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AHPs: Driving Quality and Transforming Care Across ScotlandActive and Independent Living Improvement Programme
Anticipatory Care, Early Intervention and Wellbeing
Anticipatory Planning Programme BoardFriday 21st October 2016.
1. What matters to YOU as an individual to keep you healthy, active and independent? < 3000 responses
2. Thinking of what AHPs could do in Health and Social Care in the future what should we focus on to make services the best they can be?
< 3000 responses
• Thinking of what AHPs could do in Health and Social Care in the future what should we? < 2000 responses to Q3
AHP Strategic Vision – 2015 and beyondPowerful Questions
2
VISION“Allied Health Professionals will work in partnership with the people of Scotland to enable them to live healthy, active and independent lives by supporting personal outcomes for health and wellbeing”
AMBITIONS•AHPs promoting Health & Well Being and early intervention•AHP Services are easily accessible•All stakeholders are aware of AHP Services•AHPs working in Partnership •AHPs delivering excellence through research and innovation•AHP Workforce equipped to contribute to future health and social care requirements of population
What matters to YOU as an individual to keep you healthy, active and independent?
Thinking of what AHPs could do in Health and Social Care in the future what should we focus on to make services the best they can be?
Thinking of what AHPs could do in Health and Social Care in the future what should we
Scottish Social Work Vision and Strategy 2020Key Themes from Occupational Therapy Engagement Events 2016
• Leadership – Local and National
• Workforce– Effective Utilisation of Occupational Therapy Workforce– Career Pathways– Training and Development
• Service Quality and Performance– Measuring Impact– More effective use of staff for early intervention and rehabilitation
• Improving Use of Evidence– Access to best practice– Use of evidence based practice– Opportunities to participate in research
• Promoting Public Understanding
AILIP Logic Model Scoping Inputs Outputs OutcomesScoping Inputs Outputs Outcomes
Situation Ambitions Priorities Resources Activities Engagement Short -Term Medium-Term Long-Term
Health & Well-being
Access
Awareness
Partnership Working
Research & Innovation
Workforce & Practice
Transformation
Well Being
Children & Young PeopleSTARTING WELL
Vocational RehabilitationLIVING WELL
MusculoskeletalProgrammeLIVING WELL
Falls & FrailtyAGEING WELL
Anticipatory CareAGEING WELL
DementiaLIVING WELL & AGEING WELL
E-Health includingOperational Measures / Workforce Tool
TEAM
CHPO & Team
Programme Director
(1 X WTE)
IA(3 x WTE)
National Leads
(? X WTE)
Partners/Suppliers
ADSG
H&SC Partnerships
Public
3rd Sector
ISD
Centre of Excellence for
Rehabilitation
Research
SAS
NES
HIS
NHS 24
Awareness• Increase awareness across H&SC Partnerships and other
partners of AHP contribution to the National Outcomes
Access•Utilise technology to support access and care allocation•Ensure visible routes for people to access AHP services•Simplify processes for inter AHP referrals across services•Ensure timely access into services to promote early intervention.•Provide flexible services to meet demands
Workforce & Practice Transformation•Ensure optimum number of AHPs working in the right settings to maximise impact•Support staff development to ensure competent, skilled and knowledgeable workforce•Support AHP workforce to undertake the cultural transformational change that will be required to drive the AHP contribution to support the H&SC agenda
Research & Innovation•Identify innovative ways of service deliver to provide better outcomes for users•Work with Partners to spread Innovation through technology to transform AHP delivery•Ensure R&D will underpin any service development where appropriate•Develop partnerships between academic institutes and AHP services
Partnership Working• Contribute to multiagency pathways• Collaborate to enhance quality of care• Develop and implement new integrated models of care and
support
Knowledge Management
•Capture and report learning and outputs from AILIP and other National Programmes
•Report impact through AILIP Measurement Framework
•Communicate AILIP through Managed Knowledge Network
Stakeholders
Public
H&SCP
NHS Boards
Third Sector Care providers
General Practise teams
Community Health Teams
Housing Organisations
Local Authorities
Other Improvement Programmes
National Policy makers
Universities / Colleges (HEIs)
AHP Federation
International Partners
Community Planners
Improvement Bodies
The transformational learning around access will be spread to all AHP Services
AHPs will work in partnership with the people of Scotland to enable them to live healthy, active, and independent lives, by supporting personal outcomes for Health and Well Being.
The ethos of Active and Independent Living will underpin all community development.
AssumptionsAssumptions AILIP will have required staff and
financial resources to deliver act ivies
Monitoring and evaluationMonitoring and evaluation Available Work Days, Team Workload,
Budget Variance
H&SCP will have the will and capacity to engage with local
AILIP improvement activity
AILIP will have access to and be able to
influence development of dataset and E-
Systems.
AILIP can capture local learning that is
relevant and transferrable to other
H&SCP
AILIP will reach all relevant officers in
H&SCP across Scotland
AILIP will have the capacity to put
learning into practice.
Engagement with: test H&SCP, National Bodies,
Partners
Project Progress, Risk & Issues, Governance
Actions
Diagnostic Support, testing
Support, Evaluation
Support, Writing-up
Projects that Demonstrate
improvements and efficiencies
Learning Events, Learning WebEx,
Learning Resources, Local
Support
Event Contributions, Publications, Blogs, Tweets
Engagement Spread, Social Media Reach,
Website Usage, Inbound Info
Req.
Scottish Government no longer identifies
AHP contribution to H&WB as a priority
Please refer to Individual Work streams for additional assumptions
Please refer to Individual Work streams for additional Measures
External FactorsExternal FactorsPlease refer to Individual Work streams for additional external factors
Short Term Outcome
Medium Term Outcome
Long Term Outcome
Resources agreed and developed to support self management, early intervention for H&WB
The benefits of technology to drive self management, early intervention and H&WB will be spread
Spread of multi-agency partnership working will be accelerated to support self management, early intervention for H&WB.
Population will have direct access to an AHP where appropriate
Population will have access to once for Scotland evidence based resources to support self management, early intervention for H&WB
Population will benefit from technologies to support self management, early intervention for H&WB
Population will benefit from multi-agency pathways to support their self management, early intervention for H&WB.
Appropriately skilled and developed workforce is contributing to the health and care needs of Scotland in a cost efficient and person centred way.
Health & Well Being (Physical & Psychological)•Promote Health and Well Being•Promote early interventions into AHP services for both physical and mental health problems•Produce evidence based self management information in a range of formats•Promote brief interventions to address both physical and mental health problems
Testing of workforce tool and development of staff to undertake transformational change
Workforce tool influencing requirements and staff leading transformational change
Introduction of Health & Well-Being Outcomes
Increased Focus on Personal Outcomes
Lack of Awareness of the AHP contribution to H&SC
Long waits to access many CYP & Adult AHP Services
High number of population with disabilities not in employment
Aging Population living with complex needs utilising more resources
Underutilisation of technology to drive innovative practice
Increased Demand on Health & Social Care Services
Integration of Health & Social Care
Increasing Challenges on GP and Primary Care Services
Health & Social Care Workforce Challenges
AHP Active and Independent Living Improvement Programme Priorities 2016-18
Well Being • Promote a Personal Outcomes approach across all AHP services• Enhance the role of good nutrition to support well being• Enhance the communication environment to support wellbeing• Promote physical activity to support well being• Promote screening for early diagnosis and intervention
Children & Young People (CYP)• Deliver on Ready to Act ambitions• Undertake pilot projects relating to 5 ambitions with selected Health and
Social Care Partnerships• Drive contribution to transformation change plans in Primary Care• rive contribution to transformation change plans in Primary CareVocational Rehabilitation (VR)• Identify Current State of VR in Scotland• Align work to the Health, Disability & Employment project in SG• Drive implementation of AHP Fit Note• Enhance approaches to VR in all AHP services• Drive contribution to transformation change plans in Primary Care
Musculoskeletal Programme (MSK)• Utilising technology to support access and care allocation• Enhance approaches to self management and well being• Create efficient pathways across acute, community and 3rd sector• Drive contribution to transformation change plans in Primary Care
Falls and Frailty• Support full implementation of the Framework for Action 2016-20• Enhance approaches to falls prevention and frailty• Partner with HSCP to drive falls/frailty ambulance pathways• Drive contribution to transformation change plans in Primary Care
Anticipatory Care (AC)• Create Pathways to facilitate AC planning• Support AHP workforce to have “good conversations”• Undertake pilot projects to test AC approaches• Drive contribution to transformation change plans in Primary Care
Dementia• Deliver on AHP Connecting People Connecting Support Policy• Increase awareness of contribution to living well with dementia • Influence and integrate AHP contribution with national transformational
changes • Drive contribution to transformation change plans in Primary Care
Operational Measures / Workforce Tool• Interrogate available data from existing systems• Align Operational Measures to National Data sets• Full Role out of Operational Measures to all AHP Services• Create an AHP workforce workload measurement tool
AILIP Measurement Plan: Core Measures(Draft Mental Health Strategy measures)
Health and Wellbeing
• People accessing and reporting benefit of self management
• More people who have AHP interventions earlier on their “Lifecurve”
Personal Outcomes
• People report improved quality of life and achieving what is important to them
• More people have interventions based on “good conversations”
• People report improved choice and control over what matters to them
Access
• People are accessing AHP services via “request for assistance”
• People referred via GP/GP Directed
Partnership Working
• People referred/signposted by AHPs to non health and social care support
• More multiagency published pathways
Workforce
• AHP staff contributing to the Workforce Workload Measurement Tool and AHP H+SC Workforce
• Partnership areas implementing Operational Measures
Research and Innovation
• AHP technology interventions/initiatives aligned to the Scottish Centre for Telehealth and Telecare
Preparing Ahead…?• What are the most difficult topics?
• Who will look after me when I’m older(42%)• Where will I live if I can’t remain in my current home (34%)• What kind of end of life care I want (46%)
• Are they important questions to ask?• 80% of people over 65 years think so• 80% of their relatives think so
“We need to talk about caring: dealing with difficult conversations” Independent Age July 2016
However……• 60% of people over 65 years haven't had this conversation (delayers) and• 30% aren't even planning to (deniers)
• 20% of relatives have actually had this conversation, despite• 41% of people who thought their loved one had died well when their wishes
were formally recorded
• Independent Age recommendations include: better information, better knowledge about options (including care homes) and addressing peoples’ denial.
Anticipatory Care – AHP role within AILIP• Long term impact
• People will have knowledge, resources and confidence to plan their future health and wellbeing
• AHP workforce will be confident in having outcomes focussed conversations which help people plan for their future
• Activities include:• Developing resilience and confidence• Brokering support networks• Personalised education/advice• Personal outcomes approach embedded across AHP services• Identification of partners for early intervention
Compressed functional decline orCompressed functional decline or the Lifecurve the Lifecurve
functional
cognitive
risk
care
connections
health
Time elapsed after joining the curve
Why individual-specific matters
“Effects of structured physical activity on prevention of major mobility disability in older adults” Marco Pahor et al 2014
Current activity• Embedding a personal outcomes approach – exploratory Good Conversations
• Synergy with improvement methodology• Partners include House of Care, Public Health, Care Inspectorate, NES, Living Well in
Communities, Primary Care, NMAHP research, Alliance Scotland
• Compressed functional decline – Lifecurve activity• Map AHPs across Scotland – where are they intervening? At what stage on the Lifecurve?
• Forth Valley Test of Change– at the start of the curve – across NHS and Third Sector
• Take a personal outcomes approach – what matters to you?• Identify where the person is on their Lifecurve• Identify where there is a falls risk• Identify where a person may benefit from an Anticipatory Care Plan (at an earlier stage)
Thank you!
My contact details:Susan Kelso, AHP Lead Early Intervention Scottish GovernmentEmail: [email protected] or [email protected]
Phone: 0794 308 3735Twitter: @susankelsoAHP
