Chair: Dr. Allan Gunning

2. Chair: Dr. Allan Gunning Joint Chair of National Steering Group for Joint Strategic Commissioning

4. Professor Jim McGoldrick Chair Joint Improvement Partnership Board

5. Joint Strategic CommissioningImprovement Agenda Jim McGoldrick

6. Joint Improvement Partnership Board • NHS Scotland • Scottish Government • COSLA • Third Sector • Independent Sector

8. Board and JIT will work with other improvement bodies to: • Accelerate the pace of transformational change • Support and challenge improvement in the delivery of integrated health and social care • Particular challenge of joint strategic commissioning

9. Need for improvement • Need “new commissioning models based on partnership and delivery of personalised outcomes”Changing Lives; report of the 21st Century Social Work Review, 2006 • “Little evidence …of significant improvement and limited progress on joint commissioning” Audit Scotland 2012 • “Very few examples of good joint planning and a slowness to develop strategic commissioning”Scottish Parliament Finance Committee 2013

12. Analysis is one of the most important activities in the commissioning cycle. Poor analysis of past or future trends will result in flawed commissioning decisions and wasted resources”. • SWIA guide to Strategic Commissioning

15. Supporting the analysis • Individual level linked health and social care data • Centrally funded team • Joint Improvement Team • Across all partnerships by 2015

16. “One of the opportunities with which integration provides us is that it will allow us to ensure through joint commissioning that we bring those services together in a much more targeted and focused way with a clear focus on the long term outcomes” • Michael Matheson MSP, Minister for Public Health, Scottish Parliament, 8 May 2013 • “Each Health and Social Care Partnership will be expected to produce joint commissioning strategies and delivery plans over the medium and long-term • Integration of Adult Health and Social Care Consultation Proposals

18. “Councils and NHS Boards do not always involve voluntary and private providers in planning which services are needed in the local area”Audit Scotland, 2012 • A significant part of the expertise required to commission and provide services….sits with the providers of service rather than the commissioners”Changing Lives, 2009

21. Councillor Peter Johnston Health and Well-being Spokesperson COSLA

22. Health and Social Care Integration: Today’s Reality, Tomorrow’s Vision Cllr Peter Johnston Health and Well-being Spokesperson COSLA

24. Trends in Care Home and Care at Home populations

25. Intensity of Care at Home Packages

26. Hospital Admissions

27. What is to be Done? • More Personalised Support • Shift the Balance of Care • Develop Strategic Commissioning • Health and Social Care Integration • Find a Funding Solution

28. Personalisation

30. Strategic Commissioning

31. Health and Social Care Integration

32. Our Changing Population

33. What is to be Done? • More Personalised Support • Shift the Balance of Care • Develop Strategic Commissioning • Health and Social Care Integration • Find a Funding Solution

34. Questions

36. Tony Homer Joint Strategic Commissioning Lead Joint Improvement Team

37. Joint Strategic Commissioning Plans for Older People 2013 Overview of Self Assessments, Improvement Themes and the Support Agenda May 2013 Tony Homer JIT National Lead, Joint Strategic Commissioning

38. Commissioning Context • Requirements: • Self evaluation return to SG • Preparation of JSC Plans • National drivers: • Policy – personalisation and prevention • Demographics – population levels and health profiles • Public sector finances – focus on efficiencies • Integration context: • All adult and older people care groups • Minimum level of acute spend into integrated budgets • Locality planning • Purpose of the review: understanding progress and challenges and preparing for further change

39. National partner review process • Who was involved? • Review timetable • Core review of plans • Thematic review of plans: • Partnership working Workforce • Outcomes Self Directed Support • Co-production Community Capacity Building • Information Financials • Housing Dementia • Intermediate Care Carers • Telehealthcare • Round table discussions

40. Review reporting • Presentation – key themes and support priorities • Thematic reports • Individual partnership feedback • Incorporation into planned improvement support prioritiesand shared learning

41. JSC Plan - Structure Analysis • 24 out of 31 plans (77%) were available to be reviewed • Most of the other 7 are well progressed and/or are awaiting sign off • 10 year horizon • 15 health and social care partnership plans/frameworks with 1 being a pan health board strategic framework and 1 a joint plan across 2 Council areas • 3 year horizon • 9 health and social care partnership strategies/plans and 7 implementation plans relating to a 10 year strategy • 1 year Change Plans – all available • Housing Contribution Statements – all available

42. Whole system overview • The challenge of scaling up from Change Plans • Scoping of the available resource pot did include acute hospital activity but the detail varied • Analysis of acute hospital activity absent beyond the brief description of services included in the scope • Nothing about how the acute spend will be used • Limited presentation and analysis of community assets and less traditional activities/approaches

43. Following some golden threads... • Personal outcomes • Partnership working • Leadership • Information and Analysis

44. Personal outcomes Recognised in the self evaluation as the area of greatest challenge – and confirmed to be so by the review Examples of how this was most apparent: • ‘When is a vision not a vision...’ • Recognising, capturing and applying personal outcomes data • Using outcomes to shape re-design activity • Understanding and addressing the culture change implications in single agencies and particularly across partners • Securing services that will deliver improved outcomes – contracts and commissioning / procurement links • Personalisation and SDS?

45. Partnership working Considered in the self evaluation to be one of the areas of greatest progress but important gaps emerged from the review Basic governance and commissioning processes in place but examples of gaps concerned: • Comprehensive engagement strategies • Co-production with all partners and stakeholders • Clear processes and joint accountability for prioritisation and decision making • Little evidence of a culture of data sharing across sectors • Joint approaches to Organisational Development • Locality/total place approaches that bring shared insights / ownership

46. Leadership Considered in the self evaluation to be an area of strength but limited evidence emerged to support this: Evidence of enabling leadership through practitioners and staff but examples of the following were scarce: • Visible senior corporate leadership through sponsorship of overall programme and key workstreams • Explicit referencing of high level corporate strategic drivers and cross sector priorities to evidence buy-in • Driving forward on known aspects and direction of travel whilst managing the present uncertainty around integration

47. Information and Analysis Considered in the self evaluation to be one of the areas of strength but variable evidence emerged from the review Strong contextualisation through use of population health and well-being profiles and good focus on key points, analysis and interpretation but examples of outstanding limitations included: • Limited referencing of health inequalities • Access to common local data/analyses for shared use • Limited application of robust option appraisal methodologies • Little analysis of expenditure patterns with a view to modelling the impact of re-design • Limited use of national mapping data

48. Thematic support priorities 1 CARERS • Mapping the future carer population • Developing an integrated approach to requirements regarding indirect/direct support, personal outcomes and carer support SDS • Drawing evidence from current support packages and PSP initiatives about the impact of SDS • Improving knowledge of what works in order to grow the ambition of plans for SDS DEMENTIA • More detailed work concerning dementia on support for carers and for specialist groups of OP (eg. people with a LD) • Use of the NES/SSSC ‘Promoting Excellence model’ and of dementia tools and evaluating the impact of service changes

49. Thematic support priorities 2 CO-PRODUCTION • A greater emphasis and focus on the application and utility of co-production in health and social care HOUSING • Improving links between housing and H&SC data • Developing the focus on the role of housing in delivering improved prevention INTERMEDIATE CARE • Aligning initiatives as a comprehensive framework of IC tailored to the locality • Development of practitioner capability for enhanced roles in the community • TELEHEALTHCARE • Despite recent progress and ongoing investment scant referencing in plans and little sign of strategic grasp of its ongoing role

50. Commissioning in practice – where are we now: • Largely treading water on progress in implementing a personal outcomes approach to commissioning – except for a very few notable exceptions • Formal partnership arrangements are being sustained but not all partners are embedded within many important JSC roles/tasks - and they need to be • Clear, consistent senior leadership is too often noticeable by it’s absence • Use of information and our analysis of it is improving but we are not making best use of available national data and are slow at growing local information • We are not making investment decisions on the basis of clear criteria, a robust decision making process and the application of relevant and focussed information • Important progress in many areas of practice/re-design but little grasp as yet of how to enable communities and local assets to engage and contribute to the strategic agenda These will form key elements of the ongoing improvement support agenda