A view of integration from a Chief Officer

Integration gives us the best platform from which to shape health and social care services for the future.

(Please note: Judith wrote this contribution when in her former role as Chief Officer of Aberdeen City Health and Social Care Partnership).

For most Integration Joint Boards (IJBs), April 2018 marks the 2 year anniversary of our ‘going live’ as new organisations and publishing our Strategic Plans, which set out how we’d deliver change though our Health and Social Care Partnerships (HSCPs).

While our ‘go live’ was an important milestone, we did recognise that it really marked the beginning, and not the end of the challenges ahead – of not only integrating significant elements of two organisations, but in relation to the wider, and longer term transformation of health and care services across Scotland.  That’s an enormous task and one that we continue to put huge effort into achieving.

So, in the two years since going live, what have we achieved in the new integrated partnerships and what’s yet to be done?

What were we set up to do?

Integration, as a policy, set out to do nothing less that shift the balance of care and transform the health and care system in Scotland.  We were set up as IJBs and HSCPs to achieve a number of things:

• Develop seamless, person centred health and care services and ensure that people don’t feel the join and can navigate them easily, accessing what they need, when they need it and which are based on self-care, and care close to home as possible.
• Support and sustain thriving and innovative primary and community care services, which are truly multi-agency and multi-disciplinary in their nature.
• Creating, through the development of localities, a move towards community empowerment and participation in planning for health, social care and wellbeing.
• Tackling long standing health inequalities and improving health and wellbeing.
• Sustaining service provision that’s safe and effective and delivered as close to home as possible while managing the challenge of our changing demography and the increase in complex multiple conditions and frailty.
• Work in partnership across all agencies that support health and social care.

We have a huge task in front of us still but in Aberdeen City we’re also hugely ambitious about the potential to transform our services and our plans set out those ambitions and the change we aspire to make.

What have we achieved?

Aberdeen HSCP has an agreed and broad ranging transformation plan in place.  This sets out the 6 ‘big ticket’ change items that we’re focussing on to help us achieve the shift in the balance of care, and the outcomes we want to see.  There’s not space here, but if you’re interested you can find much more information about our IJB, our performance and our plans on our website (this link will take you away from our website)

Through the work we’ve been doing, I believe we can point to tangible change and improvement in a number of areas and I’ve set these out below:

• We’ve delivered a sustained and significant reduction in the number of people who have been delayed in an acute hospital setting and who are ready to go home – known as Delayed Discharges. We’ve seen an almost 70 per cent drop in the number of people delayed, which means that more people are being cared for at home or in a homely setting with the care they need.  It also means that acute healthcare services are freed up for people that need them.
• More of our health and care teams are working as integrated teams and are being given the authority to make the right decisions for the people they support. For example, our hospital-based teams are fully integrated and work across social work, nursing and allied health professionals to make decisions that support us in getting people out of hospital with the care they need.  They rarely need to escalate decisions and work very positively with our third and independent sector providers so that we can do the right support for people.
• We’re live and testing two new self-managing teams, implementing the Buurtzorg principles. Our first two Integrated Neighbourhood Care Aberdeen (INCA) teams are up and running and the teams are made up of District Nurses and Care Assistants.  These teams are self-managing, supported by coaches and empowered to deliver 24/7 care and support to their case load.
• We’ve rolled out the principles of the staff engagement tool iMatter across our staff in the HSCP and have had very encouraging feedback with a high response rate and over 73 per cent of those reporting being very engaged in the organisation, informed about decision making and feeling involved. This gives us an excellent baseline to from which to improve in future years.
• Our 4 localities are at the point of going live – this will see most of our health and care operations being delivered within a locality in the city, focussing increasingly on locality and community need and in planning services with the people we support.

Progress is being made and while this piece focusses on my HSCP, I’m certain that much of this would be reflected across Scotland with new models and improved outcomes being reported in everyone’s annual performance report.

These are challenging times to work in.  The financial challenge has never been greater, and our population needs are changing.  However, I believe that it’s that which gives us the greatest opportunity for transformation as traditional models and approaches are not going to be sustainable.  We can and must change and we have an opportunity to be creatively disruptive as we do so.

There is much still to do, and the mechanics of integration and its governance are complex.  However, I absolutely believe that integration gives us the best platform from which to shape health and social care services for the future and to support us in a sustained focus on addressing long standing and unacceptable health inequalities in our communities.

Judith Proctor can be found on Twitter at @JudithProctorCO (this link will take you away from our website).

Judith’s Opinion is part of the ALLIANCE’s ‘We Need To Talk About Integration’ anthology which is available at the link below.

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