Caroline Sinclair
Chief Officer
Orkney Health and Care
(01856) 873535 ext: 2601
[email protected]
Agenda number 10.2
Integration Joint Board
Date of Meeting: 29 June 2016
Subject: Audit Scotland Report – Changing Models of Health and Social Care
1.
Summary
1.1 To present the national audit report, Changing Models of Health and Social Care,
prepared by Audit Scotland.
2.
Purpose
2.1 The purpose of this paper is to note the national audit report, Changing Models of
Health and Social Care, attached as Appendix 1 to this report.
3.
Recommendations
The Integration Joint Board is invited to:
3.1 Note the content of the national audit report, Changing Models of Health and
Social Care, attached as Appendix 1 to this report.
4.
Background
4.1 This most recent audit of the landscape of health and social care, undertaken by
Audit Scotland, builds on their previous audit work on the demands and pressures
in both the health and social care system. The audit is based on desk based
research and analysis, projection analysis, interviews with key stakeholders and
detailed ‘on the ground’ research with one partnership area.
4.2 The audit identifies significant ongoing pressures arising from demographic
changes and the financial context and asserts that the current models of care are
unsustainable. The audit highlights that the new IJBs will not be in a position to
make a major impact in the current financial year and concludes that new models of
care are needed to avoid use of hospital resources. The audit also highlights that
despite evidence of new approaches being developed, the pace of change is too
slow and the spread of change is not wide enough.
4.3 The audit identified a range of actions that should be undertaken by key
stakeholders to meet the challenges of the future summarised as follows:
4.3.1
Scottish Government should:
4.3.1.1 Provide a clear framework for the delivery of the 2020 Vision
Estimate the investment required for implementing the 2020
Vision and the new Clinical Strategy.
4.3.1.2 Ensure that long term planning (up to 2030) identifies and
address the risks to implementing the 2020 Vision and the Clinical
Strategy.
4.3.1.3 Ensure learning from new care models is shared and the pace of
change is increased.
4.3.1.4 Work to address the barriers that prevent local bodies from
implementing longer term plans.
4.3.2
NHS Boards and Councils should work with IJBs in their first year to:
4.3.2.1 Carry out a shared analysis of local need and use this to inform
plans for local redesign
4.3.2.2 Ensure ‘good practice’ ways of working from other areas are
implemented to overcome barriers to new care models
4.3.2.3 Move away from short term approaches by making necessary
changes to workforce and funding, making best use of local
data, and evaluate changes
4.3.2.4 Ensure performance measures for new models of care are
identified at the outset, and measured
4.3.2.5 Ensure clear principles are followed for implementing new care
models using an approach set out in the report (ref page 30)
4.3.3
Information Services Division should:
4.3.3.1 Ensure it shares learning across Scotland analysing and using
data and intelligence to understand health needs
4.4 The audit report sets out the challenges being faced and some of the change
examples that can be seen across Scotland. While it is acknowledged that change
models need to be right for each areas it is emphasised that more needs to be done
to spread models that are evidenced to work, and to consider a ‘whole system’
approach as illustrated in East Lothian (p22-25).
4.5 The vital role of GPs and the changes coming through the new GP contract are also
highlighted as issues that require attention along with that need to consider the
future workforce that can support the overall strategy direction.
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4.6 The ongoing focus on meeting acute service targets is highlighted as unhelpful as it
draws energy, resources and funding away from community services and service
redesign, into the maintenance of the current acute service structure and the
funding of private acute services. A need to create a long term funding source to
support transformational change is highlighted.
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6
Contribution to Quality Please indicate which of the Our Plan 2013-2018 and
2020 vision/quality ambitions are supported in this
report by ticking the relevant area(s):
Promoting survival: to support our communities

Promoting sustainability: to make sure
economic, environmental and social factors are
balanced

Promoting equality: to encourage services to
provide equal opportunities for everyone

Working together: to overcome issues more
effectively through partnership working

Working with communities: to involve
community councils, community groups,
voluntary groups and individuals in the process

Working to provide better services: to improve
the planning and delivery of services

Safe: avoiding injuries to patients from
healthcare that is intended to help them

Effective: providing services based on scientific
knowledge

Efficient: avoiding waste, including waste of
equipment, supplies, ideas, and energy
Resource Implications and Identified Source of Funding
6.1 There are no financial implications arising directly from this noting report.
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Risk Assessment
7.1 There are no risks arising directly from this noting report. The report seeks to discuss
some of the risks there are to the health and social are systems as a whole as a
result of the challenges it is facing, the lack of clarity about the investment required
to deliver change, the slow pace, and small scale of changes to date, and the lack of
national level clear leadership on this issue. These are all risks that are relevant to
the work of the IJB.
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Conclusion
8.1 The IJB will want to be aware of the audit messages in its upcoming work and
decision making, particularly around the issues highlighted in section 4.3.2 of this
report.
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Author
Caroline Sinclair
Chief Officer
Integration Joint Board
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Contact details
[email protected]
01856 873535 ext. 2601
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Supporting Documents
11.1 Appendix 1 – Audit Scotland - Changing Models of Health and Social Care
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