The Improvement Hub (ihub) and Information Services Division (ISD) support the Scottish Government Health and Social Care Delivery Plan 2017, recognising the requirement to “increase the value from, and financial sustainability of, care by making the most effective use of the resources available to us and the most efficient and consistent delivery, ensuring that the balance of resource is spent where it achieves the most and focusing on prevention and early intervention.”
Collectively, National Bodies will provide support to strategic planning and commissioning to the Integration Authorities (IAs) and NHS boards in a collaborative way. The collaboration between Healthcare Improvement Scotland (HIS) and ISD to bring together analytical and improvement support will be core to this. Support from ISD and the ihub will be coordinated through a single point of contact, simplifying access to practical assistance for Partnerships.
The support offered is based on good practice in service planning and redesign and follows the tested ihub approach, bringing consistency with other programmes of work. Support includes planning (analysis and modelling of current and future use), design, implementation and evaluation.
The support is available to strategic planning groups, locality planning and community planning groups. It includes support with a co-production approach, using methodologies which support the ability of communities and their representatives to engage meaningfully and equitably in the process. This support will extend to communities, service users and carers representation using the Our Voice framework or similar to enable effective engagement.
Support will be provided from the ihub within Healthcare Improvement Scotland through access via the IAs relationship manager with access to the Tailored and Responsive Support Team (TRIST), or the Strategic Commissioning Support Unit and linked to the relevant programmes of improvement support where appropriate. Support will be provided from ISD through the Local Intelligence Support Team (LIST) analysts already deployed.
Current examples of practical support include:
|Examples||Description and Outputs
|Delayed Discharges, Bed Days||Focus on delayed discharge, looking at who is delayed, where they are from and to look at pathways and reasons for admissions in first place.
|Unscheduled Care -A&E, Emergency Admissions
||Analysis of potentially avoidable admissions and repeat attendees to emergency departments. Contributing analysis and evidence to a clinically led, short-life working group focusing on evaluating the scope and potential methods for reducing avoidable emergency admissions.
|Performance reporting and frameworks||Collaboration between Healthcare Improvement Scotland and the Partnership to develop secondary care baseline data measurements and control charts by locality to identify the impact of the test of changes.
|Modelling and flows||Contribute to system dynamics modelling project to model current model of care for older people and people with complex care needs. Test out changes in system simulation and make recommendations for changes to the system.
Project rates of emergency admissions, emergency bed days and average occupied beds between now and 2035 using NRS population projections to estimate new beds required. Delayed discharge bed days projections for 65+ population in 2016/17 broken down by month.
In developing these support arrangements ihub and ISD intend to adopt a phased approach to interaction with Partnerships:
Create the conditions for change and use local evidence and qualitative / quantitative data analysis to agree collaborative pathway redesign.
Develop the leadership and engagement between e.g. Partnerships, strategic planning group(s) and acute service leadership for a shared vision for shifting the balance of care.
Phase 2: Design, model and appraise options to deliver required outcomes.
Develop locality based co-produced options of alternative provision.
Develop options appraisal for consultation with community / service users.
Work with acute team to estimate effects such as:
- Service change and flow to estimate effects on bed usage
- Changes / increase in community based services required
- Identify savings from service change, and net cash release.
Phase 3 Work with strategic planning group and acute to develop joint implementation plan for re-provision of service capacity to community to ensure pathway change seamless for service users
Phase 4 Evaluate change and ensure process improvement tools incorporated into implementation plan and identify where unintended consequences causing pressures.
For further information contact hcis.StrategicCommissioning@nhs.net