Integration ...... 3 ...... Clackmannanshire & Stirling Health and Social Care Partnership ...... 3 Integration Joint Board ...... 3 Chief Officer ...... 3 ...... The Strategic Plan ...... 3 ...... Localities ...... 3 Community Planning Partnerships ...... 3 The Case for Change ...... 4 ...... Why do we need to change? ...... 4 Profile of Clackmannanshire Council & Stirling Council Areas ...... 4 Our Vision and Outcomes ...... 9 Our Local Vision and Outcomes ...... 9 Outcomes ...... 9 How we will achieve Improved Outcomes ...... 10 What does all of this mean for you? ...... 11 Services workingDRAFT in partnership ...... 11 Key Themes and Ambitions ...... 12 Our Priorities ...... 15 Case Studies ...... 16 Localities ...... 18 .. .. . Geographical Profile of Forth Valley ...... 19 Which Health and Social Care Services are included within Integration? ...... 20 ...... NHS Forth Valley Services ...... 20 ...... Clackmannanshire Council & Stirling Council Services ...... 20 Housing Contribution Statement ...... 21 Snapshots of Local Services ...... 21 The Financial Plan ...... 22 ...... Development of this Strategic Plan and Next Steps ...... 23 ...... Glossary ...... 24
1 Clackmannanshire and Stirling Strategic Plan
Foreword
Our vision is to enable people in the We know that the proportion of admissions to hospital. Getting Clackmannanshire and Stirling Health & Social older adults in our population is involved at an early stage can lead to Care Partnership area to live full and positive increasing and that more people have better long term outcomes. People lives within supportive communities. complex needs. We also know that living with a number of long-term Clackmannanshire Council, Stirling Council and there are significant differences and and complex health conditions have a NHS Forth Valley have put in place new partnership inequalities – between and within better quality of life when they are able arrangements to deliver adult health and social care our communities. We are committed to manage and be more in control of services. This is to improve the health and wellbeing to working with all our partners to their health and care. prevent and reduce inequalities, of our residents. We want to ensure that people We have developed this three-year promote equality of access and tackle have healthier, fuller lives and live as independently plan which sets out how we will deliver patterns of ill health in communities. and safely as possible in their own communities. services to meet current need but also the needs We will also make best use of all of the resources We want to ensure that we engage with individuals of the population in the future. Fundamental to available to address the agreed priorities for the and their unpaid carers at an early stage in their care this will be making best use of resources to deliver partnership. journey and avoid, wherever possible, unplanned efficient and effective health and social care. This plan has been developed with help and comment from many individuals and groups. We would like to take this opportunity to thank DRAFTeveryone who has given their time to attend events, respond to the consultation questions, and contributed to sections of the plan. All of your involvement is appreciated and over the coming years we look forward to engaging with everyone that has an interest in health and social care to help deliver on our plan.
Shiona Strachan Chief Officer, Clackmannanshire & Stirling, Health and Social Care Partnership
Clackmannanshire and Stirling 2 Clackmannanshire and Stirling Strategic Plan
Background to Health & Social Care Integration
Clackmannanshire & Stirling Health and The Strategic Plan Social Care Partnership This document, the Strategic Plan, describes The Public Bodies (Joint Working) (Scotland) Act how the Clackmannanshire and Stirling Health 2014 requires Health Boards and Local Authorities and Social Care Partnership will make changes to integrate the planning for, and delivery of, adult and improvements to develop health and social health and social care services. Clackmannanshire services for adults over the next three years. This Council, Stirling Council and NHS Forth Valley have is a high level plan underpinned by a number of established a Health and Social Care Partnership national and local policies, strategies and action across the Clackmannanshire and Stirling Council plans which will be profiled and updated on the areas. The partnership approach will also be Clackmannanshire & Stirling Integration web-page. extended to third and independent sector It will provide the strategic direction for how health colleagues. and social care services will be shaped in this area in Localities Integration Joint Board the coming years and describes the transformation that will be required to achieve this vision. The plan The Clackmannanshire & Stirling Partnership area The Integration Joint Board has representatives from explains what our priorities are, why and how we will be divided into three smaller areas called Clackmannanshire and Stirling Councils, NHS Forth decided upon them and how we intend to make a localities. The development of localities will support Valley Health Board, the Third Sector, representatives difference by working closely with partners in the the principle of collaborative working across primary of those who use health and social care services, and DRAFTClackmannanshire and Stirling area. and secondary health care, social care and third and unpaid carers. The Board, through the Chief Officer, The Strategic Plan for Clackmannanshire and Stirling independent sector provision. Further service and has responsibility for the planning, resourcing and will take account of the Strategic Plan for the condition related planning will be undertaken over operational oversight of integrated services within Falkirk partnership area, particularly where it relates the coming period including the development of the Strategic Plan. to some of the specialist and hospital services locality and neighbourhood plans to tailor services Chief Officer which are planned and delivered across the Forth to local circumstances. The Chief Officer is responsible for management Valley area. The Plan will also take account of the Community Planning Partnerships of the integrated budget and ensuring integrated Strategic Plans for other neighbouring partnerships, The Clackmannanshire and Stirling Health & service delivery. The Chief Officer is accountable recognising that some services are planned on Social Care Partnership will work closely with to the Integration Joint Board and to the Chief a regional basis and that some residents in the the Community Planning Partnerships in both Executives of the Health Board and the Local Clackmannanshire and Stirling Council areas access Clackmannanshire (Clackmannanshire Alliance) and Authorities for the delivery of integrated services. services delivered by neighbouring Health Boards. Stirling (Stirling Community Planning Partnership) to ensure that all efforts are aligned to the respective Single Outcome Agreements.
Clackmannanshire and Stirling 3 Clackmannanshire and Stirling Strategic Plan
The Case for Change Clackmannanshire and Stirling Population 2014
Why do we need to change? 142,770 We recognise that the way we provide care needs to change in order to meet both current and future challenges. If we do nothing, health and care services Age 0-15 24,618 17.2% as they are will not be able to deliver the high quality service we expect. Age 16-49 63,021 44.1% Research at a national level along with local conversations has shown that there are a number of reasons why we need to change, which include: Age 50-64 28,926 20.3% Those who use our services are asking us to deliver more integrated care Age 65-74 14,942 10.5% More people are living longer, many with a range of conditions and illnesses, therefore demand for existing services is changing 73,674 69,096 Age 75+ 11,263 7.9%
We need to continuously improve services and contribute to better Source: NRS 2014 mid-year population estimates. personal outcomes The table above tells us that in 2014 Clackmannanshire & Stirling had a There is an opportunity to make better use of public resources. combined population of 142,770, with 73,674 females and 69,096 males. In the following graphs and tables we present a snap shot of information that helps to show the scale and nature of the need for Health and Social Care services across Clackmannanshire & Stirling and some key Population Projections and Age Distribution characteristics of the current population. Clackmannanshire and Stirling A Strategic Needs Analysis containing muchDRAFT more comprehensive information, statistics and analysis relating to a range of conditions specific 75+ to each local authority area will be published in 2016. Further work will be undertaken during 2016 to provide Strategic Needs Analysis information at 65-74 2037 a more local level again and this will be used to inform the locality planning 50-64 work referred to previously on page 3. This will ensure implementation is 2012 Age tailored to specific local needs for example needs experienced in rural areas or 16-49
areas where there are higher levels of drug or alcohol misuse. 0-15 Profile of Clackmannanshire Council & Stirling Council Areas The total population of Clackmannanshire is expected to stay relatively 0 10,000 20,000 30,000 40,000 50,00060,000 70,000 stable between now and 2037 while the population of Stirling is Populaon expected to rise steadily up to 2037. During this period we expect to see a pronounced increase in the number of people aged 65 years and over Source: NRS 2014 mid-year Population estimates in both areas, and this includes a more than doubling of the population of The bar chart above shows age groups for the population of people aged 75 years and over. Clackmannanshire & Stirling in 2012 and estimated figures for the same age groups in 2037. 4 ClackmannanshireOur Vision and Stirling and Outcomes Clackmannanshire and StirlingClackmannanshire and Stirling Strategic Plan
Household Composition Population by Urban / Other Urban Areas Clackmannanshire and Stirling Rural Category Large Urban Areas C & S Scotland Accessible Rural Clackmannanshire, Stirling Accessible Small Towns One-person household, aged under 65 18.5% 21.6% Remote Rural One-person household, aged 65+ 12.8% 13.1% and Scotland Remote Small Towns Couple / family everyone aged 65+ 8.5% 7.5% 4.9% 6.1% Source: 2011 Census The table above shows the make up of households in Clackmannanshire & 14% 3.4% Stirling compared to Scotland from the 2011 Census. 11.7% 39.8% 28.7% 35.1% 53.3% 9.3% 46.2% People with a Disability 13.1% 34.5% Clackmannanshire and Stirling People with a Learning Disability 707 Clackmannanshire Stirling Scotland known to GP practices * Source: Scottish Government Urban/Rural Classification 2013/14 and National Records of People with a Physical 9,252 Scotland. Disability ^ People with a severe mental healthDRAFT The Population by Urban / Rural Category information presented above shows condition known to GP practices v 1,178 that both Clackmannanshire and Stirling have a significantly different pattern of settlement types and locations compared with the average for Scotland. Neither * Source: QOF register 2014 Clackmannanshire or Stirling have any Large Urban areas. ^ Source: 2011 Census
v Source: QOF as at March 2014 It should be noted that Stirling has just over one third of its population living in a combination of Accessible Rural and Remote Rural areas compared with 14% in The combined ‘People with a Disability’ information presented above compares Clackmannanshire and 18% on average across Scotland. favourably to equivalent rates across Scotland. Clackmannanshire has slightly higher than the national average rates of people who have learning disabilities and people who have physical disabilities. Stirling has below the national average rates for all three classes of disability and Clackmannanshire also has a lower than the national average rate of people who have a severe mental health condition known to GP practices.
Clackmannanshire and StirlingClackmannanshire and Stirling 5 Clackmannanshire and Stirling Strategic Plan
Long Term Conditions Dementia Clackmannanshire and Stirling Clackmannanshire and Stirling People diagnosed with Dementia 1,073 25,000 20,000 Alzheimer Scotland estimate of 15,000 number of people with Dementia 2,345 10,000
Number of People 5,000 Source: QOF as at March 2014
0 The table above shows (based on 2014 data) there are 1,073 people diagnosed with Asthma CHD COPD Diabetes Heart Failure Hypertension Stroke & Dementia in Clackmannanshire & Stirling, while Alzheimer’s Scotland estimate the (Coronary (Chronic Transient Heart Obstrucve Ischaemic number of people living with Dementia to be approximately 2,345. Disease) Pulmonary Aack (TIA) Disease)
Source: QOF as at March 2014 Hospital Inpatient Care 2010-12 The bar chart above shows the number of people in Clackmannanshire Clackmannanshire and Stirling & Stirling with a long term condition such as asthma or hypertension. People who had emergency admissions to hospital 26,107 Estimated Number of Long Term Conditions by People aged 65+ with two or more Age Group Clackmannanshire and Stirling 2,891 DRAFTemergency admissions in a year 100 90 1 disorder 80 2 disorders Source: ScotPHO Health and Wellbeing Profiles 2014 70 3 disorders 60 4 disorders The table above shows (based on 2014 data) that there were 26,107 emergency 50 5+ disorders admissions to hospital from Clackmannanshire & Stirling during 2010 to 2012 and 40 Paents (%) 30 of those admissions 2,891 people were aged 65+ and had 2 or more emergency 20 admissions within a 12 month period. 10 0 0-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+ The Estimated Number of Long Term Conditions by Age Group graphic to the left
Age Group (years) demonstrates that as the proportion of older adults increases in Clackmannanshire and Stirling there will be an increase in the number of people with multiple long Source: The Challenge of Multimorbidity in Scotland, Professor Stewart Mercer term conditions e.g. diabetes; heart and lung conditions. The bar chart above shows the percentage of patients by People with multiple long term conditions are currently making many trips to age category and the number of long term conditions hospital clinics to see a range of specialist services in an uncoordinated way. they are estimated to have.
Clackmannanshire and Stirling 6 Clackmannanshire and Stirling Strategic Plan
Alcohol & Drug Misuse Long Term Mental Health Conditions, Percentage of Clackmannanshire and Stirling Population within Gender and Age Group. Clackmannanshire and Stirling Indicator Clackmannanshire Stirling Scotland Alcohol related hospital stays* 510.5 456.2 696.9 12 Alcohol related mortality* 38.9 16.7 21.4 10 Drug related hospital stays* 79.9 89.5 124.6 Males 8 Drug related mortality* 14.7 6.6 10 Females
6 Source: ScotPHO Drug Profile 2013/14 *rate per 100,000 population (%) 4
Alcohol related mortality is the rate per 100,000 people where alcohol is the 2 underlying cause of death. The rate in Clackmannanshire was slightly above 0 the national rate in 2009, fell below the national average for the following three 0 to 15 16 to 24 25 to 34 35 to 49 50 to 64 65 to 74 75 to 84 85 and over years, only to rise significantly above it in 2013. In Stirling, the alcohol related Age group mortality rate has been below the Scottish average in each year from 2009 to 2013. Source: 2011 Census In 2012/2013 across Clackmannanshire and Stirling there were an estimated Note- This information is taken from the 2011 census. Households were asked 1,450 people aged 15-64 experiencing problemDRAFT drug use. Problem drug use can to self identify if they or someone within the household has a mental health lead to a number of health and social problems. The estimated prevalence of condition. The question does not define a mental health condition or take into those with a problem drug use has increased in Clackmannanshire and Stirling account multiple mental health conditions. between 2009/10 and 2012/13. This is in contrast to Scotland as a whole, where the estimated percentage of the The bar chart above from the 2011 census illustrates the percentage of the population experiencing problem drug use has fallen slightly. population in Clackmannanshire & Stirling who have self identified that they have a long term mental health condition, split across gender and age.
Clackmannanshire and Stirling 7 Clackmannanshire and Stirling Strategic Plan
The Carers Strategy for Scotland 2010-2015 states that “Carers are equal partners in the planning and delivery of care and support. There is a strong case based on human rights, economic, efficiency and quality of care grounds for supporting carers. Without the valuable contribution of Scotland’s carers, the health and social care system would not be sustained. Activity should focus on identifying, assessing and supporting carers in a personalised and outcome-focused way and on a consistent and uniform basis.” The green box below highlights how many people have been identified as providing unpaid care in the Clackmannanshire and Stirling Partnership area and acknowledges there are likely to be many DRAFTmore. Carers 12,958 People in the Clackmannanshire and Stirling Partnership area identified themselves as unpaid carers. (2011 Census) Approximately 1/3 of these unpaid carers are known to local services It is estimated that there are as many as 10,000 more unpaid carers in the Partnership area – 23,000 in total (Scottish Health Survey, 2013) 1,386 carers in Clackmannanshire provide 50 plus hours unpaid care per week (2011 Census) 1,991 carers in Stirling provide 50 plus hours unpaid care per week (2011 Census)
Clackmannanshire and Stirling 8 Strategic Plan
Our Local Vision and Outcomes
Our Vision is to enable people in the Outcomes Clackmannanshire and Stirling Health & Social Care There are nine National Health and Wellbeing Outcomes set by the Scottish Government that our Partnership Partnership area to live full and positive lives within will deliver against: supportive communities. National Health & Wellbeing Outcomes Our local outcomes are based on the national Health and Wellbeing Outcomes and were People are able to look after and improve their own health and 1 Healthier living developed in partnership with all stakeholders: wellbeing, and live in good health for longer. Self-Management - Individuals, their unpaid People, including those with disabilities, long-term conditions, or who 2 Independent living carers and families are enabled to manage their are frail, are able to live as far as reasonably practicable, independently own health, care and wellbeing; at home, or in a homely setting, in their community. Community Focused Supports – Supports are People who use health and social care services have positive in place, accessible and enable people, where 3 Positive experiences and experiences of those services, and have their dignity respected. possible, to live well for longer at home or in outcomes homely settings within their community; Health and social care services are centred on helping to maintain or Safety - Health and social care support systems 4 Quality of life improve the quality of life of service users. help to keep people safe and live well for longer; Health and social care services contribute to reducing health DRAFT5 Reduce health inequality Decision Making - Individuals, their carers inequalities. and families are involved in and are supported People who provide unpaid care are supported to look after their own to manage decisions about their care and 6 Carers are supported health and wellbeing, including to reduce any negative impact of their wellbeing; caring role on their own health and well-being. Experience – Individuals will have a fair and People who use health and social care services are safe from harm. positive experience of health and social care 7 People are safe
People who work in health and social care services are supported to 8 Engaged workforce continuously improve the information, support, care and treatment they provide, and feel engaged with the work they do.
To deliver Best Value and ensure scarce resources are used effectively 9 Resources are used effectively and efficiently in the provision of health and social care services. and efficiently
9 Clackmannanshire and Stirling Strategic Plan
How we will achieve Improved Outcomes
All integration activity must be delivered with full recognition of the nationally developed Planning The main purpose of the integration planning and delivery principles is to and Delivery Principles. The principles set out the improve the wellbeing of service-users and to ensure that those services are values and approach that we will adopt whilst provided in a way which: working together. are integrated from the point of view of service-users take account of the particular needs of different service-users takes account of the particular needs of service-users in different parts of the area in which the service is being provided take account of the particular characteristics and circumstances of different service-users respects the rights of service-users take account of the dignity of service-users take 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 DRAFT are 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
ClackmannanshireClackmannanshire and Stirling and Stirling 10 Strategic Plan
What does all of this mean for you?
Services working in partnership By bringing health and social care services across Clackmannanshire & Stirling together, we have the opportunity to improve our outcomes through joint working, better communication, improved efficiency and reduced duplication. The people of Clackmannanshire & Stirling will be at the heart of redesigning services. They will be involved in designing changes to services which will focus on people and put them first. Through working together, we can start to tackle the issues identified in our Strategic Needs Assessment. We recognise the critical role of the whole workforce in determining the success of partnership working. We held staff engagement events across It is essential that our plans are informed and owned Clackmannanshire and Stirling and these were by those who work most closely with service users, attended by colleagues from the third and their families and carers and their local communities. DRAFTindependent sectors as well as health and This will include volunteers and staff from third and social care staff. We encouraged and supported independent sector providers as well as those who participants to imagine a more integrated future work in statutory health and social care services. By and asked them to describe what this would look recognising the strengths and all of the resources and feel like from the perspective of an individual within partnerships and communities, and taking using health or social care services. The individual advantage of opportunities such as shared learning, was given a generic name - Sam - so that they we can maximise outcomes for people and improve could be either male or female. Everyone’s ‘Sam’ wellbeing. experienced different health and care needs and was in contact with different services. Through completing this exercise, we identified key themes that would enable integrated services to make things better for Sam. In the following section we will describe the key themes. 11 Clackmannanshire and Stirling Strategic Plan
Key Themes and Ambitions
Keeping SAM at the centre and using material gathered as part of the engagement sessions and from other events, we have identified our ambitions for what an ‘integrated future’ should look like for each Theme:
“Sam can “Sam’s unpaid access the right carer knows who 1 Early intervention and prevention. The right care is delivered for me at the right time service at the to call and talk to right time” if they need help .”
Sam and his/her unpaid carer When Sam requires to make contact with services he/she can do so easily and quickly, have a named care coordinator knowing where to go for help. This is supported through, for example, availability of relevant (or single point of contact), who and appropriate 7-day services, co-located services and single points of access which operate ‘facilitates’ care and support beyond business hours. planning, being able to ensure Sam also has easy access to information about community based voluntary groups and activities. timely access to appropriate This helps Sam to stay socially connected and physically active within the local neighbourhood. services. DRAFTThis reduces the likelihood of isolation and minimises the need for formal services.
“Sam is 2 Service users are supported to self manage supported to and plan care proactively plan for the Sam has an integrated, single, shared care future.” plan, which is regularly reviewed, and which is also anticipatory in nature. This plan is flexible enough to respond where his/her Those providing care and support proactively “Sam lives needs change, and ensures that outcomes are identify any change in Sam’s condition and a life – not shared, even if Sam loses capacity. ensure early intervention, avoiding the need for always dealing a subsequent crisis response. with a crisis.”
Clackmannanshire and Stirling 12 Strategic Plan
“Sam takes on responsibilities for Sam is supported to self-manage, through his/her care and has 3 Service Users exercise Choice & Control education and awareness-raising. This is fewer unnecessary balanced by ensuring that Sam knows who intrusions into to contact/where to go, should she/he need his/her life” help. Technology solutions are in place which Sam is well- informed, has a clear understanding enables Sam to be more independent, by of what to expect and from whom, and is able “Sam has the providing care closer to home. Care is better to access all of the necessary information. Sam is information to co-ordinated, with fewer people involved, in control, having choice and ownership of care make decisions consistent faces, and a frequency of involvement arrangements (e.g. through Self-directed Support), about what he/ matched to Sam’s needs. including where and when it is provided. she needs.”
“Sam’s care Sam receives high-quality, holistic, person- is wrapped centred, outcomes-focussed care, which 4 Staff are skilled and supported to deliver around his/her meets his/her individual needs and is person-centred and integrated care DRAFTneeds, not the effectively coordinated and streamlined other way even when moving between services. round.”
“Sam’s unpaid carer is fully Unpaid carers are themselves well- 5 Carers are recognised and valued as equal involved and engaged supported, their own needs having been partners in the design and delivery of care as an equal partner by assessed and met in a timely manner. all health and care providers”
13 Clackmannanshire and Stirling Strategic Plan
If Sam is admitted to hospital; effective joint “Sam does planning takes place to ensure a smooth, safe 6 There is a focus on Rehabilitation, Recovery not require and timely discharge. Rehabilitation and and Reablement across all services. There are unplanned, reablement services are in place which help fewer avoidable admissions and discharge emergency, Sam to remain at home, or to return home planning is effective and efficient. hospital care” quickly, but safely, following a period in hospital.
“Sam has “Sam is access to 7 Services work together with communities to This is supported able to stay additional, targeted through improved improve access to services and build capacity – at home and information and working with third sector and community groups participate in advice to support availability and use across and within localities. This reduces health community Sam to manage of assets within the inequalities within and across our communities. activities” his/her health community. DRAFTcare needs”
Clackmannanshire and Stirling 14 Strategic Plan
Our Priorities Provide more single points of entry to Deliver the Stirling Care Village to realise services where named care coordinators help many of the expected benefits of greater In order to address the key themes presented on people receive more holistic services. Internal levels of Health & Social Care Integration. This the previous pages and to achieve our ambitions for links will be made to any other services and will include improved personal outcomes Sam we will: supports needed rather than service users and reduced numbers of assessments by Further develop systems to enable front approaching each service anew. demonstrating many of the innovations noted line staff to access and share information above. across professions and organisations. This Develop seven-day access to appropriate will enable people receiving services, named services to maximise quality of care; the care coordinators, and other relevant staff potential for rehabilitation and recovery; and to minimise the time spent duplicating flow through acute and community services. assessment and maximise opportunities to Take further steps to reduce the number of create ‘seamless’ personal outcomes focused unplanned admissions to hospital and acute care. services by supporting more prevention, early Support more co-location of staff from intervention (including Technology Enabled across professions and organisations to Care), and community based services. This enable working in an integrated way where this includes medical and social forms of prevention facilitates the best quality of care, support, and that could impact on future health such as enablement/independence to be achieved. providing information about local groups and Develop single care pathways which activities that can help people stay socially recognise that there are many more conditionsDRAFT connected and physically active along with than services available. While one size doesn’t fit more ‘Keep Well’ style health screening and all there are benefits to be had from providing support. consistent and predictable processes. The decisions associated with our priorities Further develop anticipatory and planned identified in this section of the Strategic Plan will be care services for people with multiple long based on the efficient and effective use of available term conditions. This will include people with resources, what we already know works well in this dementia and will be tailored to meet people’s area, and from the evidence base and findings of preferred personal outcomes and maximises well conducted local, national, and international their ability to be actively involved in managing research. their own conditions.
15 Clackmannanshire and Stirling Strategic Plan
Case Studies Below are some examples that have been shared with us about how services across We already have good examples of how joined up working between health, social Clackmannanshire and Stirling are working together to support better outcomes: care, the independent and third sector can make a difference. We know that our staff are keen to build on existing relationships and remove barriers to joined up working. Janet is 27 and has a long term mental illness. She lives at home on her own. She has The focus will be on co-locating and integrating teams, starting where there is found it difficult to maintain relationships with family and friends. While she would already evidence of joint working, and supporting more streamlined and coordinated very much like to work, this has been difficult due to frequent episodes of mental illness. pathways for those who use our services. Janet has experienced times of crisis in her life and she has been detained in hospital due to significant concerns about her safety in the community. Mary had a Stroke and was admitted to hospital. She is now ready to go home, but not Having these yet able to live independently on her own as she did before. Janet is now arrangements in place supported by the enables Janet and those that support Integrated Mental Health her to recognise when her mental health Mary needs is fragile and what supports are likely to Through one Team based at her local help with everyday tasks enable Janet’s mental health to stabilise assessment, by an Occupational Resource Centre. She has a key such as showering, walking, meal once again. She can contact her key worker Therapist from the Integrated worker who has supported Janet to preparation and shopping. This and, if necessary, a prearranged plan Reablement Team, Mary agrees an develop care management and usually involves Homecare, can be put in place before a crisis action plan which deals with all of her risk management plans. Physiotherapy, Occupational Therapy, results in her returning needs. Equipment is promptly provided meal delivery, social care for some to hospital. and the Reablement Home Carers visit With Janet equipment and emergency alarm as Mary twice a day to help her return as feeling confident that services well as potentially some other far as possible to her former will support her in the way which community based DRAFT independent self. she has identified as being effective supports. Mary is and at the time she needs them, she is reviewed regularly by the confident that she can cope better through Occupational Therapist or developing social contacts in group work Physiotherapist and after three settings and by undertaking voluntary months Mary no longer needs work with a view to employment homecare. With the Reablement Home in the future. Janet has Carers support she has met her goals of avoided falling into crisis and With some walking to the local shop and has not required emergency extra bathing equipment, carrying out most treatment in many months. She meal delivery service and a everyday tasks. continues to be able to access community alarm, Mary feels support as and when she has safe and happy to live at identified she requires it. home independently She feels far more in control.
Clackmannanshire and Stirling 16 Strategic Plan
Mr Brown (81) lives at home with his wife and had fallen three times during the night Mrs Smith was a resident in a local Independent Sector Care Home for the last six within 4 months. The social care Mobile Emergency Care Service (MECS) had been called months of her life, due to a progressing life limiting condition. each time. Mrs Brown is frightened that her husband will not be able to stay at home with her if he keeps on falling. She wants to continue to care for him but she does not Care home staff know how she can do this and keep them both safe. NHS Forth Valley and Strathcarron Hospice were able to initiate have supported the care sensitive conversations with The assessment MECS support home staff to develop good Mrs Smith and her family identified that Mr Brown a falls pathway and they regarding progression and had difficulty locating the toilet quality skills and knowledge automatically alerted the management of her illness at night, he had recent diagnosis about providing quality falls service to Mr Brown’s of dementia, his medications end of life care. early in her care. case and a full falls made him drowsy and his assessment was offered mobility was slower than and completed. Through sensitive would be expected. Mrs Smith died discussion an advanced care peacefully in her care plan tailored to her needs was Mr Brown is home with her family developed. This included her wishes now able to safely go present. The family felt their regarding her physical, psychosocial and Mr Brown was to the toilet at night and mother had a good death spiritual outcomes and also decisions offered an enhanced Telecare continues his falls preventionDRAFT and her care had been with regards to resuscitation. Her GP solution in the form of an alternative exercises with his wife. sensor light. He was also offered a excellent. was involved and key information He has not short course of therapeutic day care on her medical records fallen again. where he learned strength and updated. balance exercises and he saw Due to anticipating his GP to discuss his needs and planning for Mrs Brown medication. was supported to access advanced care, no crisis arose, a regular short break to no Out of Hours medical enable her to both continue calls were required and no within her caring role and admission to hospital to sustain a life out was necessary. with it.
17 Clackmannanshire and Stirling Strategic Plan
Localities
The Public Bodies (Joint Working) (Scotland) Act There will be three localities within the 2014 requires the partnership to identify localities Clackmannanshire and Stirling partnership: one
for the planning and delivery of services at a local locality in Clackmannanshire and two in Killin level. A locality is defined in the Act as a smaller Stirling. These three localities areas are Tyndrum A85 area within the borders of the partnership area. sufficiently large to offer scope for Crainlarich Lochearnhead The development of localities will support the service planning and development, principle of collaborative working across primary while also providing scope for local and secondary health care, social care and third and involvement. The three localities are independent sector provision. There will be a strong aligned as far as possible with the ways in Callander focus on community involvement and engagement which Primary and Secondary Health Services, A84 aligned with the existing place based initiatives and Housing and Social Services, and other services, Aberfoyle Dunblane Community Planning Partnership neighbourhood are currently delivered. The localities reflect the River Forth Alva A91 Dollar level activity across Clackmannanshire and Stirling. needs of Clackmannanshire and Stirling areas Loch Alloa Lomond A811 This will include community test sites and will and recognise the differences between the large Stirling support the wider aspirations for communities rural area and Stirling City. Drymen across the partnership area. The three localities are: DRAFT Clackmannanshire - Population 51,280 Stirling City with the Eastern Villages, Bridge of Community Hospitals Allan and Dunblane - Population 70,222 Clackmannanshire Locality Rural Stirling - Population 21,038 Rural Stirling Locality Stirling City with the Eastern Villages, *Population figures are mid year estimates from Bridge of Allan and Dunblane Locality 2013 Scottish Neighbourhood Statistics Clackmannanshire & Stirling Health & Social Care Partnership Area
Clackmannanshire and Stirling 18 Strategic Plan
Geographical Profile of Forth Valley
This map shows the localities created within Clackmannanshire & A82 Dundee Stirling, and shows the Falkirk area Killin to highlight the whole geographical A90 Tyndrum area covered by NHS Forth Valley. A85 The map also illustrates the location A85 Crainlarich Lochearnhead of Forth Valley Royal Hospital which Perth provides acute services to all of Forth Valley.
A82 A92
Callander A9 A917 A83 A91 A84 Anstruther Aberfoyle Dunblane A915 River Forth Alva A91 Dollar Glenrothes Loch Alloa A97 Lomond A811 Acute Hospital Stirling A92 Kirkcaldy DRAFTA985 Community Hospitals Drymen A921 Clackmannanshire Locality Kincardine Larbert Rural Stirling Locality A81 Stirling City with the Eastern Villages, Falkirk Boness Bridge of Allan and Dunblane Locality A82 A80 Polmont Falkirk Council Area A1 Clackmannanshire & Stirling Health Edinburgh & Social Care Partnership Area Livingston A720 Dalkeith A8 Glasgow
Motherwell
19 Clackmannanshire and Stirling Strategic Plan
Which Health and Social Care Services are included within Integration?
Our partnership will be responsible for planning and NHS Forth Valley Services Clackmannanshire Council & Stirling Council commissioning integrated services and overseeing Community based services Services their delivery. These services cover all adult social Social work services for adults and older people care, adult primary and community health care District Nursing Services and support for adults with physical services and the elements of adult hospital care Services related to substance addiction or disabilities and learning disabilities which will offer the best opportunities for service dependence Mental health services redesign. Services provided by Allied Health Professionals The health and social care partnership will have in outpatient clinics or out of hospital Drug and alcohol services a key relationship with acute health services and Public dental service / Primary medical services Adult protection and domestic abuse will work closely with the full range of Community (including out of hours) / General dental, Carers support services Planning Partners to optimise wellbeing throughout Ophthalmic and Pharmaceutical services Community care assessment teams the area. This approach will include working with Services provided out-with a hospital in relation Support services third sector organisations, independent sector, to geriatric medicine and palliative care and all of the other public sector bodies to deliver Care home services Community Mental Health and Learning flexible locality based services, including services Adult placement services Disability services commissioned on a Forth Valley wide basis such as Health improvement services Continence and kidney dialysis services Alcohol and Drugs Services. DRAFTprovided out-with hospitals Aspects of housing support, and provision of While doing so, we will make the most of assistance including aids and adaptations, and Services that promote public health opportunities to work in partnership directly with gardening assistance communities in the planning and design of services. Day services Local area co-ordination Respite provision Occupational therapy services Re-ablement services, equipment and telecare
Clackmannanshire and Stirling 20 Strategic Plan
There are other, hospital based, services that are Housing Contribution Statements Snapshot of Local Services included for planning purposes. This will ensure that Housing providers have for many years contributed Did you know? we are planning for the whole pathway of care for positively to improving health and well-being across individuals. These services are listed below. Across Clackmannanshire and Stirling: our communities. It is not only about enabling Accident and Emergency independent living for people, but also being Community Nurses provide more than 1500 home Inpatient hospital services relating to (General more effective in helping to prevent admissions visits and treatment room appointments each Medicine / Geriatric Medicine / Rehab to hospital, alleviating delayed discharge and week. Medicine / Respiratory / Psychiatry of Learning contributing to tackling health inequalities affecting Community Rehabilitation Teams (ReACH) assess Disability) the population. more than 60 new people who have been referred Palliative care services Overall to achieve improved outcomes across with rehabilitation / reablement needs, and make Inpatient hospital services provided by General the population it is important that Integration around 300 community based visits, each week. Medical Practitioners. Authorities and Strategic Housing Authorities work Social Services commission 11,500 hours per week Hospital based Mental Health and addiction or closely together on key aspects of housing support of post reablement Personal Care at Home from dependence services including: private sector providers that is provided free of Assessing the range of housing support needs charge to service users. across the population and understanding the Integrated Mental Health Services in link with health and social care needs; Clackmannanshire receive 200 appropriate Identifying common priorities that are reflected referrals per month and strive to maximise in both the Local Housing Strategy and the proportion of referrals that are picked up by DRAFTStrategic Commissioning Plan; community based mental health services (current Identifying and making best use of resources target is 65%). A similar approach is being adopted to meet the housing support needs of the local across Stirling. population. Care Homes are at 90% occupancy levels with 228 Separate Housing Contribution Statements have beds across 4 care homes in Clackmannanshire been developed for Clackmannanshire and Stirling and 511 beds across 13 care homes in Stirling. on an individual local authority basis and can be accessed on the Clackmannanshire & Stirling Integration web-page.
21 Clackmannanshire and Stirling Strategic Plan
The Financial Plan
Partnership Budget The partnership budgets have been set taking into Financial and Economic Outlook account: The budget has been set taking into account the The UK Spending Review published in November requirements of The Public Bodies (Joint Working) A ‘due diligence’ process which examined the 2015 and the subsequent Scottish Draft Budget set (Scotland) Act 2014, national guidance and the budgets and expenditure for the 3 financial out the short to medium outlook for public finances Integration Scheme for the partnership. years preceding the establishment of the of year on year real term reductions in overall public partnership expenditure until 2020. This financial settlement The partnership budget for 2016/17 totals £X.XXXm. National guidance on budgets for Health and is set against the demographic pressures outlined The budget is made up from contributions from the Social Care Partnerships from the Integrated within the Strategic Needs Assessment and the NHS Forth Valley, Clackmannanshire Council and Resourcing Advisory Group (IRAG) need to redesign services to meet our vision and Stirling Council as follows: outcomes. The Integration Joint Board will require to The financial settlements to NHS Boards and ensure that all of the redesigned and commissioned £m Local Authorities for 2016/17 from Scottish services are aligned to the eight priorities within Government NHS Forth Valley X.XXX the Strategic Plan through a process of both review Clackmannanshire Council X.XXX and alignment of the existing redesigns already underway within the partner agencies during Stirling Council X.XXX 2016/17. Total Partnership Budget 2016/17 X.XXX In the early part of financial year 2016/17 the DRAFTpartnership will develop a Financial Plan to underpin this strategic plan setting out how it would intend to best utilise the resources available to meet the priorities stated within this plan. It would be the intention to develop a Financial Plan covering 3 years to allow medium to longer term service planning.
Clackmannanshire and Stirling 22 Strategic Plan
Development of this Strategic Plan and Next Steps
The improved service delivery methods proposed Participation and Engagement as part of Health and Social Care Integration have The process undertaken to develop the Strategic Plan not been developed in isolation. The approaches has been underpinned by the Partnerships desire detailed in this plan are the result of many cycles of to ensure the participation and engagement of all continuous improvement, national guidance and stakeholders. A Participation and Engagement Strategy strategies, and many local strategies and plans. A will be published on the Clackmannanshire & Stirling summary of some of the national guidance and Integration web-pages. legislation, local strategies, plans, processes and events is provided below: How will we know we have been successful? National A Performance Framework is being developed The Public Bodies (Joint Working) (Scotland) based on national guidance and national and local Act 2014; indicators. This will also help to measure progress against the national and local outcomes. The The Social Care (Self-directed Support) framework will be profiled and updated on the (Scotland) Act 2013; and Clackmannanshire & Stirling Integration web-page Community Empowerment (Scotland) Act when published. 2015. Next Steps Equality Act 2010 DRAFT Alcohol, Drug and Tobacco Strategies The Strategic Plan for the Clackmannanshire & Stirling Partnership is based on a Strategic Needs Assessment Local Plans and Strategies and draws on a range of existing initiatives and plans Joint Strategic Commissioning Plan for Older which are consistent with the vision and outcomes People’s Care 2013-2023 for the Partnership. The Strategic Needs Assessment Consultation Autism strategy along with the National Outcomes, the Housing Mental Health strategy The Draft Strategic Plan was consulted Contribution Statements for Clackmannanshire and upon between the 18 November 2015 and Clackmannanshire and Stirling Integrated Carers Stirling Councils, the Performance Framework, the the 24 December 2015 and the resulting Strategy implementation Plans Participation & Engagement Strategy, and the Easy comments shaped the final version of the Read version all form part of the Strategic Plan. Clackmannanshire and Stirling Integrated Care plan. A report outlining the results of the Programme During the life of the Strategic Plan further work will consultation process is available on the be carried out to develop the detailed priority and Clackmannanshire & Stirling Integration implementation plans; the three Locality Plans; and web-page. the Market Facilitation Plan.
23 Clackmannanshire and Stirling Strategic Plan
Glossary
Acute Care is a branch of health care where people The Housing Contribution Statement (HCS) sets ReACH is an NHS Forth Valley Service which receive active but short-term treatment for a severe out the arrangements for carrying out the housing provides outreach Physiotherapy and Occupational injury or episode of illness, an urgent medical functions delegated to the Integration Authority Therapy services covering “Rehabilitation & condition, or during recovery from surgery. Acute under the Public Bodies (Joint Working) (Scotland) Assessment in Community & Home”. care services are generally provided in a formal Act 2014. Strategic Commissioning is the term used hospital setting. The Independent Sector encompasses those for all the activities involved in assessing and Anticipatory Care / Plans can take many forms traditionally referred to as the ‘private’ sector. It forecasting needs, linking investment to agreed however it is expected to help reduce avoidable includes organisations of varying types and sizes, desired outcomes, considering options, planning and unscheduled acute admissions for people with amongst them single providers, small and medium the nature, range and quality of future services pre-existing conditions. The purpose of advanced/ sized groups and national providers. and working in partnership to put these in place. anticipatory care planning is to support the Joint commissioning is where these actions are Long Term Conditions (LTC) are conditions that individual to have greater choice, and control of undertaken by two or more agencies working last a year or longer, impact on many aspects of care preferences through communication across together, often from a pooled or aligned a person’s life, and may require ongoing care and the support team, across agencies and across care budget. ( National Steering Group for Strategic support. The definition does not relate to any one settings. Commissioning 2012) condition, care group or age category, so it covers The Body Corporate Model is a model of adults and older people as well as children and The Strategic Needs Assessment is an analysis of integration where a Health Board and Local mental as well as physical health issues. Common the health and social care needs of the population Authority delegate the responsibility for planningDRAFT long term conditions include epilepsy, diabetes, to inform and guide service planning. The main and resourcing service provision for health and some mental health problems, heart disease, goal of the Strategic Needs Assessment is to social care services to an Integration Joint Board, chronic pain, arthritis, inflammatory bowel disease, accurately assess the health and care needs of a established as a separate entity. asthma and chronic obstructive pulmonary disease local population in order to improve the physical Health Inequalities are the unfair and avoidable (COPD). and mental health and wellbeing of individuals and communities. differences in people’s health across social groups Reablement is about giving people the opportunity and between different population groups. Health and the confidence to relearn/regain some of the Technology Enabled Care refers to the use of Inequalities do not occur randomly or by chance, skills they may have lost as a result of poor health, telehealth, telecare and telemedicine in providing but are socially determined by circumstances largely disability / impairment or entry into hospital or care for people that is convenient, accessible and beyond an individual’s control. These circumstances residential care. As well as regaining skill, reablement cost-effective. These services use technology to disadvantage people and limit their chance to live a supports service users gain new skills to help them support people to live safely and independently in longer, healthier life. maintain their independence. their own homes, and can be helpful to people at risk of falls.
Clackmannanshire and Stirling 24 Strategic Plan
Glossary
The Third Sector is a term used to describe the range of organisations that are neither public sector nor private sector. It includes voluntary and community organisations (both registered charities and other organisations such as self-help groups and community groups), social enterprises, mutuals and co-operatives. It also includes local intermediary organisations (Third Sector Interfaces).
A further glossary of terms can be found on the Clackmannanshire & Stirling IntegrationDRAFT web-page.
25 Clackmannanshire and Stirling Strategic Plan
DRAFT
Clackmannanshire and Stirling Strategic Plan
Publications in Alternative Formats
We are happy to consider requests for this publication in other languages or formats such as large print. Please call 01324 590886 (24hrs), fax 01324 590867 or email [email protected] DRAFT
Clackmannanshire and Stirling
Clackmannanshire and Stirling Draft Final Strategic Plan - Easy Read Version
2016 - 2019 Health and Social Care Partnership
Hello, Clackmannanshire Council, Stirling Council and NHS Forth Valley will be working together in new ways to help people to stay healthy, happy and independent. People are living longer and often with more health problems. We want to help with this and make sure everyone has the same chance of good health and wellbeing. We want to make sure that people stay healthy. We want people to be more in control of their health and care. We want people to live happily at home for as long as possible. This is our 3 year plan. It is called The Strategic Plan.
Shiona Strachan, Chief Officer, Clackmannanshire and Stirling, Health and Social Care Partnership
Why are things changing?
People have asked for better joined up services from the NHS and Councils.
People are living longer and with more health problems.
We can spend public money in a better way.
There is a new Government law called The Public Bodies (Joint Working) (Scotland) Act 2014. NHS and Council areas have to work together in adult care. This is called integration. Clackmannanshire Council, Stirling Council and NHS Forth Valley are now in a Health and Social Care Partnership. Who will help to make it happen?
This is the plan of how we will make adult services better. The Integration Joint Board and the Chief Officer need to make sure the integrated services are doing well.
What are the outcomes?
Outcomes are the result of what we do. We will look for outcomes in these areas to see if things are getting better.
Self-Management - People are able to look after their health, care and wellbeing.
Community Supports - People can live well at home or in a home they like in their community, for as long as possible.
Safety - People are safe and live well for longer.
Choice - People make choices about their care.
Feelings - People are happy with the care they get.
Everyone getting care should feel well supported. Everyone should feel that their care support teams are working well together. In the next 3 years we will
Make sure that your care team can easily find out and share important information about your care.
Make sure that staff who work best together for you work in the same place.
Make sure it’s easy to understand what will happen when you need help.
Set up support plans for people with long term health problems.
Make it easier for you to contact the service you need for help.
Set up more 7 days a week health and care services.
Open the Stirling Care Village.
Spend money on what works well.
Try to help people stay healthy and well at home so that they don’t need to go into hospital.
Together we can work to make sure you get the best care. Localities
Killin Tyndrum A85
Crainlarich Lochearnhead
Callander A84 Aberfoyle Dunblane River Forth Alva A91 Dollar Loch Alloa Lomond A811 Stirling Drymen
Community Hospitals Clackmannanshire Locality Rural Stirling Locality Stirling City with the Eastern Villages, Bridge of Allan and Dunblane Locality Clackmannanshire & Stirling Health & Social Care Partnership Area
The Clackmannanshire & Stirling Partnership area will be divided into three smaller areas called localities to help plan and deliver services.
Publications in Alternative Formats
We are happy to consider requests for this publication in other languages or formats such as large print. Please call 01324 590886 (24hrs), fax 01324 590867 or email [email protected] Appendix 3
Clackmannanshire & Stirling Health and Social Care Partnership
Consultation & Engagement Report
Draft 2 February 2016
Last updated: 2 February 2016
Foreword
Clackmannanshire Council, Stirling Council and NHS Forth Valley have put in place new partnership arrangements to deliver adult health and social care services. This is to improve the health and wellbeing of our residents. We want to ensure that people have healthier, fuller lives and live as independently as possible in their own communities. We will also make best use of all of the resources available to address the agreed priorities for the partnership.
This report provides an overview of the engagement and consultation work which has taken place in partnership over 2014, 2015 and early 2016. This has enable the Strategic Planning Group to develop a three-year plan which sets out how we will deliver services to meet current need but also the needs of the population in the future.
I would like to take this opportunity to thank everyone for their part in this. Particular thanks to everyone who has engaged in the development process to date or provided comment on the draft Strategic Plan as this has enabled us to coproduce our first Strategic Plan for 2016 - 2019.
Shiona Strachan Chief Officer, Clackmannanshire & Stirling Health and Social Care Partnership Chair, Clackmannanshire & Stirling Strategic Planning Group
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Executive Summary
Participation and engagement is at the heart of health and social care integration and we will not achieve the ambitious aims of integration without working in partnership.
This report provides a summary of the engagement and consultation work which has taken place over 2014, 2015 and early 2016; in terms of the vision & outcomes, Integration Scheme and draft Strategic Plan.
The reports demonstrates broad engagement with a wide variety of stakeholders: approximately 700 people attended over 30 face to face sessions, whilst 56 individuals provided comment on the draft Strategic Plan and 27 sessions provided written group feedback.
We have also identified some lessons learned through this process which we hope will inform further engagement work for the Partnership.
The engagement and consultation work has enabled a number of specific changes to be made to the draft Strategic Plan, such as:
• Clearer descriptions of what the data tells us about current position; • Adding a “How we will know what we are doing is working” section which will show how we will measure the impact of integration; • Adding a next steps section which sets out the plan for the coming year.
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Table of Contents
Foreword ...... 2
Executive Summary ...... 3
Table of Contents ...... 4
1.0 Purpose ...... 6
2.0 Background ...... 6
3.0 Definitions ...... 7
4.0 Methods ...... 7
5.0 Engagement around Integration Scheme & Vision and Outcomes ...... 9 5.1 Feedback Received ...... 10 5.2 Conclusion ...... 12
6.0 Consultation on Draft Strategic Plan...... 13 6.1 Introduction ...... 13 6.2 Feedback Received ...... 13 6.2.1 – Individual Responses ...... 13 Table A – Individual Responses ...... 13 Table B – Individual Responses Themes ...... 14 6.2.2 Session Feedback ...... 14 Table C – Session Feedback ...... 14 Table D – Session Feedback Themes ...... 14 6.2.3 Organisation Feedback ...... 15 Table E – Organisation Feedback ...... 15 Table F – Organisation Feedback Themes ...... 15 6.2.4 Equalities Information ...... 16 Table G – Equality Data ...... 16 6.3 Themes and Issues Raised During the Consultation ...... 16 6.3.1 General Comments on Plan...... 17 6.3.2 Comments Provided on Strategic Themes ...... 18 6.3.3 Other issues indentified ...... 21
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6. 4 Impact of Consultation...... 23 Table H – Action taken so far ...... 23 7.0 Summary & Conclusions ...... 25 7.1 Summary ...... 25 7.2 Lessons Learned ...... 25 Table I: Lessons Learned ...... 25 7.3 Participation and Engagement ...... 26
8.0 References ...... 26
9.0 Appendices ...... 27 Appendix 1 – Strategic Themes – Workshop Template ...... 27 Appendix 2 – Summary of Engagement Conversations ...... 29 Appendix 3 – Summary of draft Strategic Plan distribution ...... 32 Appendix 4 – Strategic Plan Specific Consultation Sessions ...... 40
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1.0 Purpose
The purpose of this document is to report on how the Clackmannanshire & Stirling Health and Social Care Partnership engaged with stakeholders on the Integration Scheme, vision and outcomes, draft Strategic Plan and the outcome of these engagements.
2.0 Background
The Scottish Government defines health and social care integration as “one of Scotland's major programmes of reform. At its heart, health and social care integration is about ensuring that those who use services get the right care and support whatever their needs, at any point in their care journey” (Scottish Government, 2015).
The Public Bodies (Joint Working)(Scotland) Act 2014 sets out what must and may be integrated and how much of this must happen.
With respect to engagement with stakeholders the Integration Authority have a number of responsibilities, in short these are: • Engagement must be conducted with, at least, the list of prescribed stakeholders, these are:
o Users of health & social care o Carers of users of health & social care o Commercial & Non-commercial providers of health & social care o Non-commercial providers of social housing o Health & social care professionals o Staff of the Health Board and local authority who are not health professionals or social care professionals
o Third sector bodies carrying out activities related to health or social care • Engage with stakeholders to produce a Strategic Plan • Develop and implement a participation and engagement strategy
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• Ensure stakeholders are enabled to participate • Services must be planned using the integration planning and delivery principles and in order to do so stakeholders must be engaged in discussions about how services are planned and delivered.
3.0 Definitions
It is important to distinguish what we mean when we talk about communicating, consulting and engaging. In line with the draft Participation and Engagement Strategy currently in development the following definitions are being used.
Communication – Sending out key messages Consultation – Seeking feedback on a developed proposal Engagement – Building something together
4.0 Methods
A variety of methods have been employed by the Health and Social Care Partnership over 2014, 2015 and 2016 to ensure the participation of all stakeholders.
To date this has focussed on two stages: engagement around the integration scheme and vision & outcomes and consultation on the draft strategic plan.
• Engagement around the Integration Scheme and Vision and outcomes – These were mostly Face to face conversations were held across 2014 and 2015 in a range of fora, for example:
o Integration Scheme Meetings – January 15 o Public Engagement Event – March 15 o Staff Engagement Events – May / June 15 o Public Engagement Events – Sept / Oct 15 o Clackmannanshire Alliance on 4 December 2015
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• Consultation on the draft Strategic Plan - Stakeholders could provide their views on the draft Strategic Plan through four main routes
o Completing the online feedback form which was available on the Integration web page here http://nhsforthvalley.com/about-us/health-and-social-care- integration/clackmannanshire-and-stirling/
o Downloading the form and submitting in writing to the Freepost address below:
FREEPOST RRLS-JAXC-AZZE Clackmannanshire & Stirling Health and Social Care Partnership NHS Forth Valley Carseview House Castle Business Park Stirling FK9 4SW
o Emailing comments to [email protected] o Telephoning 01786 434049 • To make resources as accessible as possible the Partnership:
o Made printed materials available through a variety of locations and forums and on request (for the draft Strategic Plan this included an easy read version);
o Made documents available through the integration web pages; o Communicated with stakeholders through a range of media, including social media o Worked with colleagues in Learning Disabilities Services to develop an easy read version of the draft Strategic Plan.
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5.0 Engagement around Integration Scheme & Vision and Outcomes
In 2014 and early 2015 a series of conversations were held which focussed on: • building a vision and outcomes together • answering staff questions about integration • hearing comments on the Integration Scheme
In order to hold these sessions a review was conducted of existing Strategic Plans. There are a number of existing Strategic Plans which have been developed and implemented by partners over the last 5 years. Whilst not an exhaustive list these include:
• Local
o Clackmannanshire Council Single Outcome Agreement (2013 - 2023) o Stirling Council Single Outcome Agreement (2013 - 2023) o NHS Forth Valley Local Delivery Plan 2014 o NHS Forth Valley Winter Plan 2014-2015 o NHS Forth Valley Workforce Plan 2013-2014 o NHS Forth Valley Integrated Healthcare Strategy 2011 – 2014 / Clinical Services Review
o Strategic Commissioning Plan for Older People 2013 - 2023 o FV Falls Fracture Prevention & Bone Health Strategy 2008-2013 o Priority Based Budgeting o Making Clackmannanshire Better o Forth Valley Integrated Carers Strategy 2012 - 15 o Drug and Alcohol Strategy (2015) • National
o National Mental Health Strategy o National Keys to Life Strategy (Learning Disabilities) o National Dementia Strategy
There are a number of similar themes which emerge from the existing Strategic Plans, these can be summarised as:
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• Communities are inclusive and feel safer • Deliver faster access to clinical services • Frail elderly are supported and cared for in a way that suits them • People with complex comorbidities are enable and supported • Area of inequality are identified and minimised • Learning Disabilities – escape harm, shift culture, alter attitudes and cultures • Dementia – diagnosis, post diagnosis support, improve hospital care, safe and supportive home environments, and promote best practice in advanced care planning. • Mental Health – improve access to psychological therapies and more effectively link the work on alcohol and depression and other common mental health problems to improve identification and treatment
These themes were then utilised to form the basis of a workshop format which would engage stakeholders around the existing themes. Appendix I illustrate the outline template used by facilitators.
5.1 Feedback Received
The engagement work was carried out across 2014 and 2015, the detail of these events is summarised in appendix II, however to summarise:
• 23 sessions (including public events) were hosted or attended covering almost 400 people • 8 staff engagement sessions were hosted covering almost 300 people – a separate report summarising the output from the staff engagement sessions is available on the integration web pages.
As a result of these conversations a number of themes emerged as important to all stakeholders, these were:
1. Early intervention and prevention. The right care is delivered for me at the right time. “Sam can access the right service at the right time”
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“Sam and those who care about her know who to call and talk to if they needed help.”
2. Staff are skilled and supported to deliver person-centred and integrated care “Sam's care is wrapped around his needs, not the other way round.”
3. Service Users exercise Choice & Control. “Sam takes on responsibilities for his care and has fewer unnecessary intrusions in his life” Sam is supported to self-manage, He has better co-ordinated care, with fewer people involved, consistent faces that he knows, and the frequency of their involvement matched to his needs. “Sam has the information to make decisions about what he needs.” Sam is in control, having choice and ownership of his care (e.g. through self-directed support), including where and when care is provided.
4. Service users are supported to self manage and plan care proactively. “Sam is supported to plan for the future.” Sam has an integrated, single, shared care plan, which is regularly reviewed, and which is also anticipatory in nature. “Sam lives a life – not always dealing with a crisis.”
Those providing care and support proactively identify any change in Sam’s condition, avoiding the need for a subsequent crisis response.
5. Carers are supported to be partners in delivering care. “Sam’s carer is recognised as a key partner in his care.” Carers are themselves well-supported, their own needs having been assessed and met in a timely manner.
6. There is a focus on Rehabilitation Recovery and Reablement across all services. There are fewer avoidable admissions and discharge planning is effective and efficient. “Sam does not require unplanned, emergency, hospital care” If Sam is admitted to hospital; he experiences a smooth, safe and timely discharge
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7. Services work together with communities to improve access to services and build capacity – working with third sector, community groups across and within localities. This reduces health inequalities within and across our communities. “Sam is able to stay at home and participate in community activities" “Sam has access to additional, targeted information and advice to support him to manage his health care needs"
5.2 Conclusion
The above themes along with suggestions made during engagement sessions were then utilised to build the draft Strategic Plan.
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6.0 Consultation on Draft Strategic Plan
6.1 Introduction
Following the extensive engagement program described in section 5 and during the six week period of 18 November until 24 December 2015, the draft Strategic Plan was distributed to stakeholders widely; appendix III has the detail of this distribution. A total of 15 engagement events and meetings were attended where presentations were given and feedback sought.
6.2 Feedback Received
During the six week consultation period of 18 November until 24 December 2015 we received:
• 56 completed questionnaires from individuals
• 11 feedback summaries from specific sessions held on the Strategic Plan
• 17 written feedback summaries from specific organisations
• 37 equalities information questionnaires completed
A detailed breakdown of the information from the sessions and responses made is provided in Appendix 5 and a summary of comments made on the strategic themes and main issues raised is provided below.
6.2.1 – Individual Responses
Tables A and B detail the individual responses received.
Table A – Individual Responses Number of responses 56 In relation to Health and Social Care, does Yes 37 No 13 this Strategic Plan address the most important issues for you? If no, please give your reasons: 12 people provided further comment Have we missed anything else you would 35 people provided further comment like to tell us? If so what? Do you have any other comments you wish 43 people provided further comment to make? (required) Please use this page for comments not 11 people provided further comment
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covered within the questionnaire overleaf Contact Information 6 people provided their name and contact information – 4 indicated they would be happy to be contacted about the comments they provided. Which area do you live in? Clackmannanshire 4 Stirling 8 Blank 37
Table B – Individual Responses Themes Theme Number of comments made1 General Comment on Plan 20 Resources (time, capacity, finance) 10 Strategic Commissioning & Delivery 13 Transitions 2 Communication 0 Case for Change / Strategic Needs Assessment 2 Safety 0 Strategic Plan Theme 1. Early Interventions & Prevention 7 Strategic Plan Theme 2. Service users are supported to self manage and plan care 8 proactively Strategic Plan Theme 3. Service users exercise choice and control 4 Strategic Plan Theme 4. Staff are skilled and supported to deliver person centred 5 and integrated care Strategic Plan Theme 5. Carers are recognised and valued as equal partners in the 2 delivery of care Strategic Plan Theme 6. Focus on rehabilitation, recovery and reablement 3 Strategic Plan Theme 7. Services work together with communities to improve access 7 to services and build capacity
6.2.2 Session Feedback
Tables C and D detail the session feedback received.
Table C – Session Feedback Number of sessions 11
Table D – Session Feedback Themes Theme Number of comments made2 General Comment on Plan 27 Resources (time, capacity, finance) 42
1 Please note this does not relate to the number of individuals commenting but rather the number of comments made, an individual could have made several comments in their response. 2 Please note this does not relate to the number of individuals commenting but rather the number of comments made, an individual could have made several comments in their response.
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Strategic Commissioning & Delivery 37 Transitions 42 Communication Case for Change / Strategic Needs Assessment Safety 43 Strategic Plan Theme 1. Early Interventions & Prevention 41 Strategic Plan Theme 2. Service users are supported to self manage and plan care 40 proactively Strategic Plan Theme 3. Service users exercise choice and control 39 Strategic Plan Theme 4. Staff are skilled and supported to deliver person centred 41 and integrated care Strategic Plan Theme 5. Carers are recognised and valued as equal partners in the 41 delivery of care Strategic Plan Theme 6. Focus on rehabilitation, recovery and reablement 44 Strategic Plan Theme 7. Services work together with communities to improve access 36 to services and build capacity
6.2.3 Organisation Feedback
Tables E and F detail the organisation responses received.
Table E – Organisation Feedback Number of organisations 17
Table F – Organisation Feedback Themes Theme Number of comments made3 General Comment on Plan 13 Resources (time, capacity, finance) 5 Strategic Commissioning & Delivery 9 Transitions 5 Communication 2 Case for Change / Strategic Needs Assessment 5 Safety 2 Strategic Plan Theme 1. Early Interventions & Prevention 5 Strategic Plan Theme 2. Service users are supported to self manage and plan care 7 proactively Strategic Plan Theme 3. Service users exercise choice and control 3 Strategic Plan Theme 4. Staff are skilled and supported to deliver person centred 6 and integrated care Strategic Plan Theme 5. Carers are recognised and valued as equal partners in the 5 delivery of care Strategic Plan Theme 6. Focus on rehabilitation, recovery and reablement 4
3 Please note this does not relate to the number of individuals commenting but rather the number of comments made, an individual could have made several comments in their response.
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Strategic Plan Theme 7. Services work together with communities to improve access 9 to services and build capacity
6.2.4 Equalities Information
36 people completed an equalities questionnaire and the summary of this information is below in table G.
Table G – Equality Data Equality Dimension Area 26 Respondents lived in Clackmannanshire, 9 in Stirling and 1 in Falkirk. Individual / Group 30 were responding as individuals, 3 as a group, 1 as an individual and group and 2 were left blank Stakeholder Group The majority of respondents were users of services as well as providers of unpaid care Gender 27 Respondents were female, 6 male and 3 declined to answer. Ethnic Group Scottish 17 Polish 14 English 2 British 1 Scottish & English 1 Religion Church of Scotland 10 Roman Catholic 8 Budhist 1 Church of England 1 Episcoopalean 1 Other Christian 3 None 5 Sexual Orientation Heterosexual / straight 30 Prefer not to answer / blank 6 Age The average age of respondents who completed the equalities information was 49, with the oldest being 76 and youngest 19.
6.3 Themes and Issues Raised During the Consultation
The majority of respondents (almost three quarters) and participants in the sessions held to discuss the plan were supportive of the approach outlined. However a significant number of comments were made in terms of suggested additions, improvements or issues that should be addressed in developing the integration agenda. Those who indicated they were not fully supportive almost a quarter) also made a number of comments on what could be included and the
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issues that they thought should be addressed. The comments are summarised in the following sections: • General comments on the Plan • Comments Provided on Strategic Themes • Other Issues Identified
6.3.1 General Comments on Plan
While the integration plan was supported by the majority of respondents a number of comments were provided both in support, but also highlighted concerns.
Support for integration plan:
• Yes, it is a good idea to have this partnership. • The easy read version is the most refreshing report I have read in a long time. Plain language, not too long, readable. • The following was appreciated and identified as working well:
o Adopting a ‘big picture’ / high level approach for the Plan o Provision of an ‘easy-read’ version. o Wording of the key themes and ambitions (described as ‘powerful’ by one group member).
o Clear description of the ‘sources’ that informed the development of the Plan and the evident alignment of staff and public / service user views (having looked at staff engagement outputs earlier) .
o Use of case studies and the ‘Sam’ outputs from staff engagement sessions. o Clear, simple and well-used graphics, with emphasis on the service user. • We should demonstrate good practice by identifying where things work and supporting positive work. • A good overall ethos for services
Concerns about the Integration Plan:
• This "plan" is all "motherhood and apple pie." We need to know exactly how services will improve and savings will be made.
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• What needs to be done in a practical sense to actually achieve the aspirational outcomes set out in the strategic plan? • The plan does not set out the level of detail that I expected. • A number of comments were made about the Integration Joint Board including its size, ability to set the strategic direction and hold Executive Officers to account, creation of more administration, and cost associated with creating another public body. • There appears to be no clear statement in relation to what this means for services / teams and the ways in which services will be delivered. Although the specifics of this may not be clear at this time, for example, perhaps it might be helpful to include a statement to explain that e.g. this will be based on and driven by ‘need’ and so, the outcome may look different for each team / service . • Some group members felt that the Plan read as predominantly ‘Health’-oriented (e.g.: emphasising a ‘medical model’ of health on the whole; use of terms such as ‘managing health conditions’, case studies used etc.). • The document is colourful and engaging but somewhat weighty. • Difficult to see the connection as to how this will work and be better • Whenever I see changes I want to be reassured it is for the better and not just a temporary stop gap.
6.3.2 Comments Provided on Strategic Themes
The comments received on the strategic themes were broadly supportive with a number of comments received. The strategic themes are: • Strategic theme 1: Early Interventions & Prevention • Strategic theme 2: Staff are skilled and supported to deliver person-centred and integrated care • Strategic theme 3: Service Users exercise Choice & Control. • Strategic theme 4: Service users are supported to self manage and plan care proactively. • Strategic theme 5: Carers are supported to be partners in delivering care. • Strategic theme 6: There is a focus on Rehabilitation Recovery and Reablement across all services. There are fewer avoidable admissions and discharge planning is effective and efficient.
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• Strategic theme 7: Services work together with communities to improve access to services and build capacity – working with Third Sector, community groups across and within localities. This reduces health inequalities within and across our communities.
A summary of comments is provided under each strategic theme below:
Strategic Plan Theme 1 - Early Interventions & Prevention
The main focus of comments in relation to this theme focussed on the importance of: • Early intervention and the different options for different groups in addressing preventative health promotion • The importance of mental health, self esteem and loneliness as well as physical issues • The importance of food and nutrition and easing access to help and support
Strategic Plan Theme 2 - Service Users are Supported to Self Manage and Plan Care Proactively
A number of comments were made in relation to this theme with a focus on: • The link to Self Direct Support and how this is currently managed (see theme 3) • The need for a focus on self management • Access to a minimum level of help, support monitoring and evaluation • Access to a coordinator “named person” to manage the complex interface with a range of services • Development of peer support relationships and initiatives • The role of education, training and access to information • A number of comments highlighting good practice or initiatives that could be rolled out • The role of professionals and the need to adapt to the issues impacting on individuals i.e. ”moved beyond the system or conveyor belt approach”
Strategic Plan Theme 3 - Service Users Exercise Choice and Control
A number of comments were made under this theme with a focus on: • How Self Directed Support is being implemented and changes required
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• Access to advocacy and support to help • Difficulty in accessing serves in rural areas • Organisation of services can be “confusing and stressful”
Strategic Plan Theme 4 - Staff are Skilled and Supported to Deliver Person Centred and Integrated Care
The comments on this theme covered the following main areas: • Flexibility of workforce • Trained and skilled workforce • Sharing information • A separate report has been developed following an Organisational Development session held in November which also highlighted a number of implications for the future and highlighted a number of aspirations for the future for staff and services. A summary is provided below. • There is a multidisciplinary agency team approach to meeting service users needs • Communication between all staff is easier and better with consistent up to date sharing of information (including single shared assessment) • Team members are clear regarding their own and colleagues roles “which ensures that the right person is doing the right job at the right time” • Staff describe an aspiration for well managed resources and capacity which will further allow access to special support time with and focussed on the service user • Staff are more engaged and involved, experiencing lower levels of stress and sickness absence • Systems are simple and clear, user friendly and easy to navigate. There is improved efficiency and avoids duplication • Efficient, easy to use, integrated IT systems are in place, which all services can access and update enabling ease of information sharing and more efficient use of staff time
Strategic Plan Theme 5 - Carers are Recognised and Valued as Equal Partners in the Delivery of Care
Comments on this theme covered the following main issues:
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• Need to address the needs of all carers irrespective of age and ensure their health needs are met • Providing support to carers that recognises their individual requirements and needs of the person they are caring for • Specific needs of carers in difficult circumstances, parenting , gender, end of life care and beyond etc • The issue of “Kinship Carers” and the role of grandparents etc • Need to recognise the role of unpaid carers as being equals at all levels to the integration process from planning to delivering supportive care.
Strategic Plan Theme 6 - Focus on Rehabilitation, Recovery and Reablement
Majority of focus of comments was on role of Third Sector, gaps in relation to housing and aids and adaptations, “red tape and bureaucracy” and gaps in rural areas.
Strategic Plan Theme 7 - Services Work Together With Communities to Improve Access to Services and Build Capacity
• Rurality and access to services and support and need to develop a rural plan / strategy • Transport and access to acute and other services • Disability not barrier to services • Cross boundary working between services especially when accessing services in other NHS Board areas or getting repatriated from service • Equality of access to services • Supporting communities in relation to developing service provision.
6.3.3 Other issues indentified
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Role of Third Sector in relation to working as equal partners, delivery of services for example mental health, housing, acting as a single point of contact and collocation.
Resources which covered following: • The lack of information in plan, difficulty in accessing affordability having a negative impact • Capacity issues around availability of staff and ability to meet rising demand. • Time in relation to short term funding of projects
Strategic Community and Operational Actions covering the following areas: • Discussion on how services are commissioned and impact on families for example travelling to services out with the Forth Valley area • Delivery of services and how this will be achieved including clients views, effectiveness and impact • Issues around what will happen to services not mentioned in the plan for example Maggie’s Centre, technology Enabled Care, use of premises such as GP Practices • Discussion about services in relation to aids and adaptations, housing • Impact on staff terms and conditions including statutory, voluntary and independent sector providers • The role of effective use of volunteers
Transitions between Services which focussed on: • Transferring of services for children and young people to adult and recognising impact of childhood trauma on adults and the need for adult care services • Between services for adults for example discharge from hospital to community housed services that are more effective and reduce distress • Identifying examples of good practice and rally them out across the system • Raising awareness of what is available and improving collaboration between professional and developing skills through building on learning
Communication was highlighted as being important, including: • With the client being supported at all stages and being honest at what can be achieved • Sharing information identified as being important
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• Better communication strategy between services including housing, social work and health
Case for Change mainly related to specific issues around formatting, exclusions and presentation Technology Enabled Care was highlighted as an omission from the strategic plan with examples given around information systems, role in future service provision and overcoming barriers to deliver care
Monitoring Improvements / Outcomes was a theme where a number of comments were made primarily in relation to: • Clarification around links between national and local outcomes identified in the plan – the value of local outcomes vs national • A number of comments on “how will we know” if it has worked • Should be a focus on improving outcomes for the individual • Are the outcomes as described too idealistic given the financial situation and increasing levels of activity
6. 4 Impact of Consultation
There are a number of issues raised within the comments made on the Draft Integration Plan that are more applicable to some of the mechanisms that are being developed in relation to the delivering the integration agenda for example Locality Planning, Stakeholder Engagement Plan or the Organisation Development Plan. The detailed comments will be given to groups taking these processes forward.
Table H below summarises what action has been taken so far as a result of comments made.
Table H – Action taken so far You Said the following were important.... Action Taken It was important to acknowledge the role of We have amended some of the SAM journeys unpaid carers in supporting individuals to live to reflect this well in communities It was important to consider safety when We have added safety to Janet and Mr Brown supporting individuals to live well in case studies communities Say more about what this would mean for the Added some more information about people of Clackmannanshire and Stirling aswell Commissioning Services. as staff working in the Partnership. Be clearer about what the charts and tables of Amended these to be clearer and added
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data in the case for change are saying statements around what the charts or tables are telling us. To refer to other conditions in the case for Added a statement that describes the Strategic change such as cancer, mental health, Need Assessment which has been developed neurological conditions, drug and alcohol use. and will be published on the Integration web page, which holds more detail than can be provided in the Strategic Plan. Include the number of households where an Unfortunately we are unable to do this as the older adult or couple has moved in with their Scottish CENSUS (data this table is created family. from) does not collate this information in their fixed responses. Describe how people will be involved in the new Added a paragraph describing the work being Partnership taking forward around Participation and Engagement. How will we know that what we are doing is Added a paragraph to provide information on working performance framework development. What will happen next We have added a next steps section which outlines some of the further work required.
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7.0 Summary & Conclusions
7.1 Summary
Through the extensive engagement and consultation work carried out in the Partnership over the last 18 months we have been able to build a Strategic Plan together which speaks to what is important to all stakeholders going forward.
7.2 Lessons Learned
In any consultation exercise it is important to reflect on what went well and could be done again, what could have been better and any new ideas to be considered for the next consultation exercise. The Strategic Plan working Group has considered this and believes that there are a few items to consider:
Table I: Lessons Learned What went well? • Engagement with the consultation has been encouraging and future engagement work would seek to capitalise on this work. • Partnership working with third sector organisations, third sector interfaces and local communities to support the engagement and consultation processes. • Distribution of the plan through existing networks What could have been better? • Time constraints meant the consultation period was shorter than the Partnership would have preferred and in the next cycle of Strategic Plan development for 2020 – 2023 the Partnership will begin engagement for development work earlier. • The consultation questionnaire posed very open questions, whilst this was by design as wanted to ensure as open a dialogue as possible this made coding and categorising responses challenging. Ideas to consider for next • Use of a smart phone app to support distribution of consultation? information • Making Strategic Plan available in html mode online to support accessibility
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7.3 Participation and Engagement
Building on the extensive engagement we have taken forward during 2014/2015 we are in the process of developing a Participation and Engagement Strategy which will set out key principles for participation and engagement with all stakeholders. A key element of this will be the development of Locality Planning which sets out how we will ensure the engagement of local communities in the delivery of future plans and services.
8.0 References
Scottish Government (2015), Integration of Heath and Social Care [Online]. Available at http://www.gov.scot/Topics/Health/Policy/Adult-Health-SocialCare-Integration (6 January 2016)
Scotland. Scottish Parliament. Scottish Parliament (2014) Public Bodies (Joint Working)(Scotland) Act. Place of publication, The Stationary Office (2014 asp9).
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9.0 Appendices
Appendix 1 – Strategic Themes – Workshop Template Priority Meaning What might that look like? Preventative and • Community capacity building • Improving public health through increased use of use of a variety of approaches, such proactive supports in • Capability and resilience of as: smoking cessation clinics; walking groups; the community communities • Maximise the potential of the Key Information Summary (KIS) and improve the focus • Keeping people “well” on Anticipatory Care Planning (ACP) • Improved signposting and navigation – Bo’Ness Project, NHS Inform, Living It Up • Improved working with the Third Sector • Expansion of social prescribing models including direct access to low intensity psychological therapies and health literacy. • Increase access to low level psychological support • Influencing public transport plans, not only to support access but as a key component in an asset based approach to health and wellbeing. Care is provided as • Providing care in the right place • Reducing delayed discharges so that people are receiving the right care in the right close to home as for individuals place possible • Reduce reliance on institutional care as final destination (e.g. number of Care Home places purchased) • Reducing presenting demand at A&E • Stirling Care Village transitional Care Hub Model as a key enabler Support for unpaid • Involving carers in care planning and decisions about the people they care for carers Redesign of high cost • Shifting the balance of care • Providing more care at home and in the community services • Reverse increase in numbers of Emergency Admissions to hospital • Increase number of patients “Discharged to assess” (reduce occupied bed days in FVRH for people ready to move on to next stage of care) • Stirling Care Village transitional Care Hub Model as a key enabler Help people to help • Enablement • Involving unpaid carers in care giving themselves • Self Management • Technology enabled care supporting people and their families • Providing care at the right time • Increase availability of 24/7 services
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for individuals • Improving Care Processes between Health and Social Care. This would include single • Short term, recovery based points of access to services; multidisciplinary case management at GP level for services complex patients; streamlined (direct) access to health and social care services e.g. housing adaptations. • Stirling Care Village transitional Care Hub Model as a key enabler Tackling & reducing • Links to redesign • Targeting commissioned services by building in targeting in communities which inequalities • Targeting provision of experience inequality, e.g. Those living in areas of inequality are provided with free commissioned services where access whilst others would pay a contribution there is the greatest need Effective support at • Dignity and respect • Improving infrastructure to support better communication and a more streamlined times of transition • Seamless / integrated care care process between Health and Social Work. • Efficient processes for moving • Stirling Care Village transitional Care Hub Model as a key enabler from one level/type of service to another • Providing the right service at the right time Protecting the most • Adults with Incapacity • Expansion of Anticipatory Care Models, intermediate care and rehabilitation at home vulnerable people • Adult Support and Protection and wider availability of community services 24/7. Linked with these is a priority to • Mental Health Act build capacity for some key services including District Nursing, AHPs, and Community Mental Health Services. • Continued focus on tackling health inequalities and maintaining support to people who require significant support to address substance or lifelong serious mental health problems
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Appendix 2 – Summary of Engagement Conversations Integration Scheme & Integration Sessions
Opportunity Date Lead Status
social
commercial providers of commercial providers of commercial providers of
- - -
Number of People professionals Health Users of health care Carers of users of health care Commercial providers of health care Non health care Social care professionals of Users social care care of social users of Carers Commercial providers of social care Non social care Staff of the Health Board and not are who authority local or professionals health professionals care Non social housing out carrying bodies sector Third activities related to health or social care Joint Management Team 28/11/14 Lesley Fulford Complete 1 X X X 0 Clacks CHP Sub Committee 02/12/14 Lesley Fulford Complete 1 X X X X X X X 5 Reshaping Care Strategy 08/12/14 Lesley Fulford Complete 1 X X X X X Group 5 Stirling CHP Sub 13/01/15 Lesley Fulford Complete 5 X X X X X X X Committee Area Clinical Forum 15/01/15 Lesley Fulford Complete 2 X X 5 Mental Health Services 21/01/15 Helena Scott Complete 2 X X Users & Carers 5 Carers Community House 12/01/15 Ian McCourt Complete 1 X Coffee morning 0 Stirling Carers Centre 29/01/15 May Kirkwood Complete 2 X X Carers Voice Meeting 0 Area Medical Committee 03/02/15 Scott Williams Complete 1 X 0 Older Peoples Reference 04/02/15 Lesley Fulford Complete 1 X X Group 6 Third sector session 11/02/15 Alasdair Complete 2 X Tollemach 0
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LD AHP Team Leads 16/02/15 Sheila Wason Complete 5 X Charge Nurse / CPN Forum 26/02/15 Ross Cheape Complete 1 X 0 Staff Session 06/02/15 Chris Sutton / Complete 1 X X Lesley Fulford / 0 Divya Prakash Staff Session 09/02/15 Chris Sutton / Complete 1 X X Lesley Fulford / 0 Divya Prakash Staff Session 11/02/15 Chris Sutton / Complete 1 X X Lesley Fulford / 0 Divya Prakash Public Meetings 07/03/15 Chris Sutton / Complete 3 Rural Stirling Lesley Fulford 0 X X X X Stirling City Clackmannanshire
Public Events Opportunity Date Lead Status
authority who are not are who authority commercial providers of commercial providers of commercial providers of
- - -
Number of People professionals Health Users of health care Carers of users of health care Commercial providers of health care Non health care Social care professionals of Users social care care of social users of Carers Commercial providers of social care Non social care Staff of the Health Board and local professionals care Non social housing out carrying bodies sector Third activities related to health or social care health professionals or social or social professionals health Stirling City 30/09/15 Shiona Complete 35 X X X X X X
Strachan Kilearn Village 01/10/15 Shiona Complete 15 X X X X X X
Strachan Alloa 07/10/15 Shiona Complete 25 X X X X X X
Strachan
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Staff Events
Opportunity Date Status
of health care commercial providers of commercial providers of commercial providers of
- - -
Number of People professionals Health Users Carers of users of health care Commercial providers of health care Non health care Social care professionals of Users social care care of social users of Carers Commercial providers of social care Non social care Staff of the Health Board and not are who authority local or social professionals health professionals care Non social housing out carrying bodies sector Third activities related to health or social care Town Hall, Alloa 26/05/15 Complete 9 X x x Killearn Village Hall 29/05/15 Complete 13 X x x x x x x Lesser Albert Hall, Stirling 02/06/15 Complete 34 X x x x x x x Town Hall, Alloa 03/06/15 Complete 23 X x x x x x x Sauchie Hall, Alloa 08/06/15 Complete 49 X x x x x x x Old Viewforth, Stirling 09/06/15 Complete 34 X x x x x x x Stirling Community Hospital 22/06/15 Complete 27 X x x x x x x Town Hall, Alloa 29/06/15 Complete 35 X x x x x x x
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Appendix 3 – Summary of draft Strategic Plan distribution Forum Detail Contact Name Method of Distribution Status Opticians NHS mail distribution list 1 Email for posting Email sent Poster sent to opticians Hard copies sent to display Dentists NHS mail distribution list 1 Email for posting Email sent Poster sent to dentists to Hard copies sent display Pharmacy NHS mail distribution list 1 Email Email sent Poster sent to Hard copies sent Pharmacy’s to display Leisure Centres The Peak Jane Neil 1 0300080101 Hard copies sent [email protected]. Leisure Bowl Alloa Ask at reception uk Posters sent to display Rent Offices • Aberfoyle Local Office 1 Posters sent to display Hard copies sent Main Street, Aberfoyle, FK8 3UQ • Balfron Local Office 32 Buchanan Street, Balfron, G63 0TR • Bannockburn Library and Council Office Tel: (01786) 237870 (01786) 237870 • Callander Local Office South Church Street, Callander, FK17 8BN • Cornton Local Surgery
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Tel: 01786 451136 01786 451136 Cornton Community Centre Johnston Avenue, FK9 5BW • Cowie Local Office Old Schoolhouse Main Street, Cowie, FK7 7BL • Customer First Local Office Tel: 0845 277 7000 0845 277 7000 5 Port Street, Stirling, FK8 2EJ • Dunblane Local Office Burgh Chambers, The Cross • Fallin Local Office, 6-8 The Square, Fallin Tel: (01786) 814018 (01786) 814018 • Killin Local Office 8 Lyon Villas, Lyon Road, Killin, FK21 8TF • Raploch Local Surgery Tel: 01786 272306 01786 272306 Raploch Community
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Campus Drip Road, FK8 1RD
Alloa - 8 Bank Street Alva Community Access Point, 153 West Stirling Street, Alva Clackmannan Community Access Point, Main Street, Clackmannan Dollar Community Access Point, Dollar Civic Centre, Dollar Menstrie Community Access Point, Dumyat Centre, Dollar Sauchie Community Access Point, Main Street, Sauchie Ben Cleuch Centre, Park Street, Tillicoultry Tullibody Rent Office, Tron Court, Tullibody
Health Buildings FVRH 1 Poster and hardcopies Hard copies Clackmannanshire Community Stephanie McNairney sent for display. delivered Health Centre Stephanie McNairney Email for posting Stirling Community Hospital Supermarkets 1 Posters taken with request to Manager to display.
Community Centres? TBC 1 / Poster and hardcopies Hard copies sent 2? sent for display. Email for posting Local Resilience Partnerships 2 GP’s 57 Practice Managers Forum 2 Poster and hardcopies Email sent NHS mail distribution list sent for display. Hard copies sent Email for posting
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Libraries Clacks - Morag Hunter 2 Poster and hardcopies sent for display. Stirling – Lindsay McKrell Drop copies into Speirs centre and they will distribute. Ask librarians at libraries and library bus to highlight poster and sign post people. Copies to be dropped into Spingkerse and Speirs Centre Council Buildings Old Viewforth TBC – SM liaising with 2 Poster and hardcopies Hard copies to Kilncraigs Viewforth to arrange sent for display. Margaret for Ludgate Margaret Robbie Email for posting distribution – Riverbank 24.11.15 Muncpal Buildings Teith Allan Water Endrick Sensory Centre Charlene Condecco 3 01324 590888 Hard copies sent (Jacquie Winning – Centre Email and send poster to Manager) display Public Partnership Forum’s Is there a Citizen’s Panel that Jessie Jessie Anne Malcolm 3 Email Email sent could include in her emailing? Patient Public Panels TBC – Helena Buckley 3 Email Email sent CHP Sub Committees? Kathy O’Neil 3 Email Email sent ?? Clacks Older Peoples Reference Group Flo McKenzie 3 Email Email sent Older Peoples Forum Claire McDonald 3 Email Email sent Community Councils TBC 3 Email Carers Centres Stirling Carers Centre May Kirkwood 3 Email and send poster to Email sent Clackmannanshire Ian McCourt / Agnes display Hospice Marjory MacKay 3 Email and send poster to Email sent
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display Scottish Health Council Via any distribution networks they Derek Blues 3 Email Email sent may have Third Sector Interface and Sector Clackmannanshire Liz Rowlett 3 Email and send posters Email sent through engagement officers Stirling Polly Roger to display Hard copies sent Professional Advisory Committees Allied Health Professionals Bette Locke 3 Email Email sent Area Clinical Forum Dr Allan Bridges Area Medical Forum Dr Allan Bridges General Practice (GP) Sub Dr James King Committee Allison Ramsay Area Nursing and Midwifery Andrew Baird Advisory Committee (ANMAC) Area Optical Committee SMT & CMT Kathy O’Neil & Val De Souza 3 Meetings? Email sent CPPs Stirling Stacey Burlet 3 Email sent Alliance Stuart Crickmor Locality Coordinators Scott Williams 3 Meetings & Email? Email sent Housing Associations Via Housing Departments Susan White 3 Email and send posters Email sent Steve Mason to display CSREC Arun Gopinath 3 Arun.Gopinath@centrals Email sent cotlandrec.org.uk Email and send posters to display MSPs TBC 4 Board Members 4 Email sent Councillors - Stirling Mary Bright 4 [email protected] Councillors - Clacks 4 Community Councils Jessie Anne - Stirling 4 Email sent Clacks - ?? Adult Care Providers 4 Email sent Stirling University Marketing and PR Team 4 [email protected] Email sent 01786 467058 Hard copies sent Email and send poster to
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display Forth Valley College Lyndsay Condie 4 Lyndsay.condie@forthva Email sent lley.ac.uk Hard copies sent 01324 403116 Email and send poster to display Managed Clinical Networks David Munro 4 Email Email sent Public Consultation List NHS mail distribution list 4 Email Email sent Managers For dissemination through Val de Souza 4 Email Email sent networks and to relevant groups. Phillip Gillespie Chris Sutton Louise Johnston Linda Melville Maureen Dryden Janice Young Kathy O’Neill Rhona Morrison Lorraine Robertson Bette Locke Fiona Gordon Phil Cummins Integration Joint Board Members Distribution List 4 Email Distribution List Email sent Strategic Planning Group Members Distribution List 4 Email Distribution List Email sent Fair For All Committee Angela Wallace Jackie McEwan 4 Email sent Lynne Waddell Reshaping Care Strategy Group Bette Locke / Philip Gillespie 4 Email Distribution List Email sent Keep Well Bernie Silver Email sent [email protected] Living It Up Janet MacDonald Email sent [email protected] Clackmannanshire Healthier Lives Norrie Moane 1 & Email sent 4 Scottish Ambulance Service Julie Shields 1 & Email for posting Email sent
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4 Fire Service Gordon Pryde 1 & Email for posting Email sent 4 Police Scotland Fiona Murphy 1 & Email and send posters Email sent 4 to display Hard copies sent Independent Care Homes Margaret McGowan 1 & Email and send posters Email sent 4 to display Disability Access Groups 1 & Email and send posters 4 to display Tenants and residents Association 1 & Email and send posters 4 to display Additional means of communication Local Radio Article / interview for radio Comms Team Radio Royal Comms Team Alloa Advertiser Press release Comms Team Stirling Observer Neighbouring Partnerships to consult with East Dunbartonshire Chief Officer – Karen Murray Email sent Programme Manager - [email protected] v.uk Fiona McCulloch: [email protected]. uk Falkirk Chief Officer – Tracy McKigen Email sent Programme Manager – Suzanne Thomson Fife Chief Officer – Sandy Riddell Email sent Programme Manager - [email protected] [email protected] North Lanarkshire Chief Officer – Janice Hewitt Email sent Programme Manager - Ross
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McGuffie: [email protected] t.nhs.uk Euan Duguid: [email protected]. nhs.uk SharonSimpson [email protected] cot.nhs.uk Brain McAteer: [email protected] k South Lanarkshire Chief Officer – Harry Stevenson Email sent Programme Manager - MartinC.Kane@southlanarkshir e.gcsx.gov.uk [email protected]. nhs.uk Perth & Kinross Chief Officer – Robert Packman Email sent Programme Manager - Lorna Cameron [email protected]
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Appendix 4 – Strategic Plan Specific Consultation Sessions Opportunity Date Lead Status
ers of
of social care commercial providers of commercial providers of commercial provid
- - - Number of People of Number professionals Health Users of health care Carers of users of health care Commercial providers of health care Non health care Social care professionals Users care of social users of Carers Commercial providers of social care Non social care local and Health Board the of Staff health not are who authority care or social professionals professionals Non social housing out carrying bodies sector Third activities related to health or social care Clacks PPF Coordinating 03/11/15 Robert Complete 4 x x x x Group Stevenson / Chris Sutton Reshaping Care Strategy 26/11/15 Lesley Fulford Complete 10 x x x x x x Group Stirling PPF Coordinating 11/11/15 Robert Complete 4 x x x x Group Stevenson / Chris Sutton AHP Professional Advisory 11/11/15 Lesley Fulford Complete 10 x Committee Stirling Carers Voice 12/11/15 Shiona Complete 18 X X Strachan / Lesley Fulford GP Sub Committee 17/11/15 Shiona Complete 18 x Strachan Stirling PPF 18/11/15 Robert Complete 35 x x x x Stevenson / Chris Sutton / Lesley Fulford Joint Management Team 19/11/15 Shiona Complete 15 x x x x Strachan
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Opportunity Date Lead Status
commercial providers of commercial providers of commercial providers of
- - - fessionals Number of People of Number professionals Health Users of health care Carers of users of health care Commercial providers of health care Non health care Social care professionals of Users social care care of social users of Carers Commercial providers of social care Non social care local and Health Board the of Staff health not are who authority care or social professionals pro Non social housing out carrying bodies sector Third activities related to health or social care Clackmannanshire Carers 25/11/15 Lesley Fulford Complete 15 x x x x Forum Clackmannanshire Alliance 4/12/15 Shiona Complete x x x x x x x x x x x Strachan Stirling Community 7/12/15 Shiona Complete x x x x x x x x x x x Planning Partnership Strachan NHS Forth Valley Health Shiona Complete x x Board Strachan Stirling Elected Members 15/12/15 Shiona Complete x Briefing Session Strachan NHS Forth Valley 17/12/15 Shiona Complete x x Corporate Management Strachan Team Clackmannanshire Council Shiona Complete x x Strachan SVE Session Complete x x cTSI Session Complete x x
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Appendix 4
‘ A WORKFORCE FOR INTEGRATION’ –
A report summarising the outputs from an initial phase of engaging the Clackmannanshire and Stiling Partnership workforce in relation to the integration of Health and Social Care.
Prepared by: Divya Prakash, OD Advisor On behalf of the Clackmannanshire and Stirling Partnership OD & Workforce Development Group
14th August 2015 CONTENTS:
Foreword Page 3
Introduction Page 4
Overview of engagement sessions Page 4
Number of sessions and participants Page 5
Themes from participants’ evaluation of sessions Page 5
WHERE ARE WE NOW? Page 6
What is working well already in terms of integrated working? Page 7
What could be better and what are some of the challenges Page 11 for integration
What the picture currently looks & feels like for ‘SAM’ and Page 14 services / staff
WHERE DO WE WANT TO BE? Page 14
Aspirations for the future of ‘SAM’ Page 14
Aspirations for the future of staff and services Page 16
What the picture would look & feel like for ‘SAM’ and Page 17 Services / Staff
WHAT ARE STAFF PERCEPTIONS – FEARS AND HOPES? Page 18
Fears and potential barriers to success Page 19
Hopes and potential enablers to success Page 21
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FOREWORD:
Clackmannanshire Council, Stirling Council and NHS Forth Valley are working together in a new way to bring together Health and Social Care services. The purpose is to deliver better outcomes for our service users. Specifically, we want to ensure that people live healthier, longer lives, can be independent and have choice and control, no matter who they are and where they live in the Clackmannanshire and Stirling areas. We are committed to working alongside all our partners in making this vision a reality.
Recognising the critical role of our workforce in determining the success of this approach, we believe that it is essential that our planned approach is appropriately informed, and importantly ‘owned’, by those who work most closely with our service users, their families and carers and their local communities. To that end, staff across health, Local Authorities, Third and Independent sector organisations came together recently to share views on how services are currently being delivered and their vision, hopes and fears for the changes they wish to see in making integration a reality.
This report summarises what our workforce described as their views of the current picture and their aspirations for the future of Health and Social Care. Participants identified many existing examples of effective collaborative working between different disciplines and agencies which are already contributing to improved outcomes for service users. However, there are also aspects that are not as integrated as we would wish and participants identified several considerations to enable outcomes to be improved further still.
We are strongly committed to making best use of this valuable source of information in further informing our strategies and commitments to plan and deliver services for both, current needs and needs of people in the future. We recognise that this is a first phase of engagement and our ongoing commitment is to continue this dialogue as the process develops. We will ensure that the information captured in this report is shared widely and further resources and initiatives are developed for staff engagement across the partnership.
Shiona Strachan
Chief Officer
Clackmannanshire and Stirling Health and Social Care Partnership
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INTRODUCTION:
During May and June 2015, an initial phase of staff engagement on Health and Social Care Integration was undertaken across the Clackmannanshire and Stirling partnership. The purpose of this facilitated face-to-face dialogue was to:
‘Plant the seed’ in terms of the potential benefits of integration and the changes which might require to be made in order for them to be realised Improve understanding of and respect for one another’s respective roles within a workforce for integration Answer, as fully as possible, any questions which staff might have and to alleviate any potential anxieties Improve awareness & understanding of Health & Social Care Integration.
This report outlines key themes from the data collected during interactive workshop part of the sessions, particularly in relation to: • Participants’ views on what the picture looks like ‘NOW’ for services users, staff and services • Participants’ views on what the picture should look like for the ‘FUTURE’, to help us achieve the vision for Health and Social Care Integration • Feedback in relation to staff experiences and perceptions regarding the current period of change and direction of travel.
The purpose of this paper is to inform further discussions in the Partnership in relation to strategic planning and consequently, further phases of staff engagement. It is also intended that key themes of feedback will be shared with staff and the information collected also used to inform the development of a ‘toolkit’ for staff and managers, to encourage their ongoing engagement in the process for Health and Social Care Integration.
Please note: The themes and ideas presented in this report are based solely on the perception of those who participated in the engagement process, either via pre-information for the sessions or during the sessions themselves. As such, the points cited should not be viewed as ‘universal’, but rather providing a snapshot from which to undertake further, more in-depth analysis and inform strategic planning.
OVERVIEW OF ENGAGEMENT SESSIONS:
Delivery took place via 8 sessions across the Clackmannanshire and Stirling area. Each 2.5 hour session included an initial presentation on the Partnership vision for Health and Social Care Integration and our planned approach to-date, followed by individual and table group exercises, focussing on the person at the centre of health and social care services (i.e. ‘SAM’, a typical service user, used as an example). These exercises aimed at exploring: • Examples of good practice and what is working well already, that supports the vision for health and social care integration
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• What could be better and some key challenges in achieving the vision • What the future could look like for ‘Sam’ on achieving this vision • What the future could look like for staff and services • Staff perceptions in relation to the integration agenda and their role in its delivery i.e. individual hopes, fears and expectations for the future of health and social care. (Participants were also asked to take away their own ‘pledges’ at the end of the session, recognising their individual roles and commitment in making integration a reality.).
The 8 sessions were attended by 215 participants and facilitators from across Clackmannanshire and Stirling Councils, NHS Forth Valley, and Third and Independent Sector partner organisations. A breakdown of attendance is as below: No. % Social Services 108 50.2% NHS Forth Valley 50 23.3% Third Sector 26 12.1% Integrated Community Teams 25 11.6% Housing 3 1.4% Independent Sector 1 0.5% University 1 0.5% Council Member 1 0.5% TOTAL 215
Overall, the sessions were well-received, with participants highlighting, for example, that they were taking away “a clearer vision of what integration means”, “positive thoughts”, “a pledge to share information with staff and keep involved fully in process”, and “a feeling of being listened to”.
Examples of comments provided include:
“It was slick, well thought out, one of the best things I have attended in a long time.” “Well run enjoyable event, well facilitated.” “Good discussions, everybody included, you did what you said you would, clear tasks.”
Key themes from evaluation from participants highlighting the following:
• They had an improved awareness and understanding of the current state of play and direction of travel in relation to Health and Social Care Integration.
5
“Good overview of planned changes, gained a much better understanding.” “Reassuring that we all want the same thing – the best for our service users.” “I think I am more convinced it is a good thing for all these changes, as I now know more about it. Session was most helpful.”
• They valued the opportunity of multi-disciplinary and multi-agency participation, which facilitated developing understanding of others’ roles and recognising shared hopes, fears and expectations.
“Good to speak to others in other departments/services. Good mix of staff, ease of contribution in small groups.” “Alleviated fears, positive opinion on change.” “Clearer understanding of integration services & that we are all anxious regarding change.” “Very engaging, enjoyed sharing views with other professionals.”
• The interactive format of the sessions allowed for exploration and sharing of views, while maintaining focus on the person at the centre of Health and Social Care.
“The workshop idea is excellent. Stimulates discussion and enables people to hear ideas thoughts from different services.” “The workshop sessions made you think about people and other needs.” “The layout of the sessions was interesting and informative. Good facilitators!”
• The sessions provided an opportunity for reflection and exploration on ‘transitions’ and participants’ own role and response to change.
“The focus on both individual & organisational change was good.” “I liked being reminded (nicely) of taking ownership of our own thoughts and process of change.” “Not as scary as I first thought.”
In terms of areas for improvement, when considering future sessions, participants requested that the timings of the session were considered to allow more time for a comfort break and in some cases, for more appropriate venues to be chosen (particularly in relation to acoustics). Some participants also highlighted that while they had found the session useful, they were keen to see follow-through on the commitments made, particularly in relation to receiving feedback on their contribution and its role in shaping next steps.
WHERE ARE WE NOW?
This section highlights key themes from participants’ feedback in relation to:
• What is working well already in terms of integrated working
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• What could be better and what are some of the challenges for integration • What the picture currently looks & feels like for ‘SAM’ and Services / Staff What is working well already in terms of integrated working?
In identifying examples of good practice in effective collaborative working, participants highlighted, in the main, their experience was that:
• The workforce across the agencies and organisations is very skilled, doing their best and committed to their jobs. • A range of examples and stories do exist that highlight positive experiences and outcomes for staff and service users. • What works well is often due to informal relationships and communication amongst staff across agencies and informal networks and advocacy by individuals (i.e. not necessarily due to formal structures and bureaucracy involved in setting these up).
The following are examples of effective collaborative working and integrated services highlighted:
1. Adult Day Services A range of examples of collaborative and multi-disciplinary team-working in delivering the service (e.g. NHS, Dieticians, Physiotherapists, Learning Disability Team, Nurses, Speech and Language etc.) were highlighted for their success in holistically addressing service user's needs and improving their health and well-being. “This way of working allows us to provide support whilst gaining insight from a trained professional. This positively impacts on a service user's care, which is the main priority.”
2. Intermediate Care Services and Rapid Response Highlighted specifically for examples of “joined up working and thinking 'on the coal face'”, the work of these services was cited as evidence for ensuring smooth transitions between services and tapping into the potential of the various services involved, in meeting outcomes for the service users.
3. Complex Care Reference was made to effective joint working between social work and the complex care team, in setting up and managing joint packages of support, resulting in good outcomes- focussed care planning.
4. Single Shared Assessment Reference was made to effective single shared assessment processes operating within some areas (with specific reference to Mental Health and District Nursing services). “Completing Single Shared Assessments & Carers’ Assessments on their behalf has enabled Social Services to focus on putting the support package together sooner.”
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5. Reablement and REACH • The Reablement Service involves a multi-disciplinary, multi-agency team working in partnership, to transfer older adults from acute hospital beds to a ‘halfway to home’ environment, prevent admission to hospital / care home and assist older adults to return home. It was highlighted that working alongside other professionals has enabled team members to gain a better understanding of one another’s roles, with the team learning to compromise with one another to enable setting of achievable goals for service users, in order to provide the best possible service. • The ‘Rehab at Home’ service, provided jointly by the Homecare 24/7 team and ReACH has improved outcomes for people who are keen to return to their previous level of independence/increase confidence following a period of stay in hospital. The service is described as continuing to evolve as a result of successful partnership working. “REACH Rural is successful in that the patients who I have referred have usually had good outcomes, also communication between REACH team and community nursing is very good.” (Social Worker)
6. Care Home Liaison Joint clinics between social work and the care home liaison nurse to prevent hospital admissions, as well as, Short term Assessment Bed Services at Allan Lodge and Beech Gardens were cited as excellent examples of collaborative working. “This is most effective, supportive and beneficial to the client group, when palliative care is being given as both services work together providing the best quality care.”
7. Integrated Mental Health Service • The single referral pathway was highlighted for its role in improving pathways to mental health services for service users and ensuring that service users have access to services in a quicker, more effective and more appropriate manner. • The development of integrated community mental health teams were mentioned as having supported improved team communication and more effective joint working, particularly as a result of co-location (e.g. Livilands Resource Centre). • The benefits of improved information sharing were cited in terms of ensuring that the level of input provided met individuals’ care needs, and enabling professionals to prioritise their time more effectively. “The development of an integrated mental health services has strengthened existing partnerships between statutory and third sector agencies.”
8. Older People’s Mental Health In relation to community Older People’s mental health services, reference was made to good communication and information sharing between nursing and social work staff, and in particular to acceptance of others’ assessments. Again positive working relationships were
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described, alongside specific instances of joint working which have supported improved outcomes for service users, such as: o conducting joint visits together o working together to source appropriate care providers o working together to provide and/or improve packages of care o assessing risks together and looking at ways to reduce them o attending case review meetings.
9. Learning Disabilities The work in Learning Disabilities was cited as providing a great model of integration, with a range of available services, and with service users and carers experiencing less duplication and avoidance of time wastage.
10. Care Programme Approach The Care Programme approach was mentioned in relation to both learning disabilities and mental health services, as providing a formal system which has helped to facilitate collaborative work. This is described as supporting a shared vision and goals, while maintaining clear professional identity and responsibility within the service user journey.
11. GP Practice Liaison Meetings Multi-disciplinary, multi-agency GP practice liaison meetings were cited as having helped with more effective communication and information sharing, particularly for those with more complex needs.
12. Discharge Discharge planning meetings, alongside discharge protocols, allowing good collaborative working between disciplines/agencies, were cited as supporting safe and effective discharge from hospital, whilst at the same time promoting independence (e.g. CCHC Ward 1 Rehab meetings with social work, REACH and ward staff). “All patients on ward, plans for discharge are discussed; this allows for knowledge to be shared and for all professions to be involved with planning.”
13. Anticipatory Care Planning and ‘Keep Well’ Programme • The multi-disciplinary, multi-agency approach to anticipatory care planning in some areas was cited as a good example of integrated working. • The Clackmannanshire Healthier Lives Programme was specifically cited as an example of effective work in partnership across Clackmannanshire, as a multi-disciplinary programme offering early intervention and anticipatory approaches. • The ‘Keep Well’ programme, a nurse led primary prevention programme, was also highlighted as an example of multi-disciplinary working to support service users with lifestyle and other social and environmental and psychological support services, as needed and identified by the service user.
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14. Tele-healthcare and MECS • Joint working was described between MECS and health staff, to provide technical solutions to some of the challenges for people with disabilities at home, in care homes and in hospitals. • The implementation of community falls bundles, and the establishment of a pathway for MECS assessors to directly refer service users who are falling to health colleagues, are cited as good examples of effective joint working.
15. Co-location of Community Care Teams Staff reported that they valued co-location for multi-disciplinary teams, as this encourages regular liaison and collaborative working. Benefits described include supporting better communication for referrals, encouraging services to ask for advice or signposting, and more effectively identifying/addressing difficulties that require both health and social work input.
16. Joint working between District Nursing and Care at Home This was cited in terms of enabling and supporting people to remain at home - for example, when District Nurses request a referral for crisis care or ongoing Care at Home support, or when an existing service user has changes to their care needs (e.g. skincare, equipment, palliative care).
17. Joint working with Third Sector, examples of those that are working well include: • Joint working between Older People’s Mental Health Services, Alzheimer Scotland and the Carers Centre providing support for people newly diagnosed with dementia and their carers. • Joint working with Action in Mind – E.g. Housing, Police, Money & Benefits 'surgeries' have been offered on their premises, enabling service users to access these in a 'safe' environment, that they are comfortable with. • Stirling Cares Voice (i.e. Stirling Carers Centre's carer engagement group), a group of local unpaid carers, working with local professionals across sectors to ensure that the needs and wishes of carers and the people they care for are taken into account and considered throughout the development of relevant programmes and strategies.
18. Dental Services • Staff highlighted Dental Action Plan Projects as examples of successful working relationships with Older Adults services / homeless services and Third Sector staff, in taking into consideration what matters to service users and the outcomes they want and expect from the service. E.g. training of care staff in oral hygiene measures for older adults in long term care. • The Childsmile Programme was also cited as involving close working, effective communication and information sharing with many other health care professionals and educational establishments (e.g. local schools and nurseries) to help improve the children's oral health.
19. Substance Misuse Services
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Participants cited that there has been joint working between Substance Misuse Services, Criminal Justice Services and the Voluntary Sector for a number of years, ensuring better communication between professionals, particularly for service users with complex needs.
20. Employability Service The work of the Employability Service was described as ensuring good partnership working and an integrated approach with NHS for a number of years, including the secondment of an Occupational Therapist to the service, to support service users whose health is a barrier to gaining employment.
21. Performance Measures Staff mentioned that working groups across health and social care services have been set up in order to agree performance measures, and are realising the benefits of collaborative working e.g. Social Service staff were invited to ‘readiness sessions’ to share information on the systems being implemented to capture service user information by NHS.
What could be better and what are some of the challenges for integration
Participants described the following characteristics that could be better, as part of the Service Users’ (and Carers’) experience in the current scenario: • Service Users experience difficulties in accessing the right service at the right time. • People are asked to provide the same information on multiple occasions. • Transitions from hospital to the community or between services can be confusing and challenging due to a lack of coordination and information-sharing. • Care is not consistently person-centred, i.e. there is need for improvement in terms of how professionals communicate and share information with service users, how effectively they involve service users in decisions and support them to take responsibility and ownership for their needs. “Confusing, patchy, not empowered and stressed.” “Overwhelmed, hopeless, not knowing who to call, lack of own wishes and thoughts being taken into consideration.”
Detailed discussion highlighted that there are a number of factors that contribute to cases where one or more of the above characteristics are part of the service user experience. These factors are categorised as follows.
In relation to staff and those who deliver services:
1. Staff are unclear as to who to contact and how. There is a lack of knowledge amongst service providers, as to what services are available, provided by whom and how these can be accessed (or an up-to-date source detailing this information). In particular, participants highlighted the need for better signposting of community-based sources of care and support.
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2. Staff are not always clear on the roles and responsibilities of others, or may underestimate (or indeed overestimate) their abilities. “Confusion regarding multiple services & professionals.”
3. Communication and information sharing within and between disciplines and services could be improved – e.g. staff described experiences of an inability or unwillingness to share information, or misunderstandings about what can be shared and with whom or that where information was shared, it was not consistent. Specific mention was made of multiple (rather than shared) assessments and its impact on service user experience. “Inconsistency in communication between workers.”
In relation to the ways in which services are delivered:
4. Care and support is not coordinated and not effectively reviewed, so as to change, stop or reduce provision where it is no longer needed. The lack of a key worker / link person is described is a key contributing factor to this. Participants are described this as a challenge particularly when transitioning between services (e.g. from children’s services to adult services). “It’s nobody’s job.” “Needs slip through the loop holes.” “Information at point of referral about what other services are involved already is missing.” “Main carer through default ends up managing care.”
5. There is a lack of consistency, with variable availability and quality of services in different locations and for different groups. Particular challenges in availability of services out with normal business hours were highlighted. “No equality of services, time to refer, who to refer to.”
6. Services are reactive and crisis led, rather than proactive. To manage capacity, people are moved on when they are not in crisis, or conversely can sometimes escalate into crisis when there isn’t enough capacity to see to them in a timely manner, reducing our ability to deliver more sustainable outcomes. “We should deal with long term and not just ‘fix it’ or ‘quick fix’.” “Identify issues/risks prior to crisis point, e.g. hospital admissions.”
7. There are difficulties with referral processes (including referrals to and from Third Sector organisations) – particularly linked to communication and information sharing challenges highlighted earlier. “Different routes of referral.” “Reliance on care providers to make contact.”
8. Transitions from hospital to the community can be without effective planning and coordination, including communication with community-based staff, resulting in discharge going wrong. “Shortages of packages of care available can hold up discharge.”
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“Initial transfer of care but ongoing planning & co-ordination dissolves.”
9. Connections with communities and with the Third and Independent Sector are not sufficiently effective to ensure that people are well supported in the community, particularly where NHS and Council services withdraw. This can also result in avoidable deterioration in physical and mental health and wellbeing, as a result of social isolation. “Communication from hospital to 3rd sector before discharge (could be better).”
10. There is need for improvement in relation to carers, both in terms of ensuring that they are appropriately informed and involved as partners in care, but also in terms of ensuring that their own needs are appropriately met and in a timely manner.
In relation to resources and the ‘whole system’:
11. IT systems don’t talk to one another, to enable effective information-sharing and seamless transition between services. This was consistently highlighted as one of the biggest barriers to effective integrated working. “We all use different IT systems and they do not interact with each other.”
12. There is a lack of overall coordination, between and within disciplines and agencies, resulting in significant inefficiencies and fragmented care. It was specifically highlighted that, there can be too many people involved and duplication between roles and services.
13. Bureaucracy and red tape was described as a barrier in delivery of seamless services. “Too many procedures to put resources/services (required) in situ.” “Delays due to paperwork being processed.” “Processes are prohibitive, too many processes & systems.”
14. Staff described that they perceive there is insufficient resource and capacity within services to meet demand. This is described as having been further exacerbated due to the financial pressures in the public sector. “Being truly person centred is prohibited by time/resource constraints.”
15. There are continuous and often significant changes underway and these are not always effectively managed. The culture could ideally be more focussed on transformation and being less risk averse.
16. Workforce issues, such as recruitment challenges in some areas e.g. posts unfilled and covered by temporary staff); inconsistency in pay and staffing across the public sector and its impact on job satisfaction; varied cultures and a lack of awareness and understanding of these; were also raised as having an impact on care.
17. There are challenges in relation to transport and housing and the availability of services and appropriate equipment within the community to support people to live at home.
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18. There is a need to manage public expectations and create more awareness / signposting of the various services, what they offer and crucially, what they don’t offer.
What the picture currently looks & feels like for ‘SAM’ and services / staff
In summary, participants described the current (‘NOW’) picture in the following ways: For ‘SAM’: • “Confused” • “Being passed from one service to another” • “ ‘Nice lady with uniform comes to visit, don’t know who she is’ ” • “Fragmented” • “Frustrated” • “Lonely, anxious, demoralised, lots of people to remember” • “Overwhelmed” • “‘Roll of a dice’ on how it’s going” • “Disempowered” • “Anxious” • “Isolated”
For Services / Staff: • “Flashes of Brilliance” • “Want it to work but scared that it does not” • “Inefficient” • “Pressurised” • “Unclear” • “Disjointed / disorganised” • “Overwhelmed”
WHERE DO WE WANT TO BE?
Aspirations for the future of ‘SAM’
Keeping SAM at the centre, participants described the following as their aspirations for what an ‘integrated future’ might look like:
1. Sam receives high-quality, holistic, person-centred, outcomes-focussed care, which meets his individual needs. When accessed, care is effectively coordinated and streamlined to ensure that it is seamless for Sam, even when transitioning between services. “Seamless. Less stressful. Outcomes being achieved.” “More streamlined, more confidence in the services provided.”
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“Won’t have to repeat himself.” “The service wrapping around the person, not the other way round.”
2. Sam has a named care coordinator (or single point of contact), who he has chosen and who ‘facilitates’ his care and support on his behalf, being able ensure timely access to appropriate services. “Sam would know who to call and talk to.” “Has a single point of contact with regular reviews.”
3. When Sam requires access to services, he can do so easily and quickly, knowing where to go for help. This is supported through, for example, availability of relevant and appropriate 7- day services, which operate beyond business hours; single points of access / referral and being able to re-access appropriate services after discharge. “Sam can access the right service at the right time” “Doesn’t have to wait until a crisis happens to get help.” “Sam is more in control. Navigation of services is easy.”
4. Sam is well- informed, has a clear understanding of what he can expect and from whom, and is able to see all of the information he wishes. There are regular meetings involving Sam, his carer and key people involved in his care, during which he is listened to and involved in decisions. Moreover he is in control, having choice and ownership of his care (e.g. through self-directed support), including where and when it is provided. “Two-way conversation - ask Sam what he wants.” “Sam is actively engaged.” “Sam has a say in his own care.” “Sam is empowered.” “Sam has the information to make decisions about what he needs.”
5. Sam has an integrated, single, shared care plan, which is regularly reviewed, and which is also anticipatory in nature. This plan is flexible enough to respond where his needs change, and ensuring that outcomes are shared, even when Sam loses capacity. “Able to plan for the future.”
6. Those providing care and support proactively identify any change in Sam’s condition and ensure early intervention, avoiding the need for a subsequent crisis response. “Having a life – not always dealing with a crisis.”
7. Sam is able to stay at home, rather than have to go into hospital. This is supported through improved availability and use of assets within his community. “At ease – Living the life he wants – Feels supported.” “Less isolated. Makes use of all available resources.” “Involved in social activities and social groups.”
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8. Sam is supported to self-manage, through education and awareness-raising. This is balanced by ensuring that he knows who to contact/where to go, should he need help. Technology solutions are in place which enables Sam to be more independent, by providing care closer to home. “Sam is taking on responsibilities for his care” “Right balance for Sam.” “Sam has control back.”
9. There are fewer unnecessary intrusions in Sam’s life by staff, with fewer people involved and consistent faces that he knows, and a frequency of their involvement matched to his needs.
10. With less pressure in hospital and no delays to discharge, there is ease of access to a bed when Sam does require acute care and effective joint planning takes place to ensure a smooth, safe and timely discharge. Rehabilitation and reablement services are in place which help Sam to remain at home, or to return home quickly, but safely following a period in hospital.
11. Sam’s carer is recognised as a key partner in his care. They are themselves well-supported, their own needs having been assessed and met in a timely manner, for example, being able to access the Carers Centre or have planned respite in place where needed. “Families know where to go to for help at an early stage.” “Partner is well-supported. (less like carer and more like partner again).” “Regular respite for the carer.”
Aspirations for the future of staff and services
To enable this vision of an ‘integrated future’, participants described their aspirations for where we would like to be, in relation to staff, services, resources and the ‘whole system’ with reference to these key areas:
1. There is a multi-disciplinary, multi-agency team approach to meeting service users’ needs (which includes the third and independent sector). Where possible, the teams are co-located. They have a shared vision of working together to keep people at home, for which they are jointly responsible and demonstrate shared values in their approach. Services across the public, third and independent sectors are effectively integrated and working in partnership. “Information sharing with good clinical governance.” “Acknowledging that colleagues ‘talking’ is worthwhile.” “Removing service focus and looking at what people want to achieve and how to help that happen.”
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2. Communication between all staff is easier and better, with consistent, up-to-date sharing of information, which is written in a language that is meaningful to all. This includes single shared assessment processes, which remove duplication for staff and service users. Specifically, there is improved communication between acute and community based services upon admission and discharge. “Right people know the right information at the right time.” “Everyone knows what is important to Sam. Working together, shared information, more co-ordinated, less duplication.” “‘Singing from the same hymn sheet’.”
3. Team members are clear regarding their own, and their colleagues’, roles. There are both core and shared roles, which ensure that the right person is doing the right thing at the right time for the service user. Team members trust and respect one another as equal partners, ensuring positive relationships and ‘true’ partnership working. There is no room for risk aversion or for blame. Instead, the team learn from each other and think together to bring about creative solutions. “Staff are empowered – they know their role and remit, they use initiative.” “Staff have a sense of achieving Sam’s expectations.”
4. Staff describe an aspiration for well-managed resources and capacity, which will further allow them to spend sufficient time with, and focussed on, the service user. They perceive that in such a scenario, they are able to access training and development opportunities, and feel there is equity and fairness of pay across the system. “Resources and funding are more appropriately allocated.” “Resources are more efficiently and effectively used.”
5. Staff are more engaged and motivated, experiencing lower levels of stress and sickness absence. This includes having increased morale and improved job satisfaction. They described a desire to be feeling more confident and supported in their roles, feeling valued and listened to, and experiencing improved health and wellbeing themselves.
6. Systems are simple and clear, user-friendly and easy to navigate. There is improved efficiency and less duplication through e.g. portable devices, electronic recording of data etc.
7. Efficient, easy to use, integrated IT systems are in place, which all services can access and update, enabling ease of information sharing and more efficient use of staff time. Where possible, staff are able to access and update these systems from mobile devices in the community.
What the picture would look & feel like for ‘SAM’ and Services / Staff
In summary, participants described their aspirational picture for the ‘FUTURE’ as follows:
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For ‘SAM’: • “Better outcomes for service users across the range of services.” • “More streamlined care, right person, right place.” • “Better outcomes for patients, better health, more independence.” For Services / Staff:
• “Excellent service delivery that always meets individuals’ needs.” • “To move forward with better and improved care for the service user.” • “Things are better for everyone.” WHAT ARE STAFF PERCEPTIONS – FEARS AND HOPES?
Prior to attending the engagement events, participants were asked to provide a list of three words that first come to mind, in relation to Health and Social Care integration. Their responses are presented here using a ‘Wordle’. This graphical representation includes the words provided, with the size of the word being indicative of the frequency with which the word was used i.e. the larger the word, the more frequently it was used.
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Fears and potential barriers to success:
In relation to outcomes and impact:
1. A number of participants expressed fears in relation to uncertainty about what the future will look like, and specific worries about potential reduction in staff numbers, job losses, dilution of skills / loss of professional identity, changes to terms and conditions of employment and increased workloads.
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“[I fear that] jobs may be lost or change greatly.” “[There will be] loss of identity and dilution of clear roles.” “[I fear] loss of employment /service and lack of job security.”
2. A significant fear expressed amongst participants was that ‘integration’ doesn’t work, and fails to deliver or it may even be disingenuous. Unrealistic expectations, the vision being ‘lost in translation’, politics and power influences were cited as reasons for these concerns. “Nothing will change.” “Things won’t necessarily get better.” “Too big to do well.” “Too much focus on politics and power.” “Just a cost cutting exercise.” “Gaps in communication at all levels, will affect care and staff morale.” “[I fear that] this is a lip service exercise.” “Another piece of legislation creating additional reporting.”
3. Concerns were expressed on the ‘real impact’ of the changes to service users and their carers, and whether things would in fact, get worse for them as a result of changes. It is feared that integration (particularly during the transition period) will lead to even more people being involved in providing care, increased confusion over roles, and greater difficulties in communication within and between services. As a consequence, there were concerns expressed over greater confusion for services users who, being unsure of who to contact, will end up feeling isolated or just ‘go to A & E anyway’. “Too much bureaucracy that creates negative outcomes for service users.” “I fear there will be little change to clients’ experience.” “[I fear] that some people slip through the system and don’t get the support they deserve.” “[I fear] that carers will not be seen and treated as equal partners in care.” “Breakdowns in communication may hinder the process.” “[I fear] that services get more complicated & harder to navigate than before, or that there are fewer services available.”
Participants also expressed concerns around the challenge of creating single care co- ordinator roles. Some questioned its merit, whilst others questioned who would undertake such a role i.e. whether it would be a standalone role or, if not, how effectively it could be undertaken as part of existing substantive roles. 4. Participants highlighted a fear of integration being service-led (rather than outcomes- focussed), resulting in what is already working well being lost or inequity in the partnership. There was recognition of the challenge of moving from a reactive, crisis-led service to a proactive one. “I fear that it becomes ‘top heavy’ exercise and does not filter down to practice level.” “[I fear] some services being lost in the mix.” “[I fear] changes to non-core services due to budget constraints.” “The needs of a person might outweigh what a service can deliver.”
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“[I fear] that we won’t be brave or radical enough to achieve the changes we need to make.” “We have excellent working relations with other agencies, these have been fostered over many years and are threatened by changes in working practices.”
5. In relation to the third and independent sector, there was recognition of current sustainability challenges, as well as a fear that their voices (and that of individual third and independent sector organisations) would not be not be heard or understood. “[I fear] recognition is not given to third sector services.” “[I fear] reduced funding to third sector services.”
6. People cited the challenge of being able to manage public expectations (e.g. reducing dependency on services, improving self-management), and a fear of increased, unrealistic expectations from the public, which would create even greater pressure on already overstretched services. “Front line staff will once again be left to explain to clients/patients why promises are not being kept.”
In relation to the change process:
Participants expressed the following concerns regarding the change process, as potential barriers to the success of health and social care integration:
7. It would be difficult to implement and take a lot of effort i.e. it won’t be a smooth transition and there will be some chaos and confusion, teething problems and errors. Staff were also concerned about not being sufficiently involved in the process. “Another change that is poorly managed with little communication and consultation.” “Overly complicated.” “Problems changing culture and postponed views of different authorities, leads to delays.” “It will take a long, long time.” “Time frames will continue to be poor.” “I fear there will be too much effort put into developing plans and not enough in implementing them.” “[I fear] ‘Chinese whispers’ breeding negativity.” “[I fear] that staff become so stressed an anxious about potential changes, it impacts on service users and their outcomes.”
8. There would be challenges in overcoming existing cultural barriers (e.g. ‘professional preciousness’, silo working, relationships between disciplines / agencies etc.), with people finding it difficult or being unwilling to change. There could also be conflict and disagreement between disciplines / agencies, or that personal agendas get in the way, which stall progress. “It requires a huge shift in culture and way of working.”
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“[I fear] clashes in professional values.” “So many professional backgrounds coming together – there will be difficulties coming to a consensus /agreement.” “Some people can’t let go of the past and embrace power/ resource sharing.” “I fear health and social care don’t understand each other enough at present and there’ll be gaps in service in the future.” “[I fear] services will say ‘that is not our responsibility that is another service’.”
9. Staff expressed concerns that they perceive funding and resources (including staff) may be insufficient to make the change happen, considering existing capacity challenges and financial pressures in the public sector. This included a recognition of current recruitment and retention difficulties (and recognising the impact of an ageing workforce). “Financial constraints may prevent individuals being outcome focused and return to a service led approach.” “Will there be enough funding & staff?”
Hopes and potential enablers to success:
In considering the vision for integration of health and social care, participants were also asked to express their hopes and expectations in making this a reality. Although several key themes in relation to this have been captured under the ‘Where do we want to be?’ section of this report, the points below provide a summary of what staff highlighted as being important to them in realising the vision.
Significantly, participants expressed acknowledgement of the importance of the vision and their key desire that “integration works”. This was described as bringing change for the better by making a real difference to those who use services and their carers; i.e. they receive the care and support that they need to achieve better outcomes. “My hope would be that Health & Social Care Integration lives up to its vision.” “[I hope that] things are better for everyone.” “[I hope that], with integration potential is maximised and services will be person centred and make changes to lives.”
In identifying their examples of ‘SAM’, some groups also highlighted that it was crucial to remember this wasn’t just about ‘older people’ i.e. it was recognised that integration impacts a range of people across a range of services (e.g. a young adult transitioning from Children’s services to Adult Services).
Participants expressed hopes in relation to the opportunities within the health and social integration, and its potential to bring about changes and improvements not only for service users, but also staff and the ways is which services are delivered.
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“Seamless care delivery to all individuals both identified and those not on the systems!” “I hope that people take it on board and use a positive attitude towards it.” “[I hope that] integration is seen as a great opportunity by all partners.”
Participants also cited the following, as potential enablers to a smooth transition and effective execution of health and social care integration:
1. The process is well-led, with focus on our vision and outcomes throughout. “[I hope we] keep a focus on delivery not get distracted by politics, bureaucracy.” “It can work with all working together and when people have an understanding of what the possibilities may be.”
2. There is a clear plan and effective structures in place to facilitate the process. Participants expressed hopes for the process to not take too long, and equally not be too rushed. “[I hope that there are] clear explanations of how integration will be put into practice.”
3. The process is subject to regular review and there is timely identification and resolution of difficulties. “[I hope] it will work, that we can STOP just changing things and really make it happen!”
4. There is regular and informative communication to manage expectations update on progress (both staff and the general public). Staff expressed a desire to have sufficient opportunity to influence the shape and direction of the process. “[I hope that] our views are listened to by people in higher positions.” “[I hope that] staff morale and engagement is improved.”
5. Efforts are made to learn from, sustain and spread what is already working well.
6. Everyone takes responsibility to make it work, with particular references made to support and commitment required from leaders and managers.
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Clackmannanshire & Stirling Integration Joint Board
24 February 2016
This report relates to Item 9 on the agenda
Strategic Needs Assessment
(Paper presented by Shiona Strachan)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Oliver Harding, Consultant in Public Health Medicine Lesley Fulford, Programme Manager Date: 24 February 2016 List of Background Papers: 2015.10.27 Clackmannanshire & Stirling IJB - Strategic Plan & Strategic Needs Assessment Update Appendix 1 – Strategic Needs Assessment
Title/Subject: Strategic Needs Assessment Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 24 February 2016 Submitted By: Oliver Harding Lesley Fulford Action: For Approval
1. Executive Summary
1.1. The Partnership has produced a Strategic Needs Assessment to support the development of the Strategic Plan.
1.2. A draft Strategic Needs Assessment was previously presented to the Integration Joint Board on 27 October 2015.
1.3. The Integration Joint Board is asked to approve this draft Strategic Needs Assessment for publication alongside the draft Strategic Plan.
2. Recommendations
The Integration Joint Board is asked to:
2.1. Approve the draft Strategic Needs Assessment for publication alongside the draft Strategic Plan.
2.2. Approve further work to be undertaken to understand differences between and within localities and communities.
3. Considerations
3.1. The Strategic Needs Assessment poses a number of considerations to be made when planning services. These are:
• Both Clackmannanshire and Stirling have an ageing population. The number, and proportion, of older adults across Clackmannanshire & Stirling is projected to double. Older people are generally more intensive users of health and social care services. Therefore this could impact significantly on demand for these services in years to come. Both Clackmannanshire & Stirling are projected to see an increase in the ratio of non working aged people to people of working age. Clackmannanshire is also projected to experience a decrease in the number of people of working age living in the area. This means that at the same time as demand for services could be increasing, it could be more challenging to employ the workforce to meet this demand.
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• It is projected that Clackmannanshire and Stirling will have growing numbers of individuals living with long term conditions, multiple conditions and complex needs. There is a need to rebuild services in such a way to better meet the requirements of people with complex needs. Patients with several complex long term conditions are currently making multiple trips to hospital clinics to see a range of uncoordinated specialist services. A proposed way forward could be to look at developing new pathways and guidelines away from the current disease specific models to generic approaches focused on the holistic needs of patients (Lunt, 2013, p. 17).
• Reducing unplanned, emergency, hospital care will benefit the service as well as the individual. The average monthly attendance at Accident & Emergency has increased by 8.8% over the years 2007-2015 and the rate of emergency hospital admissions in Clackmannanshire and Stirling has remained broadly similar over the past decade. However, the elderly population in Clackmannanshire and Stirling account for a growing percentage of emergency admissions. Given the projected increase in the elderly population Emergency Departments could struggle to meet this demand. Early intervention and community based services could help ease the pressure.
• Supporting unpaid carers is a priority. One of the aims of health and social care integration is to keep people living independently in the community for longer. The projected increase in the elderly population is likely to mean there will be an increasing need for unpaid carers. In turn, these unpaid carers will need to be supported.
• Reducing behaviours such as smoking, alcohol consumption, drug use and poor diet could have a positive effect on an individual’s health. Latest estimates suggest 28.9% of people in Clackmannanshire smoke. The corresponding figure for Stirling is 20% and for Scotland is 23.1%. The alcohol related mortality rate in Clackmannanshire in 2013 was 38.85 per 100,000 population, which was significantly worse than the average rate of 21.43 for Scotland. The estimated prevalence of those with a problem drug use has increased in Clackmannanshire and Stirling when comparing the data from 2009/10 and 2012/13. Continuing efforts around health promotion and early intervention could assist people improve their own health and wellbeing, and live in good health for longer.
4. Conclusions
4.1. The Strategic Needs Assessment will support service planning and delivery.
5. Resource Implications
5.1. Further work is required to build on the draft Strategic Needs Assessment and understand differences between and within localities and communities.
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6. Impact on IJB Outcomes, Priorities and Outcomes
6.1. The findings of the Strategic Needs Assessment and suggestions for implementation should help in developing work to meet the priorities and outcomes identified.
7. Legal & Risk Implications
7.1. There are no legal or risk implications.
8. Consultation
8.1. The Strategic Needs Assessment has been consulted on through the Strategic Planning Group and has taken account of their suggestions.
9. Equalities and Human Rights Assessment
9.1. The Strategic Needs Assessment includes reference to equality and diversity characteristics and a full EQIA has been drafted on the Strategic Plan. This will be brought before the Integration Joint Board at the March meeting.
10. Exempt reports
10.1. No
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Appendix 1
Clackmannanshire & Stirling
Health and Social Care Partnership
Draft Strategic Needs Assessment
DRAFT Version 2.1 19/01/2016
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Table of Contents
Executive Summary ...... 6 1 Introduction ...... 8 1.1 Background ...... 8 1.2 What is a Strategic Needs Assessment ...... 11 2 Population ...... 12 2.1 Current Population ...... 12 2.1.1 Ethnic Origin ...... 16 2.1.2 Religion...... 16 2.1.3 Sexual Orientation ...... 17 2.2 Projections of future population...... 17 2.3 Dependency Ratio ...... 19 2.4 Population Considerations/Implications ...... 21 3 Life Circumstances ...... 21 3.1 Scottish Index of Multiple Deprivation ...... 21 3.2 Housing ...... 23 3.3 Fuel Poverty ...... 25 3.4 Employment, Benefits and Financial Issues ...... 26 3.5 Life Circumstance Considerations/Implications ...... 30 4 Risk Factors ...... 30 4.1 Smoking ...... 30 4.2 Alcohol ...... 33 4.3 Drugs ...... 35 4.4 Diet and Obesity ...... 36 4.5 Risk Factors Considerations/Implications ...... 38 5. Population Health ...... 39 5.1 General Health ...... 39 5.2 Life Expectancy and Healthy Life Expectancy ...... 39 5.3 Long Term Health Conditions ...... 41 5.3.1 Dementia ...... 43 5.3.2 Cancer ...... 44
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5.4 Projected Long Term Health Conditions ...... 46 5.5 Multi-Morbidity...... 48 5.6 High Resource Individuals ...... 52 5.7 Disability ...... 53 5.7.1 Learning Disability ...... 53 5.7.2 Physical Disability ...... 56 5.8 Mental Health and Wellbeing ...... 57 5.9 Premature Mortality ...... 62 5.10 Cause of Death ...... 64 5.11 Population Health Considerations/Implications ...... 65 6 Current Provision of Health and Social Care Services ...... 66 6.1 Workforce ...... 66 6.2 General Practice Services ...... 67 6.3 Unscheduled Care ...... 69 6.3.1 Accident &Emergency Attendances...... 69 6.3.2 Emergency Admission to Hospital ...... 71 6.4 Delayed Discharges from Hospital ...... 77 6.5 Community Care Assessments ...... 80 6.6 Care at Home ...... 80 6.7 Self -Directed Support ...... 85 6.8 Day Care ...... 86 6.9 Telecare ...... 88 6.10 Care Homes ...... 88 6.11 Equipment ...... 90 6.12 Specialist Accommodation ...... 91 6.13 Experience of Care Recipients...... 91 6.14 End of Life Care ...... 93 6.15 Respite Care ...... 94 6.16 Substance Misuse Support Services ...... 96 6.17 Provision of Health & Social Care Services Considerations/Implications ...... 97 7. Carers ...... 98 7. 1 Characteristics of Unpaid Carers ...... 98
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7.2 Experience of Carers ...... 100 7.3 Carers Considerations/Implications ...... 102 8. Summary and Conclusion...... 103 Summary ...... 103 Conclusion ...... 105 Appendix A ...... 109
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Executive Summary This needs assessment provides a comprehensive description of health and social care data relevant to Clackmannanshire & Stirling Health & Social Care Partnership.
The following key issues have emerged from the needs assessment:
• Both Clackmannanshire and Stirling have an ageing population. The number, and proportion, of older adults across Clackmannanshire & Stirling is projected to double. Older people are generally more intensive users of health and social care services. Therefore this could impact significantly on demand for these services in years to come. Both Clackmannanshire & Stirling are projected to see an increase in the ratio of non working aged people to people of working age. Clackmannanshire is also projected to experience a decrease in the number of people of working age living in the area. This means that at the same time as demand for services could be increasing, it could be more challenging to employ the workforce to meet this demand. • It is projected that Clackmannanshire and Stirling will have growing numbers of individuals living with long term conditions, multiple conditions and complex needs. There is a need to rebuild services in such a way to better meet the requirements of people with complex needs. Patients with several complex long term conditions are currently making multiple trips to hospital clinics to see a range of uncoordinated specialist services. A proposed way forward could be to look at developing new pathways and guidelines away from the current disease specific models to generic approaches focused on the holistic needs of patients (Lunt, 2013, p. 17). • Reducing unplanned, emergency, hospital care will benefit the service as well as the individual. The average monthly attendance at Accident & Emergency has increased by 8.8% over the years 2007-2015 and the rate of emergency hospital admissions in Clackmannanshire and Stirling has remained broadly similar over the past decade. However, the elderly population in Clackmannanshire and Stirling account for a growing percentage of emergency admissions. Given the projected increase in the elderly population Emergency Departments could struggle to meet this demand. Early intervention and community based services could help ease the pressure. • Supporting unpaid carers is a priority. One of the aims of health and social care integration is to keep people living independently in the community for longer. The projected increase in the elderly population is likely to mean there will be an increasing need for unpaid carers. In turn, these unpaid carers will need to be supported. • Reducing risky behaviours such as smoking, alcohol consumption, drug use and poor diet could have a positive effect on an individual’s health. Latest estimates suggest 28.9% of people in Clackmannanshire smoke. The corresponding figure for Stirling is 20% and for Scotland is 23.1%. The alcohol related mortality rate in Clackmannanshire
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in 2013 was 38.85 per 100,000 population, which was significantly worse than the average rate of 21.43 for Scotland. The estimated prevalence of those with a problem drug use has increased in Clackmannanshire and Stirling when comparing the data from 2009/10 and 2012/13. There is likely to be variation across both Clackmannanshire and Stirling and further work on locality profiles may help to identify these areas. Continuing efforts around health promotion and early intervention could assist people to improve their own health and wellbeing, and live in good health for longer.
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1 Introduction
1.1 Background The integration of health & social care is a key Scottish Government Programme of reform designed to improve care and support for those who use health and social care services. The legislation relating to the integration of health and social care is set out in the Public Bodies (Joint Working) (Scotland) Act 2014.
A list of 9 high-level statements of what health and social care partners are attempting to achieve through integration have been produced. These are known as the National Health and Wellbeing Outcomes.
By working with individuals and local communities, health and social care partnerships will support people to achieve the following outcomes:
Outcome 1: People are able to look after and improve their own health and wellbeing and live in good health for longer
Outcome 2: People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community
Outcome 3. People who use health and social care services have positive experiences of those services, and have their dignity respected
Outcome 4. Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services
Outcome 5. Health and social care services contribute to reducing health inequalities
Outcome 6. People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and well-being
Outcome 7. People using health and social care services are safe from harm
Outcome 8. People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide
Outcome 9. Resources are used effectively and efficiently in the provision of health and social care services
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Linking the Information presented to the Intended Outcomes
Information Section Outcome:
Population Life Circumstances Factors Risk Health Population Health of Provision and Social Care Carers Outcome 1: People are able to look after and improve their own health and wellbeing and live 1 2 3 4 5 6 in good health for longer Outcome 2: People, including those with disabilities or long term conditions, or who are 7 8 9 10 11 12 frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community Outcome 3. People who use health and social care services have positive experiences of those 13 14 services, and have their dignity respected Outcome 4. Health and social care services are centred on helping to maintain or improve the 15 16 17 quality of life of people who use those services Outcome 5. Health and social care services 18 19 contribute to reducing health inequalities Outcome 6. People who provide unpaid care are supported to look after their own health and 20 wellbeing, including to reduce any negative impact of their caring role on their own health and well-being Outcome 7. People using health and social care 21 services are safe from harm Outcome 8. People who work in health and social care services feel engaged with the work they do 22 and are supported to continuously improve the information, support, care and treatment they provide Outcome 9. Resources are used effectively and 23 efficiently in the provision of health and social care services
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Comments on connections and gaps:
1 The total population and demographic profile impacts on the number of people whose self-care and longevity are under consideration 2 Life circumstances impact on ability to look after oneself and improve health. This may be through mental wellbeing or less tangible concepts such as resilience 3 Health improvement often requires the addressing of risk factors 4 Longevity is strongly affected by the development of individual diseases and multiple conditions 5 Provision of health and social care should be enabling and health improving, and increase longevity 6 Carers can enable individuals to improve their health, reduce risk factors and live longer 7 The total population and demography impact on the number of people living at home or in homely settings 8 Life circumstances include a consideration of the home setting and extent to which housing needs can be and are met 9 People, including those with long term conditions have opportunities for health improvement through addressing risk factors 10 Population health includes a consideration of the epidemiology of long term conditions and frailty etc, 11 Provision of health and social care should be enabling and encourage rehabilitation 12 The role of carers is important and may be crucial in helping people continue to live at home 13 Life circumstances are an important factor in individuals’ attitudes to and therefore use of health and social care services 14 Good information on health and social care service activity is available. Information on the quality of provision in terms of experience is collected through more qualitative means such as surveys (not presented here) 15 Health and social care services can have a positive impact on life circumstances 16 Health and social care services can be health improving through addressing risk factors 17 The provision of health and social care is based on evidence of effectiveness (which may be variable). Direct impact in terms of health and social outcomes may need to be inferred. 18 Experience of deprivation and other equality / inequality factors come under life circumstances 19 Health and social care services should reduce health inequalities through positive health and social outcomes for those experiencing deprivation. However the ‘inverse care law’ applies – those with less need are better able to access services (see items 2 and 13) 20 Carers have health and social care needs, which when met also have a positive impact on the person being cared for. 21 The information presented may not quite capture the ‘safe from harm’ aspect. More
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qualitative data from inspectorate reports or patient safety initiatives could provide further evidence 22 The information on workforce is fairly basic and quantitative. Further information from staff surveys etc. would be useful. Workforce development is key to achieving the nine outcomes. 23 The information presented does not quite capture effectiveness and efficiency – this may need to be implied or extrapolated. More complex methods such as benchmarking, data envelopment analysis or economic evaluation such as (social) return on investment may be required.
1.2 What is a Strategic Needs Assessment Each health and social care partnership is required by the legislation to produce a detailed Strategic Plan. Clackmannanshire & Stirling’s Strategic Plan will explain how the partnership will make changes and improvements to develop health and social services for adults over the coming three years.
In order for the partnership to produce a detailed Strategic Plan that best meets the needs of its local population we first require a clear understanding of the health and care needs of the population, from the perspective of stakeholders.
Need is the discrepancy between “what is” and “what should be”. This document aims to bring together the available data in order to describe the current pattern and level of supply of these services and where possible identify the extent of the gap between need and supply. This will be an ongoing process and over the next year work will continue on the needs assessment to build upon it.
Locality Needs
Understanding the differing levels of need and service provision across the partnership will be key to its future success. Therefore the ability to assess need at locality level is extremely important. This document will focus on information and analysis at partnership/local authority level and will sit alongside a locality profile document. There is likely to be variation across both Clackmannanshire and Stirling and the work on locality profiles may help to identify these areas. The three localities for Strategic Planning purposes are: • Clackmannanshire; • Stirling City with the Eastern Villages, Bridge of Allan and Dunblane; • Rural Stirlingshire.
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2 Population
2.1 Current Population A key aspect for determining the need of many health and social care services is the size and age distribution of the local population. Table 2.1a, below, illustrates the population profile across Clackmannanshire and Stirling. Clackmannanshire and Stirling as a whole has an estimated population of 142,770 with Stirling accounting for 64% (91,580) and Clackmannanshire accounting for 36% (51,190).
Table 2.1a Clackmannanshire & Stirling Population Profile
Clackmannanshire and Clackmannanshire Stirling Stirling Total Males Females Total Males Females Total Males Females 0-15 9,082 4,670 4,412 15,536 7,956 7,580 24,618 12,626 11,992 16-49 21,938 10,972 10,966 41,083 19,685 21,398 63,021 30,657 32,364 50-64 10,841 5,297 5,544 18,085 8,840 9,245 28,926 14,137 14,789 65-74 5,569 2,629 2,940 9,373 4,447 4,926 14,942 7,076 7,866 75+ 3,760 1,551 2,209 7,503 3,049 4,454 11,263 4,600 6,663 Total 51,190 25,119 26,071 91,580 43,977 47,603 142,770 69,096 73,674 Source: National Records of Scotland (NRS) mid-year population estimates 2014
Figure 2.1a, below, illustrates the age distribution in Clackmannanshire and Stirling compared to Scotland. The age profile in both areas is very similar to that of Scotland as a whole. Roughly 64% of the population are aged between 16 and 64, 17% under 16, 10% aged 65-74 and roughly 8% aged over 75.
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Figure 2.1a Clackmannanshire & Stirling age distribution compared to Scotland
Source: National Records of Scotland (NRS) mid-year population estimates 2014
In terms of population density, Stirling is one of the most sparsely populated regions of Scotland with 41 people per square kilometre (Figure 2.1b). This compares with Clackmannanshire where there are 324 people per square kilometre.
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Figure 2.1b Population Density (persons per square kilometre) 2011
Source: Census 2011
There are no ‘Large Urban areas’ in Stirling or Clackmannanshire. Fifty three per cent of Stirling residents live in ‘other urban areas’ and a significant proportion (34%) live in rural communities compared to the Scotland figure of 18% (Figure 2.1c). Forty six percent of Clackmannanshire residents live in ‘accessible small towns’ and 40% live in ‘other urban areas’.
Stirling has a higher percentage of residents living in rural areas compared to Scotland as a whole. This combined with Stirling’s low population density may impact on the ability to plan and deliver services compared to more densely populated areas such as Glasgow or Edinburgh.
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Figure 2.1c Urban/Rural Classifications
Category Description 1 – Large Urban Areas Settlements of 125,000 or more people. 2 – Other Urban Areas Settlements of 10,000 to 124,999 people. 3 – Accessible Small Towns Settlements of 3,000 to 9,999 people and within 30 minutes’ drive of a settlement of 10,000 or more. 4 – Remote Small Towns Settlements of 3,000 to 9,999 people and with a drive time of over 30 minutes to a settlement of 10,000 or more. 5 – Accessible Rural Areas with a population of less than 3,000 people, and within a 30 minute drive time of a settlement of 10,000 or more. 6 – Remote Rural Areas with a population of less than 3,000 people, and with a drive time of over 30 minutes to a settlement of 10,000 or more. Source: Scottish Government Urban/Rural Classification 2013/14 and National Records of Scotland (NRS) (NRS).
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2.1.1 Ethnic Origin Table 2.1.1a shows that in the 2011 Census Clackmannanshire had a less diverse population than Scotland on the whole, with a greater ‘White – Scottish’ population and a smaller proportion of Black and Minority Ethnic (BME) groups (1.5%) compared to 4.0% at national level. Stirling has a lower ‘White – Scottish’ population than Clackmannanshire or Scotland though this seems to be offset by a larger ‘White – Other British’ population. Stirling is also home to a greater Black and Minority Ethnic (BME) population than neighbouring Clackmannanshire though it is still less than the Scotland average.
Table 2.1.1a – Ethnicity in Clackmannanshire, Stirling and Scotland 2011
Ethnicity Stirling (%) Clackmannanshire (%) Scotland (%) White - Scottish 82.0 88.2 84.0 White - Other British 10.8 7.4 7.9 White - Irish 0.9 0.6 1.0 White - Polish 0.6 1.0 1.2 White - Other 2.5 1.2 2.0 Asian, Asian Scottish or Asian British 2.3 1.0 2.7 Other ethnic groups 0.9 0.5 1.3 Source: 2011 Census
2.1.2 Religion The 2011 Census reports that the Clackmannanshire population is largely non-religious (43.5%), this compares to 36.7% at Scotland level. The Church of Scotland is the largest religion within the Clackmannanshire population and there are no other religions representing more than 10%. The Stirling population was found to be more closely aligned with the Scottish population for most religions. There was however a smaller Muslim population of just 0.6% in Stirling compared to 1.4% in Scotland which is also reflected in Clackmannanshire.
Table 2.1.2a – Religion in Clackmannanshire, Stirling and Scotland 2011
Religion Stirling (%) Clackmannanshire (%) Scotland (%) Church of Scotland 35.0 34.5 32.4 Roman Catholic 12.3 9.4 15.9 Other Christian 6.1 5.0 5.5 Muslim 0.6 0.6 1.4 Other religions 1.0 0.5 1.1 No religion 37.8 43.5 36.7 Not stated 7.1 6.5 7.0 Source: 2011 Census
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2.1.3 Sexual Orientation It is not currently possible to accurately report sexual orientation either at national or local level and it is likely that the numbers of Lesbian, Gay, Bisexual and Transgender (LGBT) are under- represented. The health needs of the Lesbian, Gay, Bisexual and Transgender (LGBT) population are not well understood since they are not routinely identified in health surveys or population- based surveys. The Scottish Household Survey 2013 does include a question on Sexual Orientation but the results of this have not been included as the survey only covers a small sample of the population and are not representative.
2.2 Projections of future population The size and make-up of the population going forward will be a key consideration when planning and delivering health and social care services. The National Records of Scotland (NRS) population projections (Table 2.2a) show the projected change in the population to 2037.
Table 2.2a Population projections to 2037
2012 2032 2037 Age Group Number % Number % Number % Clackmannanshire 0-15 9,166 17.9 8,702 17.1 8,320 16.6 16-49 22,747 44.4 17,449 34.3 16,886 33.7 50-64 10,636 20.7 10,259 20.2 9,174 18.3 65-74 5,163 10.1 7,336 14.4 7,590 15.2 75+ 3,568 7.0 7,149 14.0 8,073 16.1 Total 51,280 100.0 50,895 100 50,043 100 Stirling 0-15 15,923 17.5 17,559 17.0 17,952 17.0 16-49 41,309 45.4 44,395 43.0 46,184 43.6 50-64 17,517 19.2 16,432 15.9 15,141 14.3 65-74 9,022 9.9 12,223 11.8 12,426 11.7 75+ 7,249 8.0 12,565 12.2 14,157 13.4 Total 91,020 100 103,174 100 105,860 100
Source: National Records of Scotland (NRS) population projections
It is projected that Clackmannanshire and Stirling will experience different changes in both population size and age distribution. The Clackmannanshire population size is projected to remain at a similar level to the 2012 size, but will experience a small decrease (1,200) by 2037. Despite the size of the population remaining similar the age distribution is expected to experience significant changes (Figure 2.2a). The percentage of individuals aged 16-49 is expected to drop from 44% to 34%. Whereas the percentage of individuals aged 65-75 and 75+ is expected to increase from 10% and 7% respectively to 15% and 16%. This means that although the general population levels are projected to remain stable there will be a large
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increase in those in the elderly categories with numbers in the 75+ age group expected to double.
Figure 2.2a – Projected Population Age distribution in Clackmannanshire
75+
65-74
50-64 2037 Group Age 2012 16-49
0-15
0.0 10.0 20.0 30.0 40.0 50.0 %
Source: National Records of Scotland (NRS) Population Projections
The size of the Stirling population is expected to grow by approximately 16% from 91,000 to approximately 106,000 by 2037. As well as a change in population size there is a projected change in the age distribution of Stirling (Figure 2.2b). The percentage of children and 16-49 year olds that make up the population is expected to remain similar. It is expected that the percentage of 50-64 year olds will experience a decrease from 19% to 14%. The two older adult age groups, 65-75 and 75+, are expected to experience an increase from 10% to 12% and 8% to 13% respectively. Older people make a valuable contribution to our society, both economically and socially, through, amongst other contributions, taxes, spending power, provision of social care and the value of their volunteering (WRVS, 20111).
1 WRVS (2011). Gold Age Pensioners, Valuing the Socio-Economic Contribution of Older People in the UK.
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Figure 2.2b – Projected Population Age Distribution in Stirling
75+
65-74
50-64 2037 Group Age 2012 16-49
0-15
0.0 10.0 20.0 30.0 40.0 50.0 %
Source: National Records of Scotland (NRS) Population Projections
2.3 Dependency Ratio The dependency ratio is a measure of the proportion of the population seen as economically ‘dependant’ upon the working age population. The definition generally used in Scotland is: ‘those aged under 16 or of state pensionable age, per 100 working age population’. Table 2.3a illustrates the projected change in dependency ratio for Stirling, Clackmannanshire and Scotland to 2037. Stirling, Clackmannanshire and Scotland have similar ratios for 2012 with Stirling and Scotland following a similar upwards projection rising from 55% and 53%, respectively, to 63%.
Table 2.3a – Projected Dependency Ratios to 2037
Source: National Records of Scotland (NRS) population projections
While Stirling is projected to follow a similar upwardly pattern to Scotland as a whole, Clackmannanshire is projected to experience a more accelerated upwardly trend. Figure 2.3a examines this trend more closely. The green dotted line represents the increasing dependency ratio. There are some dips in the projected trend but these can largely be explained by changes
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to the state pension age. Figure 2.3a helps to explain why Clackmannanshire has an accelerated projected increase in its dependency ratio as the solid red line illustrates a decreasing population of working age individuals and the solid blue line illustrates a steadily increasing population of people of non-working age. This increase of non-working age people can be largely attributable to the fact that the number of people over 75 is projected to more than double in Clackmannanshire by 2037 (Table 2.2a).
Figure 2.3a – Clackmannanshire Projected Dependency Ratios
Source: National Records of Scotland (NRS) population projections
The projected increases in dependency ratios could potentially have a significant impact on both areas. Both areas are projected to have more individuals of a non-working age as a proportion of those of a working age and this will impact upon the services required locally as with the potential increase in service demand. This effect is potentially exaggerated in Clackmannanshire as not only is there a projected increase in non-working age people but there is a projected decrease in working age people. This means that the demand for services could be increasing and at the same time it could be more challenging to employ the workforce to meet this demand.
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2.4 Population Considerations/Implications • Stirling has a high percentage of people living in rural areas. This will need to be considered when planning and delivering services. • Older people are generally high users of services. The number, and proportion, of older adults across Clackmannanshire & Stirling is projected to double and this could impact significantly on demand for services. • Both Clackmannanshire & Stirling are projected to see an increase in the ratio of non working aged people to people of working age. Clackmannanshire is also projected to experience a decrease in the number of people of working age living in the area. This means that the demand for services could be increasing and at the same time it could be more challenging to employ the workforce to meet this demand. 3 Life Circumstances
3.1 Scottish Index of Multiple Deprivation The Scottish Index of Multiple Deprivation (SIMD) identifies small areas concentrations of multiple deprivation across all of Scotland. It ranks small areas called datazones from the most deprived (ranked 1) to the least deprived (ranked 6,505). One way ISD (Information Services Division) uses these is to divide all of the datazones in Scotland into 10 equal deprivation deciles, by calculating each individual zone’s rank from the distribution of all ranks. For example if a zone in Stirling is ranked 517, it is in the bottom 7.9% of all zones so would be in the first decile which encompasses values between 0 and 10. If a zone is ranked 1985, it would be in the bottom 30.5%, and in the fourth decile for values between 30 and 40.
Within the deciles, 1 is the most deprived and 10 the least deprived (this categorisation is applicable for Scottish Index of Multiple Deprivation 2009v2, 2012 and future releases). Figures 3.1a and 3.1b below illustrate the number of people and data zones in each decile in Clackmannanshire and Stirling. The first highlights the range of deprivation in Clackmannanshire with more people living in 20% of the most deprived areas than in 20% of the least deprived areas. On the other hand in Stirling there are more people living in the least deprived areas.
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Figure 3.1a Clackmannanshire population by Scottish Index of Multiple Deprivation decile
Source: Scottish Index of Multiple Deprivation (SIMD) 2012 http://www.gov.scot/Topics/Statistics/SIMD/DataAnalysis/Background-Data-2012
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Figure 3.1b Stirling population by Scottish Index of Multiple Deprivation decile
Stirling Population by SIMD decile 18000 20
16000 18
14000 16
14 12000
12 10000 10 8000
Population 8 6000 6 Number of of Number datazones 4000 4 2000 2 0 0 1 2 3 4 5 6 7 8 9 10 Most Deprived Decile Least Deprived
Population Number of datazones
Source: Scottish Index of Multiple Deprivation 2012 http://www.gov.scot/Topics/Statistics/SIMD/DataAnalysis/Background-Data-2012
3.2 Housing This section will provide an overview of the housing issues in Clackmannanshire and Stirling. A Housing Contribution Statement has been prepared by Clackmannanshire and Stirling Councils which can be found on the Integration web pages.
• The National Records of Scotland household projections predict that while household numbers in both local authorities will increase between 2012 and 2037 Stirling’s increase will be greater (25%) than both Clackmannanshire’s (5%) and Scotland’s (17%). • Households headed by someone aged 75 and over is estimated to increase from 2012 to 2037 by 121% in Clackmannanshire and 91% in Stirling, greater than in Scotland (82%). • The number of households with one adult only is predicted to increase by 41% in Stirling between 2012 and 2037, higher than in Scotland (35%) and Clackmannanshire (24%). The predicted increase in households with one adult and one or more children is
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similarly greater in Stirling (54%) than in Scotland (27%) with there being very little increase in Clackmannanshire. • In 2013 home ownership accounted for 64% of households in Clackmannanshire and 68% in Stirling, comparable to Scotland (61%). (Scottish Household Survey 2013). Social renting was the second largest accounting for 27% in Clackmannanshire and 18% in Stirling. Private renting accounted for a smaller percent although half in Clackmannanshire (7%) than in Stirling (14%) • In 1999 2% of households were privately rented in Clackmannanshire which had increased to 7% in 2013. In Stirling 6% of households were privately rented in 1999 which had increased to 14% in 2013. Over the same period social renting had decreased from 36% to 27% in Clackmannanshire and 29% to 18% in Stirling. (Scottish Household Survey 2013) • There are a greater proportion of houses than flats in both Clackmannanshire (78%) and Stirling (72%) than in Scotland (63%). More households in Stirling were built before 1945 (34%) than in Clackmannanshire (22%). (Scottish House Conditions Survey, 2011- 2013, Local Authority Analyses). • Evidence from the Clackmannanshire Housing Need and Demand Assessment (2011) showed that over the next 10 years there will need to be an additional 5,724 properties provided across all tenures (tenure provides information about whether a household rents or owns the accommodation that it occupies). Of these around 4,546 (three quarters) require to be affordable and 1,178 for sale on the open market. The Clackmannanshire Housing Strategy 2012-2027 advises that in the current climate this is not considered to be realistic and achievable and the preferred option, in the short term, is to target the Land Audit figures aiming to complete around 173 new private and 31 affordable houses each year (as opposed to 118 private and 454 affordable houses each year as proposed in the HDNA). • The Scottish Government guidance on Local Housing Strategies requires them to set housing supply targets for the council’s Local Development Plans. These targets derive from the Housing Need and Demand Assessment and enable the Local Development Plans to identify their housing land requirement. Stirling’s Local Housing Strategy (2012) advises that the Council has set the housing supply target for private housing at 328 units a year and for affordable homes at 88 a year in the Stirling Local Development Plan area. • Further work will be taken forward to identify specialist housing/supported housing models for the older adult population.
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3.3 Fuel Poverty The term fuel poverty refers to a situation where a household is unable to heat its home at a reasonable cost. A person is living in fuel poverty if, to heat their home to a satisfactory standard2, they need to spend more than 10% of their household income on fuel. Extreme fuel poverty is where they need to spend more than 20% of their household income on fuel. This affects households greatly especially during the winter months, as the colder outside temperature and lack of suitable heating inside increases the risk of developing health problems such as cardiovascular and respiratory conditions. Fuel poverty also means that the dwelling is more susceptible to issues such as damp and mould, which in turn affects the quality of life and health of the people living in that environment.
Table 3.3a below shows the percentage of households in Clackmannanshire and Stirling that can be considered fuel poor and extreme fuel poor compared to the Scottish average (the fuel poor figure includes the extreme fuel poor). Whilst Clackmannanshire is slightly below the Scottish average, the percentage of households in Stirling that are fuel poor is higher than the Scottish average, in both categories.
Table 3.3a Fuel Poverty in Clackmannanshire & Stirling – All Households
Fuel Poverty (required fuel Extreme Fuel Poverty (required All households costs >10% of income) fuel costs >20% of income) Clackmannanshire 35% 8% Stirling 38% 13% Scotland 36% 10% Source: Scottish House Condition Survey Local Authority Tables 2011-2013
Table 3.3b shows the percentage of older adult households in Clackmannanshire and Stirling that are fuel poor and extreme fuel poor. Whilst approximately half of these households in both local authorities are fuel poor, fewer than 1 in 10 in Clackmannanshire are extreme fuel poor whilst over 1 in 5 in Stirling are extreme fuel poor.
Table 3.3b Fuel Poverty in Clackmannanshire & Stirling – Pensioner Households
Pensioner Fuel Poverty (required fuel Extreme Fuel Poverty (required households costs >10% of income fuel costs >20% of income) Clackmannanshire 49% 8% Stirling 52% 21% Scotland 54% 15% Source: Scottish House Condition Survey Local Authority Tables 2011-2013
2 An adequate standard of warmth is usually defined as 21ºC for the main living area, and 18ºC for other occupied rooms.
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There are a number of factors that contribute to fuel poverty.
• In Stirling, a third of the dwellings were built before 1945, and older properties are more likely to have no insulation or be poorly insulated. This increases heating and fuel costs as well as affecting the quality of life for inhabitants. In 2011/13 an average of only 59% of the dwellings in Stirling were wall insulated (cavity and solid/other). In comparison, 22% of the properties in Clackmannanshire were built before 1945, and 71% of all dwellings had wall insulation in 2011/13.
• The Stirling area also includes a higher proportion of rural households (33.6%) compared to those in Clackmannanshire (14%). Rural properties tend to be older properties, and their location makes them more exposed to the elements than those in urban areas. Exposure to wind, rain, and snow makes the household more expensive to heat. Additionally, rural locations are less likely to be connected to the mains gas lines, with energy being provided by other methods including heating oil and gas bottles. These types of energy supply are less efficient than mains gas, thus increasing fuel costs. In Stirling in 2011/13, 18% of properties were off the gas grid, whereas in Clackmannanshire only 8% were not connected.
The energy efficiency of the dwelling also affects the fuel costs. The lower the efficiency of the dwelling, the higher the fuel costs. In Stirling 4% of properties are in the lowest groupings for energy efficiency, this is the same as the Scotland average. In Clackmannanshire, only 2% of dwellings are classed as having low energy efficiency.
3.4 Employment, Benefits and Financial Issues The 2011 Census return details the economic activity of respondents. This is categorised into those who are economically active (in or seeking employment) and those who are economically inactive (not in or seeking employment).
Table 3.4a below shows the percentage of the population aged 16-74 by their economic activity in Clackmannanshire, Stirling, and Scotland as a whole. The percentage of people who are economically active is about 62% of the population, but in Clackmannanshire there are a slightly higher percentage of people who are unemployed. Similarly, for those inactive economically, the percentage of people who are long-term sick or disabled is highest in Clackmannanshire.
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Table 3.4a Percentage of total population by economic activity
Unemployed Economically inactive Economically (actively seeking (includes retirees & Long-term sick Area active work) students) or disabled Clackmannanshire 62.3% 5.8% 37.7% 5.5% Stirling 62.0% 4.8% 38.0% 3.9% Clackmannanshire & Stirling 62.1% 5.2% 37.9% 4.5% Scotland 62.8% 5.1% 37.2% 4.8% Source: 2011 Census
Figures from the Department for Work and Pensions show that there were 10,489 housing benefit claimants in Clackmannanshire and Stirling in August 2015, a decrease from the previous month.
Table 3.4b Housing benefit claimants by local authority July-August 2015
Housing benefit claimants Jun-15 Jul-15 Aug-15 Clackmannanshire 5150 5152 5092 Stirling 5464 5465 5397 Total 10614 10617 10489 Source: Department for Work and Pensions Stat-Xplore
Financial issues and concerns can cause health and social problems. Job insecurity, redundancy, debt and financial problems can all cause emotional distress, affect a person’s mental health and contribute to other health issues. Information from the 2013 Scottish Household Survey shows statistics for how well households manage finances. The charts below show how well households managed their finances by the amount of income and also by the main source of income. They show that more households in Clackmannanshire report that they manage finances less well than those in Stirling, especially households who have an annual income up to £15,000 and those whose main income is from benefits.
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Figure 3.4a Household management by annual household income - Clackmannanshire
Household management by annual household income - Clackmannanshire 2013 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Up to £15,000 £15,001-£30,000 Over £30,000 Base: 90 Base: 100 Base: 80 Manages well Gets by Does not manage well
Source: Scottish Household Survey
Figure 3.4b Household management by annual household income - Stirling
Household management by annual household income - Stirling 2013 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Up to £15,000 £15,001-£30,000 Over £30,000 Base: 70 Base: 80 Base: 100 Manages well Gets by Does not manage well
Source: Scottish Household Survey
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Figure 3.4c Household management by income type - Clackmannanshire
Household management by income type - Clackmannanshire 2013 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Main income from earnings Main income from benefits Base: 150 Base: 100 Manages well Gets by Does not manage well
Source: Scottish Household Survey
Figure 3.4d Household management by income type Stirling
Household management by income type - Stirling 2013 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Main income from earnings Main income from benefits Base: 150 Base: 70 Manages well Gets by Does not manage well
Source: Scottish Household Survey
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3.5 Life Circumstance Considerations/Implications • Deprivation can be a key contributing factor in the health of a population. Clackmannanshire and Stirling have very different Scottish Index of Multiple Deprivation profiles with Clackmannanshire containing a higher proportion of its residents living in more deprived areas. • Households headed by someone aged 75 and over is estimated to increase from 2012 to 2037 by 121% in Clackmannanshire and 91% in Stirling, greater than in Scotland (82%). • Stirling has a higher proportion of the population living in fuel poverty than in Clackmannanshire and Scotland as a whole. • Clackmannanshire has a higher proportion of residents unemployed and actively seeking work than in Stirling and in Scotland as a whole. • More households in Clackmannanshire report that they manage finances less well compared to households in Stirling, especially households who have an annual income up to £15,000 and those whose main income type is from benefits.
4 Risk Factors Risk factors have an effect on a person’s health and well-being. Behaviours such as smoking, alcohol consumption, drug use, and poor diet can have an adverse effect on health.
4.1 Smoking Smoking related illnesses not only affect an individual’s health but also result in higher demands on health services. It is estimated that in NHS Forth Valley in 2009 there were 2,187 hospital admissions as a result of smoking and that over £15 million was spent treating smoking related illness.3 Continued focus on prevention is important to improve health and to reduce pressures on services.
Table 4.1a shows the percentage of the adult population (16 years of age and over) who smoke in the Local Authorities, both separately and combined, compared with the Scotland average from 1999 to 2013. Data for individual local authorities for 2011 is not available.
The percentage of the adult population who smoke decreased between 1999/2000 and 2013, but there was a slight increase between 2012 and 2013 across all local authorities and Scotland as a whole.
3 ScotPHO Smoking Ready Reckoner – 2011 Edition
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In 1999/2000, 33.8% of adults in Clackmannanshire smoked, by 2013 this had fallen to 28.9%. In Stirling, the percentage of adults who smoked had fallen from 26.9% to 20.1% over the same time period. This is comparable to the trend for the total Scotland figures in the years between 1999/2000 and 2013.
In 2013, the percentage of adults who smoked was higher in Clackmannanshire than in Stirling and this figure was also greater than the Scottish average (see Figure 4.1b).
Table 4.1a Percentage of adult smokers 1999-2013
1999- 2001- 2003- 2005- 2007- 2009- Area 2000 2002 2004 2006 2008 2010 2011 2012 2013 Clackmannanshire 33.8 35.0 30.3 29.8 30.4 23.7 22.0 28.9 Stirling 26.9 23.5 24.1 23.9 23.3 20.4 17.0 20.1 Clackmannanshire & Stirling 30.3 29.0 27.2 26.8 26.7 21.9 19.5 24.8 Scotland 30.0 28.6 27.5 26.0 25.4 24.2 23.3 22.9 23.1 Source: Scottish Household Survey - Annual Report 2013 - LA Tables
Figure 4.1a shows the trend in the percentage of adults who smoke from 1999/2000 to 2013.
Figure 4.1a Percentage of adults who smoke, 1999/2000 to 2013
Percentage Adult Smokers Scottish Household Survey 2013 40 35 30 25 20 15 10 5 0 1999-2000 2001-2002 2003-2004 2005-2006 2007-2008 2009-2010 2011 2012 2013
Clackmannanshire Stirling Clackmannanshire & Stirling Scotland
Source: Scottish Household Survey - Annual Report 2013 - LA Tables
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Figure 4.1b shows a breakdown of those who smoked in 2013 by gender. It demonstrates that in all localities fewer women smoked than men. Also, in Clackmannanshire 35% of the adult male population smoked, this is 10% higher than the Scottish average where in 2013 25% of the adult male population smoked.
Figure 4.1b Smoking by gender
Percentage of adult smokers by gender 2013 40 35 30
25 20 15 % of % of population 10 5 0 Clackmannanshire Stirling Clackmannanshire Scotland & Stirling
Male Female
Source: Scottish Household Survey - Annual Report 2013 - LA Tables
Tables 4.1b and 4.1c show the rates of smoking related illnesses in Clackmannanshire and Stirling compared to the Scotland rate.
In Clackmannanshire in 2012 the rates for smoking related deaths, lung cancer deaths and chronic obstructive pulmonary disease (COPD) deaths were higher than the rate for Scotland. In Stirling, the rates for these measures were lower than the rates for Scotland.
Table 4.1b Age standardised rate of smoking related illnesses Measure Year Clackmannanshire Scotland Smoking attributable admissions 2012 1,955.9 3149.4 Smoking attributable deaths 2012 329.3 325.9 Lung cancer registrations 2011 124.6 133.3 Lung cancer deaths 2012 145.2 107.1 COPD incidence 2012 364.3 391.1 COPD deaths 2012 99.7 77.9 Source: ScotPHO Tobacco Control Profile
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Table 4.1c Age standardised rate of smoking related illnesses Measure Year Stirling Scotland Smoking attributable admissions 2012 1,912.10 3149.4 Smoking attributable deaths 2012 272.5 325.9 Lung cancer registrations 2011 114.9 133.3 Lung cancer deaths 2012 97.8 107.1 COPD incidence 2012 267.8 391.1 COPD deaths 2012 57.0 77.9 Source: ScotPHO Tobacco Control Profile
4.2 Alcohol Alcohol related health issues are a major concern for public health in Scotland. Excessive consumption of alcohol can cause both short-term and long-term health and social problems. This includes liver and brain damage, as well as mental health issues, and it is also a contributing factor in cancer, stroke and heart disease.
The rate of alcohol related hospital admissions in Clackmannanshire has increased slightly in the five years between 2009/10 and 2013/14 from 497.7 to 510.5. The number of hospital stays has remained relatively static over those five years, in 2013 there were 265 stays related to alcohol.
In Stirling the rate of hospital admissions has fallen from 610 in 2009/10 to 456.2 in 2013/14. Nevertheless, the number of alcohol related hospital stays in Stirling has fallen since 2009/10 although the number of hospital stays is higher than in Clackmannanshire. In 2013 there were 397 alcohol related hospital stays in Stirling. For information on Substance Misuse Support Services please see section 6.16.
Tables 4.2a and 4.2b show the figures for the different measures from 2009/10 to 2013/14.
Table 4.2a Alcohol Related Hospital Statistics 2013/14 Clackmannanshire EASR Standardised rate Number of hospital stays 2009/10 497.7 260 2010/11 441.2 230 2011/12 499.6 260 2012/13 502.4 260 2013/14 510.5 265 Source: ISD Scotland
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Table 4.2b Alcohol Related Hospital Statistics 2013/14
Stirling EASR Standardised rate Number of hospital stays 2009/10 610.0 516 2010/11 453.6 387 2011/12 483.5 410 2012/13 409.0 358 2013/14 456.2 397 Source: ISD Scotland
Table 4.2c displays the age standardised rates for both Clackmannanshire and Stirling compared to the national average between 2009 and 2013. The figures are also presented in the form of a chart in Figure 4.2a.
The alcohol related mortality rate in Clackmannanshire in 2013 at 38.85, was significantly worse than the average rate of 21.43 for Scotland. Alcohol related mortality is the rate per 100,000 people where alcohol is the underlying cause of death. The rate in Clackmannanshire had been slightly above the national rate in 2009, and fallen below the national average in the intervening years only to rise above it in 2013.
In Stirling, the alcohol related mortality rate has been below the Scottish average in each year from 2009 to 2013.
Table 4.2c Alcohol related mortality
Clackmannanshire Stirling EASR EASR Standardised Standardised National average Year mortality rate mortality rate mortality rate 2009 26.73 24.59 25.65 2010 9.75 20.27 26.14 2011 23.01 16.26 24.56 2012 13.22 18.19 21.19 2013 38.85 16.67 21.43 Source: ISD Scotland/National Records of Scotland (NRS)
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Figure 4.2a Alcohol related mortality
Alcohol mortality rate 45 40 35 30 25
Rate 20 15 10 5 0 2009 2010 2011 2012 2013
Clackmannanshire EASR Standardised mortality rate Stirling EASR Standardised mortality rate National average mortality rate
Source: ISD Scotland/National Records of Scotland (NRS)
4.3 Drugs In 2012/2013 across Clackmannanshire and Stirling there were an estimated 1,450 people aged 15-64 with a problem drug use. Problem drug use can lead to a number of health and social problems.
Table 4.3a Estimated number of individuals with problem drug use by Council area (ages 15 to 64); 2012/13
Estimated number of people with Council area a problem drug use Clackmannanshire 630 Stirling 820 Source: ISD Scotland
The estimated prevalence of those with a problem drug use has increased in Clackmannanshire and Stirling when comparing the data from 2009/10 and 2012/13. This is in contrast to Scotland as a whole, where the estimated percentage of the population with a problem drug use fell slightly.
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Table 4.3b Estimated prevalence of problem drug use (ages 15 to 64)
Estimated Prevalence Estimated Prevalence Council Area 2009/10 2012/13 % % Clackmannanshire 1.52 1.84 Stirling 1.23 1.36 Scotland 1.71 1.68 Source: ISD Scotland
The rate of drug related deaths (European age and sex standardised rate per 100,000 population) has been above the national average every year from 2011 to 2014 in Clackmannanshire but below it in Stirling.
The local Alcohol and Drug Partnership are currently undertaking a needs assessment specifically relating to substance misuse. Once this work is complete any relevant considerations will be taken on board by the Health and Social Care partnership.
4.4 Diet and Obesity Obesity is when a person’s weight increases to an extent that it could potentially cause health problems. Having a Body Mass Index (BMI) of over 30 is considered to be obese. Obesity is linked to a number of health problems and diseases and common complaints include cardiovascular disease and diabetes. One of the major factors that cause an individual to become obese is poor diet.
For Scotland in 2013 it was estimated that 27% of the adult population aged 16+ were obese (a Body Mass Index (BMI) of 30 or more). When this is broken down into different age groups and by gender, it shows that obesity is highest for men between the ages of 55 and 64, and for women between the ages of 65 and 74.
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Figure 4.4a Percentage of population with a BMI of 30 plus - 2013
Percentage of population with a BMI of 30+ by age and sex 2013 45
40
35
30
25
20 Percentage 15
10
5
0 16-24 25-34 35-44 45-54 55-64 65-74 75+ All ages
Male Female
Source: The Scottish Health Survey 2013
Data and information concerning diet and obesity is not regularly published at local authority or health board levels. Information from the Scottish Health Survey in 2011 showed a four year average of obesity rates in NHS Forth Valley. This information is shown in Figure 4.4b.
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Figure 4.4b Percentage of the adult population in Forth Valley with a BMI of 25 plus, 30 plus, and 40 plus - 2008-2011.
Percentage of Adult population in Forth Valley with BMI of 25+, 30+, and 40 + 100.0 90.0 80.0 70.0 60.0 50.0
Percentage 40.0 30.0 20.0 10.0 0.0 25 and over 30 and over 40 and over BMI Men Women
Source: The Scottish Health Survey 2011
4.5 Risk Factors Considerations/Implications • Despite the introduction of the smoking ban in public places in 2006, latest estimates suggest 28.9% of people in Clackmannanshire still smoke. The corresponding figure for Stirling is 20% and for Scotland is 23.1%. Tobacco smoking is the main risk factor for lung cancer, accounting for an estimated 80-90% of cases in developed countries and is linked to other cancers and Chronic Obstructive Pulmonary Disease (COPD). • The alcohol related mortality rate in Clackmannanshire in 2013 at 38.85, was significantly worse than the average rate of 21.43 for Scotland. In Stirling, the alcohol related mortality rate has been below the Scottish average in each year from 2009 to 2013. • The estimated prevalence of those with a problem drug use has increased in Clackmannanshire and Stirling when comparing the data from 2009/10 and 2012/13. This is in contrast to Scotland as a whole, where the estimated percentage of the population with a problem drug use fell slightly. • Obesity is a major problem nationally and the most recent data suggests approximately 25% of the NHS Forth Valley population are considered obese. Obesity is known to be a
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key contributor to long term conditions such as Type 2 Diabetes and coronary heart disease, both of which are life-limiting for the patient and costly to the joint services.
Often it is the combination of risk factors rather than a single risk factor that is important. This and the interaction with diseases and conditions can be complex. For example alcohol and drug use often co-exist and combine with mental health and wider social problems.
Some of the lifestyle/risk factor indicators included in Chapter 4 suggest that riskier behaviour/lifestyles may be more prominent in Clackmannanshire than in Stirling. There is likely to be however, variation across both Clackmannanshire and Stirling. Further work on locality profiles may help to identify these areas.
5. Population Health 5.1 General Health According to the 2011 Census the majority of people in both Clackmannanshire and Stirling considered their general health to be good or very good (Table 5.1a) and only a small percent bad or very bad.
Table 5.1a: General health for Clackmannanshire and Stirling
Good / Very Bad / Very bad Local Authority good health Fair health health Clackmannanshire 81.6 12.7 5.7 Stirling 84.7 10.8 4.5 Source: 2011 Census
In both Clackmannanshire and Stirling there is an increase in people considering their general health to be fair or bad/very bad with age.
5.2 Life Expectancy and Healthy Life Expectancy Life expectancy is an estimate of how many years a person might be expected to live. As table 5.2a illustrates female life expectancy at birth is greater than male life expectancy in Clackmannanshire, Stirling and Scotland. Both male and female life expectancy at birth is higher in Stirling that the Scottish average. In Clackmannanshire female life expectancy at birth is lower than the Scottish average.
While life expectancy at birth has improved for both males and females in Clackmannanshire and Stirling since 2001-2003 there has been a more rapid improvement for males.
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Table 5.2a: Life Expectancy for Clackmannanshire, Stirling and Scotland, 2001-2003 and 2011- 2013
Clackmannanshire Stirling Scotland Life expectancy at birth Life expectancy at birth Life expectancy at birth Male Female Male Female Male Female 2011 -13 77.0 79.9 78.5 82.2 76.9 81.0 2001-03 73.5 78.7 75.5 79.3 73.5 78.8 % change between 2001-2003 and 2011- 2013 4.7 1.6 4.0 3.7 4.6 2.7
Source: National Records of Scotland (NRS)
Figure 5.2a: Life expectancy at birth in Clackmannanshire, Stirling and Scotland, 2011-2013
83 82.2 82 81.0 81 79.9 80
79 78.5
Age 78 77.0 76.9 77 76 75 74 Clackmannanshire Stirling Scotland
Male Female
Source: National Records of Scotland (NRS)
Healthy life expectancy is an estimate of how many years a person might live in a ‘healthy’ state. The chart below (Figure 5.2b) compares life expectancy and healthy life expectancy in Clackmannanshire, Stirling and Scotland based on data for the five year period 1999-2003. It shows that both life expectancy and healthy life expectancy is higher in Stirling than the Scottish average. In Clackmannanshire while both male and female life expectancy is comparable to Scotland both are expected to have a lower healthy life expectancy.
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Figure 5.2b: Life Expectancy and healthy life expectancy at birth in years for the five year period 1999-2003 for Clackmannanshire and Stirling Community Health Partnerships and Scotland
100.0 73.3 78.5 75.4 79.5 72.2 73.3 78.7 80.0 65.7 69.1 69.3 66.3 70.2 60.0
Age 40.0 20.0 0.0 Male Female Male Female Male Female Clackmannanshire Stirling Scotland
Life Expectancy Healthy Life Expectancy
Source: Scotpho (http://www.scotpho.org.uk/population-dynamics/healthy-life- expectancy/data/community-health-partnerships)
5.3 Long Term Health Conditions Long term conditions (LTCs) are health conditions that last a year or longer, impact on a person’s life, and may require ongoing care and support. Long term conditions can have a serious impact upon a person’s personal life but can also have a serious economic impact on health and social care services. Sixty per cent of all deaths are attributable to long term conditions and they account for 80 per cent of all GP consultations (http://www.gov.scot/Topics/Health/Services/Long-Term-Conditions).
As part of the Quality and Outcomes Framework (QOF), GP practices across the UK are funded to keep registers of all of their patients that they know to have certain health conditions. Table 5.3a and Table 5.3b illustrate the number of patients, in Clackmannanshire and Stirling, known to GP practices having selected long term conditions as at March 2014.
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Table 5.3a - Numbers of patients on selected QOF registers of Stirling GP practices
QOF register Numbers Percentage of all Numbers Numbers practice patients at as at March 14 March 2014 as at March 13 as at March 12 Asthma 5,100 5.65 5,034 5,025 Atrial Fibrillation 1,530 1.69 1,464 1,415 Cancer 2,129 2.36 1,989 1,861 CHD (Coronary Heart Disease) 3,714 4.11 3,755 3,812 CKD (Chronic Kidney Disease) 3,010 3.33 3,046 3,067 COPD (Chronic Obstructive Pulmonary Disease) 1,564 1.73 1,527 1,489 Diabetes 3,963 4.39 3,843 3,705 Epilepsy 598 0.66 592 596 Heart Failure 701 0.78 664 682 Hypertension 12,324 13.65 12,221 12,140 Hypothyroidism 3,007 3.33 3,003 2,939 Osteoporosis 135 0.18 N/A N/A Peripheral Arterial Disease 593 0.66 N/A N/A Rheumatoid arthritis 431 0.48 N/A N/A Stroke & Transient Ischaemic Attack (TIA) 1,866 2.07 1,824 1,887 Source: Quality and Outcomes Framework (QOF) www.isdscotland.org/qof
Table 5.3b - Numbers of patients on selected QOF registers of Clackmannanshire GP practices
QOF register Percentage of all Numbers as at practice patients at Numbers as at Numbers as at March 2014 March 2014 March 2013 March 2012 Asthma 3,435 6.09 3,480 3,384 Atrial Fibrillation 879 1.56 835 819 Cancer 1,309 2.32 1,222 1,178 CHD (Coronary Heart Disease) 2,688 4.77 2,726 2,745 CKD (Chronic Kidney Disease) 1,882 3.34 1,890 1,822 COPD (Chronic Obstructive Pulmonary Disease) 1,258 2.23 1,197 1,122 Diabetes 2,891 5.13 2,753 2,606 Epilepsy 429 0.76 412 407 Heart Failure 501 0.89 488 493 Hypertension 8,329 14.77 8,282 8,158 Hypothyroidism 1,816 3.22 1,775 1,724 Osteoporosis 76 0.13 N/A N/A Peripheral Arterial Disease 546 0.97 N/A N/A Rheumatoid arthritis 303 0.54 N/A N/A Stroke & Transient Ischaemic Attack (TIA) 1,294 2.30 1,268 1,269 Source: Quality and Outcomes Framework (QOF) www.isdscotland.org/qof
Stirling had a slightly lower prevalence rate than Scotland for 12 out of 15 conditions listed above. Whereas Clackmannanshire had a slightly higher prevalence rate compared to Scotland for 11 out of 15 conditions listed.
The following subsections will look at particular long term conditions in more detail.
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5.3.1 Dementia Dementia presents a significant challenge to individuals, their carers and health and social care services across Scotland. As at March 2014 there were 424 individuals known to GP practices as having dementia in Clackmannanshire and 649 in Stirling. This equates to 0.72% and 0.75% of all patients registered to a GP practice in Stirling and Clackmannanshire respectively.
However, it is suspected that dementia is under diagnosed in Scotland. Alzheimer Scotland has produced estimates, by local authority, of the number of people living in Scotland in 2015 with Dementia (Table 5.3.1a). This suggests that around 50% of individuals with dementia are not yet diagnosed by their GP.
Table 5.3.1a – Estimated number of people in Clackmannanshire and Stirling with Dementia in 2015
Under 65 65+ Total Clackmannanshire 32 725 757 Stirling 53 1,535 1,588 Clackmannanshire & Stirling HSCP 85 2,260 2,345 Source: Alzheimer Scotland
If similar prevalence rates for dementia continue to occur we can expect to have significantly more cases of dementia in the local areas due to the projected increase in people over the age of 65 to 2037. This is likely to have a significant impact across health and social care services due to the complex nature of care required.
Crude projections have been estimated below using Dementia Prevalence rates from Alzheimer’s Scotland and National Records of Scotland (NRS) population projections. These estimates rely on dementia prevalence remaining the same up to 2037. (Rates are calculated with prevalence rates from EuroCode1). These figures not only demonstrate that there will be a lot more people with dementia if we see the projected increase in the older adult population, but also the significant difference in the number of female cases compared to males. This variation can be attributed to higher dementia prevalence rates for females (particularly in the 90+ age group) and the projection that there will be more females aged 90 and over.
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Figure 5.3.1a Male and Female Dementia Projections for Clackmannanshire, 2012-2037
Source: National Records of Scotland (NRS) Population Projections (2012-Based) and Alzheimer’s Scotland [1] Alzheimer Europe (2009) EuroCoDe: prevalence of dementia in Europe http://www.alzheimer- europe.org/index.php?lm3=CEE66BE91B37
Figure 5.3.1b Male and Female Dementia Projections for Stirling, 2012-2037
Source: National Records of Scotland Population Projections (2012-Based) and Alzheimer’s Scotland [1] Alzheimer Europe (2009) EuroCoDe: prevalence of dementia in Europe http://www.alzheimer- europe.org/index.php?lm3=CEE66BE91B37
5.3.2 Cancer In 2013 there were 1,665 diagnoses of cancer in Forth Valley. This was a slight increase from the year before, and also meant that the number of registrations in 2013 was the highest it had been in ten years. The number of people diagnosed with cancer is predicted to rise in the future. The risk of developing cancer increases as a person gets older, and this, coupled with an increasing older adult population means that the number of cancer registrations is set to rise.
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Table 5.3.2a Cancer registrations in NHS Forth Valley from 2004-2013
Cancer registrations 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 All cancers 1611 1445 1530 1512 1606 1648 1660 1605 1624 1665 Source: Scottish Cancer Registry, ISD Scotland
Figure 5.3.2a shows the number of registrations for breast, colorectal and lung cancer from 2004 to 2013. These three cancers account for approximately 45% of all cancer diagnoses in NHS Forth Valley.
Figure 5.3.2a Cancer registrations, 2004-2013
Cancer registrations 2004 - 2013 350
300 250 200 150 100
Number of of Number registrations 50 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Breast Colorectal Lung
Source: Scottish Cancer Registry, ISD Scotland
The rate of cancer registrations in NHS Forth Valley is below the Scottish average although it is not significantly so. In 2013, the crude rate across Scotland was 630 out of 100,000 people, in NHS Forth Valley it was 556 out of 100,000 people.
The mortality rate for cancer in Forth Valley is very close to the rate for Scotland as a whole. In 2013, the figure for Scotland was 296 per 100,000 people, and in Forth Valley it was 290 per 100,000 people. The mortality rate in Forth Valley was relatively stable between 2004 and 2013; it was at its lowest in 2008 at 259, and highest in 2012 when it was 309. Despite an overall increase in the number of new registrations of people with cancer, they are able to live with cancer for longer and this affects the mortality rate.
Cancer incidence in Scotland is projected to rise by a third over the next 10 years. In the five years between 2023 and 2027, it is estimated that there will be over 204,000 new cases of cancer across the whole country.
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Presently, about 5% of new cancer diagnoses in Scotland are registered in NHS Forth Valley and if this was to continue to be true by 2027, it would mean that there would be over 2,100 new cancer cases in the board area annually.
5.4 Projected Long Term Health Conditions Forecasting disease prevalence can provide information regarding where resources might be needed in the future or where preventative interventions could reduce disease. There are a range of factors which influence the prevalence of disease. These are:
• Age - in general most conditions are age-related. Even if other risk factors are decreasing the effect of demographic change can be overwhelming. • Genes – most diseases have at least some genetic component. • Environment – physical and social. • Deprivation – even accounting for differences in behaviour, most diseases are deprivation related. This may be mediated through stress (the socio-psycho-neuro- immuno-pathological pathway). • Health related behaviours. • Underlying mental wellbeing/ resilience/ self-efficacy / confidence / motivation. • Real engagement with life in general and personal wellbeing in particular. • Options for intervention and organisation of this.
It is easy to assume that disease trends will continue. However the trends could change to some extent. For example an increase in healthy behaviours or a change in socio economic circumstances could impact on the projected trends. To apply a crude method consisting of the application of age-specific prevalence rates to population projections gives the forecast demonstrated in Figure 5.4a and 5.4b, for Stirling and Clackmannanshire respectively, for Diabetes, Ischaemic Heart Disease (IHD) and Stroke. The figures show an increase in the forecasted prevalence of disease. The assumption has been made that the age-specific prevalence rates remain constant.
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Figure 5.4a – Estimated projections of Diabetes, IHD and Stroke in Stirling
Diabetes IHD 6000 8000 7000 5000 6000 4000 5000 3000 4000 3000 2000 2000 1000 1000 Number of individual aged 15+ Number of individual aged 15+ 0 0 2010 2015 2020 2025 2030 2035 2040 2010 2015 2020 2025 2030 2035 2040
Stroke 3500
3000
2500
2000
1500
1000
500 Number of individual aged 15+ 0 2010 2015 2020 2025 2030 2035 2040
Source: Scottish Health Survey (prevalence rates) and National Records of Scotland population Estimates
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Figure 5.4b – Estimated projections of Diabetes, IHD and Stroke in Clackmannanshire
Diabetes IHD 3500 4500 4000 3000 3500 2500 3000 2000 2500
1500 2000 1500 1000 1000 Number of individual aged 15+ Number of individual aged 15+ 500 500 0 0 2010 2015 2020 2025 2030 2035 2040 2010 2015 2020 2025 2030 2035 2040 Stroke 2000 1800 1600 1400 1200 1000 800 600 400
Number of individual aged 15+ 200 0 2010 2015 2020 2025 2030 2035 2040
Source: Scottish Health Survey (prevalence rates) and National Records of Scotland (NRS) population Estimates
5.5 Multi-Morbidity In light of an increasing older adult population there will potentially be more people with multiple long term conditions (also referred to as multi-morbidities) in both Clackmannanshire & Stirling. Figure 5.5a demonstrates that patients have more conditions as they age. The estimated number of people in Clackmannanshire and Stirling with various numbers of long term conditions is forecasted to increase between 2015 (Figure 5.5b) and 2037 (Figure 5.5c).
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Figure 5.5a – Estimated number of conditions by age group
100
90
80
70 1 disorder
2 disorders 60 3 disorders
4 disorders 50 5 disorders Patients (%) Patients
40 6 disorders
7 disorders 30 8 or more disorders 20
10
0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+
Age group (years)
Source: The Challenge of Multimorbidity in Scotland, Professor Stewart Mercer
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Figure 5.5b - Estimated number of people within Clackmannanshire & Stirling HSCP with various numbers of conditions (2015)
Number of Long Term Conditions by Age Group (estimated for Stirling & Clackmannanshire HSCP- 2015) 14000
12000
10000 0 disorders 1 disorder
8000 2 disorders 3 disorders
6000 4 disorders No of patients 5 disorders 6 disorders 4000 7 disorders 8 or more disorders 2000
0
Source: The Challenge of Multimorbidity in Scotland, Professor Stewart Mercer applied to National Records of Scotland (NRS) population estimates for Clackmannanshire and Stirling
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Figure 5.5c - Estimated number of people within Clackmannanshire & Stirling HSCP with various numbers of conditions (2037)
Number of Long Term Conditions by Age Group (estimated for Stirling & Clackmannanshire HSCP - 2037) 12000
10000 0 disorders 1 disorder 8000 2 disorders 3 disorders 4 disorders 6000 5 disorders 6 disorders 4000 7 disorders 8 or more disorders
2000
0
Source: The Challenge of Multimorbidity in Scotland, Professor Stewart Mercer applied to National Records of Scotland (NRS) population estimates for Clackmannanshire and Stirling
The estimated and projected number of individuals with multiple long term conditions has been produced using prevalence rates from a study by Professor Stewart Mercer. The study looked at data from 310 GP practices (covering 1,754,133 patients) to produce prevalence rates of multiple long term conditions. These prevalence rates have then been applied to the Clackmannanshire & Stirling populations. These are an estimate and do not take account the different circumstances, such as deprivation, in Clackmannanshire & Stirling to the population used in Professor Mercer’s study
While this will be challenging it is important to recognise the value that older people bring to our society, both economically and socially. The multiple morbidities demonstrated in Figures 5.5b and 5.5c bring both person‐centred as well as financial challenges (Christie, 2011). Patients with multiple complex long term conditions are currently making multiple trips to hospital clinics to see a range of uncoordinated specialist services. A proposed way forward could be to look at developing new pathways and guidelines away from the current disease specific models to generic approaches focused on the holistic needs of patients (Lunt, 2013, p. 17). The latter
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ties in with the Scottish Government’s 2020 Vision (Scottish Government, 2011) that by 2020 everyone is able to live longer healthier lives at home, or in a homely setting, and the values of designing the services around the person. For example, we need to make sure that people do not have to unnecessarily attend five different, disjointed, specialists for the five different conditions that they have.
5.6 High Resource Individuals Health and Social Care resources are not utilised evenly across the population and gaining a better understanding about the cohort of individuals who account for disproportionate levels of resource could allow for more effective planning and delivery of services and an improved service user experience.
ISD Scotland have undertaken cost per patient analysis on Inpatient and day case hospital admissions (including all acute specialties, maternity, geriatric long stay inpatient care, and psychiatric inpatient care), A&E attendances, consultant led outpatient clinics and community prescribing in order to define “High Resource Individuals (HRIs)”. High Resource Individuals have been defined as the cohort of individuals who account for 50% of total health and social care expenditure.
Analysis on 2012/13 expenditure found that 1,037 individuals in Clackmannanshire (2% of the population) and 1,606 individuals in Stirling (1.8% of the population) accounted for 50% of expenditure across the services mentioned above. Table 5.6a shows the figures relating to High Resource Individuals in Clackmannanshire, Stirling and Scotland.
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Table 5.6a Breakdown of all activities for HRIs and all patients in Clackmannanshire, Stirling and Scotland 2012/13
Financial Year 2012/13 Stirling Clackmannanshire Scotland HRIs 1,606 1,037 103,715 Number of patients All Patients 73,352 42,882 4,425,174 % HRI 2.2% 2.4% 2.3% HRIs 82,680 47,652 5,419,968 Number of bed days All Patients 106,134 60,828 7,439,396 % HRI 77.9% 78.3% 72.9% HRIs 119,804 66,888 7,397,856 Episodes/Attendances/ 1,662,511 917,079 96,720,899 Items1 All Patients % HRI 7.2% 7.3% 7.6% HRIs £37,922,431 £22,440,642 £2,558,775,992 Cost (£) All Patients £75,845,095 £44,890,562 £5,117,568,466 % HRI 50.0% 50.0% 50.0% HRIs £23,613 £21,640 £24,671 Cost per capita (£) All Patients £1,034 £1,047 £1,156 1 Episodes and attendances apply to inpatient, day case, outpatient and A&E activity. Items apply to prescribing only.
There is a strong association between High Resource Individuals and long term conditions. Seventy per cent of High Resource Individuals in Stirling had at least one long term condition compared to 68% in Clackmannanshire in 2012/13.
As health & social care integration progresses and more information becomes available at patient/service user level from different sources this analysis will be expanded. This will allow a more detailed look at the combinations of services that High Resource Individuals use and to explore opportunities to improve pathways of care.
5.7 Disability
5.7.1 Learning Disability Figure 5.7.1a shows the number of people in Clackmannanshire and Stirling who were recorded as having a learning disability by gender and age group at the time of the census in 2011. The age group with the highest number of people with a disability for both genders is the 35-49 age group. The number of men with a learning disability drops by 53% between those aged 35-49 and those aged 50-64, and 38% for women between the same age groups. After the age of 49 the number of people with a learning disability steadily decreases for both genders. This reflects research that tells us that people with learning disabilities are more likely to die at an
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early age than the general population, on average 20 years before4. It is a similar picture in Clackmannanshire and Stirling individually although in Clackmannanshire there is a similar number of people with a disability in the 0-15 age group than the largest 35-49 age group (Figures 5.7.1b and 5.7.1c). The Forth Valley Joint Learning Disability Strategic Framework is being developed which will highlight the local position ensuring consistency with the Scottish Government’s Learning Disability Strategy (2013), The Keys to Life.
Figure 5.7.1a Number of people in Clackmannanshire and Stirling with a learning disability, 2011.
Learning Disability Clackmannanshire & Stirling 100
90
80
70
60
50
40
Number of of Number People 30
20
10
0 0 to 15 16 to 24 25 to 34 35 to 49 50 to 64 65 to 74 75 to 84 85 and over Age Group Male Female
Source: 2011 Census
4 Tyrer F et al, Journal of Intellectual Disability Research, 2007; 51:520-7.
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Figure 5.7.1b Number of people in Clackmannanshire with a learning disability, 2011.
Learning Disability Clackmannanshire 35
30
25
20
15
Number of of Number People 10
5
0 0 to 15 16 to 24 25 to 34 35 to 49 50 to 64 65 to 74 75 to 84 85 and over Age Group Males Females
Source: 2011 Census
Chart 5.7.1c Number of people in Stirling with a learning disability, 2011. Learning Disability Stirling 70
60
50
40
30
Number of of Number People 20
10
0 0 to 15 16 to 24 25 to 34 35 to 49 50 to 64 65 to 74 75 to 84 85 and over Age Group Male Female
Source: 2011 Census
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5.7.2 Physical Disability The Scottish Government has recently announced (September, 2015) a plan, The Scottish Government’s Draft Delivery Plan 2016-2020, to address inequality and advance disabled people’s human rights.
Some of the key aspects of the plan are:
• More support for independent living for all disabled people who will have more say about how their support will be managed and provided
• Health, social care and other support services working together to remove the barriers faced by all disabled people
• Increased opportunities for disabled people to be involved in community development and service delivery
In Clackmannanshire and Stirling there were over 9,200 people recorded as having a Physical Disability in the 2011 Census.
Table 5.7.2a Number of people with a physical disability
Area Physical disability Percentage of total population Clackmannanshire CHP 3717 7.2% Stirling CHP 5535 6.1% Clackmannanshire & Stirling 9252 6.5% Source: 2011 Census
The majority of people who have a Physical Disability in Clackmannanshire and Stirling are over the age of 50. Table 5.7.2b below also shows that the proportion of those with a physical disability increases as people age. Only 1% of the population aged 16-24 had a Physical Disability in 2011, compared to 35.4% for those aged 85 and over.
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Table 5.7.2b Number of people in Clackmannanshire and Stirling with a Physical Disability by age and gender
Percentage of total Percentage of age group Age Male Female All with physical disability with physical disability 0-15 121 92 213 2.3% 0.8% 16-24 94 91 185 2.0% 1.0% 25-34 150 132 282 3.0% 1.8% 35-49 605 610 1215 13.1% 3.9% 50-64 1236 1302 2538 27.4% 9.0% 65-74 1034 1103 2137 23.1% 15.9% 75-84 704 1041 1745 18.9% 22.7% 85+ 259 678 937 10.1% 35.4% Source: 2011 Census
5.8 Mental Health and Wellbeing Mental health and wellbeing strategies and targets were established by the Scottish Government in 2012 (The Scottish Government, Mental Health Strategy for Scotland: 2012- 2015). Among the key areas of change outlined were:
• Community, inpatient and crisis mental health services • Work with other services and populations with specific needs.
A well functioning mental health system has a range of community, inpatient and crisis mental health services that support people with severe and enduring mental illness. Across Scotland there were variations in the pace of change, the delivery and the models of service for mental health as Boards attempted to move from predominantly inpatient services to services where care and treatment can be delivered mostly in the community.
Health issues that are included within the area of mental health range from common problems such as dementia, stress and depression, to more severe issues like schizophrenia, bipolar affective disorder and other psychoses.
In the 2011 Census, 2,374 people in Clackmannanshire and 3,319 people in Stirling identified themselves as having a mental health condition. This is 5,693 people in total, 4% of the total population. The distribution of this group by age group and gender for Clackmannanshire and Stirling combined and separately is shown in Figures 5.8a, 5.8b and 5.8c.
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Figure 5.8a Percentage of population with long term mental health condition in Clackmannanshire & Stirling by age group and gender 2011
Perecentage of population in Clackmannanshire & Stirling with long term mental health condition 2011 12.0%
10.0%
8.0%
6.0%
4.0% Percentage of of population Percentage
2.0%
0.0% 0 to 15 16 to 24 25 to 34 35 to 49 50 to 64 65 to 74 75 to 84 85 and over Age group Male Female
Source: 2011 Census
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Figure 5.8b Percentage of population with long term mental health condition in Clackmannanshire by age group and gender 2011
Percentage of population in Clackmannanshire with long term mental health condition 2011 9.0%
8.0%
7.0%
6.0%
5.0%
4.0%
3.0%
Percentage of of population Percentage 2.0%
1.0%
0.0% 0 to 15 16 to 24 25 to 34 35 to 49 50 to 64 65 to 74 75 to 84 85 and over Age group Male Female
Source: 2011 Census
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Figure 5.8c Percentage of population with long term mental health condition in Stirling by age group and gender 2011
Percentage of population in Stirling with long term mental health condition 2011 14.0%
12.0%
10.0%
8.0%
6.0%
4.0% Percentage of of population Percentage
2.0%
0.0% 0 to 15 16 to 24 25 to 34 35 to 49 50 to 64 65 to 74 75 to 84 85 and over Age group Male Female
Source: 2011 Census
Note- This information is taken from the 2011 census. Households are asked to self identify if they or someone within the household has a mental health condition. The question does not define a mental health condition or take into account multiple mental health conditions.
Further information on mental health and illnesses comes from the Quality and Outcomes Framework (QOF) for General Practices. Participation by general practices in the Quality and Outcomes Framework is voluntary but it measures achievement for general practitioners against a range of evidence-based indicators, and includes prevalence data for a range of conditions. Table 5.8a below shows information from the Quality and Outcomes Framework register.
A crude prevalence rate of the number of people in Clackmannanshire, Stirling and Scotland with a mental health condition is shown in Table 5.8a. It shows that the rate of people with a new diagnosis of depression is slightly higher than the Scottish rate in both areas.
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Table 5.8a Rate of people with mental health issues in Clackmannanshire, Stirling and Scotland 2013/14
New diagnosis of Schizophrenia, Bipolar affective Area depression disorder and other psychoses Clackmannanshire 6.28 0.80 Stirling 5.94 0.81 Scotland 5.81 0.88 Source: ISD Scotland
Wellbeing is linked to mental health in that it attempts to measure how happy and content people are in their everyday lives. This data has been collected by the Office for National Statistics as part of their UK Annual Population Survey since 2011. Four questions are asked concerning wellbeing and are rated on a scale of 0 to 10.
These are: 1) Overall, how satisfied are you with your life nowadays? Where 0 is 'not at all satisfied' and 10 is 'completely satisfied'. 2) Overall, to what extent do you feel the things you do in your life are worthwhile? Where 0 is 'not at all worthwhile' and 10 is 'completely worthwhile'. 3) Overall, how happy did you feel yesterday? Where 0 is 'not at all happy’ and 10 is 'completely happy'. 4) Overall, how anxious did you feel yesterday? Where 0 is 'not at all anxious' and 10 is 'completely anxious'.
The average scores for Clackmannanshire, Stirling and Scotland between 2011 and 2014 are shown in Table 5.8b below. The Stirling scores show that on average people there have better mental health wellbeing than people living in Clackmannanshire and in Scotland.
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Table 5.8b Wellbeing estimates 2011-2014
Wellbeing estimates 2011-2014 10 9 7.68 7.76 7.72 8 7.44 7.62 7.54 7.36 7.43 7.35 7 6
5 Score 4 2.91 2.87 2.98 3 2 1 0 Satisfaction Worthwhile Happiness Anxiety
Clackmannanshire Stirling Scotland
Source: Office for National Statistics
5.9 Premature Mortality Premature mortality is a measure of the number of deaths that occur under the age of 75 and can be used as an indicator of the poor health of a population. The fewer deaths that occur under the age of 75, the healthier the population is judged to be. In 2014 there were 497 deaths under the age of 75 across Clackmannanshire and Stirling, 35.9% of the total deaths. This is lower than the Scottish figure in 2014, which was 36.8%. The figures for each individual area can be found in Table 5.9a and Table 5.9b.
Table 5.9a Deaths under the age of 75, 2014
Deaths under age 75 Area Male Female Total Clackmannanshire 118 82 200 Stirling 166 131 297 Clackmannanshire & Stirling 284 213 497 Scotland 11749 8212 19961 Source: National Records of Scotland (NRS)
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Table 5.9b Deaths under the age of 75 as percentage of all deaths, 2014
Under 75s as % of all deaths Area Deaths under age 75 Total Deaths % Deaths under age 75 Clackmannanshire 200 488 41.0% Stirling 297 898 33.1% Clackmannanshire & Stirling 497 1386 35.9% Scotland 19961 54239 36.8% Source: National Records of Scotland (NRS)
The percentage of deaths occurring under the age of 75 has been gradually decreasing across Scotland between 2010 and 2014. Over the same time period the percentage of deaths under 75 fluctuated in Clackmannanshire and Stirling, but it was lower in 2014 than it was in 2010. Examining Clackmannanshire alone shows that it had a higher percentage of deaths under the age of 75 than Stirling and Scotland and this trend has continued from 2010 to 2014. Figure 5.9a shows this and compares the percentage deaths under 75 between the different areas.
Figure 5.9a Trend in deaths under age 75 as a percentage of all deaths between 2010 and 2014
Deaths under age 75 as percentage of all deaths 2010-2014 50% 45% 40% 35% 30% 25% 20% Percentage 15% 10% 5% 0% 2010 2011 2012 2013 2014
Scotland Clackmannanshire Stirling Clackmannanshire & Stirling
Source: National Records of Scotland Births, Deaths and Other Vital Events
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5.10 Cause of Death In 2014 there were 1,386 deaths registered in Clackmannanshire and Stirling. Sixty percent of this total number of deaths were caused by cancer and diseases of the circulatory system (including cardiovascular disease and strokes).
Table 5.10a Number and percentage of deaths (all ages) by cause 2014
Source: National Records of Scotland (NRS)
The percentage of all deaths caused by cancer and diseases of the circulatory system in Clackmannanshire and Stirling has not significantly changed in the years between 2010 and 2014. Each cause accounts for approximately 30% of all deaths, and this is comparable with the figures for Scotland as a whole.
Table 5.10b Number and percentage of deaths caused by cancer and diseases of the circulatory system in Clackmannanshire and Stirling between 2010 and 2014.
Clackmannanshire and Stirling 2010 2011 2012 2013 2014 Cause of death N % N % N % N % N % Cancer 402 30.8% 390 31.0% 442 31.9% 440 31.1% 421 30.4%
Diseases of the 378 28.9% 382 30.3% 416 30.0% 421 29.7% 414 29.9% circulatory system Source: National Records of Scotland (NRS)
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Table 5.10c Number and percentage of deaths caused by cancer and diseases of the circulatory system in Clackmannanshire between 2010 and 2014.
Clackmannanshire 2010 2011 2012 2013 2014 Cause of death N % N % N % N % N % Cancer 130 28.2% 145 30.4% 159 31.4% 165 29.6% 158 32.4%
Diseases of the 137 29.7% 150 31.4% 163 32.2% 157 28.2% 142 29.1% circulatory system Source: National Records of Scotland (NRS)
Table 5.10d Number and percentage of deaths caused by cancer and diseases of the circulatory system in Stirling between 2010 and 2015.
Stirling 2010 2011 2012 2013 2014 Cause of death N % N % N % N % N % Cancer 272 32.2% 245 31.3% 283 32.2% 275 32.0% 263 29.3%
Diseases of the 241 28.5% 232 29.7% 253 28.8% 264 30.7% 272 30.3% circulatory system Source: National Records of Scotland (NRS)
Table 5.10e Percentage of deaths caused by cancer and diseases of the circulatory system in Scotland between 2010 and 2015.
Scotland 2010 2011 2012 2013 2014
Cause of death Scotland % Scotland % Scotland % Scotland % Scotland % Cancer 28.9% 29.3% 29.4% 29.5% 29.8%
Diseases of the 30.6% 29.7% 28.9% 28.5% 27.7% circulatory system Source: National Records of Scotland (NRS)
5.11 Population Health Considerations/Implications • In Clackmannanshire while both male and female life expectancy is comparable to Scotland both are expected to have a lower healthy life expectancy. • Assuming age-specific prevalence remains constant for long term conditions it is projected we will see greater numbers of individuals with these conditions as the proportion of older adults in the population rises. This will impact on both health and care services. • It is also projected that the number of people with multi-morbidities, i.e. more than one long term condition, will increase. This means there will be more individuals attending
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hospital with complex needs. Currently services are un-coordinated and may mean people are making multiple visits to hospital. A re-organisation of services to ensure a more joined up approach could help to reduce the number of visits to a hospital and improve efficiency. • Currently around 2% of the population account for 50% of the hospital and GP prescribing spend. Gaining a better understanding about this cohort of high resource individuals could allow for more effective planning and delivery of services and an improved service user experience.
6 Current Provision of Health and Social Care Services 6.1 Workforce In order to aid strategic planning of the integration of health and social care services it is important to understand more about the workforce.
A data collection exercise was undertaken in order to consolidate information about the in- scope workforce for health and social care integration in Clackmannanshire and Stirling. Data was gathered as at 30th September 2015.
Table 6.1a below provides an overview of the staff relevant to the Clackmannanshire & Stirling Health and Social Care Partnership.
Table 6.1a - Number of staff (Headcount and WTE)
Employing Body Headcount WTE/FTE Clackmannanshire Council 255 186.3 Stirling Council 316 269.0 NHS Forth Valley 2484 2086.3 Source: Forth Valley Workforce Project
*Note – Forth Valley headcount/WTE refers to all staff in scope for integration and not just those considered relevant to the Clackmannanshire and Stirling population. The NHS Forth Valley figures refer to the workforce covering Falkirk, Stirling and Clackmannanshire.
Age Profiles
Age of the workforce must be considered to ensure that planned future services are sustainable. Data were not available for NHS Forth Valley and the two local authorities using the same age bandings (age bands have been aligned as best possible). Figure 6.1a, below, illustrates that 56% of the NHS Forth Valley workforce are aged over 45. Data provided direct by Clackmannanshire and Stirling Councils indicate that 64% of the Social Services workforce in Clackmannanshire are over the age of 45 and 58% of the Social Services workforce in Stirling
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are over the age of 46. Please note this may include individuals not in scope for Health & Social Care Integration.
Figure 6.1a – Workforce age profiles for NHS Forth Valley – September 2015
1,400 NHS Forth Valley 1,200
1,000
800
600 Headcount
400
200
0
Source: Scottish Workforce Information Standard System (SWISS) Note – NHS Forth Valley figures represent the entire workforce, not just those in scope for integration, it is assumed that the relevant staff will share a similar age profile.
Information is not currently available on the size and profile of the workforce not employed by NHS Forth Valley, Clackmannanshire or Stirling Council but who provide care through private organisations. However, this is an important part of care delivery and it is recommended that future versions of this document consider the external workforce.
6.2 General Practice Services General Practitioner and primary care services are an integral aspect of the provision of healthcare. In 2014 in Clackmannanshire and Stirling there were 30 practices served by 137 General Practitioners.
The number of GPs increased between 2006 and 2014 but this disguises the fact that the number of GPs in the Stirling area has been falling for the last two years whilst in Clackmannanshire the number has been rising (Table 6.2a).
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Table 6.2a The number of GPs (All GPs, headcount) in Clackmannanshire and Stirling 2006- 2014
2006 2007 2008 2009 2010 2011 2012 2013 2014 Clackmannanshire 41 45 45 45 43 46 45 48 49 Stirling 84 90 94 94 97 94 95 90 88 Clackmannanshire & Stirling 125 135 139 139 140 140 140 138 137 Source: ISD Scotland
In 2014, Clackmannanshire had the third largest average practice list size in Scotland. The seven GP practices had an average list size of 8,075 people, whereas in Stirling the 23 practices had an average of 4,259 people on their lists.
Only one of the practices in Clackmannanshire had a patient list where over 85% of the population lived in rural area5s, as opposed to 10 of the 23 practices in Stirling. This may affect the use of primary care services as people who live further away from the GP surgery may be less likely to engage with the services there.
The practices with the highest percentage of patients in the most deprived datazones are in Clackmannanshire. There are three practices where over a quarter of patients on the practice list are living in datazones defined as the 15% most deprived.
In both areas the age of the practice population is rising and in 2014 both had a higher percentage of the practice population aged 65 and over than the average figure for Scotland.
Table 6.2b Percentage of practice populations aged 65 plus - 2010 and 2014
% of practice Area population aged 65+ 2010 2014 Clackmannanshire 15.8% 18.2% Stirling 16.2% 17.5% Scotland 15.9% 17.2% Source: ISD Scotland
5 Based on the Scottish Government Urban Rural Classification
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6.3 Unscheduled Care Unscheduled care is the unplanned treatment and care of a person usually as a result of an emergency or urgent event. Most of the attention on unscheduled care is on accident and emergency attendances, and emergency admissions to hospital. The Scottish Government has made unscheduled care an important area of focus for the health service in Scotland, with reducing waiting times in Accident and Emergency and reducing the number of emergency admissions key targets.
6.3.1 Accident &Emergency Attendances Since July 2011, Clackmannanshire, Stirling and Falkirk have been served by a single Accident and Emergency department at Forth Valley Royal Hospital in Larbert, with a minor injuries unit at Stirling Community Hospital. This provides minor injury services across the health board for people in Clackmannanshire, Falkirk and Stirling between 09:00 and 21:00 hours, 7 days a week.
The average monthly attendance at an emergency department (at Stirling Royal Infirmary or Falkirk Community Hospital before July 2011 and the Accident and Emergency at Forth Valley Royal Hospital or the minor injuries unit at Stirling Community Hospital after this) between 2007 and 2015 rose from 5,828.2 in 2007 to 6,340.2 by June 2015. This represents an 8.8% increase in the average monthly attendance over the time period. During this time the percentage of people who were waiting less than 4 hours in Accident and Emergency each month ranged from a high of 97% in February 2014 to a low of 81.2% in December 2014.
Table 6.3.1a Average monthly attendance at emergency department by year
Average monthly Year attendance 2007 (Jul-Dec) 5,828.2 2008 5,894.3 2009 6,117.9 2010 6,209.8 2011 6,086.3 2012 6,244.9 2013 6,153.4 2014 6,423.4 2015 (Jan-Jun) 6,340.2 Source: ISD Scotland
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Figure 6.3.1a Average monthly attendance at emergency department by year
Average attendance at emergency department 6500
6400
6300
6200
6100
6000
5900
attendance Avergae 5800
5700
5600
5500 2007 2008 2009 2010 2011 2012 2013 2014 2015
Average monthly attendance by year
Source: ISD Scotland
The average monthly attendance at the Accident and Emergency department at Forth Valley Royal Hospital had risen from 4,603 in 2011 to 5,023 by June 2015. This is an increase of 9.3%. At the same time the average monthly attendance at the minor injuries unit at Stirling Community Hospital had risen from 1,037 when it opened in 2011 to 1,309 by June 2015. This is a 26% increase in the average monthly attendance at the unit. There has been no issue with waiting times at the minor injuries unit as each month, between 98.9% and 100% of people were waiting less than 4 hours and so within the waiting times target.
Table 6.3.1b Average monthly attendance at minor injuries unit Stirling Community Hospital
Year Average monthly attendances 2011 1037 2012 1217 2013 1192 2014 1203 2015 1309 Source: ISD Scotland
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6.3.2 Emergency Admission to Hospital The rate of emergency admissions to hospital (per 100,000 population) in Clackmannanshire and Stirling has been lower than the Scotland rate for the last ten years. The actual number of admissions has risen and fallen over the time period in both local authority areas. The figures for admissions are based on the person’s home postcode.
Table 6.3.2a Emergency admissions to hospital - Clackmannanshire 2004/05 to 2013/14
Source: ISD Scotland
Table 6.3.2b Emergency admissions to hospital – Stirling 2004/05 to 2013/14
Source: ISD Scotland
The figure below shows the information in the tables above in chart form.
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Figure 6.3.2a Emergency admissions to hospital – Clackmannanshire & Stirling 2004/05 to 2013/14
Clackmannanshire & Stirling emergency admissions 9,000 12,000
8,000 10,000 7,000
6,000 8,000
5,000 6,000 4,000 Rate
3,000 4,000 Number of of Number admissions 2,000 2,000 1,000
0 0 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Clackmannanshire admissions Stirling admissions Clackmannanshire rate Stirling rate Scotland rate
Source: ISD Scotland
Within the increase in the number of emergency admissions is an increase in the number of admissions for people aged 65 and above. A greater proportion of all admissions now come from this cohort of patients. Figure 6.3.2b below shows the increase of this group from 37.7% of all admissions in 2004/2005 to 45.3% in 2013/2014. Figures 6.3.2c and 6.3.2d show that the increase of this group was greater in Stirling than Clackmannanshire.
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Figure 6.3.2b Percentage emergency admissions by age group 2014/05 – 2013/14
Clackmannanshire & Stirling % emergency admission by age group 100% 90% 80% 37.7% 39.3% 38.5% 37.7% 39.8% 39.7% 41.4% 44.4% 44.3% 45.3% 70% 60% 50% 40% 30% 62.3% 60.7% 61.5% 62.3% 60.2% 60.3% 58.6% 55.6% 55.7% 54.7% 20% 10% 0% 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Clackmannanshire & Stirling <65 Clackmannanshire & Stirling 65+
Source: ISD Scotland
Figure 6.3.2c Percentage emergency admissions by age group, Clackmannanshire 2014/05 – 2013/14
Clackmannanshire % emergency admission by age group 100% 90% 35.3% 35.4% 80% 35.5% 36.9% 37.8% 36.8% 37.6% 40.1% 40.9% 40.6% 70% 60% 50% 40% 64.7% 64.6% 30% 64.5% 63.1% 62.2% 63.2% 62.4% 59.9% 59.1% 59.4% 20% 10% 0% 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Clackmannanshire <65 Clackmannanshire admissions 65+
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Source: ISD Scotland
Figure 6.3.2d Percentage emergency admissions by age group, Stirling 2014/05 – 2013/14
Stirling % emergency admissions by age group 100% 90%
80% 38.8% 40.6% 40.2% 39.0% 40.9% 41.3% 43.6% 46.7% 46.3% 48.1% 70% 60% 50% 40%
30% 61.2% 59.4% 59.8% 61.0% 59.1% 58.7% 56.4% 53.3% 53.7% 51.9% 20% 10% 0% 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Stirling admissions <65 Stirling admissions 65+
Source: ISD Scotland
Multiple admissions
A primary focus of the work on emergency admissions is to reduce the number of people who make multiple unplanned visits to hospital and who are then admitted. In Scotland the rate of people who have multiple emergency admissions (2 or more) has been increasing since 2004.
In Clackmannanshire and Stirling the rate for people who have had 2 or more emergency admissions was higher in 2013/14 than in 2004/05. This information is shown in the tables below for both local authority areas.
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Table 6.3.2c Rate and number of people with two or more emergency admissions Clackmannanshire 2004/05 – 2013/14
2004/ Local Council Area 05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Clackmannanshire admissions 615 602 655 771 724 698 661 672 729 751 Clackmannanshire rate (per 100,000 pop) 1,264 1,225 1,322 1,524 1,414 1,361 1,288 1,305 1,422 1,465 Scotland rate (per 100,000 pop) 1,493 1,495 1,566 1,639 1,695 1,664 1,682 1,737 1,762 1,771
Source: ISD Scotland
Table 6.3.2d Rate and number of patients with two or more emergency admissions Stirling 2004/05 – 2013/14
Local Council Area 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14 Stirling admissions 1,227 1,197 1,233 1,274 1,293 1,374 1,299 1,272 1,344 1,339 Stirling rate (per 100,000 pop.) 1,412 1,368 1,400 1,441 1,460 1,549 1,451 1,408 1,477 1,467 Scotland rate (per 100,000 pop.) 1,493 1,495 1,566 1,639 1,695 1,664 1,682 1,737 1,762 1,771
Source: ISD Scotland
Figure 6.3.2e shows the number of admissions for Clackmannanshire and Stirling and the rates for the two areas compared to the Scotland rate. The admissions rate for Clackmannanshire has risen steadily over the last four years.
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Figure 6.3.2e Rate (per 100,000 population) and number of patients with 2 or more emergency admissions Clackmannanshire & Stirling 2004/05 – 2013/14
1,600 2,000
1,400 1,800 1,600 1,200 1,400 1,000 1,200 800 1,000 Rate 800
Number if if Number admissions 600 600 400 400 200 200 0 0
Clackmannanshire admissions Stirling admissions Clackmannanshire rate Stirling rate Scotland rate
Source: ISD Scotland
As with the number of total emergency admissions, the number of multiple emergency admissions for people aged 65 and above is also increasing in Clackmannanshire and Stirling. The percentage increase of admissions for patients aged 65 plus is greater than the percentage increase for all ages.
The table below shows the percentage increase for all ages and those aged 65 plus between 2004/05 and 2013/2014. The percentage increase for multiple admissions was greatest for those aged 65 and above in Stirling, which went up by 32.3%.
Table 6.3.2e Increase in multiple emergency admissions 2004/05 to 2013/14
All ages* 65 + Area N % N % Clackmannanshire 136 22.1% 79 29.9% Stirling 112 9.1% 186 32.3% Clackmannanshire & Stirling 248 13.5% 265 31.6% *Patients with 2 or more admissions Source: ISD Scotland
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The chart below shows the trend of multiple admissions for people aged 65 and above from 2004/05 to 2013/14. It shows that in 2013/14 the number of multiple admissions in Stirling was the highest it had been in a decade.
Figure 6.3.2f Number and rate of multiple emergency admissions for people aged 65+ in Clackmannanshire and Stirling 2004/05 to 2013/14
Number and rate of multiple emergency admissions of people aged 65+ Clackmannanshire and Stirling 800 6,000
700 5,000
600 4,000 500
400 3,000 Rate 300 2,000
Number of of Number admissions 200 1,000 100
0 0 2004/05 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14
Clackmannanshire admissions Stirling admissions Clackmannanshire rate Stirling rate Scotland rate
Source: ISD Scotland
6.4 Delayed Discharges from Hospital A delayed discharge occurs when a person, clinically ready for discharge, cannot leave hospital because the other necessary care, support or accommodation for them is not readily accessible and/or funding is not available. The following provides an overview of delayed discharges for Clackmannanshire and Stirling.
At the October 2015 census the total number of standard delays for Clackmannanshire was three. There were zero delays over six weeks, one was more than four weeks and one was more than two weeks. In Stirling there were 10 standard delays, three were delayed more than six weeks, five were more than four weeks and 10 were more than two weeks.
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Table 6.4a Delayed Discharges by Length of Delay, October 2015
More than 6 More than 2 Total Standard Delay More than 4 weeks weeks weeks Clackmannanshire 3 0 1 1 Stirling 10 3 5 10 Clackmannanshire & Stirling HSCP 13 3 6 11 Source: ISD Scotland
1 Health Board figures are based on NHS board area of treatment. Local Authority figures are based on Local Authority of residence. There are a small number of patients experiencing a delay in discharge who are residents of local authorities outwith the NHS Board Areas in which they are being treated. This may mean that the NHS board area of treatment is not responsible for the patient's post hospital discharge planning. This also means that the combined figures for local authorities within a particular NHS board area might not be equal to the corresponding total for that NHS board area.
Figure 6.4a illustrates the low and fluctuating levels of delayed discharge patients in Clackmannanshire and Stirling from July 2012 to October 2015.
Figure 6.4a Total number of standard delays, July 2012 – October 2015.
Source: ISD Scotland
Table 6.4b shows the number of bed days lost in the quarter July 2015 to September 2015, 1,197 in Clackmannanshire and 1,748 in Stirling. There were a greater proportion due to Code 9 delays in Clackmannanshire (51.1%) than in Stirling (28.7%) and Scotland (20.8%). Code 9 was introduced for very limited circumstances where NHS Chief Executives and Local Authority Directors of Social Work (or their nominated representatives) could explain why the discharge of people was out with their control. Around two thirds (64.1%) of all people delayed in Clackmannanshire, between July 2015 and September 2015, were aged 75 and over compared to 82.3% in Stirling and 70.5% in Scotland.
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Table 6.4b Bed Days Occupied by Delayed Discharge Patients by Age Group and Delay Type: July 2015 to September 2015
All Ages 18 - 74 years 75 + years Local Authority of Total Standard % Code 9 % Total Standard % Code 9 % Total Standard % Code 9 % Residence 1 Clackmannanshire 1,197 585 48.9 612 51.1 430 66 15.3 364 84.7 767 519 67.7 248 32.3 Stirling 1,748 1,247 71.3 501 28.7 310 231 74.5 79 25.5 1,438 1,016 70.7 422 29.3 Clackmannanshire & Stirling HSCP 2,945 1,832 62.2 1,113 37.8 740 297 40.1 443 59.9 2,205 1,535 69.6 670 30.4 Scotland 144,414 114,435 79.2 29,979 20.8 42,646 31,420 73.7 11,226 26.3 101,768 83,015 81.6 18,753 18.4
Source: ISD Scotland
Figure 6.4b (below), is taken from the ISD delayed discharge publication. This particular chart is updated annually and the latest available information is presented for the year April 2014 to March 2015. Both Stirling and Clackmannanshire have a lower delayed discharge rate per 1,000 population aged 75+ than Scotland with Clackmannanshire having the 6th lowest rate.
Figure 6.4b Bed days occupied by delayed discharge patients per 1,000 population aged 75+, April 2014 to March2015
Source: ISD Scotland
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6.5 Community Care Assessments The number of community care assessments completed and the number of people receiving one gives an indication of the volume of activity in social care services.
Between April 2013 and March 2014 there were 2,626 people that had a community care assessment completed in Clackmannanshire, less than 1% of whom were under 18. Of the remaining 2,606, 31% were aged between 18-64 and 69% were 65 years of age or more.
For those aged 18-64, the largest care group was those with a physical disability (66.3%), followed by those with a learning disability (17.6%). For those aged 65 and over the largest care group similarly were those with a physical disability (63.5%) followed by older adults (20.2%) and those with dementia (11.5%). Two thirds of those with a physical disability were 75 and over as were the majority with dementia (88.5%). The number of people (aged 18 and over) with a completed care assessment has been decreasing annually over the past five years, from 3,096 in 2009/10 to 2,606 in 2013/14 (this includes all assessments including reviews).
In the same twelve month period in Stirling 2,771 people received a community care assessment and similarly less the 1% were under 18 years of age. Of the remaining 2,749 20% were aged 18-64 and 80% 65 and over. For those aged 18-64 the largest care group was those with a physical disability (41.4%) followed by those with a learning disability (18.4%). For those aged 65 and over the largest care group were those classed as Frail Elderly (58.7%) followed by those with a physical disability (16.3%). Two thirds of those with a physical disability were aged 75 and over as were the majority of the Frail Elderly group (91%). The number of people (aged 18 and over) with a completed care assessment has risen from 2,610 in 2010/11 to 2,749 in 2013/14.
6.6 Care at Home Care at home is care provided in a person’s own home to enable them to maintain their independence. It involves regular visits from a care at home worker and may include personal care, shopping, preparing meals and the collection of items such as pensions and prescriptions. According to the 2014 Social Care Services report, there were 693 people receiving care at home in Clackmannanshire and 1,245 in Stirling during the March 2014 census week. Figure 6.6a illustrates that in Clackmannanshire the number of people receiving care at home has been decreasing since 2008 (withstanding an increase in 2013) and has fluctuated around 700 for the last five years. In contrast the number of hours of care provided decreased in 2009 but has increased in the past few years. The past five years has seen the average hours per client increase from 9.1 in 2010 to 11.4 in 2014.
In Stirling both the number of people and hours have been increasing (Figure 6.6b) and in March 2014 the average hours per client was 14.9.
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Figure 6.6a Care at Home Clients and Hours provided, 2005-2014, Clackmannanshire
0.9 9 0.8 8 0.7 7 0.6 6 0.5 5 0.4 4 0.3 3 0.2 2 0.1 1 Number of hours (thousands) hours of Number
Number of Clients Number of Clients (thousands) 0.0 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Number of clients Total hours Total Hours excluding 24/7 Care
* from 2013 local authorities were asked to class 24-7 care as Housing Support, not Home Care. Figures rounded to the nearest 10.
Source: Social Care Services, 2014
Figure 6.6b Care at Home Clients and Hours provided, 2005-2014, Stirling
1.4 20 18 1.2 16 1.0 14 0.8 12 10 0.6 8 0.4 6 4 0.2 2 Number of hours (thousands) hours of Number
Number of Clients Number of Clients (thousands) 0.0 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Number of clients Total hours Total Hours excluding 24/7 Care
* from 2013 local authorities were asked to class 24-7 care as Housing Support, not Home Care. Figures rounded to the nearest 10.
Source: Social Care Services, 2014
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Table 6.6a Care at home clients and age, 2014
Local Authority 0-64 65-74 75-84 85+ Total No % No % No % No % Clackmannanshire 153 22.1 108 15.6 206 29.7 226 32.6 693 Stirling 383 30.8 157 12.6 335 26.9 370 29.7 1245 Source: Social Care Services, 2014
At March 2014 of those receiving care at home in Clackmannanshire 22.1% were aged under 65 and 77.9% were aged 65 and over. A third (32.6%) of all those receiving care at home were aged 85 and over. A smaller proportion of people were aged 65 and over in Stirling (69.2%) and similarly almost a third (29.7%) were aged 85 and over.
Of those people aged 65 and over a third in both Clackmannanshire (36%) and Stirling (35%) were receiving 10 hours or more a week comparative to Scotland (33%). In both local authorities half of those aged under 65 were receiving 10 hours or more a week (52% in Clackmannanshire and 51% in Stirling), slightly more than in Scotland (46%).
Figures 6.6c and 6.6d show that in March 2014 while the greatest proportion of all clients receiving care at home in Stirling were Older people, in Clackmannanshire the greatest proportion were either Older people or those with a physical disability.
Figure 6.6c Client group breakdown of clients receiving Care at home in Clackmannanshire, 1998-2014
Notes: Figures rounded to the nearest 10. Some figures have been suppressed with a "*" to protect small numbers.
Source: Social Care Survey 2013 and 2014 (Home Care Census prior to 2013)
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Figure 6.6d Client group breakdown of clients receiving Care at home in Stirling, 1998-2014
Notes: Figures rounded to the nearest 10. Some figures have been suppressed with a "*" to protect small numbers.
Source: Social Care Survey 2013 and 2014 (Home Care Census prior to 2013)
The following tables, taken from the Social Care Survey 2014, provides details of the number of hours of care at home older adults in Clackmannanshire and Stirling received between 2005 and 2014. They show that since 2005 more older people have received less than ten hours of care at home than greater than ten hours but that the proportion of those receiving more than ten hours has increased over this period with Stirling showing the greater increase.
Table 6.6b Care at home hours received for people aged 65 plus in Clackmannanshire, 2005- 2014
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Table 6.6c Care at home hours received for people aged 65 plus in Stirling, 2005-2014
The following tables present information on the number of older people who are either receiving intensive home care, resident in a care home or in continuous hospital care from 2006 to 2015. They show that in 2014 of this group a greater proportion were receiving intensive care at home than in a hospital or care home setting in both Clackmannanshire (47.3%) and Stirling (39.2%). While this proportion has increased in both since 2006, Stirling has seen the greatest increase.
Table 6.6d Percentage aged 65 plus receiving 10+ hrs of care at home in Clackmannanshire, 2006 to 2015
Source: Scottish Government, Health and Social Care Data
Table 6.6e Percentage aged 65 plus receiving 10+ hrs of care at home in Stirling, 2006 to 2015
Source: Scottish Government, Health and Social Care Data
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Care at home reported in the Social Care Survey excludes people receiving care at home with a direct payment (Option 1 under Self Directed Support). To give an indication of the level of care at home provision for all clients, including those who receive it with a Direct Payment, information from Clackmannanshire Council showed that between April 2013 and March 2014 there were 1,094 people receiving 433,005 hours of care at home (Source: Clackmannanshire Council Community Care Information System).
Reablement is a care at home service that works with people for up to six to eight weeks to give them the support, skills and confidence to stay at home or be able to return after a stay in hospital. During the financial year 2014/15 there were 280 people who received the reablement service in Clackmannanshire and 600 in Stirling. Stirling’s figure also includes people who received rehabilitation which is defined as the process of the restoration of skills by a person who has had an illness or injury so as to regain maximum self-sufficiency and function in a normal or as near normal manner as possible.
6.7 Self-Directed Support The implementation of the Social Care (Self Direct Support) (Scotland) Act 2013 has required a major change in how social care services are assessed, planned and delivered. The shifting expectations of people, who will want more choice and control and an enabling rather than a ‘doing to’ attitude and approach, was a key driver behind the Act. The ten year SDS Strategy will drive a cultural shift on the delivery on services that views people as equal citizens with rights and responsibilities. Principles mean a right to practical assistance and support to participate in society and lead an ordinary life (SDS National Strategy for Scotland, 2010).
The principles are: Involvement; Informed Choice; Collaboration; Dignity; Participation (Control) through improving Outcomes using a personalisation approach and providing safe, sustainable and economically viable responses to support planning.
The Local Authority have a duty to give the Supported Person (SP) the opportunity to choose from one of four options and an explanation of the nature and effect of each of the options. The Options are:
Option 1 – Direct Payment
Your Individual Budget will be paid (in instalments) into a dedicated bank account. This gives you the flexibility and the choice to use this money to buy your own support.
Option 2 – Individual Service Fund
You can ask Social Services or a Provider organisation to hold your Individual Budget. You will direct them on how you wish to spend this money.
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Option 3 – Arranged Service
You can ask Social Services to arrange for, and directly pay for, the support you need.
Option 4 – Combined Support
You can have a combination of options 1, 2 and/or 3. For instance some services arranged by Social Services and some by yourself.
The section below provides information on Direct Payments (Option 1).
Direct Payments (Option 1)
The number of people receiving Direct Payments increased from 30 in March 2005 to 44 in March 2014 in Clackmannanshire and from 25 to 99 over the same period in Stirling.
In March 2014 over a third (38.6%) in Clackmannanshire and over half (51.5%) in Stirling were aged 65 and over.
(Source: Social Care Services 2014, www.gov.scot/Publications/2014/11/1085/downloads)
6.8 Day Care Day care offers personal care during the day for those who are assessed as needing it and is usually provided in a day care centre for those with complex physical and social care needs. Table 6.8a provides an overview of clients in Clackmannanshire receiving Day Care in 2013/14. It shows that almost two thirds (63.3%) were aged 65 and over and the highest proportion of clients (39%) were those with a Physical Disability followed by those with a Learning Disability (22.8%). While the older adults (65+) accounted for a greater proportion of the client group it was the younger adults (18-64) who received the greatest proportion of the total number of days provided (55.3%). This may be because the second largest client group, those with a Learning Disability, had the highest proportion of days provided (38.7%) and the majority of these people were under 65 years of age (95%).
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Table 6.8a Day Care in Clackmannanshire by care group and age, 2013/14
Source: Clackmannanshire Council, Adult Care Bulletin, 2013/14
In the past five years both the number of clients and days provided have been declining in Clackmannanshire, from 414 clients in 2009/10 to 346 in 2013/14 and 32,642 days in 2009/10 to 29,431 in 2013/14.
Table 6.8b provides an overview of day care provision in Stirling and shows that there were 181 clients attending day care during 2013/14, 63% of whom were under 65 years of age. The largest group of people attending were those with a learning disability who accounted for just over half (51.5%) of the weekly planned hours.
Table 6.8b Day Care in Stirling by care group and age, 2013/14
18-64 65+ Total Number of Number of weekly planned Number Number of weekly Number of Number of weekly People hours of People planned hours People planned hours Alcohol Misuse 0 0 0 0 0 0 Dementia Diagnosed 0 0 10 12 10 12 Frail Elderly 0 0 29 38 29 38 Learning Disability 88 117 12 14 100 131 Palliative Care 0 0 2 3 2 3 Physical Disability 16 31 12 22 28 53 Other 10 15 2 2 12 17 Total 114 163 67 91 181 254 Source: Stirling Council intranet site
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Over the past four years while the number of clients attending day care initially rose (from 299 in 2010/11 to 351 in 2010/11) it has been declining in the past two years.
6.9 Telecare Telecare is the remote or enhanced delivery of care services to people in their own home by means of telecommunications and computerised services. The basic level of telecare is a community alarm (a basic package which consists of a communication hub plus a button/pull chords/pendant which transfers an alert/alarm/data to a monitoring centre or individual responder) while a more advanced package can include technology such as linked pill dispensers, linked smoke detectors and linked key safes. According to the 2014 Social Care Services report, the majority of telecare clients in Clackmannanshire have a community alarm only with a few having telecare only which has been the case for the last four years. In Stirling however, there has been a shift away from having community alarms only to having them in conjunction with telecare.
In March 2014 of those receiving a community alarm and/or other telecare service in Clackmannanshire 16.2% (229 clients) were aged under 65 and 83.8% (1,185 clients) were 65 and over. In Stirling 12.6% (246 clients) were aged under 65 and 87.4% (1,709 clients) were 65 and over.
6.10 Care Homes A care home is a place where people can live in a homely setting and have their needs met by trained staff. The 2015 Care Home Census reported that there were 11 Care Homes in Clackmannanshire and 25 in Stirling with 342 and 691 registered places, respectively. The total number of residents in these care homes at the time of the census was 318 in Clackmannanshire (93% occupancy) and 609 in Stirling (88% occupancy). The majority of people were long stay residents in both Clackmannanshire (94.3%) and Stirling (91.8%).
The census reports on all people resident in the care home at the time of the census. The number of people placed in these care homes by each council during the same period however was much lower, 236 in Clackmannanshire and 359 in Stirling. The difference between these figures and the number of residents at the time of the census reflects that number of people who were not placed in care homes by the local authority.
Of the 11 care homes in Clackmannanshire, five are for people over the age of 65, four are for people with physical or learning disabilities and two are specifically for people with a mental health problem. Three of the five care homes for older people provide nursing care whilst the other two provide residential or intermediate care. All other homes in the area provide residential care only.
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In Stirling, 17 care homes are specifically for older people, of which eight provide nursing care, three provide intermediate care and the remainder provide residential care. In addition there are four residential care homes that provide support to people with mental health problems and a further four homes that provide residential care to people with disabilities. One of these is a national resource for people with Prader-Willi syndrome and thus not specific to the area and a further two are not currently used by Stirling Council.
For the 2015 census the number of long stay residents decreased slightly from the previous year in both Clackmannanshire and Stirling (from 331 and 579, respectively).
The census reported that 71% of residents in Clackmannanshire required nursing care compared with 42% in Stirling and around a third of care home residents in both had medically diagnosed dementia. In 2014 68% of care home residents in Clackmannanshire required nursing care and half of those in Stirling.
Table 6.10a Characteristics of Long Stay Residents, March 2015
Type of Resident Clackmannanshire Stirling Total Number of Long Stay Residents 300 559
Characteristics of Long Stay Residents % % Requiring Nursing Care 71 42 Visual Impairment 7 8 Hearing Impairment 6 * Acquired Brain Injury * * Other Phys.Dis. Or Chronic Illness 26 28 Dementia (Medically Diagnosed) 32 34 Dementia (Not Medically Diagnosed) 5 * Mental Health Problems 9 10 Learning Disability 17 19 Alcohol Related Problems * * Drugs Related Problems * * None of these * * Residents may have more than one characteristic and so percentages will not add up to 100%. * Indicates values that have been suppressed due to the potential risk of disclosure and to help maintain resident confidentiality. Source: Scottish Care Homes Census, 2015
At the time of the 2015 census long stay residents in Clackmannanshire were 63% female (37% male) and 59% female (41% male) in Stirling. Their average age was 75 years in Clackmannanshire and 71 years in Stirling. The mean complete length of stay was 2.5 years in Clackmannanshire and 2.8 years in Stirling while the mean incomplete length of stay (for those
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still living at the care home at the time of the census) was 5.2 years in Clackmannanshire and 4.9 years in Stirling. Tables 6.10b and 6.10c show how the mean and median complete and incomplete length of stay has changed over the past five years.
Table 6.10b Mean and Median Complete and Incomplete Length of Stay for Long Stay Residents in Clackmannanshire, 2011-2015
Mean and Median Complete and Incomplete Length of Stay (years) 2011 2012 2013 2014 2015 Mean Complete Length of Stay 4.2 3.0 1.9 2.2 2.5 Median Complete Length of Stay 1.9 1.9 0.6 1.1 1.7
Mean Incomplete Length of Stay 6.1 3.6 5.4 5.1 5.2 Median Incomplete Length of Stay 3.7 2.3 2.5 1.9 2.2
Table 6.10c Mean and Median Complete and Incomplete Length of Stay for Long Stay Residents in Stirling, 2011-2015
Mean and Median Complete and Incomplete Length of Stay (years) 2011 2012 2013 2014 2015 Mean Complete Length of Stay 3.4 3.0 2.2 2.9 2.8 Median Complete Length of Stay 2.1 2.3 0.9 2.1 2.2
Mean Incomplete Length of Stay 4.0 3.9 4.2 4.6 4.9 Median Incomplete Length of Stay 2.7 2.6 3.0 3.1 3.3
6.11 Equipment Even simple equipment can help people to live independently at home. During the 2013/14 financial year 1,636 people in Clackmannanshire received equipment, over two thirds of whom (67.5%) received more than one item. Seventy percent were aged 65 and over and a large proportion (70%) had a Physical Disability. The types of equipment that can be provided include bath and shower, eating and drinking, seating and toileting equipment. Over the past four years the number of people receiving equipment although initially slightly rose from 1,716 in 2010/11 has been decreasing over the last two years. (Source: Clackmannanshire Council Community Care Information System).
In Stirling 2,065 people received community care equipment in the same year and in total 5,961 items/equipment were issued (these relate to daily living aids). Eighty percent were aged 65 and over and (based on the main category) almost half (49%) were categorised as Frail Elderly and a third (34%) as having a physical disability. Over the past four years the number of people
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receiving community care equipment has been annually increasing, with 1,244 receiving equipment in 2010/11. (Source: Stirling Council Community Care Database).
6.12 Specialist Accommodation Clackmannanshire’s Housing Strategy 2012-2017 advises that Clackmannanshire’s Housing Need and Demand Assessment (2011) showed there was a lack of variety of specialist accommodation in Clackmannanshire. It tells that of the 812 properties available at that time, the majority were for older people with only 4% (32) for people with learning disabilities and 4% (33) for people with a physical disability. In addition, of the 354 registered care places available at that time the majority were for older people and a quarter were for people with complex needs and a quarter for those with learning disabilities, many of these being older people. There were very few places for those with mental health issues and young people. The Housing Strategy also advises that the number of major adaptations carried out within the private sector had risen from 11 in 2007/08 to 18 in 2011/12.
Stirling’s Local Housing Strategy 2012 advises that the existing accommodation for older people at that time was 18 residential care and nursing homes providing 608 places and 770 places in houses suitable to the needs of older people (including sheltered housing and amenity older person’s houses). The council and its partners undertake adaptations in several ways sourced from funding for adaptations to private homes (100-120 a year), to council homes (140 a year), Social Services budget (80 a year) and (in recent years) Scottish Government funding (around 50 a year). The needs of people with physical disabilities were met by a limited amount of specialist grouped accommodation, housing built to specific needs, adaptations and privately developed lifetime homes.
Further work will be taken forward to identify specialist housing/supported housing models for the older adult population.
6.13 Experience of Care Recipients The Scottish Health and Care Experience survey aims to provide local and national information on the quality of health and care services from the perspective of those using them. It is a postal survey sent to a random sample of patients who were registered with a GP in Scotland asking about their experiences of access and using GP practice and out-of-hours services and their outcomes from NHS treatments. Eight hundred and sixty patients in Clackmannanshire and 2,624 patients in Stirling took part in the 2013/14 survey. Of those people who completed the section on Care, support and help with everyday living, 18% in Clackmannanshire (162 people) and 19% in Stirling (468 people) indicated that they had had help or support with
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everyday living in the last 12 months. Participants in Clackmannanshire rated their overall experience of the help, care or service they received higher (86%) than those in Stirling (76%).
Figure 6.13a Health and Care Experience Survey 2013/14, Clackmannanshire
Figure 6.13b Health and Care Experience Survey 2013/14, Stirling
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6.14 End of Life Care End of life care is the care experienced by people who have an incurable illness and are approaching death. There are in-patient, day care and home-care services staffed by people with specialist training which enable them to help people with complex needs. It can be an important measure to indicate whether adequate plans and structures have been put in place to allow patients to spend their last six months of life at home or in the community and not in an acute hospital setting.
Just over 9 out of every 10 people in Clackmannanshire and Stirling spend the last six months of their life at home or in the community, this has been the case for every year between 2009/10 and 2013/14. The percentage nationally is similar.
Table 6.14a Percentage of last six months of life spent at home or in a community setting
Council Area 2009/10 2010/11 2011/12 2012/13 2013/14 Clackmannanshire 90.6% 92.0% 91.9% 91.8% 92.3% Stirling 91.2% 91.5% 91.9% 91.4% 90.5% Scotland 90.5% 90.6% 91.0% 91.1% 90.8% Source: ISD Scotland and National Records of Scotland (NRS)
Figure 6.14a Percentage of last six months of life spent at home or in a community setting in Clackmannanshire
Percentage of last 6 months spent at home or in a community setting Clackmannanshire 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2009/10 2010/11 2011/12 2012/13 2013/14
Home or community setting Other
Source: ISD Scotland and National Records of Scotland (NRS)
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Figure 6.14b Percentage of last six months of life spent at home or in a community setting in Stirling
Percentage of last 6 months spent at home or in a community setting Stirling 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2009/10 2010/11 2011/12 2012/13 2013/14
Home or community setting Other
Source: ISD Scotland and National Records of Scotland (NRS)
6.15 Respite Care Respite care is a service intended to benefit a carer and the person they care for by providing a short break from caring tasks. This section aims to provide an overview of respite care and the following figures have been taken from the most recent Respite Care report (2014). Figures in this report are rounded to the nearest ten. Table 6.15a shows that the total number of respite weeks have increased in Clackmannanshire and decreased in Stirling between 2012/13 and 2013/14. Both overnight and daytime respite weeks have increased in Clackmannanshire but in Stirling while the number of overnight respite weeks have increased daytime respite weeks have decreased.
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Table 6.15a: Overnight and Daytime respite weeks, 2012/13 to 2013/14
Source: Respite Care, Scotland, 2014
The report also details respite care provided for the benefit of carers. Table 6.15b and 6.15c detail the number of respite weeks (total, overnight and daytime) provided to support unpaid carers in Clackmannanshire, Stirling and Scotland for the years 2012/13 and 2013/14. In Clackmannanshire the total number of respite weeks has increased for those aged 18-64 and decreased for those aged 65 plus. In Stirling the total provision has increased for both age groups, particularly for overnight respite in the younger age group and daytime respite in the older.
Table 6.15b Respite weeks provided for the benefit of the carers of adults aged 18-64, 2012/13 to 2013/14
Source: Respite Care, Scotland, 2014
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Table 6.15c Respite weeks provided for the benefit of the carers of older people aged 65+, 2012/13 to 2013/14
Source: Respite Care, Scotland, 2014
In the 2013/14 financial year there were 208 people receiving overnight and 247 receiving daytime respite care in Clackmannanshire. A large proportion in both overnight (78%) and daytime (66%) respite care were those aged 65 and over and the largest client group in both were those with a physical disability (44% of those in overnight respite and 39% of those in daytime respite) (Source: Clackmannanshire Council Community Care Information System).
In the 2013/14 financial year in Stirling there were 238 people receiving respite care, the majority (86%) being aged 65 and over. The largest proportion were people with a physical or sensory disability (61%) followed by those with dementia (25%). (Source: Stirling Council intranet site)
6.16 Substance Misuse Support Services The national HEAT (Health improvement, Efficiency, Access, Treatment) target stated that by March 2013, 90% of clients will wait no longer than 3 weeks from referral received to appropriate drug or alcohol treatment that supports their recovery. This was established to ensure more people recover from drug and alcohol problems so that they can live longer, healthier lives, realising their potential and making a positive contribution to society and the economy. Although no longer a HEAT target it is now a HEAT standard.
Clackmannanshire is achieving a high standard for drug and alcohol treatment times with 99.1% of people commencing treatment within 3 weeks, the figures show that Clackmannanshire is performing better than Scotland (Table 6.16a). Stirling is performing at a similar level to Scotland with 94% of its drug and alcohol clients starting treatment within 3 weeks.
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Table 6.16a – Clackmannanshire & Stirling Alcohol & Drug treatment waiting times, 2013/14
Drugs & Alcohol Alcohol Drugs No. of % seen No. of % seen No. of % seen completed within completed within completed within waits 3 weeks waits 3 weeks waits 3 weeks Clackmannanshire 1168 99.1 670 99 498 98.2 Stirling 299 94 131 93.9 168 94 Scotland 46430 95.7 29515 96.4 16915 94.4 Source: Drug and Alcohol Treatment Waiting Times Database (ISD)
6.17 Provision of Health & Social Care Services Considerations/Implications • It is apparent that there is an increasing demand on all services, particularly for those aged 65 and over. This is reflected in both hospital and community services and given that the proportion of younger people (those aged 16-49) is projected to either remain similar (as in Stirling) or drop (as in Clackmannanshire) it could be more challenging to employ the workforce to meet this demand. • The average monthly attendance at Accident & Emergency and Minor Injury Unit has increased by 8.8% over the years 2007-2015. The rate of emergency hospital admissions in Clackmannanshire and Stirling has remained broadly similar over the past decade. However, the elderly population in Clackmannanshire and Stirling (over 65s) account for a growing percentage of emergency admissions. Given the projected increase in the elderly population Emergency Departments in their current form could struggle to meet the demands of the increasing elderly population. • Just over 9 out of every 10 people in Clackmannanshire and Stirling spend the last six months of their life at home or in the community which has been the case for every year between 2009/10 and 2013/14. • The number of individuals with long term conditions and multi-morbidities is projected to increase. This will have an impact on both health and care services. There will be more individuals with complex need requiring health and care services in hospital, care and at home.
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7. Carers
7. 1 Characteristics of Unpaid Carers Unpaid carers are people who provide care and support to family members, other relatives, friends and neighbours. Some carers are life-long carers while others may care for shorter periods of time and a carer does not need to be living with the person they care for to be considered a carer. The most recent Scotland’s Carers report (The Scottish Government, March 2015) brings together statistical analysis and research on caring, drawing from recent population surveys such as Scotland’s 2011 Census and the Scottish Health Survey. The following overview is taken from the report.
• There are an estimated 759,000 carers aged 16+ in Scotland, 17% of the adult population. This is currently the best estimate of the number of carers in Scotland (Scottish Health Survey 2012/13). • There are an estimated 29,000 young carers in Scotland, 4% of the child population (aged 4-15) (Scottish Health Survey 2012/13) • There are estimated to be over 171,000 carers in Scotland aged 16+ caring for 35 hours a week or more.
Scotland’s census, which showed that 11% of the adult population (aged 16+) are carers, is thought to underestimate the extent of low level caring but does provide a good estimate of people with substantial caring responsibilities. Differences in the results from the Census and Scottish Health Survey may be because people do not often recognise themselves as a carer or due to differences in the surveys design.
The following section, taken from Scotland’s Census 2011, provides an overview of carers in both Clackmannanshire and Stirling.
• According to the 2011 Census there were 4,693 unpaid carers in Clackmannanshire and 8,265 in Stirling, 9% of the population in both. • A greater proportion of females report that they have carer responsibilities than males (59% in Clackmannanshire and 60% in Stirling). • Of those providing unpaid care around two thirds were aged between 35 and 64 (67% in Clackmannanshire and 64% in Stirling) • Over half were providing under 20 hours of unpaid care (52% in Clackmannanshire and 59% in Stirling). • Thirty eight percent of carers in Clackmannanshire and 32% in Stirling were providing 35 hours or more unpaid care. Of this group 28% in Clackmannanshire and 31% in Stirling were aged 65 and over.
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• A large proportion in Clackmannanshire (30%) and Stirling (24%) were providing 50 hours or more of unpaid care and of this group around a third (and the largest proportion) were those aged 65 and over (32% in Clackmannanshire and 36% in Stirling). • Forty two percent of carers in Clackmannanshire and 41% in Stirling have one or more long term condition. The percent of carers with one or more long term condition increases with the increasing amount of unpaid care provided (Figure 7.1a). • Of those who rated their general health a greater percent of those who provided no unpaid care rated their health as good or very good compared to those who provided unpaid care. The percent of those rating their health as bad or very bad increases with the increasing amount of unpaid care provided (Figures 7.1b and 7.1c).
Figure 7.1a Percentage of unpaid carers who have one or more condition by level of care in Clackmannanshire and Stirling (Scotland’s Census 2011)
Source: Scotland’s Carers, 2015
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Figure 7.1b: Provision of care by general health, Scotland’s Census 2011
Very good or good health Fair health Bad or very bad health
100 5 7 4 6 12 10 16 80 19
60 85 40 83 74 78 20 Percentage of of people Percentage 0 No unpaid care Provides unpaid care No unpaid care Provides unpaid care Clackmannanshire Stirling
Source: 2011 Census
Figure 7.1c: Provision of unpaid care by general health, Scotland’s Census 2011
Very good or good health Fair health Bad or very bad health
100 4 6 7 3 6 8 14 13 11 12 80 20 19 24 17 27 27 60
40 83 86 74 75 70 76 59 62 20 Percentage of of people Percentage 0 1-19 hours 20-34 hours 35-49 hours 50+ hours 1-19 hours 20-34 hours 35-49 hours 50+ hours Clackmannanshire Stirling
Source: 2011 Census
7.2 Experience of Carers The Health and Care Experience Survey 2013/14 asks people’s experiences of accessing and using primary care services and includes aspects of care, support and caring to support the draft national outcomes for health and well being proposed under The Public Bodies (Joint Working) (Scotland) Act 2014. While the sample is small it does provide useful information on the experiences of adult carers.
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In Clackmannanshire 816 completed the section on Caring Responsibilities with 15% (123) indicating that they provided care with 33% (41) of them saying that this care was 35 hours a week or more.
In Stirling 2,496 completed the section on Caring Responsibilities with 15% (382) indicating that they provided care with 34% (129) of them saying that this care was 35 hours a week or more.
The results from both (Figures 7.2a and 7.2b) indicate that there is scope for improvement.
• 29% of carers in Clackmannanshire and 32% in Stirling felt that caring had had a negative impact on their health and wellbeing which is comparable to Scotland (32%). • Only 34% of carers in Clackmannanshire felt supported to continue caring, less than in Stirling (45%) and Scotland (44%). • 40% in Clackmannanshire and 46% in Stirling felt the services were well coordinated for the people they looked after, less than in Scotland (48%). • Less carers in Clackmannanshire (40%) felt that they had a say in the services provided for the person they looked after than Stirling and Scotland (both 49%).
Figure 7.2a Experience of a sample of Unpaid Carers in Clackmannanshire, 2013/14
Source: Health and Care Experience Survey 2013/14 www.gov.scot/Topics/Statistics/Browse/Health/GPPatientExperienceSurvey
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Figure 7.2b Experience of a sample of Unpaid Carers in Stirling, 2013/14
Source: Health and Care Experience Survey 2013/14 www.gov.scot/Topics/Statistics/Browse/Health/GPPatientExperienceSurvey
7.3 Carers Considerations/Implications • There is an estimated 759,000 carers aged 16+ in Scotland, 17% of the adult population. This is currently the best estimate of the number of carers in Scotland (Scottish Health Survey 2012/13). • There are estimated to be over 171,000 carers in Scotland aged 16+ caring for 35 hours a week or more. • According to the 2011 Census there were 4,693 unpaid carers in Clackmannanshire and 8,265 in Stirling, 9% of the population in both. • Thirty eight percent of carers in Clackmannanshire and 32% in Stirling were providing 35 hours or more unpaid care. Of this group 28% in Clackmannanshire and 31% in Stirling were aged 65 and over • 42% of carers in Clackmannanshire and 41% in Stirling have one or more long term condition. The percent of carers with one or more long term condition increases with the increasing amount of unpaid care provided. • The results from the Health and Care Experience Survey 2013/14 indicate that there is scope for improvement in supporting unpaid carers and service provision.
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8. Summary and Conclusion Summary This needs assessment has presented information describing current health and social care needs in Clackmannanshire and Stirling, and has forecast a significant increase in these needs. This summary aims to re-iterate some of the implications and considerations presented at the end of each section.
Section 2 presented information on the demographics as well as the current and projected populations for Clackmannanshire and Stirling. The number, and proportion, of older adults across Clackmannanshire & Stirling is projected to double. Older people are generally more intensive users of health and social care services. Therefore this could impact significantly on demand for these services in years to come. Both Clackmannanshire and Stirling are projected to see an increase in the ratio of non working aged people to people of working age. Clackmannanshire is also projected to experience a decrease in the number of people of working age living in the area. This means that at the same time as demand for services could be increasing, it could be more challenging to employ the workforce to meet this demand. The information presented also showed that Stirling has a high percentage of people living in rural areas. This will need to be considered when planning and delivering services.
Life Circumstances (Section 3) can be a key contributing factor in the health of a population. Clackmannanshire and Stirling have very different Scottish Index of Multiple Deprivation profiles with Clackmannanshire containing a higher proportion of its residents living in more deprived areas. That said, both Clackmannanshire and Stirling will have pockets of higher deprivation. One of the next stages of the strategic planning process is to analyse the available data at locality level to better understand the needs of the population at a more local level. Stirling has a higher proportion of the population living in fuel poverty than in Clackmannanshire and Scotland as a whole and this may be partly due to Stirling having a higher proportion of houses built before 1945, and older properties are more likely to have no insulation or be poorly insulated. This can increase heating and fuel costs as well as affect the quality of life for inhabitants. The ability to find work is an important contributing factor to the health and well-being of the population. The information presented showed that Clackmannanshire has a higher proportion of residents unemployed and actively seeking work than in Stirling and in Scotland as a whole.
Risk factors (Section 4) have an impact on a person’s health and well-being. Behaviours such as smoking, alcohol consumption, drug use, and poor diet can have an adverse effect on health. The figures presented show that 28.9% of people in Clackmannanshire smoke. The corresponding figure for Stirling is 20% and for Scotland is 23.1%. Tobacco smoking is the main risk factor for lung cancer, accounting for an estimated 80-90% of cases in developed countries
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and is linked to other cancers and Chronic Obstructive Pulmonary Disease (COPD). The alcohol related mortality rate in Clackmannanshire in 2013 was 38.85 per 100,000 population, which was significantly worse than the average rate of 21.43 for Scotland. In Stirling, the alcohol related mortality rate has been below the Scottish average in each year from 2009 to 2013. The estimated prevalence of those with a problem drug use has increased in Clackmannanshire and Stirling when comparing the data from 2009/10 and 2012/13. This is in contrast to Scotland as a whole, where the estimated percentage of the population with a problem drug use fell slightly.
Section 5 contains an extensive presentation of data of the current, and where possible, the projected health needs of the Clackmannanshire and Stirling populations. The information shows that in Clackmannanshire while both male and female life expectancy is comparable to Scotland both males and females are expected to have a lower healthy life expectancy. Information was presented on the prevalence of long terms conditions in the Clackmannanshire and Stirling populations. If current prevalence rates continue it is expected we will see greater numbers of individuals with these conditions as the proportion of older adults in the population rises. It is also projected that the number of people with multi-morbidities, i.e. more than one long term condition, will increase. This means there will be more individuals attending hospital with complex needs. Currently services are un-coordinated and may mean people are making multiple visits to hospital. A re-organisation of services to ensure a more joined up approach could help to reduce the number of visits to a hospital and improve efficiency. Some early analysis undertaken by Information Services Division (ISD) suggested around 2% of the population account for 50% of the hospital and GP prescribing spend. Gaining a better understanding about this cohort of individuals could allow for more effective planning and delivery of services and an improved service user experience.
Section 6 presents information on the current provision of health and social care services. It is apparent that there is an increasing demand on all services, particularly for those aged 65 and over. This is reflected in both hospital and community services. Projections show that the elderly population, who are the most intensive users of services, is expected to rise significantly. The average monthly attendance at Accident & Emergency (A&E) and Minor Injury Unit (MIU) has increased by 8.8% over the years 2007-2015. The rate of emergency hospital admissions in Clackmannanshire and Stirling has remained broadly similar over the past decade. However, the elderly population in Clackmannanshire and Stirling (over 65s) account for a growing percentage of emergency admissions. Given the projected increase in the elderly population Emergency Departments in their current form could struggle to meet this demand.
Unpaid carers (Section 7) are people who provide care and support to family members, other relatives, friends and neighbours. According to the 2011 Census there were 4,693 unpaid
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carers in Clackmannanshire and 8,265 in Stirling, 9% of the population in both. These figures may be an under representation of the actual number of carers in Clackmannanshire and Stirling as many carers do not recognise themselves as cares. The results from the Health and Care Experience Survey 2013/14 indicate that there is scope for improvement in supporting unpaid carers and service provision. It is likely, given the population projections that more carers will be required locally and it is important that they receive the appropriate levels of support.
It should be noted that although the projected increase in older people will have an impact on services older people make a valuable contribution to our society, both economically and socially, through, amongst other contributions, taxes, spending power, provision of social care and the value of their volunteering.
Underpinning the needs, outlined above, are the concepts of engagement and redesign which are fundamental to making a real difference through integration.
Engagement with all stakeholders will also be required in identifying how to progress. This document has provided the basis for discussion on strategic planning and highlights the key areas of focus for the integrated services.
Conclusion The traditional public service model – is to identify and 'assess' need and aim to meet it (on both an individual and population basis)
The public sector as we know it was established in the immediate post-war period where the population experienced poverty, overcrowding and slum housing. At this time the UK Welfare State was being established to ensure at least a minimum standard of living, through the National Assistance Act and a range of other legislation.
Since that time there has been great change:
• Demographic change (in part a result of the success of the welfare state) • People living longer and healthier • (This despite an increase in the prevalence of Long Term Conditions (LTCs) - due to a combination of new conditions and better/ earlier-diagnosis) • So, the population of Clackmannanshire and Stirling is growing in size, ageing and increasing in complexity and multiplicity of health and social problems such that demand is exceeding supply in the present model • There are rising costs and debt (national and personal)
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However it may be argued that the traditional model for public services has often required individuals to abdicate responsibility, leading to ‘learned helplessness’ on the part of individuals, and risk aversion on the part of services / staff/ clinicians.
So there are positive consequences and negative consequences of current service provision. The changes experienced since 1945 are so great that the traditional model is no longer fit for purpose
The new paradigm needs to:
• put the individual person at the centre • encourage individual responsibility and motivation for change to maximise wellbeing • encourage ambition on the part of individuals, staff and all stakeholders • encourage critical realism - the empathetic approach - based on intention, attention, mutual understanding, exploring options etc.
This is not to say that the individual is to be abandoned by public services, or that help will be with-held. Rather it is to recognise that intervention can be unintentionally disabling longer term, and that to maximise wellbeing longer term, we should provide support that is the minimum required to be effective, empathetic and enabling.
'Engagement' is key
• to recognise value as a key concept 'values-based value management' • to consider how to maximise value generated by limited resources
The service implications, therefore are:
• real engagement ++ • workforce development in person-centredness • wholesale, continuous redesign of public / third sector • realistic access - e.g. consider signposting rather than referral (the onus is then on the individual to make the arrangements), but also a realistic increase in opportunities for access / addressing barriers (by working with carers and other stakeholders) • realistic risk management - e.g. falls prevention (some risk of a fall needs to be accepted for the re-enablement process to occur)
The recommendations for the future therefore come under the following headings:
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Engagement:
• Of the workforce in these issues, to generate understanding and a positive attitude to the future. And to build on workforce development in person-centred care (see appendix for examples) • Of individuals – in their own health and wellbeing, facilitated by staff and other contributors and based on understanding, empathy, to improve connectedness, beliefs and values, knowledge and skills etc. (coming under the general heading of ‘resilience’). And thence to health improving behaviours – physical activity, diet and nutrition, no substance use; and also recognising adherence to medication and advice, for example, as a health behaviour.
Redesign
• Wholesale public sector/ third sector redesign, outcomes-focussed yes, but recognising that process is key. • Linking with engagement work – MCDM (Multi-criteria Decision Making), PSP (Public Social Partnerships) to reach a common understanding of goals and how these may be met • Person-centred redesign – based on the above and work on person-centred care developed locally • Working with CPPs (Community Planning Partnerships) on the ‘determinants of health’ with the aim of improving structural approaches and reducing the tendency for ‘lifestyle drift’. And emphasising work as key to health (not just paid employment, but caring and volunteering) which is often the basis for meaning and purpose in people’s lives. • ‘Integrated anticipatory care’ – whereby the value of each of: prevention, early identification, treatment, management etc. is recognised in a spectrum of help/ intervention from a range of contributors – not least the person themselves (self-care).
If we make these changes....then we can expect
• better motivation in individuals - decreased risk factors, increased adherence to (minimal) intervention • longer term, reduced disease (could be up to 40% or so) • more efficient processes / less waste • increased wellbeing, increased employability, increased work/ productivity of the population
The findings of this needs assessment have informed the development of our strategic plan which emphasises the following:
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• A need to consider prevention and early intervention, and shift the emphasis of activity upstream. • Understand and build on the important role of carers • Develop staff and services to provide support to individuals who need it, and further improve on this to maximise rehabilitation, resilience and recovery. This will be done in partnership across all sectors including the public sector and Third sector.
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Appendix A
Framework and Methods
A general philosophical framework considers ontology (what exists), epistemology (how knowledge is created) and logic (reasoning, causality and if...then relationships). The methods used attempts to work to the principles of applying these disciplines.
The following is a discussion of current and potential methods, in two groups – use of data items (usually singularly), and creation and development of models (using multiple data sources).
Data
• In using data it is important to consider their validity, which depends on the source, what the original intention was when they were generated, general reliability and validity etc. • Population projections are based on modelling, using data from the census, modified to take into account various factors. • Population projections tend to be inappropriately precise – down to single figures for single year of age – and are forecasts rather than predictions. • Prevalence data often comes from a sample (e.g. through a survey) with the assumption that it is sufficiently representative, e.g. Scottish Health Survey • Activity data relate to activity and any extrapolation to disease needs to be carried out with caution, e.g. data from ISD. • Benchmarking is comparison with different areas’ healthcare arrangements and again requires caution that the areas being compared are sufficiently alike. • ‘Synthesis’ is applying data from one source to another to give an estimate – e.g. applying prevalence data to population projections (also known as spreadsheet modelling). It is important to be aware of the assumptions and caveats etc. with this kind of forecasting.
Models
• As discussed above models may be of different types – static or dynamic • The findings section includes a large number of models, some of which are class models, others the beginnings of dynamic models (produced in a qualitative way but may be developed to using data) • There is potential to use more sophisticated modelling techniques:
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• Data envelopment analysis is used for assessing efficiency. Rather than simply benchmarking, it allows various data items to be combined as ‘inputs’, and others as ‘outputs’. Plotting inputs against outputs for a range of ‘decision making units’ gives an ‘efficiency frontier’. The advantage of this is that it gives a better idea of the scope for improvement for individual units, should inputs be increased. • The origins and development of benchmarking have recognised the need to consider values, and processes in addition to a simple comparison of outcomes or outputs • Discrete event simulation is used to forecast the results of changes in process or capacity at an operational level (see paper on modelling stroke beds) • Systems dynamic modelling is higher level, considering ‘stocks and flows’ and might be used for modelling at the population level.
Needs assessment methods
What is need? One definition is the gap between ‘what is’ and ‘what should be’ – which is inherently a value judgement. Hence we need to be clear on the value base of this work.
NHS Forth Valley has specified 6 core values. These are:
• Respect • Ambition • Team work • Supportiveness • Integrity • Person-centredness
It seems likely that in the process of integration these can be adopted by the whole of the public sector for Clackmannanshire and Stirling. A further value of ‘fairness’ could also be added, as our objectives include addressing inequalities.
The process of needs assessment could include expanding the agreed objectives, based on our values, to consider in more detail ‘what is’ and ‘what should be’. For example, to be ambitious (a core value) about what ‘should be’ in regards to living longer and healthier lives we could say everyone should live a perfectly healthy life and die on or after their 100th birthday.
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Types of need
The ontological basis of our needs assessment helps in defining types of need. Within this report we have described
• the people in our communities – demographics, but also their attributes in terms of life circumstances, risk factors, disease and long term conditions. • The services and their attributes – including capacity So need can be described at each level – population health and social care needs, which can be met by service activity; and service needs which require to be met in order to optimise service activity.
These elements come together as illustrated in the diagram below:
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Person
women and children, cancer, frail older LTCs, people/ end of mental (ill-)health/ life care Disease LD
planned, Service unplanned, Setting infrastructure
Gaps Identified / Recommendations from Needs Assessment
Workforce: Number – type Knowledge skills attitude etc.
Facilities Materials Equipment Intangibles: Processes, Guidelines, Pathways
Clackmannanshire and Stirling Integrated Services
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Beyond these needs, other types of need can be described, e.g. the ‘engagement’ needs of individuals – i.e. improvement in attitude and motivation in regard to the individual’s own health, and for services organisational needs and redesign needs. In many ways a needs assessment is not required for us to know that there is significant room for improvement in each.
Further Description of needs assessment
Population based needs assessment tends to be one-size-fits-all whereas working from a person-centred holistic approach we want everyone to be treated as individuals – implies 150,000 or so needs assessments/ personal health plans
The process of needs assessment is iterative (encompassing impact assessment, evaluation etc.) – not just a one-off exercise
Interpretation of data can depend on perspective – is the glass half full or half empty? And identified need in terms of a gap does not imply that resources should be allocated to it necessarily – effectiveness, feasibility, fairness etc. must also be considered.
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Curve Model
This needs assessment will feed in to a strategic planning process, for which there are a number of important factors to consider prior to implementation, summarised as the CURVE model for strategic improvement
CURVE is
• Culture • Understanding • Responsibility • Values, value, valuing • Enterprise
Culture
Culture is defined as “what is learned, shared, and transmitted in a group – reflected in that group’s beliefs, norms, behaviours, communication and social roles” (Kreuter and Haughton, 2006)
Further it can be defined using the ‘model for a person’ and extending this to collective attributes of a group or community etc. – i.e.
Collective:
• Physical and social environment • Behaviour and sensation / perception within this environment • Memory, imagination, and emotion • Knowledge, skills and creativity • Beliefs, values and attitudes • Identity • Spirituality / sense of connectedness
Culture change
Culture changes over time. The extent to which this can be guided or facilitated is debatable. It has been suggested that certain factors can facilitate culture change at the ‘edge of chaos’. These are:
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• Diversity • Information flow • Connectivity • Reducing barriers or inhibitors • Enhancing or increasing catalysts • Watchful waiting • Positive intent
Understanding
Knowledge is a personal attribute and collective knowledge is a community or cultural attribute. But to be really useful it needs to go deeper to form understanding. There are several senses to the term understanding:
• Awareness of a situation in context, its meaning – based on evidence. Being able to see how things relate to each other, often in complex ways. • Having and demonstrating common understanding between individuals, which relates to empathy and positive intent.
Responsibility
Within the context of family support, for example, improvement ultimately relies on individuals taking responsibility. Such individuals may be children, parents, other family members, peers, public sector or third sector staff. A process of engagement and involvement may be required to facilitate this, as may the meeting of some basic needs. Within the public sector there is increasing recognition that individuals’ rights need to be balanced with responsibilities (as described in the recent Patient Charter for the NHS in Scotland, which is derived from legislation)
Values, value, valuing
Fundamental to improvement work is the underlying set of core values to which we are working. NHS Forth Valley has defined its core values as:
• Respect • Integrity • Person-centredness • Supportiveness • Ambition • Teamwork
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Value is also an important concept, as improvement work / redesign is often aimed at increasing the value gained from the use of resources. Value can be subjective however and this needs to be considered.
Valuing can also be important in terms of appreciating resources or actions. For example if the services offered are not valued by people, uptake will decline as will value.
Enterprise
Organisations and partnerships are engaged in some form of enterprise – establishing a vision and working towards it. Entrepreneurship encompasses core skills that are relevant for improvement work in general:
• Establishing and developing networks, teamwork and collaboration • Understanding value and value chains • Identifying and developing personal skills • Identifying and developing innovative practice • Understanding motivation The emergence of the concept of a ‘Social Enterprise’ is particularly important for the public and third sectors. In the field of social enterprise a “triple bottom line” is described consisting of the 3 ‘P’s
• Profit (monetary value) – or value for money in public spending • People (social value) – quality and effectiveness in making a real difference to people’s lives • Planet (ecological value) – long-term sustainability of public services
Implementation
Each element needs to be considered in some depth. The CURVE model sets out ‘what?’ but for implementation there needs to be a consideration of ‘how?’
This strategic needs assessment document forms only the first part of a longer process which will involve:
• Further explication of needs from the information, in particular that produced down to locality level. • Application of impact assessment processes, including Equality and Diversity Impact Assessment
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Clackmannanshire & Stirling Shadow Integration Joint Board
24 February 2016
This report relates to Item 10 on the agenda
Integration Joint Board Development
(Paper presented by Morag Mclaren)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Morag Mclaren; Associate Director of HR; OD & Learning Date: 24 February 2016 List of Background Papers: • Transitional Board Organisational Development Update 17/09/2015 • Transitional Board Organisational Development Update 01/04/2015. • Organisational and Workforce Development for Health and Social Care Integration (Appendix to Integration Scheme) December 2014.
Title/Subject: Integration Joint Board Development Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 24 February 2016 Submitted By: Morag Mclaren Action: For Discussion
1. Introduction
1.1 The purpose of this report is to provide the Integration Joint Board with a summary of the outputs from the recent Board Development Session held on 20 November 2015 and to discuss the future development needs of the individual Board members and for the Board as a group.
2. Executive Summary
2.1 The IJB is asked to review the summary outcomes report from the Development Session held on 20 November (Appendix 1). The Board is also asked to discuss the next steps for the IJB in terms of its development plan and to discuss the recommendations below as areas for consideration.
3. Recommendations
The Shadow Integration Joint Board is asked to:
3.1. Note the content of the full Integration Joint Board Development Session Report from 20 November 2016 [Appendix 1].
3.2. Agree the future Board developments as set out within section 5 for the period 2016-2018
4. Background
4.1. The Board may find the recent guide received from the Scottish Government ‘Facilitating the Journey of Integration’ (Appendix 2) interesting in support of the recommendations. This Guide was produced by NHS and the Scottish Social Services Council Organisational Development Leads to support those involved in local Board Development.
4.2. The guide suggests some development work which Boards may find useful. The Clackmannanshire and Stirling IJB have already undertaken some of this in relation to the development of the Strategic Plan, the exploration of the Role of the Board and that of individual members and the development of the Board's culture including the identification of values and collaborative behaviours. Whilst this has been a useful start to development, the work of the
Board will now move from shadow towards delivery of the Strategic Plan and the national and local Outcomes. It will be essential that the Board develops its effectiveness and coherence to take advantage of the opportunities for transformation and meet the challenges ahead.
5. Main Body Of The Report
5.1. The full Integration Joint Board Development Session Report from 20 November 2016 is contained in Appendix 1.
5.2. Drawing on both the Scottish Government guide and the outcome of the development session held on 20 November 2015 the recommendations for future Integration Joint Board development are: • An area-wide Masterclass session with national speakers; for both of the Forth Valley Partnership IJB members and senior officers. This would be a stimulating session, covering national level strategic and future thinking; challenges and opportunities for transformation of Health and Social Care. It would also provide an opportunity for Board members to meet each other across Forth Valley. • A Board development session in 2016 to further review the delivery and implementation of the Strategic Plan, the functioning of the Board and the contribution of Board Members to the delivery plan. • A process of personal development for individual Board members who wish to take part, reviewing personal skills and development needs to support full contribution and confidence in their role. and, an individual assessment tool for use by Board members in relation to their own functioning and development needs. • The development of a Board Review Toolkit based on: the progress the Board has achieved on the national and local outcomes; the Board effectiveness in process; and the functioning of the Board in relation to the agreed values and behaviours for collaboration. This could include a Board collective self assessment tool focussing on the effectiveness of the Board.
6. Conclusions
6.1. The development plan for the Integration Joint Board and for individual members has been established by drawing on national work and the output from the earlier development session. This is an appropriate time to consider the next steps required as the Board moves towards full incorporation from April 2016.
7. Resource Implications
7.1. The Board Development Plan will be produced by the Partnership OD Advisor and the development work recommended would form part of the Organisational Development Advisor’s Workplan for 2016 – 2017.
8. Impact on Integration Joint Board Outcomes, Priorities and Outcomes
8.1. The strategic aim of this Board Development Plan is to support the delivery of the Strategic Plan through the development of the Integration Joint Board.
9. Legal & Risk Implications
9.1 No obvious risk or legal implications would be associated with this Plan.
10. Consultation
10.1. All members of the IJB will continue to be involved in the production of a Development Plan and subsequent development interventions will be discussed in detail with the Board and in particular with the Board Chair and Vice-Chair.
11. Equality and Human Rights Impact Assessment
11.1. The Integration Joint Board will be a public body, for the purposes of the Equality Act 2010. Officers must ensure that equalities implications have been considered and that an equalities impact assessment is completed, where appropriate. A combined NHS/Council tool is being developed for this purpose.
12. Exempt reports
12.1. Is this report exempt? No
Apprndix 1
Clackmannanshire and Stirling Health & Social Care Partnership
Integration Joint Board Development Session
20th November 2015
Session Report: Prepared by Morag McLaren, Associate Director of HR; OD & Learning
The Integration Joint Board members and Senior Officers from the Partnership met within a facilitated workshop to agree a Vision, Values, Behaviours and Ways of Working for the Board. The full Session programme and participants can be found as Appendix 1. The outputs from this session will be taken forward by the members and used to guide the working of the Board and individual member’s contribution and interactions.
Contents: Page Number
The Vision for the Integration Joint Board 3
The Role and Purpose of the Integration Joint Board 4
The Integration Joint Board Values 5
The Integration Joint Board High Impact Collaborative Behaviours 6
Ways of Working for the Integration Joint Board 7
Appendix 1: Session Programme and Participants
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The Vision for the Clackmannanshire and Stirling Integration Joint Board
The Clackmannanshire and Stirling Integration Joint Board will aspire at all times to a Joint Vision
• Our approach will be Assets • We will have clear, based, promoting quality of unambiguous outcomes where life and prevention of ill there is visible progress in health. achieving our goals. • Promoting self management • We will be creative yet and Reablement, enabling our pragmatic in delivering services people to have good that are responsive, supportive outcomes for themselves and Be Ambitious and and innovative. their communities. Innovative Put the Person at the centre of its Managing and work delivering the outcomes for Integration
Developing Services Maximise use of all Work Inclusively, Resources, collaboratively, in • We will develop and deliver Demonstrate Value true Partnership effective services and care for Money • We will be a cohesive Board which support best value that works with consensus. • We will work within clear • We will involve our governance and assurance stakeholders, co-producing frameworks services adn outcomes for our • We will be creative while people managing risks and impact of • We will break barriers and change. silos, valuing all contributions
Joint Vision for the Board
We will be clear about our Vision for services, always driving development towards the achievement of the local and national outcomes for Health and Social Care Integration.
Our approach: We will take an assets-based approach which puts the person at the heart of services, focusing on prevention, quality of life and evidence-based care which supports personal empowerment and reablement.
How we will work with others: We will be inclusive, involving all our stakeholders, broadening our networks and breaking down barriers to ensure we listen, hear and take account of the views of a wide range of people in a meaningful way in order to co-produce effective services.
How we will develop our services: We will develop all our services in an innovative, creative way, ensuring responsiveness, supported self care which feels seamless to service users. We will ensure best value, maximising resources available, working within a clear governance framework which both supports and encourages innovation and considers risks and impact.
How we will work as a Board: We will work collaboratively, demonstrating cohesiveness and maturity, always working to achieve consensus and full accountability. We will demonstrate our agreed Values and Collaborative behaviours in how we conduct ourselves, valuing the diverse roles, views and opinions of all Board members.
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The Role and Purpose of the Integration Joint Board, its members and the Senior Management team Role/purpose of IJB Role of Individual board members Role of senior officers and managers Accountabilities • Purpose & role set out by the • Bring individual expertise, • Deliver/Implement the Strategy Board Accountabilities Scottish Government experience and contribution and transformational change • To Scottish Government • Provide a range of services to • Non-partisan • Work across boundaries, driving • Community Councils meet national outcomes • Provide challenge, scrutiny, integration • Local Authorities • Provide the Vision, set strategic direction and support to ensure • Day to day delivery of services • Health Board direction & balance this with purpose is achieved • Work in partnership with Board • Straight / dotted line reality of resources available • Representation of and and individual Board Members • General accountability to the • Develop Strategic Plan & consultation with specific sector • Translate the Vision and inspire Public Locality Plans and/or stakeholders and staff to deliver • Legal accountability (in • Provide Financial, Care and representatives of ‘the whole’ • Supporting the administration and statute) Clinical governance, scrutiny & • Contribute to collaborative the business of the Board • Governance accountabilities: surety partnership & take collective • Actively seek opportunities to do • Care/Clinical • Review & carry out joint responsibility something different, adopt new • Financial commissioning of services • Managing the tension between ideas – become risk takers, • Staff based on data/information on different roles and providing a empowering staff Role Accountabilities needs (strategic plan) two-way conduit • Providing advice and information • Respect for the efficiency • Hold services & management (representative body/IJB) o Strategy vs. operational reality and planning and info • team to account for achieving Acknowledge tension between o Risks / exceptions / challenges / provided to board outcomes for service users – voting and consensus, work for opportunities • Provide evidence of spend & seamless, best experience consensus (see page 7) o Bring a level of individual and best value • Monitor outcomes and Ways of working: collective expertise – drive • Provide quality services to evidence of change • Joint working, not self-interest forward positive outcomes Service Users and their carers • Work in partnership with • Work in partnership with o Provide robust basis for • Make Informed decisions Management Team Management Team decision-making • Be ambassadors for the new • Overseeing Role: • Keep an eye on Culture, o Flag up issues effecting delivery vision & outcomes • Things are working smoothly ensuring it is collaborative • Contribute to policy • Facilitate the Integration of • Advocates for change – get Ways of working: development • Be available, approachable and services with service users at behind issues & champion them • Scrutinise and review centre of decision making • Taking responsibility to read helpful and non-partisan information • Ensure communication is effective • Experience of the service users and be up to date on issues • Being all about people, not are taken into account, needs • Engaged in the process and and information is presented politics met and expectations managed. decisions without jargon • Demonstrate the IJB Values and • Demonstrate the Board Values and Collaborative Behaviours. Collaborative behaviours
Clackmannanshire and Stirling Integration Joint Board Values
Equity Enabling
Collaboration Accountability Integrity Decision- Making Trust Taking Openness Responsibility Person Centred Respect
Quality Helping Safety Others Innovation Caring Ambition Compassion Efficiency Value for Money Prevention Whole System view
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Clackmannanshire and Stirling Integration Joint Board
Be Creative Innovative and Seek Feedback Be Brave Be Honest and Committed, Resilient and Open Minded Focused Value others Views
Work Collectively Be Flexible, supportive Seek Consensus and Be Co-operative High Impact Approachable Behaviours for Collaborative
Working Be Strategic, Walk in Each Rigorous, Others Shoes Productive and Analytical
Communicate; Learn and Listen, Question Grow as a Board and Share Information Be Decisive
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Ways of Working for the Integration Joint Board
1. What we need to do to get to the vision and reach good outcomes
• We need to review what is happening in other Partnerships both nationally, UK wide and internationally to find best practice examples of integrated services. • We need to clearly map our strategic Plan and agree our priorities for implementation. • We need to adopt robust project planning techniques to drive our change and achieve these priorities. • See the financial pressures as an opportunity to do things differently. • Build strong relationship between the IJB and the frontline staff and the service users. • We need to build good networks and accessibility with all partners. • We need to periodically review how we are demonstrating our Core Values and Collaborative Behaviours, building that into the work of the Board. • Review the use of inclusive technology both for the Board and frontline services.
2. How will we prepare for and deal with the difficult decisions that the Board may have to make?
Areas of Challenge • For all decisions we need to return to the Strategic Plan and ‘first principles’, reviewing impact and priorities, focussing on longer-term outcomes as much as possible. • We need to be fully aware that Finances will be challenging for all partners. For all changes and service developments we need to complete cost benefit analysis. • The Board also needs to build in a process to review ‘upcoming national/external factors’ which will impact on the work of the Partnership. • The Board should have no surprises; any areas of challenge should come to the Board very early to ensure full involvement and awareness. Forthcoming difficult decisions should be anticipated and dealt with through evidence and reliable data from the management team.
A well-informed Board • The Board needs to have as much information as possible and be well informed, to enable informed decision-making. • It will be easier for the Board to reach consensus when it is well-informed and has a full understanding of the issues and the views and advice from the management team. o Specialist briefings would be useful to enable much more detailed look at and understanding of particular issues, services and pathways. This could provide a ‘spotlight’ on particular areas where we know the agenda is going to be challenging. Board members could request this to enhance their individual understanding and also to review the data and benefit of particular actions etc. o Can the Board form Sub-groups where members can support the Management Team in developing alternative options/implementing change?
The Role of Board Members • Effective communication to and from the Board will support awareness and understanding of difficult issues: o Open and transparent information out of ‘own cultures’. o Take on the interests of the board what is achievable (IJB/Partnership as a whole – no silo thinking) • The Board needs to make best use of the supporting structures and groups e.g. Joint Management Team/Strategic Planning Group (not all ‘business’ needs to happen at the Board meeting)
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Development for Board and Members • Chair needs to take on the role of ensuring that the Board reviews its performance and ways of working to ensure the Values and Behaviours are demonstrated. • Mentoring/buddying for new board members, where they are paired with people in the partnership who are very aware of particular agenda issues and information. • Support ongoing development and awareness of services and the issues affecting them currently e.g. walk-arounds and visits to services – widening out from Health &Social Care services.
3. How will we avoid the Board becoming ‘stuck’ in relation to potentially difficult issues?
• Ensure all of the suggestions from item 2, above are put in place to prevent the Board getting ‘stuck’. • It is essential the Board notices when views are polarising and any impasse is likely to occur. In order to prevent this: o The Board will avoid voting if at all possible, consensus is key. o The Board needs to find middle ground as far as possible. o If ‘stuck’ return to review, revisit evidence based options. o Check out the quality and consistency of information o Set time aside to review if the Board has been presented with sufficient options. o Be objective / analytical • The Board needs to be aware of the realities of the issue at hand: o Being risk aware o Learning from elsewhere o Equity of service, quality and affordability o Reminders relating to agreed outcomes/purpose and for the greater good. o Implement internal ‘scrutiny’ if necessary. o Honesty and openness with service users about ‘why’ is essential.
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Appendix 1
Aims of the session: • To explore and confirm the purpose of the Integration Joint Board, the roles of individual members and the Board as a team. • To support the Board Members and Senior Officers to explore and agree their Vision for how the Board will operate. • To agree joint Values and behaviours for the Board and how these translate to ways of working that will support the delivery of the Partnership outcomes. • To discuss how the Board might prepare for and deal with potential areas of current and future challenge in a collaborative way.
Outline Programme:
1.15 Welcome and Introductions: Our hopes for this session. Alex Linkston; Chair of the Shadow Integration Joint Board
1.30 The Role of the IJB and the Individual members • What is the fundamental purpose of the IJB? • What do we see as the role of individual Board members? • What do we see as the role of the Senior Officers and members of the Management Team? • What are our individual and joint accountabilities?
2.20 The Vision and Values for the Integration Joint Board • Reviewing the Vision and Outcomes for the Partnership • The Vision for the Integration Joint Board – what would ‘good’ look like for this Board? o In how we work together? o In what our staff and public see us doing? • What are the Values we can jointly sign up to as a Board? • What is the culture we wish to demonstrate?
3.30 Ways of Working for the Integration Joint Board • Given the Values we have suggested, how do we want to work with each other to demonstrate them? o How would we be at our best? o How will we prepare for and deal with the difficult decisions that the Board may have to make? o How will we avoid the Board becoming ‘stuck’ in relation to potentially difficult issues? o What will help us to reach good outcomes in challenging times, achieving the Board Purpose and Vision?
4.30 Next Steps and close Shiona Strachan, Chief Officer
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Session Participants
Wendy Sharp 3rd Sector Representative Kathleen Martin Councillor, Clackmannanshire Council Tracey Gillies Director of Medicine, NHS Forth Valley Alex Linkston Non-executive Director, NHS Forth Valley Ewan Murray Chief Finance Officer Abigail Robertson Trade Union Representative, Stirling Council Morag |Mason Service User Representative, Stirling Teresa McNally Service User Representative, Clackmannanshire Shubhanna Hussain-Ahmed Carer Representative, Stirling Tom Hart Employee Director, NHS Forth Valley Christine Simpson Councillor, Stirling Council Natalie Masterton 3rd Sector Representative Angela Wallace Director of Nursing, NHS Forth Valley Pamela Robertson Trade Union Representative, Clackmannanshire Council Shiona Strachan Chief Officer Natalie Masterton 3rd Sector Representative, Stirling Voluntary Enterprise Elizabeth Ramsay Carer Representative, Clackmannanshire Stewart Carruth Chief Executive, Stirling Council Scott Farmer Councillor, Clackmannanshire Council Donald Balsillie Councillor, Clackmannanshire Council Jane Grant Chief Executive, NHS Forth Valley Fiona Gavine Non-executive Director, NHS Forth Valley James King Non-executive Director, NHS Forth Valley Val de Souza Head of Social Work Services, Clackmannanshire Council Angela Leask-Sharp 3rd Sector Representative, Sauchie Community Group Lesley Fulford HSCI Programme Manager
Apologies
Councillor Johanna Boyd, Stirling Council Councillor Les Sharp, Clackmannanshire Council Elaine MacPherson, Chief Executive, Clackmannanshire Council John Ford, Non-executive Director, NHS Forth Valley Kathy O’Neill, General Manager, NHS Forth Valley Scott Williams, Primary Care Clinical Lead Graham Foster, Director of Public Health & Planning, NHS Forth Valley
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Facilitating the Journey of Integration A Guide for those supporting the formation of Integration Joint Boards
Public Bodies (Joint Working) (Scotland) Act 2014 A Guide for Organisational Development Leaders
Contents
1 Introduction
1.1 The Public Sector Reform Agenda Page 3
1.2 Health and Social Care Integration Page 3
1.3 The Wider Context Page 4
1.4 Who is this guide for? Page 4
1.5 The aim of the guide Page 5
1.6 How to use this guide Page 5
2. Development Exercises
Exercise 1 Mapping our Health and Social Care Partnership Page 7
Exercise 2 National Health and Wellbeing Outcomes Page 8
Exercise 3 The Principles of Integration Page 10
Exercise 4 Role of an Integrated Joint board and its Members Page 12
Exercise 5 Membership of the Integrated Joint Board Page 14
Exercise 6 Organisational Culture Page 17
Exercise 7 Leadership Page 18
Exercise 8 Working to Support Localities Page 20
Exercise 9 Strategic Commissioning Plans Page 22
Exercise 10 Board Development Page 24
3. Appendices
Appendix 1 – Personal Development Page 25
Appendix 2 – Key messages for Integration Joint Boards Page 28
Appendix 3 – A brief history of Integration Page 31
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A Guide for Organisational Development Leaders
1. Introduction
1.1 The public sector reform agenda
In 2011, Campbell Christie produced a report, commissioned by the Scottish Government on the future delivery of public services. The Christie Commission, called for organisations delivering public services to work together and integrate in order to provide a more efficient and effective service to people. Amongst his key recommendations he urged that “public service providers must be required to work much more closely in partnership, to integrate service provision and thus improve the outcomes they achieve”; and that “our whole system of public services – public, third and private sectors – must become more efficient by reducing duplication and sharing services wherever possible”.
1.2 Health and social care integration
The integration of health and social care is part of the Scottish Government's ambitious programme of public sector reform. It embodies the recommendations of the Christie Commission in that it aims to improve outcomes for those who use health and social care services by requiring those services to integrate.
The Public Bodies (Joint Working) (Scotland) Act 2014 came into force on 1 April 2014. It provides the legislative framework for the integration of health and social care in Scotland. It requires local integration of adult health and social care services, with Health Boards and Local Authority partnerships deciding whether to include other services in their integrated arrangements.
The vision for Health and Social Care Integration in Scotland
Ensuring better outcomes for people where users of health and social care services can expect, for themselves and those that they care for, to be listened to; to be involved in not just in deciding upon the care they receive, but to be an active participant in how it is delivered; and to enjoy better health and wellbeing within their homes and communities as a result.
Shona Robison, Cabinet Secretary for Health and Wellbeing and Sport has stated that:
“We want those who use health and social care services to have integrated care – services that work together to give the best outcomes based on that person’s personal circumstances.”
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A Guide for Organisational Development Leaders
1.3 The wider context
It is important to remember that health and social care integration is part of a wider agenda of public sector reform. These reforms are vital to ensure the sustainability of our public services and to deliver better outcomes for those that use them.
The reforms are focused on joining up public services, organisations working together and improving outcomes for the most vulnerable people in our society. Success will ensure the sustainability of health and social services and wider public services not just for now, but also for years to come.
Integration Joint Boards need to pursue the principles of reform as a fundamental part of their role. They must work closely with other public services and also the third, independent and private sectors, to integrate service provision, use resources effectively and direct spend towards prevention and early intervention.
In this context community planning partnerships provides a pivotal vehicle for achieving effective public service reform at local level. By working with partner bodies in Community Planning Partnerships, Integration Joint Boards (IJBs) can build close connections with local communities, and shape and target the collective use of local public service resources towards integrated and efficient approaches.
This change and will require clear and cohesive leadership across all levels of the partnerships involved and confident and focused governance arrangements will be critical to getting this right.
1.4 Who is this guide for?
This guide is designed for use by a broad audience of those helping to support Integration Joint Boards as they establish themselves and begin to formulate their shared strategic vision for the partnership.
In considering the unique support requirements of Integration Joint Boards and their members, it is important to recognise that individual members will bring a variety of different skills, knowledge and understanding of particular issues to the Board. As a result, some material within the guide may be of more use to some members than others.
It is recommended that to support development approaches, IJBs start to collect data and insights that allow for the establishment of individual and collective development programmes. This will help to ensure that IJB members have the skills, knowledge and support to carry out their roles and ensure that they effectively scrutinize the governance arrangements which are in place.
The approaches detailed in this document are suggestions that can be used to begin the process of data collection, however, there is no requirement to
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A Guide for Organisational Development Leaders
undertake the activities outlined and those providing support to Boards are free to pursue alternative approaches should they wish.
The majority of partnerships have implemented the „body corporate‟ model of integration and therefore have an Integration Joint Board, but this resource could equally be of use for those in a governance role in partnerships based on the „lead agency‟ model. However, for ease of use, the resource will refer to the Integration Joint Board throughout.
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1.5 The aim of this guide
The resource highlights the important roles that are required to make the integration of health and social care a success. It is structured around providing key pieces of information followed by „development exercises‟ that can be used to support the effective development of an Integration Joint Board, either individually or collectively. .
This guide focuses on three main areas:
1. How can an Integration Joint Board make a difference to people‟s lives in delivering integrated health and social care services through the principles of integration? 2. What may be different about being a member of an Integration Joint Board? 3. How can members make a difference on an Integration Joint Board? What skills and experience do members bring from their respective backgrounds?
1.6 How to use this guide?
This resource works at an individual and collective level and can be used to stimulate discussion, affirm purpose and create conditions for effective team working. It can be used to help create a development plan for the Integration Joint Board or as an on-going reflective resource to support the strategic vision.
It aims to help develop reflective thinking in order to support:
Identification of the collective and individual roles required to carry out the responsibilities of an Integrated Joint Board; Reflection on how an Integration Joint Boards will exercise collaborative leadership to achieve the outcomes for integration; The principles of integration being visible throughout all Integration Joint Board work; Discussion on how Integration Joint Boards can make a difference; Acknowledgment that all Integration Joint Board members come with rich but sometimes differing experience and perspectives; and The development of a shared understanding and appreciation of integration and how collective thinking can contribute to improving outcomes for people.
There may be times where the responses to some of the questions and development exercises create a range of different and opposing thoughts from board members. Acknowledging and working through these areas of difference will be important and could provide the greatest opportunities for learning for an Integration Joint Board as it navigates its way through new ways of working.
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It is important to recognise that things will change as integration progresses. Using this guide at different points along the path of integration may illicit different responses to areas. Integration Joint Board may therefore want to revisit discussions over time to assess where members are at with their thinking.
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DEVELOPMENT EXERCISES
DEVELOPMENT EXERCISE 1 - MAPPING OUR INTEGRATION JOINT BOARD
MAPPING OUR INTEGRATION JOINT BOARD
This exercise is to highlight where the key relationships are between the Health and Social Care Partnership and the other planning and delivery organisations that contribute to health and social care.
Given that the Integrated Joint Board sits within a complex system with different relationships with other organisations, this exercise has been developed to explore what that may mean to the Integration Joint Board members.
Activity
Ask the Integration Joint Board members to work in small groups to draw the partnership and where it sits in relation to the NHS Board, the Local Authority, the Community Planning Partnership and any other significant delivery organisations.
Use discs or other shapes to represent the organisations or draw them freehand. Then using tracing paper put a layer over the shapes and then draw in the relationships, reporting and communication channels between the partnerships and the other organisations.
What does this map look like? Is there agreement in the group and across the groups? Is there a common perspective that emerges? How does this relate to me as an Integration Joint Board member?
Notice how much agreement there is on the relationships and where organisations sit, discuss different perspectives. Is there a common perspective that emerges?
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DEVELOPMENT EXERCISE 2 -NATIONAL HEALTH AND WELLBEING OUTCOMES
Successful health and social care integration will be measured against the nationally agreed outcomes.
These outcomes, set out below, should be the focus for all the work of the Integration Joint Board.
1. People are able to look after and improve their own health and wellbeing and live in good health for longer.
2. People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community.
3. People who use health and social care services have positive experiences of those services, and have their dignity respected.
4. Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services.
5. Health and social care services contribute to reducing health inequalities.
6. People who provide unpaid care are supported to look after their own health and wellbeing, including reducing any negative impact of their caring role on their own health and wellbeing.
7. People who use health and social care services are safe from harm.
8. People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide.
9. Resources are used effectively and efficiently in the provision of health and social care services.
The National Health and Wellbeing Outcomes Framework has been published and can be accessed here.
The accompanying measurement framework which supports the Integration Joint Board to identify the indicators that are appropriate to them can be accessed here.
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DEVELOPMENT EXERCISE 2 - NATIONAL HEALTH AND WELLBEING OUTCOMES
NATIONAL HEALTH AND WELLBEING OUTCOMES
The use of outcomes in measuring success will be familiar to some Integration Joint Board members and not so familiar to others. Each Integration Joint Board will select the indicators that they will use to show whether an outcome is being achieved or worked towards.
It is crucial that Integration Joint Board members understand what the outcomes are and how they will be achieved, but also that they should be the focus of the partnership.
Are Integration Joint Board members comfortable about the difference between an outcome, input, output and process?
How do Integration Joint Board members know if the indicators the Integration Joint Board are using let them know the real extent to which national outcomes are being met?
How are these high level outcomes translated into something meaningful for your Integration Joint Board to tackle?
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DEVELOPMENT EXERCISE 3 - THE PRINCIPLES OF INTEGRATION
The integration planning and delivery principles are the lens through which all integration activity should be focused to achieve the national health and wellbeing outcomes. They set the ethos for delivering a radically reformed way of working and inform how services should be planned and delivered in the future.
The principles also set a clear tone for both the national guidance and local implementation of the Public Bodies (Joint Working) (Scotland) Act 2014.
The main purpose of the integration planning and delivery principles is to improve the wellbeing of service-users and to ensure that those services are provided in a way which:
Are integrated from the point of view of service-users
Take account of the particular needs of different service-users
Takes account of the particular needs of service-users in different parts of the area in which the service is being provided
Take account of the particular characteristics and circumstances of different service-users Respects the rights of service-users
Take account of the dignity of service-users
Take 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
Are 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
Guidance on the planning and delivery principles which describe how integrated care should be planned and delivered and how the principles will work in tandem with the National Health and Wellbeing Outcomes can be accessed here – Integration Planning and Delivery Principles.
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DEVELOPMENT EXERCISE 3 – THE PRINCIPLES OF INTEGRATION
PRINCIPLES OF HEALTH AND SOCIAL CARE INTEGRATION The following statements have been developed to help Integration Joint Boards consider how well they are embedding the principles of integration.
As an Integration Joint Board , each member should indicate where they feel their board sits on the following statement with 1 strongly agree and 5 strongly disagree
The Integration Joint Board should collectively look at the responses and;
consider the differences and similarities reflect on what they might mean identify potential areas and opportunities for improvement
Please give a rank to the domains below in terms Scale: of the development required by the Integration Joint 1 = Strongly agree to Board 5 = Strongly disagree
Focus on service users 1 2 3 4 5 The Integration Joint Board is assured that the needs of individual service users are met with respect, dignity and safety.
Focus on communities The Integration Joint Board is assured that the services developed and delivered within their localities reflect full engagement with their communities and will deliver improved outcomes for local people.
Resources and accountability The Integration Joint Board is confident that it will deliver on its strategic priorities, effectively manage associated risks and that it makes the best use of available resources.
Board dynamics Integration Joint Board members are motivated individuals who have the right blend of skills and experience to help deliver the strategic intent. Board members work constructively together in a climate characterised by informed trust, involvement and robust dialogue.
Leadership The Integration Joint Board is confident that it has the conditions to support collaborative leadership and that every member‟s voice is heard and valued.
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DEVELOPMENT EXERCISE 4 – THE ROLE OF AN INTEGRATED JOINT BOARD AND ITS MEMBERS
The principles and outcomes that have been developed for integration are designed so that the people in your communities have the best possible services which are tailored to local circumstance and deliver high quality results. The role of Integration Joint Board member is to ensure that this is central to the decision-making process.
Making decisions about how integrated health and social services are planned and delivered for communities both now and in the future presents Integration Joint Boards with their most significant challenge but it also has huge opportunities for all parties. Working with complex multi-faceted problems will require a collective wisdom and approach that seeks to draw on all the assets of the Integrated Joint Board members and the communities and groups they serve. There will be difficult decisions to be made on the journey of integration and how the Integration Joint Board approaches these will be crucial in defining its success.
It is important to acknowledge that with so many different stakeholders and interests represented on the Integration Joint Board it is likely that there will be times of disagreement from respective organisational points of view. It is therefore important to remember that when members sit on an Integration Joint Board they are representing the interests of the Integration Joint Board. They will have been nominated by their parent organisations and must act in the best interests of the Integration Joint Board. This may at times mean decisions are made that do not sit easy with colleagues in their parent organisations or indeed with communities and members of the public. It is therefore important that the principle of collective decision making is reinforced and Integration Joint Board members accept that once decisions have been agreed, they may need to function as a community leader to make sure the changes which have been agreed happen.
Constructive challenge and discussion within Integration Joint Boards is imperative. Rigorous scrutiny of proposals that are put before the Integration Joint Board will help to justify potentially difficult and unpopular decisions .Integration Joint Boards should ensure that appropriate professional advice from your fellow Integration Joint Board members and others is sought as appropriate. Adopting this approach as individuals and as a collective will enable the successful redesign of pathways of care and ensure that the co-productive nature of the Integration Joint Board is maintained.
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DEVELOPMENT EXERCISE 4 – THE ROLE OF AN INTEGRATED JOINT BOARD AND ITS MEMBERS
INTEGRATION JOINT BOARD - DECISION-MAKING ARRANGEMENTS
The following issues for consideration have been developed to help Integration Joint Board discuss and reflect on decision-making arrangements. It will help clarify how Integration Joint Boards will engage with and ensure that all members contribute to the business of the board. The purpose is to generate discussion and reflection on „how‟ the Integration Joint Board works together. Exploring different perspectives will enrich how the Integration Joint Board works together and forms their own ways of reaching agreement .
Issues for consideration How do we as an Integration Joint Board make decisions around areas where members may have different opinions? As an Integration Joint Board member you may be in a position where the decisions that are agreed by the board do not reflect your own views. How will you provide effective leadership in these circumstances? As an Integration Joint Board member you may at some point have a conflict between the goals of the Integration Joint Board and that of your parent organisation. What preparation and support can you draw on to work this through, when it occurs? How do we, as an Integration Joint Board, ensure transparency in our decision-making? How do we ensure the Integration Joint Board works collectively and „corporately‟ to achieve best improved outcomes across the Health and Social Care Partnership? How will the Integration Joint Board hold itself to account for its decisions? How do we ensure the Third and Independent sectors in the Integration Joint Board feel included and involved in deliberations. How do we evidence this? How will we ensure engagement with relevant stakeholders not on the Integration Joint Board, and facilitate their contribution? How will we ensure the voices and perspectives of all members are equally considered in our decision-making processes How do we know if the Integration Joint Board strategy, vision and principles are collaborative and integrated? What difference will we notice when the Integration Joint Board vision, strategy and principles of integrations are upheld or implemented?
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DEVELOPMENT EXERCISE 5 - MEMBERSHIP OF THE INTEGRATED JOINT BOARD
The job of the Integration Joint Board is to help shape the development of integrated arrangements and decide how best to plan and oversee the delivery of the functions that have been delegated to it. The Integration Joint Board is made up of voting and non-voting members. It is important to understand the following:
Voting membership must have parity in terms of membership, the Local Authority and the Health Board who make up the voting cohort must agree on the same number of representatives to sit on the Integration Joint Board. The Integration Joint Board must have a minimum membership which is outlined in the Public Bodies (Joint Working) (Integration Joint Board) (Scotland) Order 2014. The Integration Joint Board can add additional non-voting members to the Board if there is agreement.
It will be important for Integrated Joint Board members to have a clear understanding of the the role they hold and those of other members of the Integration Joint Board. Below is a description of the varying roles that must make up the membership of an Integration Joint Board
Local Authority and NHS Members (Voting members) These members are nominated in equal numbers by the Health Board and Local Authority. Their role is to bring the perspectives of their parent organisation onto the Integration Joint Board and help shape the strategic direction of the Integration Joint Board to improve outcomes for their communities.
Advisory Members (Non-voting) The non-voting members of the Integration Joint Board are there to provide advice and support to ensure that the integration of services makes a difference for the people using them and being supported by them
Chief Officer of the Integration Joint Board is the single point of accountability for integrated services. They are appointed by the Integration Joint Board and are responsible for the development, delivery and oversight of the Integration Joint Boards Strategic Plan. The Section 95 Officer (Chief Financial Officer CFO) of the Integration Joint Board is statutorily responsible for the financial assurance and accountability of the Integration Joint Board. The Chief Social Work Officer of the constituent Local Authority has the statutory responsibility with regards to the governance of social care services. A General Practitioner, appointed by the Health Board, is required to provide advice to the Integration Joint Board on matters relating to primary care services and represent the GP and primary care communities. A Secondary Medical Care Practitioner, employed by the Health Board is required to provide advice to the Integration Joint Board on matters relating to the Secondary Medical Care and represent Secondary Medical Care Practitioner more broadly.
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A Nurse representative, employed by the Health Board; is required to provide advice to the Integration Joint Board on matters relating to nursing and represent the views of the nursing community more broadly. A staff-side representative is expected to provide advice on staff issues to the Integration Joint Board and to report to their membership on the topics discussed at meetings. These individuals are non-voting members of the Integration Joint Board. A Third Sector representative is required to provide advice to the Integration Joint Board on matters relating to Third Sector and represent the views of the Third Sector more broadly. A carer representative; is required to provide advice to the Integration Joint Board on matters relating to carers and represent the views of the carers community more broadly. A service user representative; is required to provide advice to the Integration Joint Board on matters relating to service users and represent the views of the service users more broadly
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DEVELOPMENT EXERCISE 5 - MEMBERSHIP OF THE INTEGRATED JOINT BOARD
BUILDING RELATIONSHIPS The following issues for consideration have been developed to help the Integration Joint Board discuss and reflect on how they will develop and build effective relationships to deliver the vision and principles of integration. They can be used in a variety of ways, through paired discussions, group discussion or whole board reflection. However they choose to use them, the purpose is to build trust, communication and understanding between Integration Joint Board members.
What do we value about working in partnership? What is important to us in working together, what do we need to be present? How do we demonstrate the principles for integration in how we work? What might get in the way of this and how would we deal with these situations? What people skills are important for us in these roles? What does effective collaboration look and feel like as an Integration Joint Board member? How will we build trust across the Integration Joint Board, what are our /my roles in this? How will we work with challenge, difference or disagreement to reach decisions that improve outcomes for people? If we get „stuck‟ how will we notice this and move forward? Where will we seek help and support to help us to continually develop? How will we recognise and celebrate success?
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DEVELOPMENT EXERCISE 6 - ORGANISATIONAL CULTURE
Bear in mind that all Integration Joint Board members will come from different organisations, some with political backgrounds and alliances.
The issues that an Integration Joint Boards will face will be challenging and it is essential that in taking this forward the business of the Integration Joint Board it is conducted in line with the Ethical Standards in Public Life etc. (Scotland) Act 2000.
CULTURE OF THE INTEGRATION JOINT BOARD
Public, Third and Independent Sector services have very different; ever changing and evolving cultures
The culture of Integration Joint Board will be different from members „parent‟ organisations in that it will be bringing together a variety of cultures. The challenge for the Integration Joint Boards will be to bring the best from these existing cultures and establish the essential elements within Integrated Joint Boards as they plan and commission integrated services.
There are lots of different elements that shape culture. The following questions have been developed to prompt discussion across the Integration Joint Board membership to help them to acknowledge culture differences, celebrate what is good already about culture and how they can help to shape new culture.
What are the symbols which mark a healthy work culture? What do we want to highlight as important now? What are the aspects of our culture that we wish to focus on? How do we model these aspects in our leadership role? Do we understand our informal culture creators?
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DEVELOPMENT EXERCISE 7 - LEADERSHIP
The leadership role of a member of the Integration Joint Board is complex; invariably requiring members to juggle competing demands and deal with complex situations. Some of the skills required to successfully fulfil the role of an Integration Joint Board member include collaborative and collective working, self-awareness and astute governance.
In relation to meeting governance and accountability expectations, maintaining a focus on the national outcomes for people will enable these commitments to be met. In working this way as an Integration Joint Board will be able to have confidence in knowing that people‟s needs are clearly at the centre of service design and delivery rather than services driving activity. This guide provides a focus for Integrated Joint Board members to consider what skills they may have and need to contribute, in order to support the Integration Joint Board to work in this way.
To achieve the vision of integration, where people are at the centre of delivery, leadership is required at all levels. It is crucial that the Integration Joint Board are able to lead by example and model the kind of inclusive, collaborative and person- centred behaviour expected from practitioners and organisations. It is recognised in research that the focus and priorities of the board will have an impact on the quality and delivery of care. The role of an Integration Joint Board member is fundamental in establishing the future vision and culture change required to support integration.
It is important to understand people, what matters to them and why. Being self- aware will enable Integrated Joint Board members to first understand their strengths and what drives them, how they relate and react to others personally and professionally, how they process information and the ways in which this informs how they reach conclusions and take action.
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DEVELOPMENT EXERCISE 7 - LEADERSHIP
LEADERSHIP
To enable effective relationships it is important that you consider the following questions:
What do individual members bring to Integration Joint Board? What do the other Integration Joint Board members bring? What will the Integration Joint Board do together that will make a difference to people?
Effective relationships are at the heart of effective organisations. The core of developing relationships is building trust and understanding across the members of the Integration Joint Board.
The space for listening to what is important to individuals may seem like a luxury or indulgence, however it has the potential to pay dividends in terms of time saved and problems avoided through the Integration Joint Board having a high degree of trust. Working together with other Integration Joint Board members to deliver effective leadership and create resilient relationship is crucial and requires building trust through honest relationships and maintaining clarity of role and purpose.
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DEVELOPMENT EXERCISE 8 -WORKING TO SUPPORT LOCALITIES
One of the key components of the Public Bodies (Joint Working) (Scotland) Act 2014 is that it requires the establishment of localities, so what does establishing localities mean for the Integration Joint Board?
Within each Health and Social Care Partnership there will be at least two localities, although partnerships can have more if they wish. Localities will be shaped differently across Scotland; however the guiding principle that Integration Joint Board members must remember is that localities are in place to enable services to be tailored to local circumstance.
Integration Joint Boards must ensure that the rationale for identifying localities is sound and robust. Localities should relate to natural communities and take account of clusters of GP practices and levels of deprivation and health inequalities. The key to the success of localities is the involvement of different participants: GPs primary care, secondary care, social care and most importantly local communities all have a role to play. Therefore, members of Integration Joint Boards must ensure that the rationale for developing localities is sound, it is even more important that skills and insights of these key groups are successfully heard. Drawing on the expertise of the professional advisors to the Integration Joint Board and having close links with Community Planning Partnerships will support Integration Joint Boards to do this.
Localities and partnerships need to develop in tandem with decisions about local resource being made as close to the locality as possible. Localities should have the ability to allocate resources and enable close community and workforce involvement to support innovation and service design to meet local needs. Engagement of professionals, including primary care will be a key element of in developing thriving and effective locality working.
In addition, the establishment of localities puts in place certain legal requirements and Integration Joint Board members should make themselves aware of these as localities are developed.
For further information in relation to localities, Integration Joint Board members can refer to the All Hands on Deck, the think piece previously published by the Scottish Government on the importance of localities.
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DEVELOPMENT EXERCISE 8 -WORKING TO SUPPORT LOCALITIES
WORKING ACROSS LOCALITIES
The reflective questions and issues for consideration below are designed to support a discussion across the Integration Joint Board. Notice what is similar and different in perspectives. What does this mean for the Integration Joint Board? What are the agreed areas for development?
Reflective questions Although each locality will be unique, are there common priorities across them all? How does the Integration Joint Board respect different locality needs in our decision-making? Does the Integration Joint Board have effective engagement with primary care and the wider workforce within our localities? How is this being evidenced? What conditions will enable decision-making and resource transfer to localities? What does it mean for the Integration Joint Board if priorities in the localities are widely different and conflicting? How can the principles for integration help us be flexible and adaptive? How flexible/responsive are we able to be if priorities change locally? How confident do Integration Joint Board members feel about their knowledge and understanding of the communities in the partnership area? How does the Integration Joint Board ensure that engagement with the communities is effective in each locality?
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DEVELOPMENT EXERCISE 9 - STRATEGIC COMMISSIONING PLANS
The Act places a duty on Integration Authorities to develop a “strategic plan” for integrated functions and budgets under their control. The strategic plan is the output of what is more commonly referred to as the “strategic commissioning” process.
Strategic commissioning is the term used for all the activities involved in assessing and forecasting needs, linking investment to agreed desired outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place1.
Each Integration Authority must produce a strategic commissioning plan that sets out how they will plan and deliver services for their area over a three year rolling period. All members of the Integrated Joint Board must be fully engaged in the preparation, publication and review of the strategic commissioning plan, in order to establish a meaningful co-productive approach, to deliver the national outcomes for health and wellbeing, and achieve the core aims of integration.
By developing new strategic commissioning plans for all adult care groups, Integration Joint Boards have an opportunity to design and commission services in new ways in collaboration with their partners. Strategic commissioning plans should incorporate and leverage informal, community capacity and assets to deliver more effective preventative and anticipatory interventions.
Services cannot continue to be planned and delivered in the same way. The current situation is neither desirable in terms of optimising wellbeing, nor financially viable. The focus should be less about how it is done now and more about how it should be done in the future. This might mean, through a robust option appraisal process, that the Integration Authority makes decisions about disinvesting in current provision of services in order to reinvest in other services and supports that are required to meet on-going and changing demand.
1 Joint Strategic Commissioning – A Definition: Strategic Commissioning Steering Group, June 2012
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DEVELOPMENT EXERCISE 9 - STRATEGIC COMMISSIONING PLANS
STRATEGIC COMMISSIONING PLANS
The reflective questions and issues for consideration below are designed to support a discussion across the Integration Joint Board. Members may find it useful to reflect on their own perspective then share this with others. Notice what is similar and different in how you see things. What does this mean for the Integration Joint Board? Where are your agreed areas for development?
How will we assure ourselves that the strategic commissioning process is robust and reflects a new way of working? How will the Integration Joint Board negotiate amongst itself if there are areas of disagreement about the strategic commissioning process or outcome? Where there are areas of disinvestment, what will the process be for this and how will the Integration Joint Board communicate this message to stakeholders? How do the values and principles of health and social care integration challenge traditional commissioning and planning – what impacts will these have, what skills might Integration Joint Board members need to bring about positive change and outcomes? How will the Integration Joint Board ensure an outcomes approach to commissioning is implemented? How might procurement processes need to change? What support do we require as an Integration Joint Board to achieve this?
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DEVELOPMENT EXERCISE 10 - BOARD DEVELOPMENT
Each Integration Joint Board is required to produce a Board Development Plan which sets out how the Integration Joint Board plans to develop a continuous improvement approach to how it operates.
The Board Development Plan will pull together the themes and areas for improvement as well as detail actions required and monitoring process. This exercise is just one example of these and the questions that may assist with the process of creating the plan.
ASSESSING CONTINUOUS IMPROVEMENT
The Integration Joint Board should collectively review and discuss the themes and questions and from the discussion the themes for improvement should emerge.
Themes What are we What do we need What action do we doing well? to change in the need to take to way we are make this working to improvement? improve our effectiveness as an Integration Joint Board? Focus on service users
Focus on localities
Resources and accountability
Board Dynamics
Leadership
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APPENDIX 1
PERSONAL DEVELOPMENT
This section is for Integration Joint Board members to work though on their own. The additional tools and resources are freely available. The questions are designed to help members reflect on their own leadership style and role.
There is a personal action plan to help Integration Joint Board members to develop a personal leadership journey and sources of support and further reading. You may choose to use an existing or alternative PDP format. The key point is to invite Integration Board members to reflect on what they bring to the Integration Joint Board and capture the actions which would support their development in this role.
Those who are supporting the formation and development of the Integration Joint Board will need to clarify the process by which the specific and general development needs stemming from the personal development plans will be addressed. This should be negotiated with the Chair or Chief Officer of the Integrated Joint Board.
What do individual members bring in relation to Integration Joint Board? Each member of the Integration Joint Board is a unique person with their own set of values and beliefs. Knowing what is important to them and how they communicate with others and listen to their ideas and perspectives is vital in developing the Integration Joint Board and individual members leadership role. Essentially the more members pay attention to the behaviours needed to fulfil the tasks they are asked to fulfil, the better they will be able to provide authentic leadership when serving on the Integration Joint Board.
Questions to stimulate personal reflection by Integration Joint Board members
Question Reflection Actions based on reflection What are my values? Would those around me recognise that I am living these values? What skills, knowledge, and attributes do I bring to the role? How do I operate when I am at my best? What do I need to watch out for when under pressure or stressed? What or who inspires me? Who is supporting me in my leadership role? How does this differ from other roles/positions I possess? What is different about how I need to operate as a member of an Integration Joint Board?
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A Guide for Organisational Development Leaders Useful tools and resources
Psychometric Individual developments to help me Board or group assessments to gain perspective and new insights developments to improve help me collaborative working understand my and functioning preferences and character e.g. 360 degree e.g. coaching, mentoring, eLearning on e.g. facilitated Board feedback, specific leadership qualities or technical development workshops on Behavioural skills (e.g. finance, data analysis, group dynamics, Board profiles e.g. appreciative inquiry skills, critical dialogue on critical issues, MBTI, 16 PF, thinking/systems thinking), creative locality visits to confirm Insights, Disc thinking approaches, personal resilience, realities and impact of mindfulness, leadership exchanges, paired decisions made, regional or learning, action learning national networking events (profession specific or whole system)
These can These can generally be accessed through: These can generally be generally be Organisational Development leads in NHS accessed through: accessed or Local authorities Organisational through: Development leads in NHS Organisational Coaching Collaborative via Workforce or Local Authorities Development Scotland National organisations leads in NHS or http://www.scottishleadersforum.org/public- which provide support to Local Authorities service-collaborative-learning Integration Joint Board SSSC - http://www.sssc.uk.com/ JIT http://www.sssc.uk.com/ NES http://www.nes.scot.nhs.uk/ Improvement Service
What do other Integration Joint Board members bring? When considering the role and responsibility of the Integration Joint Board it is important to understand what other Integration Joint Board members bring. Appreciating different perspectives and ideas is important and adds strength to a group and helps them to develop ideas and work more comfortably with ambiguity and complexity.
Much has been written in leadership and organisational development research about how groups function, the roles of group members and group processes. The majority of groups work best when there is a group environment where all members feel listened to, valued, are able to contribute to debate and discussion, where different opinions are aired and respect for members is a core aspect for how the group works. It is also important for groups to be able to identify where they may have gaps in their knowledge or skills and seek to continually improve and build on their ways of working.
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A Guide for Organisational Development Leaders Questions to stimulate personal reflection by Integration Joint Board members
Question Reflection Actions I may take as a result of reflection How do I know what others bring? How do I ensure that I operate on facts and not assumptions? How do I ensure that I value difference? What do I value about partnership working? What is the difference between cooperation and collaboration – where are we? What annoys me about working in partnership and what is in my ability to change? Is there shared and equal power amongst other Integration Joint Board members? How do I know what other Integration Joint Board members‟ priorities are? How will we make new Integration Joint Board members welcome?
PERSONAL ACTION PLAN This section is for you as an Integration Joint Board member to capture learning and insights and create a plan to build on these.
What are my key insights What are my next steps to What support do I need to and learning from using develop myself in this do this? this guide? role?
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APPENDIX 2 KEY MESSAGES FOR INTEGRATION JOINT BOARD MEMBERS
General messages about why we are integrating health and social care services
Health and Social Care Integration is the Scottish Government's ambitious 1 programme of reform to improve services for people who use health and social care services.
It will ensure that health and social care provision across Scotland is joined-up 2 and seamless, especially for people with long term conditions and disabilities, many of whom are older people.
The Public Bodies (Joint Working) (Scotland) Act 2014 was granted Royal 3 Assent on 1 April 2014. This means changes to the law which requires Health Boards and Local Authorities to integrate their adult health and social care services.
4 One of the main aspects of the Act is to create statutory Integration Authorities which will replace existing Community Health Partnerships.
Overarching national core messages People can expect to be supported to live well at home or in the community for 1 as much time as they can. People can expect to have a positive experience of health and social care 2 when they need it, with services planned and delivered in ways that are joined- up and person-centred. People can expect to experience the same high quality of care wherever they 3 live in Scotland.
Key messages for all stakeholders
Health and Social Care Integration will enable people to maintain their health 1 and wellbeing for longer and to live independently and safely for as long as possible.
2 There will be a better understanding of an individual‟s whole needs to allow for earlier interventions and prevention before problems arise.
3 There will be better and fairer use of resources, as services and networks are used more efficiently.
Services will be co-produced with the communities they serve. They will be 4 built on people's assets and will support the health and wellbeing of the whole person and their family.
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Individuals using services will have a stronger voice in their treatment and 5 care. This voice will be listened to and respected and will help to shape health and social care services for the future.
Key messages for people who use care and support services Individuals can expect health and social care services to work in a co- 1 ordinated way with them, to understand what matters most in their lives, and to build support around achieving the outcomes that are important to them. The necessary joined-up health and social care support will be provided to help individuals, their carers and families to better manage their conditions on 2 a day-to-day basis; formalising networks within the community; and working with individuals as true partners, rather than just as patients or people who use services. Individuals can expect to be supported to live not just longer, but healthier lives and will receive locally based services and support that best meets their 3 needs and which are organised around them, their family and their informal support network. People with care and support needs should have the same choice, control 4 and freedom as every other citizen.
Key messages for the general public
The general public can expect family members, someone that they are caring 1 for, or themselves at some point in the future to receive a coordinated, seamless system of care and support that recognises their individual needs and aspirations whenever they need it.
Depending on their previous experience of health and social care services, 2 individuals will notice a change if they ever require similar care and support in the future.
Key messages for those delivering services – the workforce
At its heart, health and social care integration is about enabling services to 1 work together effectively to support people achieve the outcomes that matter to them.
2 This is a transformational change most likely to be achieved by actively engaging with people who are delivering services.
3 Workers need to be supported to feel engaged in the work that they do and to continuously improve the information, care and support that they provide
4 Workers and organisations need to build on what is already working well locally, drawings on resources and assets that already exist.
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Workers and organisations need to further develop the skills focused on what 5 matters to the person; creating networks, making connections, building shared values and working with people and communities to produce shared solutions.
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APPENDIX 3 A BRIEF HISTORY OF INTEGRATION
Seventy nine Local Health Care Cooperatives established across 1999 Scotland to bring health and social care practitioners together to deliver a range of primary and community health services and promote joint working with councils and the voluntary sector.
Scottish Government adopts recommendations from the Joint Futures Group, a collection of senior figures from the health service 2000 and local Government. These include shared assessment procedures, information sharing, joint commissioning and joint management of services.
Community Care and Health (Scotland) Act includes powers, but 2002 not duties, for NHS Boards and local authorities to work together more effectively.
NHS Reform (Scotland) Act 2004 requires Health Boards to establish one or more Community Health Partnerships (CHPs) in their 2004 local area to bridge gaps between primary and secondary healthcare, and health and social care. Between 2004 and 2006 each local area established a partnership which is a subgroup of the health board with strong local representation.
Scottish Government launches the Reshaping Care for Older People Programme to prepare for a projected rise in older people 2010 and drive improvements in support and services. The programme and arrangements for the related Change Fund both require closer collaboration between Health Boards and Local Authorities and with the third and independent sectors.
2011 All major political parties include commitments to integrate health and social care in their Scottish Parliament Election manifestos.
2012 Scottish Government consults on its proposals for the integration of adult health and social care.
Publication of the Public Bodies (Joint Working) (Scotland) Bill 2013 proposing the creation of 32 Health and Social Care Partnerships, one in each Local Authority area, to replace CHPs/CHCPs.
2014 Public Bodies (Joint Working) (Scotland) Act 2014 receives Royal Assent on 1 April.
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Clackmannanshire & Stirling Integration Joint Board
24 February 2016
This report relates to Item 11 on the agenda
DELAYED DISCHARGE PROGRESS REPORT
(Paper presented by Val de Souza and Kathy O’Neill)
For Noting
Approved for Submission by Shiona Strachan, Chief Officer Author Phillip Gillespie, Assistant Head of Social Services Date: 24 February 2016 List of Background Papers:
Page 1 of 10
Title/Subject: Delayed Discharge Progress Report Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 24 February 2016 Submitted By: Phillip Gillespie, Assistant Head of Social Services Action: For Noting
1. Introduction
1.1 The purpose of this paper is to update the Integration Joint Board on the performance of the Clackmannanshire and Stirling Partnership in relation to the national delayed discharge target of 2 weeks. The longer term trend information relating to delayed discharge performance is set out in appendices 1, 2 and 3 of this report.
2. Recommendation
2.1 The Integration Joint Board (IJB) is asked to; • note the performance of the partnership based on the January 2016 census and provide appropriate challenge; • note the service improvements undertaken by the Partnership in managing hospital discharge;
3. Background
3.1 As at January census date, there were a total of 4 patients delayed awaiting discharge from hospital for Clackmannanshire, and 1 patient delayed for more than 2 weeks. In Stirling, there was a total of 8 patients delayed awaiting discharge from hospital, of which 1 patient was delayed for more than 2 weeks.
3.2 Table 1 - Clackmannanshire Council Apr May Jun Jul Aug Sept Oct Nov Dec Jan 15 15 15 15 15 15 15 15 15 16 Total delays at census point (As of 0 2 5 6 3 2 3 8 2 4 15th of each month) Total numbers of 0 1 0 4 1 2 1 1 0 1 delays over 2 weeks
Table 2 - Stirling Council Apr May Jun Jul Aug Sept Oct Nov Dec Jan 15 15 15 15 15 15 15 15 15 16 Total delays at census point (As of 1 15 11 11 7 9 10 17 5 8 15th of each month) Total numbers of 0 3 3 6 3 4 10 6 1 1 delays over 2 weeks
3.3 In addition to standard delays, there are patients whose discharge is complex (code 9) and whose discharge is part of a longer discharge planning process (code 100). The latter tend to be patients who are in long stay learning disability or mental health inpatient services. Code 100 relates to those patients who have been assessed for transfer to a specialist resource where no such resource is available or exists. Examples of this include patients awaiting transfer to a community setting as part of a commissioning or resettlement programme. As of 15 January 2016, Clackmannanshire and Stirling both had 1 patient each with a Code 100 applied.
3.4 Code 9 was introduced for very limited circumstances where NHS Chief Executives and local authority Directors of Social Work (or their nominated representatives) could explain why the discharge of patients was out with their control. These include patients delayed due to awaiting place availability in a high level needs’ specialist facility where no facilities exist and where an interim option is not appropriate, patients for whom an interim move is deemed unreasonable or where an adult may lack capacity.
Table 3 - shows the total number of delays in Clackmannanshire expressed as bed days lost.
Table 3 - Clackmannanshire Council Apr May June July Aug Sept Oct Nov Dec Jan 15 15 15 15 15 15 15 15 15 16 Total Bed Days lost 0 26 23 122 33 43 49 87 14 32 Standard Delays
Table 4 shows the total number of standard delays in Stirling expressed as bed days lost
Table 4 - Stirling Council Apr May June July Aug Sept Oct Nov Dec Jan 15 15 15 15 15 15 15 15 15 16 Total Bed Days lost 60 106 140 248 95 109 316 233 33 68 standard Delays
4. Analysis of reasons for delay
4.1 The principal reasons for delay during the reporting period was the result of the primary choice of care home being unavailable and the resourcing of care packages and patients awaiting the conclusion of a legal process/Guardianship. At the January census 5 patients were delayed awaiting the conclusion of a legal process in Stirling and 3 patients delayed in Clackmannanshire. The primary reason for Guardianship delays during this reporting period was a delay in acquiring legal aid for private Guardianship applications.
4.2 There continues to be ongoing challenges in relation to the resourcing of packages of care for people being discharged from hospital, particularly in rural Stirling. Despite this in Stirling there has been a decrease in the number of patients awaiting a package of care from 6 patients as at 17 December to 2 patients awaiting packages of care as at 14 January. As outlined in previous reports to the Integration Joint Board the Social Services Contracts and Commissioning team continue to work with a range of Care at Home providers to review contracting arrangements and ensure best value.
National Benchmarking
4.3 In terms of the performance of the Clackmannanshire and Stirling Partnership this is set against a range of key national performance indicators. The graphs outlined below provide a comparison of performance relating to the total number of delays over 3 days and the annualised rate of bed days lost as a rate per 1,000 over 75 population, broken down by each Local Authority area.
Total number of delays over 3 days October 2015
The annualised rate of bed days lost as a rate per 1,000 over 75 population, broken down by local authority area is shown in the table below.
5. Conclusions
5.1 The report sets out the performance of the Clackmannanshire and Stirling Partnership based on the census data of 15 January 2016. The report advises the Integration Joint Board on the principal reasons for delay and the actions and the improvements being taken forward by the Partnership to mitigate the delays.
6. Resource Implications
6.1 N/A
7. Impact on IJB Outcomes, Priorities and Outcomes
7.1 The actions outlined in this report contribute to the delivery of the National and local outcomes set out in the Strategic Plan.
8. Legal & Risk Implications
8.1 Risk as above.
9. Consultation
9.1 The Head of Social Services, the General Manager for Forth Valley Community Health Partnership's and the Chief Officer for Clackmannanshire & Stirling Health and Social Care Partnership have been consulted in the compiling of this report.
10. Equalities Assessment
10.1 N/A
11. Exempt reports
11.1 No
Appendix 1
Delayed Discharges Over 2 Weeks by Month and Local Authority Excludes Codes 9 and 100
Appendix 2
Delayed Discharges OBDs Over 2 Weeks by Month and Local Authority Excludes Codes 9 and 100
Appendix 3
Clackmannanshire & Stirling Integration Joint Board
24 February 2016
This report relates to Item 12 on the agenda
Participation and Engagement Strategy
(Paper presented by Chris Sutton)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Christine Sutton, Service Manager Date: 24 February 2016 List of Background Papers: Draft Participation and Engagement Strategy (appendix 1) Equality Impact Assessment (appendix 2)
Page 1 of 4
Title/Subject: Participation and Engagement Strategy Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 24 February 2016 Submitted By: Chris Sutton Action: For Approval
1. EXECUTIVE SUMMARY
1.1 This report presents the draft Participation and Engagement Strategy for approval by the Clackmannanshire and Stirling Integration Joint Board for approval. The draft Strategy has been developed by Participation and Engagement workstream members. Group members include representatives from key partner agencies. The Strategy is designed to ensure that there is effective and meaningful engagement with communities and partners to support the delivery of the Partnership's vision.
1.2 The intention is to build on existing good practice in participation and engagement across the Partnership. The next step will be to develop an action plan to support delivery of the Strategy. This will include a review of current mechanisms that support engagement and development of proposed structure and resources to support participation and engagement and the identification of a framework to evaluate the delivery of the Strategy.
2. RECOMMENDATION(S)
The Integration Joint Board is asked to:-
2.1 To approve the draft Participation and Engagement Strategy set out at Appendix One and provide comment and scrutiny, as appropriate.
2.2 To note the development of the detailed action plan to support the delivery of this strategy which will be reported back to the Integration Joint Board in August 2016.
3. MAIN BODY OF REPORT
3.1 The Public Bodies (Joint Working) (Scotland) Act 2014 requires each Health and Social Care Partnership to produce a Participation and Engagement Strategy for the Integration Joint Board.
3.2 The Community Empowerment (Scotland) Act 2015 requires public bodies to engage with communities and community organisations. The 2015 Act requires the Integration Joint Board to put in place a participation process and to report on the ways this engagement has shaped the delivery of outcomes.
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3.3 The Clackmannanshire and Stirling Health and Social Care Integration Scheme committed to produce a strategy for participation and engagement in line with the principles and practice endorsed by the Scottish Health Council and those set out in the National Standards for Community Engagement in the shadow year.
3.4 A work-stream was established to lead on the development of a draft Participation and Engagement Strategy. Two workshops have taken place to support the design and development of the draft Strategy. These workshops have involved representatives who are currently involved in supporting participation and engagement across the Partnership.
3.5 The draft Participation and Engagement Strategy sets out the proposed vision and principles for participation and engagement. The proposed methods to be adopted and the next steps required to support the delivery of the Strategy are identified.
3.6 The intention of the Participation and Engagement work-stream is to develop an action plan to support the delivery of the Strategy and to review current mechanisms for participation and engagement across the partnership. The most effective arrangements to support the delivery of participation and engagement will be identified for presentation to the Integration Joint Board.
4. RESOURCE IMPLICATIONS
4.1 All activity will be carried out within existing resources, which will require support from all partners.
5. IMPACT ON IJB OUTCOMES AND PRIORITIES
5.1 The content of this report supports the Integration Joint Board in the discharge of its legislative duties. The draft strategy is consistent with the vision and core priorities of the Integration Joint Board.
6. LEGAL AND RISK IMPLICATIONS
6.1 Not applicable for the purpose of this report.
7. CONSULTATION
7.1 The draft Strategy provides details of the approach taken to developing the Strategy and the membership of the Participation and Engagement work- stream.
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8. EQUALITIES ASSESSMENT
8.1 An equality impact assessment is attached at appendix 2.
9. EXEMPT REPORTS
9.1 Not exempt.
10. APPENDICES
Appendix 1 – Draft Participation and Engagement Strategy
Page 4 of 4
Appendix 1
Clackmannanshire and Stirling Integration Joint Board Participation & Engagement Strategy
“Your Life Your Say”
Date of First Not yet issued Issue: Approved by : Not yet approved On: Current Issue Draft - 3 February 2016 Date: Review Date: February 2017 EQIA: Complete Lead Authors: Chris Sutton, Service Manager, Social Services and Lesley Fulford, Programme Manager HSCI
Contents Page
Background ...... 3 Purpose ...... 3 Approach and Methodology ...... 4 Drivers ...... 5 Vision ...... 6 Principles ...... 6 Objectives ...... 7 Approach ...... 8 Next Steps ...... 9 Roles & responsibilities ...... 9 Glossary ...... 9 Appendices ...... 10 Appendix I – List of prescribed stakeholders ...... 10 Appendix II – Participation & Engagement Work Stream Members ...... 11 References ...... 12
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Background
The Public Bodies (Joint Working)(Scotland) Act 2014 sets out the Scottish Government’s programme of reform to improve services for people who use adult Health and Social Care services. The objective of integration that health and social care provision is more joined-up and seamless, especially for people with long term conditions and disabilities, many of whom are older people.
Partners and providers of health and social care services in Clackmannanshire and Stirling are committed to working together to ensure that people live healthier, longer lives, can be independent and have choice and control, no matter who they are and where they live in the Clackmannanshire and Stirling areas.
In making this a reality, the Clackmannanshire and Stirling Partnership recognises the importance of participation and engagement of all partners and stakeholders, including those people, groups and communities who are considered hard to reach.
Appendix I sets out the prescribed stakeholders from the Public Bodies (Joint Working) (Scotland) Act 2014 regulations.
Purpose
This Clackmannanshire and Stirling Partnership Participation and Engagement strategy sets out the Partnership’s vision and shared principles with respect to participation and engagement of all stakeholders in enabling the successful integration of Health and Social Care services. It is intended to ensure that all stakeholders are involved, consulted with and actively engaged with Health and Social Care Integration.
The overarching aim of this strategy is to support the achievement of the Clackmannanshire and Stirling Partnership vision for integrated Health and Social Care services. In doing this, it is essential that:
• Stakeholders are key players in shaping and delivering the outcomes for Health and Social and Care integration • Delivery of Health and Social Care integration is via a partnership culture and behaviours that facilitate effective integrated working across professions and agencies • Stakeholders possess the necessary knowledge and information regarding their participation and involvement in Health and Social Care integration and what it means for them.
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Approach and Methodology
The Strategy has been developed in partnership, involving a range of groups and partners across the Clackmannanshire and Stirling area. The steps undertaken to develop this strategy include:
• Establishment of a Participation and Engagement work stream and working group, involving representatives from a range of groups and partners across the Clackmannanshire and Stirling area (Appendix II lists the members of the work stream) • Development and agreement on high level principles for Participation and Engagement for the Partnership • A comprehensive review of existing literature and strategies in relation to Participation and Engagement in the Public Sector and amongst communities • A facilitated workshop with members of the Participation and Engagement work stream, capturing their views in relation to the content of this strategy, i.e.: o Drivers that influence participation and engagement o Our vision and principles that are important to adopt in relation to participation and engagement o Our overarching objectives and a summary of next steps and the support available in the implementation of this strategy.
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Drivers
In order to consider the drivers behind participation and engagement within the Partnership we utilised the STEEPLE approach. STEEPLE is a simple to use tool which helps analyse the socio cultural, technological, economical, Ecological / environmental, political, legal and ethical factors within your environment. This in turn helps us understand the "big picture" forces of change and how we might take advantage of the opportunities that they present.
Driver Detail Socio cultural For example: The proportion of older adults in our society is increasing meaning people are living longer, therefore we want to ensure people are able to participate and engage in planning, development and decision making around how we provide care and support. It is also vital that there is wider public understanding and engagement to promote more active involvement in decision making about health and social care needs.
• Enabling people to take responsibility for health & care needs – previously people have been passive recipients of care • Encouraging prevention • Culture change in terms of expectations of health and social care e.g. dental care toothbrushes to kids • Community engagement e.g. Public Partnership Forums events discussing relevant topics Technological For example: Technological advances have offered different ways to participate and engage with people over recent years. Social media in particular has become a fast way of providing feedback on service provision.
• Use of online media for service users (web site, social media, application) • Telehealth e.g. video link access via local GP to avoid lengthy trips to hospital Economical For example: Pressure on public finances means that there is increased emphasis on using all the resources available to maximum benefit. In this context it is vital to engage the wider public, promote discussion about priorities and what matters most. It is also necessary to have a flexible, skilled workforce.
• The use of technology could support better use of resources and more flexible use of staffing resources Ecological / For example: sustainability - locality planning approaches environmental • Approaches to planning public transport arrangements Political For example: The Scottish Government has demonstrated a clear desire to participate and engage with stakeholders through their support of a variety of initiatives at local level. For example Joint Improvement Team programme around coproduction.
• Meets the requirements of all Parties • ‘Our Voice’ Legal For example: • The Public Bodies (Joint Working) (Scotland) Act 2014 • Social Care (Self Directed Support)(Scotland) Act 2013
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• Community Empowerment (Scotland) Act 2015. Ethical For example: links to principles for integration – person centred - it is the right thing to do
• Taking participation to where people are because you are respecting other time away from their families / usual activities • The partnership approach can contribute to identifying and tackling health inequality and foster a greater understanding of human rights within health and social care.
Vision
Your Life, Your Say
The vision ‘Your Life, Your Say’ was developed in consultation with a wide range of Health and Social Care partners and stakeholders. The participation and engagement vision is that those who use health and social care services, carers, the public will be engaged and involved with representatives from the key stakeholders in improving local service delivery. This will require the Partnership to put in place the necessary supports to engage with people at an individual, community, locality and partnership level. This will help the Partnership to plan and co-produce services that will meet current and future needs and for service users to be well informed and supported to be proactively involved in their care.
Principles
The Partnership mapped the standards and principles contained within “A Participation Standard” for the NHS in Scotland, Scottish Health Council and “National Standards for Community Engagement”, Communities Scotland. In doing so we highlighted the overlap of both of these documents and agreed the following principles.
Together we will ensure participation of all stakeholders by:
• Ensuring participation and engagement is accessible; identifying and overcoming any barriers to involvement. • Ensuring participation and engagement is driven by local needs. We will also ensure area-wide coordination of common key messages and participation and engagement activities across the Forth Valley area. • Developing the knowledge, skills and confidence of all participants. • Working towards a language that is shared across agencies and professions. • Learning from experience, sharing information and feeding back the results of all engagement and participation activities to the wider community. • Providing people with feedback, demonstrating how their views have been considered and any telling them about any changes that have been made following their input.
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• Utilising a wide range of formats to communicate, consult and engage in a timely manner. • Using a stakeholder approach to participation and engagement for the Partnership in its widest sense (e.g. service users, unpaid carers, third sector, independent sector, staff and providers). • Proactively seeking input to shape direction and facilitate coproduction particularly in relation to (to different extents regarding legal frameworks): o What enables: timely, wide channels, what enables delivery against commitments o Clarity of expectations • Ensuring clarity of purpose and scope in all communications and face-to-face interactions (e.g. for information, for engagement). • Emphasising individual responsibility to actively engage with the information provided and the opportunities for getting involved. • Ensuring robust accountability and governance of the Participation and Engagement strategy for delivery against the agreed key principles. • Where service change is proposed that will have an impact on staff members of either Council or NHS Forth Valley, early engagement will take place with relevant parties.
Objectives
This is the first Participation & Engagement Strategy for the Clackmannanshire and Stirling Integration Joint Board and it builds on existing good practice. These objectives will be used to measure the delivery of the Strategy:
• Ensure that those who use services and their unpaid carers are at the heart of service design , planning and delivery; • Ensure that diverse perspectives are represented; • Ensure that feedback and information gathered is used to support creativity, innovation and service change; • Encourage participation by groups that can be difficult to reach, where there may be barriers to engagement; • Ensure that the necessary resources are available to support participation and engagement, specifically with groups that can be difficult to reach; • Use the data equalities and demographic data published in the Strategic Needs Assessment to inform engagement activities and approaches.
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Approach
Resources
We have used existing structures and networks to inform the development of the Participation and Engagement Strategy. There is a need to determine the resources and support that will be necessary to support participation and engagement across the partnership. By bringing together resources, a more effective and comprehensive approach will be possible.
We have identified the current mechanisms that support participation and engagement across Forth Valley and within the two local authority areas. Existing networks are known to the public and have established methods of contact. It will be important to build on existing good practice and to use the established links to wider stakeholder groups. There are also interest groups and condition specific groups operating across the Forth Valley area. Both of the Third Sector Interfaces have their own fora and wider connections to other networks locally and nationally and are continually reviewing and building up their membership networks.
The health and social care vision will be promoted within the partner organisations across all work areas. Working alongside the staff forum to agree and disseminate information. The partners will work together to plan their approach towards wider mapping of communities and engagement to ensure that the support structure is robust.
Appendix III sets out the existing networks and fora within the Stirling and Clackmannanshire partnership area.
Methods of Engagement
Methods of engagement are likely to include face to face meetings, events and focus groups whilst dissemination of information and debate will also take place using new media such as Facebook, Twitter, Online discussion groups/e-panels, webpages, newsletters and small publications.
Understanding complaints received by the Partnership will also be a valued source of information and an area that stimulates conversation with service users.
Using real life stories as case studies will help to take the print off the page, demonstrate what we are trying to achieve in an easy to understand way and encourage feedback.
Equalities Monitoring
Equalities monitoring of interactions is vital as it indicates groups of people that are already engaging, helps identify those that have yet to express an opinion and leads to inquiry as to how we can better include them. Partners will agree what data is gathered to enable consistency of approach. Ensuring that our communications are accessible and applying best practice regarding inclusive communications at meetings and events will go some way to ensuring people can work with us.
There are established existing models and templates for recording of equalities monitoring information. We use an established national template and reporting mechanism for this aspect in all parts of our work to record our reach in to community.
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Next Steps
• Continue to promote the health and social care vision within partner organisations across all work areas and communities • Develop an action plan to implement the strategic principles • Develop a monitoring framework • Determine the resources necessary to support participation and engagement across the partnership. • Develop an effective and comprehensive approach to Engagement and Participation through efficient use of resources. • Build on existing networks, utilising their established methods of communication with wider stakeholder groups.
Roles & responsibilities
The active engagement and participation of all stakeholders and partners is key to the success of Health and Social Care Integration in Stirling and Clackmannanshire.
Participation and engagement is key to the development of a culture of effective integrated partnership working between the professionals and agencies within the Stirling and Clackmannanshire Partnership. Everyone has a role in ensuring the positive participation and engagement of all stakeholders.
• All partners have a key role in communicating, consulting and engaging with other stakeholders and partners.
• All partners have a responsibility to ensure that all communication, consultation and engagement is accessible to stakeholders and partners.
• All partners and stakeholders have a key role in engaging and participating in order that their particular expertise can be used in shaping and delivering the outcomes for Health and Social and Care integration
Glossary
Communication – Sending out key messages
Consultation – Seeking feedback
Engagement – Building something together
JIT - Joint Improvement Team: Strategic improvement partnership between the Scottish Government, NHSScotland, COSLA (Convention of Scottish Local Authorities) and the Third, Independent and Housing Sectors.
Co-production - “Co-production is the process of active dialogue and engagement between people who use services, and those who provide them” – Sir Harry Burns, Former Chief Medical Officer for Scotland
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Appendices
Appendix I – List of prescribed stakeholders
• Users of health care • Users of social care • Carers of users of social care • Carers of users of health care • Commercial providers of social care • Non-commercial providers of social care • Commercial providers of health care • Non-commercial providers of health care • Non-commercial providers of social housing • Health professionals • Social care professionals • Staff of the Health Board and local authority who are not health professionals or social care professionals • Third sector bodies carrying out activities related to health or social care other local authorities operating within the area of the Health Board preparing the integration scheme or the revised integration scheme. • Residents of the locality
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Appendix II – Participation & Engagement Work Stream Members
Name Role Organisation Lesley White Programme Manager Joint Appointment Agnes McQuaid HR Stirling Council Helen Kelly HR NHS FV Alison Richmond HR NHS FV Ferns Lesley Gallagher Programme Manager Stirling Council Robert Stevenson Planner NHS FV Mark Hamilton Planner NHS FV Divya Prakash OD Advisor Joint Appointment David Murray OD Advisor Stirling Council Johnny Keenan Head of Health Improvement and CHP NHS FV (Corporate) Services Jessie Anne Malcolm PPF Development Co-ordinator NHS FV Karen McLure Person Centred & Patient Relations NHS FV Manager Pauline Marland Person Centred & Patient Experience NHS FV Coordinator Elsbeth Campbell Health of Communications NHS FV Karen Payton Communications Clackmannanshire Council Kirsty Scott Communications Stirling Council Abigail Robertson Joint Trade Union Chair Stirling Council Pamela Robertson Co Chair, Staff Forum Clackmannanshire Council George Kerr Co-Chair of CHP Forum NHS FV Gillian Taylor Manager Communities and Partnership Stirling Council Polly Roger Integration Engagement Officer SVE Liz Rowlett Integration Engagement Officer CTSI Chris Sutton Service Manager Strategy, Social Clackmannanshire Services Council Scott Williams Locality Lead NHS FV David Cairns Public Health Practitioner NHS FV Charlene Condeco Disability Nurse Advisor Lynn Waddell Equality Manager NHS FV Lynn McInley Team Leader, Community Engagement Stirling Council Derek Blues Local Officer (Forth Valley) Scottish Health Council
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Appendix III – List of Networks and Fora
• Clackmannanshire o Clackmannanshire Alliance (Community Partnership, which includes a the Clackmannanshire 1000 reference group) o Clackmannanshire Credit Union o Clackmannanshire Citizens’ Advice o Carers’ Forum o Clackmannanshire Healthier Lives o Clackmannanshire Tenants and Residents Forum o Community Transport Association o Disability Awareness Group/ Access Panel o Integrated Mental Health Service users’ network o Older Adults Forum o Third Sector Forum o Tullibody Healthy Living o Volunteer Managers Forum • Stirlingshire o Carers’ Network o Children and Families Forum o Health and Social Care Forum o Stirling Area Access Panel o Stirling Council on Disability o Volunteer Managers Forum o Older People’s Forum
References
A Participation Standard for the NHS in Scotland, Scottish Health Council
National Standards for Community Engagement, Communities Scotland
‘Our Voice’
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Appendix 2 Standard Impact Assessment Document (SIA) Please complete electronically and answer all questions unless instructed otherwise.
Section A
Q1: Name of EQIA being completed i.e. name of policy, function etc. Clackmannanshire & Stirling Health and Social Care Partnership draft Participation & Engagement Strategy Q1 a; Function Guidance Policy Project Protocol Service Other, please detail
Q2: What is the scope of this SIA
Service Specific Discipline Specific Other (Please Detail)
Clackmannanshire & Stirling Health and Social Care Partnership Adult & older adult services.
Q3: Is this a new development? (see Q1)
Yes No
Q4: If no to Q3 what is it replacing?
Q5: Team responsible for carrying out the Standard Impact Assessment? (please list) Lesley Fulford, Programme Manager, Clackmannanshire & Stirling Health and Social Care Partnership Chris Sutton, Service Manager, Strategy, Clackmannanshire & Stirling Councils Divya Prakash, Organisational Development Advisor, Clackmannanshire & Stirling Health and Social Care Partnership Elizabeth Rowlett, Engagement Officer, Clackmannanshire Third Sector Interface Polly Roger, Engagement Officer, Stirling Voluntary Enterprise
Q6: Main person completing EQIA’s contact details
Name: Telephone Number:
Department: Email:
Q7: Describe the main aims, objective and intended outcomes The scope of the health and social care partnership is adults and older adults.
The participation and engagement vision is that those who use health and social care services, carers, the public will be engaged and involved with representatives from the key stakeholders in improving local service delivery.
Principles
Together we will ensure participation of all stakeholders by:
1 Page of 8 • Ensuring participation and engagement is accessible; identifying and overcoming any barriers to involvement. • Ensuring participation and engagement is driven by local needs. We will also ensure area-wide coordination of common key messages and participation and engagement activities across the Forth Valley area. • Developing the knowledge, skills and confidence of all participants. • Working towards a language that is shared across agencies and professions. • Learning from experience, sharing information and feeding back the results of all engagement and participation activities to the wider community. • Providing people with feedback, demonstrating how their views have been considered and any telling them about any changes that have been made following their input. • Utilising a wide range of formats to communicate, consult and engage in a timely manner. • Using a stakeholder approach to participation and engagement for the Partnership in its widest sense (e.g. service users, unpaid carers, third sector, independent sector, staff and providers). • Proactively seeking input to shape direction and facilitate coproduction particularly in relation to (to different extents regarding legal frameworks): o What enables: timely, wide channels, what enables delivery against commitments o Clarity of expectations • Ensuring clarity of purpose and scope in all communications and face-to-face interactions (e.g. for information, for engagement). • Emphasising individual responsibility to actively engage with the information provided and the opportunities for getting involved. • Ensuring robust accountability and governance of the Participation and Engagement strategy for delivery against the agreed key principles. • Where service change is proposed that will have an impact on staff members of either Council or NHS Forth Valley, early engagement will take place with relevant parties.
Objectives
This is the first Participation & Engagement Strategy for the Clackmannanshire and Stirling Integration Joint Board and it builds on existing good practice. These objectives will be used to measure the delivery of the Strategy:
• Ensure that those who use services and their unpaid carers are at the heart of service design , planning and delivery; • Ensure that diverse perspectives are represented; • Ensure that feedback and information gathered is used to support creativity, innovation and service change; • Encourage participation by groups that can be difficult to reach, where there may be barriers to engagement; • Ensure that the necessary resources are available to support participation and engagement, specifically with groups that can be difficult to reach; • Use the data equalities and demographic data published in the Strategic Needs Assessment to inform engagement activities and approaches.
Q8: (i) Who is intended to benefit from the function/service development/other (Q1) – is it staff, service users or both?
Staff Service Users Other Please identify ___Providers, third sector, independent sector
(ii) Have they been involved in the development of the function/service development/other?
2 Page of 8 Yes No
(iii) If yes, who was involved and how were they involved? If no, is there a reason for this action? Comments:
A wide range of stakeholders have been involved in the development of the draft Participation & Engagement Strategy through membership of the Participation and Engagement work stream. The development of the Strategy has been informed by the Strategic Needs Assessment.
The Strategy has been developed in partnership, involving a range of groups and partners across the Clackmannanshire and Stirling area. The steps undertaken to develop this strategy include: • Establishment of a Participation and Engagement work stream and working group, involving representatives from a range of groups and partners across the Clackmannanshire and Stirling area (Appendix II lists the members of the work stream) • Development and agreement on high level principles for Participation and Engagement for the Partnership • A comprehensive review of existing literature and strategies in relation to Participation and Engagement in the Public Sector and amongst communities • A facilitated workshop with members of the Participation and Engagement work stream, capturing their views in relation to the content of this strategy, i.e. o Drivers that influence participation and engagement o Our vision and principles that are important to adopt in relation to participation and engagement o Our overarching objectives and a summary of next steps and the support available in the implementation of this strategy.
(iv) Please include any evidence or relevant information that has influenced the decisions contained in this SIA; (this could include demographic profiles; audits; research; published evidence; health needs assessment; work based on national guidance or legislative requirements etc) Comments:
Please also see the Public Bodies (Joint Working)(Scotland) Act (2014) and supporting orders which sets out the legislative requirements for the partnership in relation to the Participation and Engagement Strategy.
Please see the draft Strategic Needs Assessment for details of the population, including: age, gender, ethnic origin, religion, sexual orientation, population projections, physical disability, learning disability, mental health and wellbeing.
Q9: When looking at the impact on the equality groups, you must consider the following points in accordance with General Duty of the Equality Act 2010 see below:
In summary, those subject to the Equality Duty must have due regard to the need to: • eliminate unlawful discrimination, harassment and victimisation; • advance equality of opportunity between different groups; and • foster good relations between different groups Has your assessment been able to demonstrate the following: Positive Impact, Negative / Adverse Impact or Neutral Impact?
What impact has your review Comments had on the following Adverse/ ‘protected characteristics’: Positive Neutral Provide any evidence that supports Negative your conclusion/answer for evaluating the impact as being 3 Page of 8 positive, negative or neutral (do not leave this area blank) Age x The participation and engagement strategy has been developed based on the principles and standards set out in the community engagement standards and the participation standard.
Our approach is based on 13 principles, outlined at Q7. We will have a positive impact on age as we will ensure participation and engagement is accessible, learn from experience, provide feedback, utilise a wide range of formats to communicate. Disability (incl. physical/ x Our approach is based on 13 principles, sensory problems, learning outlined at Q7. We will have a positive difficulties, communication impact on disability as we will ensure needs; cognitive impairment) participation and engagement is accessible, learn from experience, provide feedback, utilise a wide range of formats to communicate. Gender Reassignment x Our approach is based on 13 principles, outlined at Q7. Assessed as neutral impact Marriage and Civil x Our approach is based on 13 principles, partnership outlined at Q7. Assessed as neutral impact Pregnancy and Maternity x Our approach is based on 13 principles, outlined at Q7. Assessed as neutral impact Race/Ethnicity x Our approach is based on 13 principles, outlined at Q7. We will have a positive impact on race/ethnicity as we will ensure participation and engagement is accessible, learn from experience, provide feedback, utilise a wide range of formats to communicate and engage with specific groups in the communities. Religion/Faith x Our approach is based on 13 principles, outlined at Q7. We will have a positive impact on religion/faith as we will ensure participation and engagement is accessible and engage with specific groups in the communities Sex/Gender (male/female) x Our approach is based on 13 principles, outlined at Q7. We will have a positive impact on sex/gender as we will ensure participation and engagement is accessible and engage with specific groups in the communities Sexual orientation x Our approach is based on 13 principles, outlined at Q7. We will have a positive
4 Page of 8 impact on sexual orientation as we will ensure participation and engagement is accessible and engage with specific groups in the communities Staff (This could include x Our approach is based on 13 principles, details of staff training outlined at Q7. An implementation plan completed or required in will be developed over the coming year. relation to service delivery) We anticipate that this will have a positive impact on staff as we will ensure participation and engagement is accessible, work towards a common language and understanding, learn from experience, provide feedback, utilise a wide range of formats to communicate.
Cross cutting issues: Included are some areas for consideration. Please delete or add fields as appropriate. Further areas to consider in Appendix B Unpaid Carers x Our approach is based on 13 principles, outlined at Q7. We will have a positive impact on unpaid carers as we will ensure participation and engagement is accessible, work towards a common language, learn from experience, provide feedback, utilise a wide range of formats to communicate. Homeless x Our approach is based on 13 principles, outlined at Q7. We will have a positive impact on homeless people as we will ensure participation and engagement: is accessible and engage with specific groups who may be affected by homelessness Language x Our approach is based on 13 principles, outlined at Q7. We will ensure participation and engagement is accessible and utilise a wide range of formats to communicate. Literacy x Our approach is based on 13 principles, outlined at Q7. We will ensure participation and engagement is accessible and utilise a wide range of formats to communicate. Low income/poverty x Our approach is based on 13 principles, outlined at Q7. We will ensure participation and engagement is accessible and utilise a wide range of formats to communicate. Rural Areas x Our approach is based on 13 principles, outlined at Q7. We will ensure participation and engagement is accessible.
Q10: If actions are required to address changes, please attach your action plan to this document. Action plan attached?
5 Page of 8 Yes No
Q11: Is a detailed EQIA required?
Yes No Please state your reason for choices made in Question 11.
N.B. If the screening process has shown potential for a high negative impact you will be required to complete a detailed impact assessment.
Date EQIA Completed DD / MM / YYYY
Date of next EQIA DD / MM / YYYY Review
Signature Print Name
Department or Service
Please keep a completed copy of this template for your own records and attach to any appropriate tools as a record of SIA or EQIA completed. Send copy to [email protected]
6 Page of 8
B: Standard/Detailed Impact Assessment Action Plan
Name of document being EQIA’d:
Date Issue Action Required Lead (Name, title, Timescale Resource Implications Comments and contact details) DD / MM / YYYY Action Plan As identified in the March 2017 strategy an action plan will be required to drive implementation. DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY DD / MM / YYYY
Further Notes:
Signed: Date:
7
8
Clackmannanshire & Stirling Integration Joint Board
24 February 2016
This report relates to Item 13 on the agenda
Partnership Funding
(Paper presented by Ewan C. Murray)
For Noting and Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Ewan C. Murray, Chief Finance Officer Date: 16 February 2016 List of Background Papers: 28 August 2015 – 7. Delayed Discharge 13 May 2015 – 8. Integrated Care Programme 11 December 2015 – 8.1 Partnership Allocations Update
Title/Subject: Partnership Funding
Meeting: Clackmannanshire & Stirling Integrated Joint Board Date: 24 February 2016 Submitted By: Ewan C. Murray, Chief Finance Officer Action: For Noting & Approval
1. Introduction
1.1 The purpose of this report is to update the Integration Joint Board on the use of Partnership allocations including the allocations to support the Integrated Care Programme, address Delayed Discharges and Partnership Bridging Resources.
1.2 The term Partnership Bridging Resources relates to residual funding from prior year Partnership Allocations (the Reshaping Care for Older People's Change Fund) which are currently being deployed to support service models on a transitional basis.
2. Executive Summary
2.1 The Transitional Board approved the Integrated Care Programme at its meeting on 13 May 2015 and the use of resources allocated to address Delayed Discharges at its meeting on 28 August 2015.
2.2 An update report was provided at the 11 December 2015 meeting of the Integration Joint Board.
2.3 This report updates on projected expenditure for 2015/16, estimated partnership funding for 2016/17 and the process currently underway to review and evaluate current projects and align future investment to the priorities identified within the Strategic Plan.
3. Recommendations
The Integration Joint Board is asked to:
3.1 Note the updated summary of partnership funding and projected expenditure.
3.2 Note the process of evaluation and review of projects funded through the Integrated Care Programme, Delayed Discharges Funding and Partnership Bridging Resources that is being undertaken and estimated timescale for completion.
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3.3 Delegate authority to the Chief Officer, in discussion with the Chair and Vice- Chair of the Integration Joint Board and Chief Executives of the NHS Board, Clackmannanshire and Stirling Councils to agree interim funding of up to 6 months within available resources to current projects and support posts to allow for evaluation, review and alignment with the priorities of the strategic plan, on behalf of the Integration Joint Board.
3.5 Agree to receive, for consideration and approval, a detailed spending plan for Partnership Funding which will align to and support the priorities of the Strategic Plan at the June 2016 Board meeting.
3.6 Delegate authority to the Chief Executives, in conjunction with the Chief Officer, to consider the support arrangements for the Integration Joint Board and bring forward proposals for consideration and approval.
4. Background
4.1. The Transitional Board approved the Integrated Care Programme at its meeting on 13 May 2015 and the use of resources allocated to address Delayed Discharges at its meeting on 28 August 2015. The Integration Joint Board received a further update including details of projected expenditure levels at its meeting of 11 December 2015.
4.2. Partnership Funding which will be available to the partnership in 2016/17 and 2017/18 and referred to within this report are: • Integrated Care Fund • Delayed Discharge Funding • Partnership Bridging Resources
5. Main Body Of The Report
5.1. The following table details projected expenditure against Partnership Funding in 2015/16.
Table 1: Projected Expenditure 2015/16
This position is broadly in line with that reported in December 2015 which projected expenditure of £3.200m for the year.
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The above position would result in £0.826m of partnership funding being carried forward into 2016/17 consisting of a balance of Partnership Bridging Resources of £0.144m and Integrated Care Funding of £0.682m.
5.2. Estimated Partnership Funding Allocations for 2016/17 are detailed in table 2 below. These are subject to formal confirmation by Scottish Government and reflect that no increase is now expected in the level of Delayed Discharges Funding from 2015/16 levels.
Table 2: Estimated Partnership Funding 2016/17
The table above excludes the partnerships share of the £250m announced in the Scottish Draft Budget. Details of the implications of this for the partnership will be brought forward as part of budget setting papers for 2016/17 in March 2016.
5.3. A short life working group has been established as a sub-group of the Reshaping Care Strategy Group to complete an evaluation and review of projects funded through partnership funding streams in 2015/16. This will include alignment of investments to the priorities of the Strategic Plan. This group will report recommendations via the Joint Management Team and the outcomes of this process will inform a detailed spending plan.
To allow the working group adequate time to complete this work it is proposed that current projects and support posts are allocated interim funding of up to 6 months. The cost of this would be a commitment against the estimated funding available as detailed in Table 2 above.
A full report will be submitted to the June 2016 Integrated Joint Board meeting including how the previously identified risk of shortfall on a recurrent basis is proposed to be addressed.
6. Resource Implications
6.1. The resource implications arising from this report are detailed on appendix I.
7. Impact on IJB Outcomes, Priorities and Outcomes
7.1. The Integrated Care Programme and use of resources to address Delayed Discharges are congruent with the Integration Joint Board priorities.
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8. Legal & Risk Implications
8.1. There are no legal implications anticipated.
9. Consultation
9.1. The Joint Management Team and Reshaping Care Strategy Group have been consulted on the proposals attached.
10. Equalities Assessment
10.1. An equalities assessment is not required for this exercise.
11. Exempt reports
11.1. Not exempt
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Clackmannanshire & Stirling Integration Joint Board
24 February 2016
This report relates to Item 14 on the agenda
Provision of Internal Audit
(Paper presented by Ewan Murray, Chief Finance Officer)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Tony Gaskin, Chief Internal Auditor, NHS FV Kevin O’Kane, Audit Service Manager, Stirling Council Iain Burns, Internal Audit and Fraud Team Leader, Clackmannanshire Council Date: 24 February 2016 List of Background Papers:
Integrated Resources Advisory Group Finance Guidance.
Title/Subject: Provision of Internal Audit Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 24 February 2016 Submitted By: Tony Gaskin, Chief Internal Auditor, NHS FV Kevin O’Kane, Audit Service Manager, Stirling Council Iain Burns, Internal Audit and Fraud Team Leader, Clackmannanshire Council Action: For Approval
1. Introduction
1.1 This report sets out, for approval, the proposed arrangements for provision of internal audit to the Integration Joint Board.
2. Executive Summary
2.1 The Integration Joint Board is required to comply with Article 7 of The Local Authority Accounts (Scotland) Regulations 2014 which states:
“7(i) A local authority must operate a professional and objective internal auditing service in accordance with recognised standards and practices in relation to internal auditing”.
2.2 In order to comply with the Regulations, it is proposed that the Integration Joint Board appoints a Chief Internal Auditor.
3. Recommendations
The Integration Joint Board is asked to:
3.1 Agree that Internal Audit Services will be provided by the Internal Audit Teams, with responsibility for Integration Joint Board Internal Auditor duties undertaken by the Chief Internal Auditor of one of the constituent bodies. This responsibility will rotate between Chief Internal Auditors of the constituent bodies on a three year basis.
3.2 Agree that the Chief Internal Auditor of one of the constituent bodies is appointed to act as Integration Joint Board Joint Chief Internal Auditor in addition to their posts with the constituent bodies.
4. Background
4.1 The Scottish Government established the Integrated Resources Advisory Group (IRAG) to develop professional guidance. This guidance outlines that it is the responsibility of the Integration Joint Board to establish adequate and
proportionate internal audit arrangements for review of the adequacy of the arrangements for risk management, governance and control of the delegated resources. This will include determining who will provide internal audit for the Integration Joint Board and nominating a Chief Internal Auditor.
Provision of Internal Audit
5.1 Integrated Resources Advisory Group Finance Guidance states ‘It is the responsibility of the Integration Joint Board to establish adequate and proportionate internal audit arrangements for review of the adequacy of the arrangements for risk management, governance and control of the delegated resources. This will include determining who will provide the internal audit service for the Integration Joint Board and nominating a Chief Internal Auditor.’
5.2 The Integrated Resources Advisory Group guidance states that ‘that internal audit service should be provided by one of the internal audit teams from the Health Board or Local Authority’. At the recent Scottish Local Authorities Chief Internal Auditors Group meeting in September 2015, which was also attended by NHS Scotland Chief Internal Auditors, the Scottish Government advised that the provision of the Internal Audit function could be provided through a joint approach, involving the Internal Audit Teams of all parties. It has been agreed that this approach would help;
• utilise the relevant knowledge, skills and experience of the audit teams; • ensure that the resource requirements were shared and that the resource burden is shared across the parties; • provide a degree of resilience in relation to service provision; and; • facilitate the co-ordination also required by the national guidance.
5.3 A Chief Internal Auditor will be nominated from one of the constituent bodies. Responsibility for Integration Joint Board Chief Internal Auditor duties undertaken by the Chief Internal Auditor of one of the constituent bodies. This responsibility will rotate between Chief Internal Auditors of the constituent bodies on a three year basis, with alternate Health Board and Local Authority appointees.
5.4 Integrated Resources Advisory Group guidance requires the Integration Joint Board to have a risk-based plan that, until services had been delegated, would be focused on the risks and processes for the Strategic Plan and associated Financial Plan. The guidance specifically states that ‘The operational delivery of services within the Heath Board and Local Authority on behalf of the Integration Joint Board will be covered by their respective internal audit arrangements as at present.’ Similarly, the Scottish Local Authorities Chief Internal Auditors Group meeting was informed that the Integration Joint Board will only have responsibility for commissioning and performance management, with the associated corollary that Internal Audit of the Integration Joint Board would be focused on those areas.
5.5 Clearly the Internal Audit plan must mirror the governance and accountability arrangements of the Integration Joint Board in the parties. It can be seen that the provisions of the Clackmannanshire and Stirling Integration Scheme do not appear to be inconsistent with the position set out in 5.4 above i.e. the accountability for Governance still resides with the parties and therefore the Internal Audit plan for the Integration Joint Board is likely to be largely limited to areas of Strategic Planning, Commissioning and Performance Management.
5.6 Indicative areas that will be included for consideration in the plan include;
• Strategic plan • Financial planning and control • Performance management • Governance • Annual report • Risk Management
5.7 There are further areas which Internal Audit will be required to review and may be able to make a positive contribution including assurance on key governance and accountability documents such as the Standing Financial Instructions and Schemes of Delegation, Financial Governance plans, Clinical and Care Governance Plans etc.
5.8 As arrangements and governance structures evolve, the responsibility for some governance or assurance responsibilities will reside with the Integration Joint Board. These will need to be clearly set out, with the implications for personal and corporate responsibility fully understood, including the implications for the Annual Governance Statement of each of the bodies. These may also require amendment to the Internal Audit plans of both the Integration Joint Board and the parties, including consideration of formal provision of assurance between the Parties, the Integration Joint Board and their Internal and External Auditors.
5.9 On or before the start of each financial year, the Integration Joint Board Chief Internal Auditors will prepare and submit a strategic risk based audit plan to the Integration Joint Board for approval. In addition, they will also submit an annual audit report on Internal Audit activity to the Chief Officer and the Integration Joint Board, indicating the extent of audit cover achieved and the overall level of assurance to be provided. The annual audit report will also be reported to the Audit Committee (or equivalent) of each constituent body.
5.10 If this approach is approved then operational delivery arrangements (documenting work, reporting formats etc) will be discussed and agreed between the constituent bodies and the Chief Officer.
6. Conclusions
6.1. In order to comply with Regulations, it is proposed that the Integration Joint Board appoint the Chief Internal Auditor from a party for a three year period on a rotational basis.
6.2. This arrangement will be reviewed annually by the Integration Joint Board's External Auditor as part of their review of IA.
7. Resource Implications
7.1 There are no additional financial costs associated with the appointment of Chief Internal Auditor, or equivalent, of the constituent bodies as Chief Internal Auditor to the Integration Joint Board.
7.2 Each constituent body will provide the resources required to meet the annual plan in line with wider support services approach. Resources required will be determined once accountability/governance arrangements are more settled.
8. Impact on Integration Joint Board Outcomes, Priorities and Outcomes
8.1. The appointment of a Chief Internal Auditor is one of the key components of good financial governance.
9. Legal & Risk Implications
9.1. Approval of the appointment of the Chief Internal Auditor will ensure that the Integration Joint Board complies with The Local Authority Accounts (Scotland) Regulations 2014 and professional guidance issued by the Integrated Resources Advisory Group (IRAG) in compliance with The Public Bodies (Joint Working) (Scotland) Act 2014.
10. Consultation
10.1. Consultation has taken place between Clackmannanshire and Stirling Councils and NHS Forth Valley internal audit teams regarding the appointment of the Chief Internal Auditor.
11. Equalities Assessment
11.1. N/A
12. Exempt reports
12.1. Is this report exempt? No
Clackmannanshire & Stirling Integration Joint Board
24 February 2016
This report relates to Item 15 on the agenda
External Audit Appointment
(Paper presented by Ewan Murray)
For Approval
Approved for Submission by Shiona Strachan, Chief Officer Author Iain Burns, Internal Audit and Fraud Team Leader Date: 24 February 2016 List of Background Papers:
Integrated Resources Advisory Group Finance Guidance.
Title/Subject: External Audit Appointment Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 24 February 2016 Submitted By: Ewan Murray, Chief Finance Officer Action: For Noting
1. Introduction
1.1 This report sets out, for noting, the arrangements for external audit appointment for the Integration Joint Board (IJB).
2. Executive Summary
2.1 The Accounts Commission have appointed Grant Thornton UK LLP as external auditors for the Clackmannanshire & Stirling Integration Joint Board for 2015-16 audit.
3. Recommendations
The IJB is asked to:
3.1 Note the appointment.
4. Background
4.1. Under Section 97 of the Local Government (Scotland) Act 1973 the Accounts Commission is required to appoint external auditors to conduct the audit of the Clackmannanshire and Stirling Integration Joint Board.
5. Appointment of External Auditors
5.1 The Accounts Commission have appointed Grant Thornton UK LLP as external auditors for 2015-16. Letter of confirmation is attached at appendix 1.
5.2 The Accounts Commission appoint external auditors on a five year appointments cycle. It is anticipated that the external auditor for the local authority will be appointed to the coterminous Integration Joint Board. The current five year cycle is in the final year and so future years' appointments will be made once a tender exercise has been carried out by the Accounts Commission.
5.3 The Code of Audit Practice sets out the scope of public sector audit in Scotland and is available to download from the Audit Scotland website; http://www.audit-scotland.gov.uk/docs/corp/2011/110520_codeofauditpractice.pdf
6. Conclusions
6.1. Under Section 97 of the Local Government (Scotland) Act 1973 the Accounts Commission is required to appoint external auditors to conduct the audit of the Clackmannanshire and Stirling Integration Joint Board.
6.2. The Accounts Commission have appointed Grant Thornton UK LLP as external auditors for 2015-16.
7. Resource Implications
7.1 The Partnership have not yet been advised of the fees.
8. Impact on IJB Outcomes, Priorities and Outcomes
8.1. The appointment of External Audit is a requirement of the Local Government (Scotland) Act 1973.
9. Legal & Risk Implications
9.1. The appointment of External Audit is a requirement of the Local Government (Scotland) Act 1973.
10. Consultation
10.1. The Chief Officer, Chief Finance Officer, NHS Board Director of Finance and Section 95 Officers of Clackmannanshire and Stirling Council have been notified of this appointment.
11. Equalities Assessment
11.1. N/A
12. Exempt reports
12.1. Is this report exempt? No
Appendix 1
Clackmannanshire & Stirling Integration Joint Board
24 February 2016
This report relates to Item 16 on the agenda
Health and Social Care Integration Programme Plan Update
(Paper presented by Lesley Fulford)
For Noting
Approved for Submission by Shiona Strachan, Chief Officer Author Lesley Fulford, Programme Manager Date: 24 February 2016 List of Background Papers: 2015.09.17 Clackmannanshire & Stirling TB - Programme Work Streams Progress Report 2015.12.11 - Clackmannanshire & Stirling IJB - Work Stream Progress Report
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Title/Subject: Health and Social Care Integration Programme Plan Update
Meeting: Clackmannanshire & Stirling Integration Joint Board Date: 24 February 2016 Submitted By: Lesley Fulford, Programme Manager Action: For Noting
1. Introduction
1.1 The purpose of the report is to provide an update to the Integration Joint Board on the programme of work to implement health and social care integration.
2. Executive Summary
2.1. The Public Bodies (Joint Working) (Scotland) Act 2014 sets out a number of statutory requirements for Health and Social Care Partnerships to meet in order to implement health and social care integration.
2.2. The Integration Joint Board has received regular reports noting the programme of work to ensure the Board is satisfying itself that all relevant matters are being progressed in a timely manner.
2.3. The key achievements since the report in September 2015 and future actions for these work stream groups are attached in Appendix 1.
2.4. Work is progressing however deadlines are tight and commitment and flexibility will be required from all partners to ensure the Partnership meets its statutory obligations under the Public Bodies (Joint Working) (Scotland) Act 2014 by 1 April 2016.
2.5. A number of the work streams have significant areas of work and will continue beyond March 2016 as part of the longer terms change programme.
3. Recommendations
The Integration Joint Board is asked to:
3.1. Note the content of the report and progress to date.
4. Background
4.1. The Public Bodies (Joint Working) (Scotland) Act 2014 sets out a number of statutory requirements for Health and Social Care Partnerships to meet in order to implement health and social care integration.
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4.2. The Transitional Board received a report on 17 September 2015 noting the programme of work and agreed to regular reports being received to ensure the Board is satisfying itself that all relevant matters are being progressed in a timely manner.
5. Integration Programme Plan
5.1. The Integration Programme Plan and associated work streams should ensure the delivery and implementation of a range of tasks that are required to support new integration arrangements and to ensure the Partnership meets their statutory obligations from April 2016.
5.2. The work stream groups established to support integration arrangements are as follows:
. Strategic Planning group . Strategic Plan Working Group . FV wide Governance group . FV wide Finance group, with two supporting sub groups . FV wide HR workforce group . FV wide Performance and Measurement group . FV wide Data Sharing Partnership group . FV wide Clinical and Care Governance group . FV wide Risk Management group . Clackmannanshire & Stirling Partnership OD and Workforce Development group.
5.3. There has been work undertaken with the work streams to revise their action plans to ensure these reflect the required tasks, leads and timescales.
5.4. The key achievements updates since the report in September 2015 and future actions for these work stream groups are attached in Appendix 1. The Strategic Planning Group and Strategic Planning co-ordinating group updates are separately reported to the Integration Joint Board in the standing agenda item on the Strategic Plan
6. Conclusions
6.1. Work is progressing within challenging deadlines, which will require strong commitment from all partners to ensure the Partnership meets its statutory obligations under the Public Bodies (Joint Working) (Scotland) Act 2014 by 1 April 2016.
6.2. A number of the work streams have significant areas of work and will continue beyond March 2016 as part of the longer terms change programme.
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7. Resource Implications
7.1. The Integration Joint Board should note that the respective partners are contributing significant resources to supporting integration as reflected in the membership and areas of work being taken forward in the respective work streams. It should be noted that this is, at this point in time, considerable commitment for all parties.
8. Impact on Integration Joint Board Outcomes, Priorities and Outcomes
8.1. By completing the work associated with the work streams the Partnership will meet its statutory obligations under the Public Bodies (Joint Working) (Scotland) Act 2014 by 1 April 2016. The primary focus for the work streams is on meeting the core legal requirements and those provisions within the Integration Scheme by this deadline.
9. Legal & Risk Implications
9.1. There is a risk if work as outlined is not completed we will fail to meet our statutory obligations under the Public Bodies (Joint Working) (Scotland) Act 2014 by 1 April 2016.
10. Consultation
10.1. Work stream outputs, where required, will be subject to consultation.
11. Equality and Human Rights Impact Assessment
11.1. Equalities and Human Rights Impact Assessments will be carried out as required for each work stream. The recommendations in this report do not require an Equalities and Human Rights Assessment.
12. Exempt reports
12.1. No
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13. Appendix 1 – Programme Work Stream Update Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales Strategic Robert Produced revised draft of Strategic Plan Seek approval to publish: Planning Stevenson incorporating comments from consultation Working / Chris exercise. draft Strategic Plan February 2016 Group Sutton draft easy read Strategic Plan Produced revised draft of easy read draft Strategic Needs Assessment Strategic Plan incorporating comments draft consultation and engagement from consultation exercise. report
Produced revised draft of Strategic Needs Assessment incorporating comments from consultation exercise.
Produced draft consultation and engagement report. Governance Patricia Agreed the scope of the work stream Complaints policy and procedures March 2016 Cassidy which will ensure compliance with the Act, in place for IJB complaints the roles and responsibilities guidance and other relevant non-financial guidance. FOI policy and procedures and March 2016 Publications Scheme in place in line with FOISA
Equalities duties completed (in line 30 April 2016 with IJB requirements under the Equalities Act 2010)(Specific Duties)(Scotland) Regulations 2012
Agree template for EQIA to be used 31 March 2016
Creation of Records Management 31 March 2018 Policy, retention schedules and
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Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales when invited submission to the Keeper of the Plan in line with PRSA
Parties to agree the provision of March 2016 support services for the IJB - on incorporation - integration function are carried out
IJB to put in place its own code – November 2016 Ethical Standards in Public Life etc (Scotland) Act 2000.
Finance Fiona Three years spend and budget information 2016/17 Budget Setting from End February 2016 Ramsay shared for in scope health and social care. respective authorities
Due diligence undertaken with four issues identified for further consideration. Paper outlining 2015/16 Budget information and 2016/17 outlook scheduled for consideration at February meeting
Governance work concluded for Internal Audit and Reserves
HR Workforce Helen High level management data has been Development of Operational Plan April 2016 Kelly collated to allow an understanding of the workforce in scope for HSCI within their Further analysis of workforce data March 2016 partnership.
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Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales information. Integrated Workforce Plan drafted and submitted for consideration at January IJBs.
Held learning event with colleagues in the Ayrshire and Arran partnership, shared experiences and lessons learned.
Second formal Joint Staff Forum took place on 9 December, constitution agreed.
Performance Elaine Draft Performance Management Further update required once March 2016 & Vanhegan Framework developed and reviewed by agreement reached on operational Measurement Programme Board in January. arrangements and scope. For IJB approval in March Workstream meets regularly with main focus on requirements to 31 March 2016 Agreement on relevant and priority March 2016 and then review ongoing support in terms indicators for Year 1 based on of performance to the IJBs and national outcomes and needs of partnerships Strategic Plan – finalise on approval of Plan Three key areas of focus reported March 2016 previously continue: Preparation of Integration function • Creation of initial Performance Performance target list and Non Management Framework integration functions performance acknowledging legislative target list. Finalise on agreement on requirements and needs of both operational functions - For IJB routine reporting and production of approval in march
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Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales an Annual Report - Framework focuses on the Why and How • Metrics and Indicator mapping based on National Outcomes Integration Indicators cross linked to relevant local SOA/HEAT targets = the What • As per the Integration Schemes prepare: o Integration functions performance target list. o Non integration functions performance target list.
Close liaison with other work streams to prevent duplication i.e. data sharing IM&T
Data Sharing Jonathan Information Sharing Board (ISB) bid for Alternatives to Orion Portal pilot ISB funding to be Partnership Procter funding received in December, only half discussed and several options spent this financial the funding needed for Data Sharing being progressed year Paul Portal Pilot – further work is now required Woolman to determine how portal pilot will be taken (Interim) forward. Delayed discharges replacement End January system requirements analysis progressing
Delayed discharges social work Awaiting council process data still awaited from SW developments Councils
Outline requirements for IT network Awaiting
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Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales access being requested from requirements managers in various departments
Pursuing infrastructure options with This financial year Cisco
Joint inspection requirements March 2016 analysis is progressing
Clinical & Tracey Draft Clinical and Care governance Approve Clinical and Care March 2016 Care Gillies framework for consultation with governance framework Governance Programme Board for comment
Risk Hugh Draft Risk Management Strategy and Revised draft Risk Management March 2016 Coyle Guidance developed by work stream and Strategy and Guidance discussed circulated for comments at Programme Board March 2016 Develop Risk Register Participation & Chris Participation & Engagement workshop Seek approval to publish February 2016 Engagement Sutton held in November 15. Participation & Engagement strategy. Draft Participation & Engagement strategy developed in December 15. Develop implementation plan. August 2016
Consultation with P&E work stream members on draft strategy in January 16. Organisational Morag Clackmannanshire & Stirling Development McLaren & Workforce • Initial proposals for Joint Leadership • Strategic Planning Group Development and Management Development development session on role,
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Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales approved by JMT and IJB. remit and ways of working to be • Initial Short Intervention Leadership delivered in Feb ‘16. Programme ‘Playing to Your Strengths’ • Deliver Partnership ‘Playing to developed. Your Strengths’ Leadership • Induction Programme for Non-Voting Development Programme. IJB members undertaken (Dec. ’15). • Publish phase 1 staff • First draft of Partnership Workforce engagement outputs report and Development and Training Framework develop plans for next phase, developed and reviewed by OD Group including incorporating as part (Dec. ’15) of suite of supporting • Contribution to Workforce Strategy documents being developed for from an OD and Workforce the Strategic Plan. Development perspective (Nov/Dec. • Seek approval of draft Joint ’15) Workforce Training & Development Framework (Jan/Feb 16) and develop an
initial resulting Plan which identifies workforce development and training priorities to be taken forward during 2016/17 in support of delivery of the Strategic Plan and aligned with the wider Workforce Plan (Mar 16).
Both Partnerships Both Partnerships
• Seek IJB approval of draft • IJB development session delivered. medium-long term Workforce
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Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales • Proposals for the production of a Joint Plans (Jan/Feb 16) and engage Workforce Training and Development with key stakeholders to Framework approved. develop resulting detailed OD & WFD Plans for 2016/17 and • OD support provided to GP Whole beyond (Mar 16). Systems Working meetings. • Provide support to the strategic • Sharing of lessons learned from planning process, engaging key national groups which members of the partners to enable the OD / WD group attend. development of resulting implementation plans which are well-informed and fit for purpose. • Support Chief Officer & Senior Managers to identify Leadership development needs for 2016. • Support the Chief Officer to review and develop Joint Management & Governance Structures to meet the needs of the new Partnership. • Development of medium – long term Workforce Strategy, incorporating OD & WFD Plans for next 3-5 years (Mar ’16). • Alignment of High level outputs from the Joint Workforce Training & Development Framework to the Strategic
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Work Stream Chair Key Milestones to Date Key Priorities / Actions OutlineTimescales Plans for each Partnership. • Identify Joint Training & Development priorities based on the Framework, to make best use of resources available (April 16). • OD Support to Community Nursing Leadership Team
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