Stakeholder
presentation
23 March 2017
Content
• Issues to address
• Our vision
• Locality management teams
• Our operating model
• Phase 3 and next steps
Main issues to address
In place since April 2016, the IJB faces a number of challenges:
• Hospital delayed discharge
• Delays in the community for packages of care and care home places
• Budget reduction of 6%
• Integration of health and social care services across the Council and
NHS Lothian
Our vision
• To provide the right care, in the right place, at the right time.
• Offer a truly joined up approach across all health and care
pathways.
• Deliver services in four localities, each with
– an early intervention hub,
– two clusters for longer term services, and
– a mental health and substance misuse services team.
• Four Multi-Agency Triage Teams (MATTs) will provide the triage
decision making and referral routes to services.
Locality management teams
North West
North East
Marna Green
Angela Lindsay
Locality Manager
Locality Manager
Aileen Kenny
Alison Meiklejohn
Marian Gray
Eddie Balfour
Cluster Manager 1
(Bridge)
Cluster Manager 2
(Zoo)
Cluster Manager 1
(Leith)
Cluster Manager 2
(East)
Anne Walker
Vacancy
Fiona Stratton
Graeme Mollon
Hub Manager (Interim)
MH and SM Manager
Hub Manager
MH and SM Manager
South West
South East
Andy Shanks
Nikki Conway
Locality Manager (Interim )
Locality Manager
Patrick Jackson
Fiona Wilson
Catherine Mathieson
Cluster Manager 1
Cluster Manager 2
Cluster Manager 1
Cluster Manager 2
(Pentlands)
(Canal)
(Liberton/Gilmerton)
(City and south central)
Sylvia Latona
Mike Reid
Dawn Arundel
Vacancy
Hub Manager
MH and SM Manager
Hub Manager
MH and SM Manager
Elaine Hamilton
Our operating model
Chief Social
Work Officer
The City of
Edinburgh Council
Chief Executive
Edinburgh
Integration Joint
Board
NHS Lothian
Chief Executive
NHS Lothian
Director
Allied Health
Chief Officer
. Professional governance, safeguarding and quality
assurance for social work and statutory services
Locality
Manager
NW
Locality
Manager
NE
Locality
Manager
SW
Locality
Manager
SE
Operational locality service delivery
Chief
Strategy
and
Performance
Officer
Chief
Finance
officer
Chief
Nurse
Hospital
and
Hosted
Services
Manager
Chief
Medical
Officer
Strategic planning support function
Multi Agency Triage Team (MATT)
Monitoring
Hub
Manager
Hub
Manager
Hub
Manager
Hub
Manager
Quality
assurance
2 x Cluster
Manager
2 x Cluster
Manager
2 x Cluster
Manager
2 x Cluster
Manager
Mental Health
and Substance
Misuse
Mental Health
and Substance
Misuse
Mental Health
and Substance
Misuse
Mental Health
and Substance
Misuse
Manager
Manager
Manager
Manager
Public
protection
Service
improvements
Strategy, Planning
and Quality
Manager
Strategy, Planning
and Quality
Manager
Older People
Disabilities
Strategy,
Planning and Quality
Manager
Strategy,
Planning and
Quality Manager
Mental Health and
Substance
Misuse
Primary Care
and Public
Health
Strategy, Planning and Quality Managers’
central responsibilities
• Managing central services
• Strategic oversight and governance
• Innovation, future planning and policy development
• Service monitoring and quality assurance
• Risk management and assurance
• Public protection
• Representing IJB for service areas and on Govt groups
Locality structure
Multi-Agency Triage Team
Hub Manager
Locality Manager
Cluster Manager
Hub, clusters and
mental health and substance misuse
Senior Social Workers
Social Workers
Senior Occupational Therapists
Hub Occupational Therapists
Community Care Assistants
Home Care Coordinators
Home Care Organisers
Reablement Coordinators
Reablement Social Care Workers
Mainstream Social Care Workers
Social Care Assistants
Physiotherapists
District Nursing
Mental Health and Substance Misuse Nursing
Mental Health Officers
Cluster Manager
Residential, day and
outpatient facilities
Drumbrae Care Home
(NW)
Drumbrae Older People’s Day Care
(NW)
Granton Day Care
(NW)
Gylemuir Care Home
(NW)
Royston Court Care Home
(NW)
Ferrylee Care Home
(NE)
The Jewel Care Home
(NE)
Leith Community Treatment Centre
(NE)
Marionville Care Home
(NE)
Portlee Older People’s Day Care
(NE)
Clovenstone Care Home
(SW)
Ford’s Road Care Home
(SW)
North Merchiston Older People’s Day Care (SW)
South West Treatment Room
(SW)
Inchview Care Home
(SE)
Oaklands Care Home
(SE)
Mental Health Care and Support Services (City)
Mental Health and
Substance Misuse
Manager
Acute and
rehabilitation facilities
Western General Hospital
Royal Victoria Building
(NW)
(NW)
Royal Edinburgh Hospital
(SW)
Edinburgh Royal Infirmary
Astley Ainslie Hospital
Liberton Hospital
(SE)
(SE)
(SE)
Proposed referral pathway
MATTS, Hubs and Clusters
Public referrals: no change
Police referrals of adult concern forms
Professional referrals routed to Hub
Hospital Discharge Hub
Care Direct
Log all referrals onto data systems
Progress new referrals to Locality Hub
Progress open referral to responsible team
Professional MHO line: no change
Processed as emails, pro-forma e-referrals
(shared systems), phone calls and SWIFT workflows
No further action
Advice given or
signposted to
3rd sector
or other service
Daily multi-agency huddle
(Police Scotland)
HUB
MATT
Cluster 1
Mental Health and
Substance Misuse Services
Addiction
Hub
Public self-referrals
Cluster 2
Hospital Social Work Provision
Focus on preventing avoidable hospital admission and ensuring that anyone
admitted to hospital can be discharged quickly and safely, with the right
services available in the community.
People in hospital remain the responsibility of their Locality team. When they
are ready for discharge, the Locality Managers will be responsible for ensuring
they are moved on from hospital in line with Scottish Government standards.
Changing face ofThe
hospital
services
reductionservices
in the number
beds available
over
many of
years
changing
faceand
of hospital
and theofreduction
in the
number
beds
means a changeavailable
to currentmean
socialthat
workapractice
whilst work
retaining
the benefits
of having
a
change istorequired,
current social
practice
is required,
whilst
presence in hospitals
retaining the benefits of having a presence in hospitals.
Operating principles for HSW model
Service users and families should
not make decisions about long
term care from an acute ward
The focus of hospital SW will be
on discharge planning
Full assessments of a person’s care
needs will not be undertaken in an
Referrals for social care will be
acute setting.
allocated within 24 hours to
medically
fitavailable
for discharge,
Changing face of hospital services and reduction inOnce
the number
of beds
over many years
complete
an
initial
assessment
means a change to current social work practice is required,
whilst
benefits
the person
willretaining
returnthe
home
or toof having a
and
plan
discharge
presence in hospitals
interim care (Liberton/Gylemuir)
for long term planning
Strategy management team
Maria McILgorm
Chief Strategy and Performance Officer
Colin Beck
Katie McWilliam
David White
Vacant
Strategy, Planning
and Quality Manager
Strategy, Planning
and Quality Manager
Strategy, Planning
and Quality Manager
Strategy, Planning
and Quality Manager
Older People
Primary Care and
Public Health
Disabilities
Mental Health and
Substance Misuse
Centrally managed
Mental Health and Substance Misuse Services
Colin Beck
Strategy, Planning and Quality Manager
Mental Health and Substance Misuse
Inclusive Mental
Health and
Homelessness
Manager
Housing
Officers
Homelessness
Health Services
Social Workers
Mental Health
Care and Support
Services
Senior Social
Worker
Robert Ferguson Unit
Mental Health
Officer
Service Manager
Emergency
Social Work
Team Leader
Social Worker
Senior
Practitioners
Orchard Clinic
Emergency
Social Work
Services
Learning Disability
SP/MHO
Social Worker
Emergency
Home Care
Appropriate
Adult Services
SCD Senior
Practitioners
Centrally managed
Older People Services
Katie McWilliam
Strategy, Planning and Quality Manager
Older People
Equipment Service
Manager
Assistance
Equipment
Service Manager
Stores
Team Leader
Telecare
Team Leader
Community
Equipment
Service SOTs
Operations
Team Leader
Storepeople
Occupational
Therapists
Equipment
Technicians
Equipment
Cleaners
Community
Care Assistants
Emergency
Call Handlers
Mobile Telecare
Support Officers
Customer
Support Officers
Delayed Discharge
Business Manager
Primary Care and Public Health
Chief Officer
Ian McKay
Chief Medical
Officer
Chief Strategy and
Performance Officer
David White
Strategy, Planning and Quality Manager
Primary Care and Public Health
Structure being developed in Phase 3
4 x Locality
Clinical Leads
8 x Quality Leads
One in each cluster
4 x Locality
Pharmacy Leads
Centrally managed
Disability Services
Vacant
Strategy, Planning and Quality Manager
Disabilities
Interim Disability Service Manager
Disability Manager
Complex Care
Services
Disability Manager
Community Support
Disability Manager
Support Works
Craighall
Disability Manager
Transitions, LAC
and PD Support
Senior Social
Worker
Transitions
Castle Crags + Firhill
Castle Crags
Services + staff
Firhill
Services + staff
Craighall
Services + staff
Support Works
Services + staff
PD Support
Service
Shared Lives
Supported
Lodgings
Local Area
Coordination
Team
Edinburgh
Community
Stroke Service
Social Workers
Transitions
Chief Nurse
Vacant
Chief Nurse
HBCCC
Clinical
Nurse
Manager
HBCCCs
Astley
Ainslie
Rehab
Nursing
Services
Sexual
Health
Clinical
Nurse
Manager
Nurse
Consultant
Sexual
Health
Nurse
Consultant
Palliative
Care
Interim
Clinical
Nurse
Manager
IMPACT nursing
Evening Nursing
Service
Hospital Discharge
Facilitators
Outpatient Clinical
Continence Service
Hospital and Hosted Services
Sheena Muir
Hospital and Hosted Services Manager
Delayed
Discharge
Manager
(NHS)
Astley Ainslie
Head of
SMART
Services
Heart
Manual Lead
Continence
Service
Operational
Manager
Directorate
Assistant
Phase 3 Developments
In the next phase of our organisational review we will look at:
•
Community Alarm and Telecare Service
•
Community Equipment Store
•
Service Matching Unit
•
Carers’ and Long-Term Conditions Services
•
Primary care
•
Disability Services
•
Emergency Social Care
(Social Care Direct, the Out of Hours Service + Emergency Homecare)
We will also look at our support services including Administration,
Business Support, Contracts, Finance and Strategic Planning.
Next steps
•
Locality Managers and Strategy Managers are working on
transition plans for moving to locality working.
•
This includes contingencies for staff who have been leaving
the organisation during February and March.
•
Our move to a locality operating model will be carried out in
a safe and planned way.
•
We will do this in stages, based on minimum disruption to
clients and staff.