How did you get here today?

1. “Home is Where the Care is”Annual Conference and ExhibitionGlasgow Marriott HotelFriday 31st May 2013

3. “Home is Where the Care is”Annual Conference and ExhibitionGlasgow Marriott HotelFriday 31st May 2013

4. Bus Train Speedboat Helicopter Spaceship Bike All of the above! How did you get here today?

5. What would make the conference better? New Chairperson Have the bar open Collaborative team working New AV Company Consistency of care Safe and effective care

6. “Home is Where the Care is”Annual Conference and ExhibitionGlasgow Marriott HotelFriday 31st May 2013

7. Quality or Compromise The reality of delivering Care at Home You decide…..

8. Shadowing our conference carer Mel in real time • with a live broadcast through out the morning conference

9. Session 1

12. Quality or Compromise • Mel has been out from 06.30 to arrive at her first call at 06.45 • Starting early and working through unpaid breaks ensures she just makes all her visits on time – today was a good day • During her lunch she will now – drop off a sample to GP surgery, and pick up a prescription • No additional payment for travel /fuel of 16 miles during the morning • and for 5.25 hrs. direct contact time, Mel has been out for 6.5 hours her gross pay before deductions is £33. 80

13. Question

14. Should all care staff regardless of sector/ employer be paid the living wage of £7.45 then we can address time to care, time to travel/fuel payments Yes No Don’t Know

15. “Home is Where the Care is”Annual Conference and ExhibitionGlasgow Marriott HotelFriday 31st May 2013

16. Health & Social Care Integration Professor Jim McGoldrick Chair, Joint Improvement Partnership Board

17. JOINT IMPROVEMENT PARTNERSHIP BOARD • Angela Leitch, Chief Executive, East Lothian Council; • Angiolina Foster, Director, Health & Social Care Integration, Scottish Government; • Annie Gunner-Logan, Director, Coalition of Care Providers Scotland (CCPS); • Cathie Cowan, Chief Executive, NHS Orkney; • Colin Mackenzie, Chief Executive, Aberdeenshire Council; • Fiona Mackenzie, Chief Executive, NHS Forth Valley; • Ian Welsh, Chief Executive, Health & Social Care Alliance Scotland; • Kenneth Hogg, Director, Local Government & Communities, Scottish Government; • Martin Sime, Chief Executive, Scottish Council for Voluntary Organisations (SCVO); • Mary Taylor, Chief Executive, Scottish Federation of Housing Associations (SFHA); • Ranald Mair, Chief Executive, Scottish Care; and • Rory Mair, Chief Executive, CoSLA.

18. JIT’s STRATEGIC PRIORITIES Person centred outcomes

20. Health & Social Care Integration Underpinned by Legislation: • nationally agreed outcomes; • Healthier • Independent Living • Positive experiences and outcomes • Carers are supported • Services are safe • Engaged workforce • Effective resource use

21. Health & Social Care Integration Policy Context SG Consultation • Improve Outcomes • Focus on Population • Address funding and demographic challenges • Variability in care by geography • The Accountability/Responsibility Paradox

22. Health & Social Care Integration Key themes in the Consultation (the Bill) Consistency of approach Statutory underpinning Integrated budget Clear Accountability Professional Leadership Simplified structures and minimal disruption

23. Health & Social Care Integration Workforce development issues Definition of Workforce – not just the paid employees of Health Boards and Councils “Professional leadership” Definition of leadership – not a function of hierarchy or job title. Leadership happens at all levels.

24. Health & Social Care Integration Workforce development – strategic context • Ministerial Strategic Group • RCOP workforce work stream 2010- 2012 • Change Plans and Change Fund • Position paper in response to SG Consultation on what work has already been done • Development of a strategic narrative

25. Health & Social Care Integration Strategic Narrative on workforce development • Not about workforce planning • Not about terms and conditions • Not in isolation

26. Health & Social Care Integration Workforce Development Strategic Group – WDSG • “[SG] will work with NES and SSSC and other stakeholders to define priority training requirements within an integrated context; articulate what these mean for frontline staff and mobilise support through an education and training infrastructure” • (Consultation doc p44)

27. Health & Social Care Integration WDSG • Who are we and how do we work together? • Shared meaning and understanding for “collaborative leadership • “Reference Groups” approach (not “Expert” Group • WDSG as a portal to frontline staff

28. Health & Social Care Integration Workforce Reference Groups – emerging themes • Don’t re-invent the wheel, use existing joint working to observe the process of integration • Skills and training environment, better IT support • Leadership and Clarity of communication

29. Health & Social Care Integration Workforce Reference Groups – emerging themes Understand what is already happening – mapping existing work Issues of Professional Identity Need to define what’s national and what’s local

30. Health & Social Care Integration Workforce position paper – Scottish Care Follow-up to the reference group session Strategic narrative Well – defined priorities Challenges and opportunity

31. “Home is Where the Care is”Annual Conference and ExhibitionGlasgow Marriott HotelFriday 31st May 2013

32. Integrated Resource Framework: Supporting Health and Social Care Integration through Strategic Planning Christine McGregor, Economic Adviser, Scottish Government, Health Analytical Services Division. Scottish Care Annual Care at Home and Housing Support Conference. Glasgow Marriot Hotel, Friday 31st May 2013.

33. Outline • Integration and Strategic Commissioning • What is the Integrated Resource Framework? • Two main aspects – “IRF mapping” and “Patient (client) level analysis” • Extensive examples of where IRF has been used. • Highlight where Scottish Care and partners could input and benefit from IRF mapping.

34. Integration and Strategic Commissioning • The Bill to integrate adult health and social care places a duty on Health and Social Care Partnerships to produce Strategic Commissioning Plans . • A multi-sectorial co-production approach to be used to develop the Strategic Plan. • Knowledge and expertise of independent and third sector will be critical for successful joint commissioning. • Build on change fund experience.

35. Strategic Commissioning Cycle • “Analysis is one of the most important activities in the commissioning cycle. Poor analysis of post or future trends will result in flawed commissioning decisions and wasted resources” SWIA Guide to Strategic Commissioning • Critical for partnerships to understand current service provision, quality, costs of in house and procured services, and transparency of information for all partners. • Only then will decisions be based on robust evidence and result in positive outcomes for individuals.

36. Question 1

37. Do you think we have sufficient information to develop commissioning plans? Yes No

38. National Support and Improvement Programme Analysis • We will give you sufficient information! • Quality of “analysis” in plans varied. • Programme to support development of commissioning abilities by extending what is already offered from IRF team. • Target for all partnerships to have patient (client level) data by April 2015 to inform decision making.

39. What is IRF - 1 • Development by SG, COSLA and NHS in 2008/09, with objective being to begin to understand joint resources (NHS and LA) across population they serve. • As it developed use by all sectors. • Focus on joint resources rather then more traditional budget lines such as acute budget, community budget, social work budget. • Provide a evidence base for shifts within and across health and social care.

40. IRF mapping -1 • Every community health partnership in Scotland is given mapped data for all ages 65 and 75 plus. • Mapping consists of: • Hospital based services (£5.1bn, £2.2bn, £1.4bn) • Health community based services (£1.4bn, £439m, £245m) • GP and GP Prescribing (£1.7bn, £577m, £297m) • Local authority services (18 plus £2bn, Older people £1.3bn)

41. Question 2

42. What percentage of hospital based resource is accounted for by emergency (non elective) admissions? 25% 50% 60%

46. How has IRF mapping being used? • Joint Commissioning – baseline for current resource adult/older people across sectors. • Key to the analysis part of cycle. • Support change fund projects. • Variation analysis emergency admissions/prescribing by GP. • Routine briefing/health and social care bill. • Basis of joint budgets.

47. Patient (client) level analysis - 1 • IRF mapping examines resource and activity to various geographical levels. • Doesn’t say WHO is using services, for example emergency admissions rates and costs may fall/rise but for certain cohorts they may be rising continually. • Patient (client) level health and social care allows various questions to be answered.

48. Patient (client) level analysis - 2 • Is it the same people who use both health and social care services? • Is it the same people that are always facing a delayed discharge? • Does level of home care make a difference to level of admissions? • Does prescribing have an effect on admissions?

49. Patient (client) level analysis - 3 • ISD linked at patientlevel, hospital, prescribing, social care activity and costs for all residents across Tayside. • Social care include care home, day care home care, meals, alarms, rehabilitation. • Other partnerships’ linked health only. • Unit costing of social care will hopefully simplify LFR return for social work. • Area where we would welcome input from independent and third sector providers.

50. Patient (client) level analysis - 4 • Once data set linked at patient (client level) it can be used for multiply needs. • What IRF team would like to offer each partnership.