HEALTH AND SOCIAL CARE JOINT WORKING

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HEALTH AND SOCIAL CARE JOINT WORKING

• A Swedish National Conference for Primary Care
• 7/8 May 2009

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Joint Working

• Context
• Challenges
• Achievements

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Edinburgh

• Context
• City Population - 448,370
• Social Care - 194m
• Community Health Partnership - 225m
• NHS - 2120 staff
• Social Care - 2000 staff

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Deprivation across Lothian
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Context

• Role almost unique in Scotland
• Largest Community Health Partnership in Scotland
• Variation in integrated models considerable

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Services

• Older People
• Mental Health
• Criminal Justice
• Learning Disability
• Adult Social Care
• Primary Care Services
• Community Health Services

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Primary Care Services

• High volume of General Practice
• High quality General Practice
• Challenging interface Primary/ Secondary

GP/population ratios Sweden 1/1,800 Scotland
1/1,309 Edinburgh 1/1,276
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Health Social CareSenior Management Structure
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Health Social Care Governance
NHS Lothian Board
City of Edinburgh Council
Joint Board of Governance
Edinburgh Community Health Partnership Sub
Committee
Health, Social Care Housing Committee
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Strategic Challenges

• Demography
• Resources
• Governance
• Cultural differences
• Workforce

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Strategic Challenges - Demography
Demographic Change in Scotland 1911-2031

• 85
• Less than 2 of population
• 20 of total bed days in NHS Lothian

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Strategic Challenges Social Care

• Simply doing more of the same is not sustainable

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Achievements

• 32 million efficiency savings (4 years)
• Reorganisation and alignment of boundaries
• Joint service planning
• Joint Learning and Development agenda
• 20m investment in Information Technology

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Achievements

• Joint Asset Management Strategy
• Joint Performance Monitoring
• Change in culture
• Re-design of services

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Achievements - GPs

• Quality Outcome framework
• focus on proactive management of chronic
  conditions
• over 20,000 additional patients with CHD, stroke,
  hypertension or diabetes receiving health care
  interventions
• reduced admission rates
• improved monitoring and treatment better
  control of risk factors eg cholesterol, blood
  pressure

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4 Best Examples of Joint Working

• Capacity Plan for Older People
• Modernisation of Home Care
• Reducing Discharge Delays
• Long Term Conditions Management

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Achievements Service Planning

• Capacity Plan for Older People
• Anticipates market and demographic change
• Determines share care home market
• Major investments in
• intensive packages home care
• 6 replacement Care Homes
• Telecare
• Housing with Care
• Shifted balance of care 16 to 27, aiming for
  40
• Reduced Care Home bed capacity
• Improved delayed discharge performance

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Achievements Service Modernisation

• Modernisation of Home Care
• Largest single staff group in the Council (1500)
• Re-ablement model
• Localised teams, team leaders
• Empowered workforce
• Outcomes 40 reablement at 6 weeks

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• 350 delays October 2004
• April to October 04 up 20
• Target reductions by 40 in 6 months achieved
• Outcome 350 delays to 27

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Management of Chronic Obstructive Pulmonary
Disease

• Rehab programme low to moderate
• Dedicated physio rapid response
• Very positive feedback from patients
• Outcome 50 reduction in admissions

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Summary

• Collaboration fundamental to future success
• Relationships more important than structures
• Service re-design can produce transformational
  improvements
• Simply doing more of the same is not sustainable