1 Public Bodies ( Joint Working) (Scotland) Act 2014 The Highland Partnership (The Highland Council, NHS Highland) STRATEGIC PLAN 2015 - 2018 22 Contents Background The Highland Plans Consultation and engagement process Summary Appendix 1: Highland Improvement and Co-production Plan Appendix 2 : Strategic Commissioning Plan Appendix 3: Change and Improvement Plan Appendix 4: Local Unscheduled care plan ( LUCAP) Appendix 5: Local Delivery Plan – North and West Appendix 6: Local Delivery Plan – Raigmore Appendix 7: Local Delivery Plan – South and Mid Appendix 8: For Highland’s Children 4 3 Background: Current legislation – namely the Pubic Bodies( Joint Working)(Scotland)Act 2014, requires The Highland Partnership to draft a Strategic Plan. Unlike other partnerships, however, Highland has been drawing up integrated strategic plans and developments since integration in 2012. This Strategic Plan must, therefore, recognise and incorporate the work undertaken to date, not least the results of consultations progressed as part of the process. Guidance states that the principal requirement of the Strategic Plan is “a document that sets out the arrangements for carrying out the integrated functions, and how these arrangements are intended to achieve the national health and wellbeing outcomes.” This document should last for three years or more. The Highland Plans: The Highland Integration Scheme replaces the Partnership Agreement which was signed in 2012 and sets out the direction of travel for Integrated services in Highland over a five year period. The detail of how the Integration Scheme proposes to achieve health and well being outcomes is further explored in the Highland Improvement and Co-production Plan (Appendix 1) and the Strategic Commissioning Plan (Appendix 2). The Strategic Commissioning plan describes the way in which investment and disinvestment will follow desired outcomes whilst the Improvement and Co-production Plan represents the overarching clinical strategy to achieve these aims. The Highland Strategic Commissioning Principles: The Highland Partnership considers that all of the above work sets out the Strategic direction of the Partnership and as such contributes the main components of the Strategic Plan. The focus of the first Strategic Commissioning Plan in Highland is Older People over the period of five years to 2019, the Health Board has been clear that the expectation is for this approach to be integral to all transformational change going forward. The Strategic Commissioning Plan for Older People has been co-produced by NHS Highland and its commissioning partners, in order to communicate: The service user and carer outcomes we are striving to deliver; The current Highland position and intended direction; The shape and profile of future services which will best meet service users’ needs; How this transition will be made; Future dis-investment and re-investment decisions; Future engagement with providers; and Information to enable providers to position their service to deliver provision that people in Highland need and want. The Partners have further developed a Change and Improvement plan ( Appendix 3) to illustrate how and by when the transformational change outlined in the Integration Scheme and the Strategic Commissioning Plan will be progressed and make the essential operational links between the required inputs, outputs and the National Health and Wellbeing Outcomes. This plan focussed on all adult services. The Change and Improvement Plan has evolved and has been revised over the first two years of the Partnership Agreement with further input at District level through the District 44 Partnerships. It forms part of the Highland Strategic Commissioning Plan setting the clear direction for the Partnership in assessing local need, engaging and planning with partners and driving forward transformational change. The plan highlights detail over a two year period with the final year focussed on review and evaluation to ensure that benefits are realised and evidenced and that any required change in direction is agreed. The Local Unscheduled Care programme ( LUCAP) ( Appendix 4) and local Delivery plans (Appendices 5-7) relevant to each Operational Unit – North and West, Raigmore and South and Mid) further describe the implementation of an integrated approach to unscheduled care which harnesses the opportunities provided by integration to link previously separate agendas such as Care at Home Capacity with hospital flow and bed usage. An integrated approach to Children’s services has been in place in Highland for some time following the GIRFEC pathfinder, and in 2012 the Highland Council became the Lead Agency for Children’s services with services and functions being delegated from NHS Highland. For Highland’s Children 4 (Appendix 8) has now been developed describing the outcomes to be achieved based on the SHANARI indicators. The timing of this plan which has been established for some time expands across the first two years of this Strategic plan and will involve evaluation and review towards the end of it’s term. Further consultation and engagement will inform the next iteration which will run from 2018 until 2020. Consultation and Engagement: By signing up to the Strategic Commissioning approach, NHS Highland has committed to ongoing engagement and involvement of all stakeholders. This has meant that all Improvement Groups charged with driving forward change, evidencing improvements and influencing decision-making have as regular members, representatives from user and carer groups or the relevant client group. Public members also sit on the Health and Social Care Committee which has Corporate oversight of service change and development in the Highland Partnership, being a sub- committee of the Health Board. A simple illustration of the commissioning process is noted below, which sets out commissioning at a strategic and operational level, notes the key steps involved and highlights the importance of the service user at the centre. This illustration is the way that Service Users and Carers have told us that they wish our Commissioning activity to be both described and implemented. Elected members are engaged also through the committee referenced above and District Partnerships where District versions of the Change and Improvement plans particularly are available to evidence progress and enable discussion and debate. 55 For Highland’s Children – The integrated children’s’ service plan has been following a well established programme of consultation since the first plan was developed and a number of focus and support groups regularly feed into this process. Drafts are shared as they evolve and the whole process is dynamic with updating and sharing managed through web version control. Summary: The Highland Strategic Plan requires to be seen within the context of an already integrated and rapidly evolving environment. The various Plans that make up the Strategic Plan are evidence to this progress, however the reader’s attention is drawn to the following key characteristics that others will have to achieve: 1. The definition of shared outcomes is led by those we serve. 2. Our commissioning approach is integrated beyond the Health and Social Care. partnership to fully engage across Sectors. 3. Our resource has been combined and has in large part lost it’s original identity. 6 The Highland Care Strategy Improvement and Co-production Plan - August 2014 Board 23.07.14 1: NHS Highland’s Vision for the Future Changing demography, increasing complexity of illness in an increasingly elderly population, increasing use of technology, developments in diagnosis and treatment and financial constraints are among the many substantial drivers for change in health service provision for Highland, Scotland and across the developed world (Appendix 1). It is therefore of growing importance that NHS Highland has a clear agreed vision for the future delivery of health and social care services in Highland for the next 10 years that can inform service changes, redesign and developments. NHS Highland aims to provide high quality health care to its population that is safe and sustainable in the long-term and can adapt to the changing environment set out above. Increasingly over the next 10 years, health care delivery will become less dependent on hospitals and institutional care and will rely more on co-production and partnership with individuals and communities to support health and social care delivered in the home and local community settings. There will be continuing emphasis on prevention and early intervention to maintain and improve people’s health and independence. Care will become as patient-centred as possible, co-produced in partnership between patients and professionals, with minimal use of routine appointments and tests, focussing instead on responding to patient need as identified in self-management plans. The use of technology and provision of timely and relevant health intelligence to support remote consultation, information requirements and management will be maximised, reducing the need to travel for both patients and professionals. Such changes will support sustaining service provision in remote and rural areas; however, radical redesign of primary and out of hours care will also be essential to maximise efficient use of resources and attract and retain high quality staff. Increasingly, services and care settings will be provided jointly and seamlessly across agencies through integration and partnership working.