House of Care works to make Care and Support Planning conversations routine for people with long term conditions and support self management

Scotland’s House of Care offers a useful, locally adaptable framework. It builds a shared understanding of the critical success factors required to turn the rhetoric of health and social care, and primary care policies, into every day implementation.

It does this though practitioner training which develops a person centred ethos while building skills and leadership, underpinned by supported self management principles.

It strengthens patient and staff health literacy capabilities, and builds knowledge of and relationships with local community assets and resources.

Scotland’s House of Care programme is a collaboration between the ALLIANCE, six partnership areas across Scotland (Lothian/ Thistle Foundation, Greater Glasgow & Clyde, Tayside, Lanarkshire, Ayrshire & Arran, and Grampian), the Scottish Government, and Year of Care Partnerships. Valuable support has been received by British Heart Foundation. It also has close connections with the Royal College of General Practitioners (RCGP).

It has built on over a decade of experience of the practical implementation of collaborative care and support planning for people living with one or more long term conditions in General Practice.

It helps people be more involved in decisions about their care and identify what matters most to them. It also identifies and aligns self management resources within communities in support of their goals. Local evaluation and experience suggests it improves public and practitioner satisfaction, develops meaningful person-centred quality improvements, and enhances system transformation. It also seeks to address health care inequities and support public health aims.

It does this by preparing people through information gathering and sharing prior to a collaborative conversation involving goal setting and action planning. This promotes empathy, enablement and an active role for people and their carers.

Important information is gathered about individual support needs. This information can be aggregated at regional, locality and GP Cluster level to inform the provision of self management support (‘More than Medicine’) in local communities and help realise enhanced public health.

Case for Change to a Care and Support Planning HoC Approach in Integration and Primary Care Landscape

The shift from the process-driven approach of the Quality and Outcomes Framework (QOF), to the collaborative, personalised care and support approaches of Realistic Medicine, requires major shifts in values, relationships and care systems.

One of these shifts is in a stronger emphasis on the conversations at the heart of healthcare focussed on care and support planning, rather than capturing outputs in a range of plans. While the latter is important, the value of these plans lies not just in their content but in their practical creation through a collaborative and positive relational process between people and their professionals.

As Health & Social Care Partnerships develop and finalise their primary care improvement plans, it is important that they consider the support that health care professionals will need to implement care and support planning.

We strongly recommend explicit inclusion of a commitment to develop the principles of care and support planning and Scotland’s House of Care. If not, there is significant concern that the out-dated QOF-based approach will stop practitioners and people from realising the quality and potential within the new contract.

ALLIANCE Programme Leadership

Within the ALLIANCE, Scotland’s House of Care is located within the Self Management and Co-production Hub, which works to support the delivery of health and social care integration and transformation of primary care. Working with the other ALLIANCE programmes, Integration Support, the Self Management Fund, Self Management Programme and Self Management Network, Scotland’s House of Care Programme aims to enhance self management and emphasise a person centred approach in Primary Care.

For further information please contact; William Kloverod Griffiths, Development Officer  – House of Care william.griffiths@alliance-scotland.org.uk