Glasgow City CHP

Item No.

7 CHP Committee

Meeting Date: Paper No 2014/055 Subject: Joint Inspection of Social Work and Health Services for Older

People Presented by: David Walker, Sector Director, South Sector Recommendation(s)

The Committee notes the contents of the report and attached documents: • Position Statement submitted to The Care Inspectorate and

Health Improvement Scotland on 2nd September 2014. • Summary of the Quality Indicators on which performance will be

measured Summary/ Background

Glasgow City is currently being formally inspected in relation to the health and social care provided to older people. It is included in the first wave of local authorities to be inspected based on the experiences of four test sites (Aberdeenshire, Angus, Fife and Inverclyde). The inspection is being carried out by Healthcare Improvement Scotland and The Care Inspectorate and the theme is, “ how well health and social care services work together to support adults over 65 years to remain in their own homes or in a homely setting in their own communities”. The joint inspections are intended to align with the Scottish Government’s policies for the integration of health and social care, including Re-shaping Care for Older People, the dementia strategy and adult protection arrangements. The inspection process comprises of a number of different processes including self assessment (submitted as a position statement), a staff survey, case file audit ( a sample of 100 health and social work files), contact with patients and carers, focus groups with a range of staff, managers, elected members, Board members and partners, attendance at relevant meetings. The inspection team will be present in the city over three separate weeks; 13 October, 3 November and 17 November. The inspectors' draft report will be shared with senior managers before a final report is published and made publicly available in early 2015.

Update The first stage of the process, the submission of a position statement, was completed on the 2nd September 2014. A copy of this submission is attached along with a summary of the quality indicators. The position statement provides a self-evaluation of social work and health performance against each quality indicator, with 25 areas for development / improvement identified in the final section. A full range of supporting evidence was submitted confirming the current position. The staff survey was available for staff to complete over a four week period and this closed on 26th September 2014. 150 cases (100 actual+ 50 reserves) for sampling have now been

identified. The case audit will take place week beginning 13th October 2014 and will involve 10 inspectors and four managers from the Council and the CHP. Inspectors will use the second week to follow up on 20 of these cases. This will involve meeting the patients, carers and relevant professionals. The final week will be used as a scrutiny week whereby inspectors will attend a range of meetings / focus groups across the city which will inform their view on our approach to and performance in relation to older people’s services.

Policy/ Legislative Context

Section 115 of the Public Services Reform (Scotland) Act 2010 and its regulations set out the framework for the conduct of joint inspections. This included the lawful exercise of the inspection of case records.

Financial Implications

There are no financial implications.

Human Resources Implications

Stephen Fitzpatrick, Head of Adult Services and David Walker, Sector Director are jointly leading this process, supported by Ann Cummings Planning and Performance Manager (GCC) and Rhoda Macleod, Adult Services Manager, (CHP).

Service User/Carer Engagement

There will be service user and carer engagement as part of this process. Service users and carers will be provided with full feedback of the outcome of this joint inspection.

Equalities Implications

N/A

FoI/EIR Status tick If not to be made public, exemption

(Section/Regulation) to be relied on under FoI/EIR legislation must be inserted below. Public

Not Public

Contains Personal Data – DPA applies

S.38

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Position Statement for the Joint Inspection of Older People Services

in the Glasgow Area.

2 September 2014

Introduction for briefing purposes This report is the position statement submitted by GCC and Glasgow City CHP on 2 September 2014 as part of the Joint Inspection of Older People Services in Glasgow City. This Joint Inspection will be carried out by the Care Inspectorate and Health Improvement Scotland. This submission forms the first stage of the inspection process and provides a self evaluation of the current partnership approach to strategic planning and operational delivery of services to Older People across the City. This report and other documentation relating to the joint inspection can be found on NHS Staffnet using the following link http://www.staffnet.ggc.scot.nhs.uk/Partnerships/CHPs/GC/Pages/JointInspectionOfOlderPeople'sServices2014.aspx

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Contents Page No. Cover page 1 Introduction for briefing purposes 2 Contents 3 Introduction 5/6 1. 1.1

Key performance outcomes Improvements in partnership performance in both healthcare and social care

7/8

1.2 Improvements in the health and well-being and outcomes for people, carers and families

9/10

2. 2.1

Getting help at the right time Experience of individuals and carers of improved health, well being care and support

11/12

2.2 Prevention early identification and intervention at the right time 13/14 2.3 Access to Information about support options, including self-

directed support 15/16

3. 3.1

Impact on Staff Staff motivation and support

17/18

4. 4.1

Impact on the Community Public confidence in community services and community engagement

20/21

5. 5.1

Delivery of Key Processes Access to Support

22/23

5.2 Assessing need, planning for individuals and delivering care and support

24/25

5.3 Shared Approach to protecting individuals who are at risk of harm, assessing risk and managing and mitigating risk

26/27

5.4 Older People and Personalisation 28

6. 6.1

Policy development and plans to support improvement in services

Operational and strategic planning arrangements

29/30

6.2 Partnership development of a range of early intervention and support services

31/32

6.3 Quality Assurance, Self–Evaluation and Improvement 33/34 6.4 Involving service users, carers and other stakeholders 35/36 6.5 Information & Evidence of Commissioning Arrangements 37/38

7. 7.1

Management and support of staff Recruitment and retention

39

7.2 Deployment, joint working and team work 40 7.3 Training, development and support 41

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8. 8.1

Partnership Working Management of Resources

42/43

8.2 Information Systems 44/45 8.3 Partnership arrangements 46

9. 9.1

Leadership and direction that promotes partnership Vision, values and culture across the partnership

47/48

9.2 Leadership of strategy and direction 49/50 9.3 Leadership of people across the partnership 51 9.4 Leadership of change and improvement 52

10. Key Areas for Improvement/Development 53 Summary of how the Partnership operates strategically 54

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Introduction The Glasgow City Partnership for Reshaping Care produced its first Joint Strategic Commissioning Plan in 2013. The plan covered the three year period 2013-16 and set out the key challenges and issues for the Partnership in shifting the balance of care. Demographics • there are 83,383 people aged over 65 living in Glasgow, approximately 13.9% of

the population of the City; • while the number of people aged over 65 is not projected to increase significantly

over the next three years (only 1.3% between 2014-17), there is an 8.4% increase expected in the number of those aged over 85;

• in the longer term there are expected to be more significant increases, with a 38.7% rise forecast between 2017 and 2037;

• since the 2001 census, the BME population in the City has more than doubled. From the latest census in 2011, the non-white ethnic groupings represented 11.6% of the total population (68,684);

• all health indices for Glasgow, including life expectancy are considerably below the national average with evidence of a Glasgow effect and early ageing. A male living in Glasgow can expect to have over 11 years ill health compared to the national average of 7.6;

• it is estimated that there are approximately 48,397 people considered to be vulnerable, just over half the elderly population in the City;

• it is estimated that there are 7,830 people aged over of 65 currently living with dementia in Glasgow. By 2023 this number is predicted to increase to 8,660. Of these, it is estimated approximately 13% will have severe dementia; 32% will have moderate dementia and just over 55% will have mild dementia

Balance of Care Key characteristics associated with health, social care and housing provision within the city historically, include the following • higher rates of emergency admissions per head of population in comparison to

other parts of Scotland; • higher numbers of delayed discharges and the associated number of acute

hospital bed days delays lost as a consequence; • higher care home provision in Glasgow compared to other local authorities; • average age of admission to care homes slightly below the Scottish average; • a high proportion of people in receipt of 10 hours or more home care; • a shortage of accessible housing with most of the housing stock in Glasgow of the

tenement type. Resources The total health and social care resource devoted to older people’s services in Glasgow was approximately £282m in 2013/14 of which £119m related to NHS expenditure and £173m social work. Over and above this, prescribing costs accounted for an additional £58m, Family Health Services £173 m and Change Fund £7.9 m. In analysing this resource across the reshaping care pathway developed by the Joint Improvement Team (JIT), approximately 44% of £290m is shown to be within the ‘hospital

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and care homes’ pathway, with 5% on ‘preventative and anticipatory care’. Approximately 32% was spent on ‘proactive care and support at home’ and 19% on ‘care at times of transition’. Transformational Change The health and social care system for older people in Glasgow faces enormous strategic challenges, particularly around levels of demand versus available resources, the management of expectations and changes to established cultures. All of these challenges will only grow more intense over the coming years as the full effects of austerity are felt. The current level of delayed discharges due to the absence of funding is one barometer of the pressures being experienced. There is recognition at the strategic leadership level that for need to be met in future a programme of transformational change based on risk acceptance and management of that risk is required. This will apply particularly to those with complex needs that have historically been supported in hospital and care homes, but that in the future will increasingly be supported in the community. There will be a growing emphasis on early intervention and prevention that provides support to older people proportionate to their needs and only for the time that support is required. Non-complex referrals will be responded to through early, 'purposeful' interventions that are preventative in nature and which meet the person's immediate social care needs whilst supporting them to regain and sustain the highest level of independence they can.

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1. Key performance outcomes Key features Evidence about the real difference and benefits that healthcare and social work services have made to the lives of individual families and communities.

1.1 Improvements in partnership performance in both healthcare and social care Main areas • Improvements in performance in health and social work services.

There is a strong commitment to performance management from both NHS Greater Glasgow and Clyde (NHS GGC) and Social Work Services. Evidence of each organisation’s performance management reporting is provided, but this section concentrates on areas of joint performance focus.

We can evidence progress by reference to delayed discharge, where the approach to management structures and processes have been strengthened and underpinned by action planning, which includes weekly meetings between senior managers from acute, community, social work services; fortnightly meetings with operational managers; and, monthly delayed discharge governance meetings. These meetings are driven by the collective use of information to jointly manage performance and drive improvement. There are a number of accountability points within the governance structure of Glasgow; these include the Joint Partnership Board, CHP Committee, the Board’s Strategic Unscheduled Care Group and the Council’s Health and Social Care Policy Development Committee. We can evidence progress against a number of key performance indicators: emergency admissions, bed days lost, reablement, carer assessments, anticipatory care plans (ACPs), home care direct ordering from hospital and Telecare. We can evidence progress against delayed discharges including AWI. While these numbers fluctuate, there was an overall reduction between 2012/13 and 2013/14 from 239 to 187. There are ongoing executive level discussions within Glasgow, involving Social Work Services, Acute and the CHP with the Scottish Government to rectify the current challenges associated with delayed discharge. These include funding challenges and system changes required to tackle immediate hospital pressures and to deliver transformational change before April 2015. This includes a shared aspiration to have all patients discharged within 48 hours of their fit for discharge date (FFD). We are collaborating on the implementation of the local unscheduled care action plan (LUCAP) which identifies key primary and community care actions to relieve pressures on unscheduled care. A joint performance framework has been established to oversee the implementation and gauge impact. The Intermediate Care Service is an example of a whole system response to achieve discharge targets and manage performance, including the use of a jointly agreed balanced scorecard approach for measuring discharge and step-down care performance. We can evidence that on average 23% of step down clients have returned home, with the remainder accessing long term care. It is reasonable to assume that most or all of those who have returned home would have in the past accessed long term care directly from hospital. However, funding constraints are now resulting in blockages in the system.

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The Power of Attorney Public Awareness Campaign provides a good example of a whole system response to Adults with Incapacity (AWI) delays. This initiative is anticipatory and supports people to take control of their future affairs whilst seeking to reduce the risk of unnecessary future hospital delays due to incapacity. The initial success of this campaign has highlighted external constraints to progress, such as the Office of the Public Guardian (OPG)’s inability to process higher volumes of applications timously. There is need to develop a more systematic outcome focused performance framework. As members of the Scottish Community Care Benchmarking Network we have contributed to the Health and Care Experience Survey 2013/14 and we will use the Glasgow results as a baseline for improving patient and carer experience. As partners we are outward looking as evidenced by benchmarking sessions on community and unscheduled care including challenges of delayed discharge that have taken place with Edinburgh, Renfrewshire, Dundee and Aberdeenshire. The partnership's drive for improvement is supported by a range of national policy drivers and we can evidence that these are driving service re-design and service developments. Examples of these include Glasgow Carers Partnership, Post Diagnostic Services for people with dementia, Intermediate Care, Anticipatory Care Planning, Falls and Community Reablement and Rehabilitation. All of these service developments are delivered in partnership by health and social care using current resources and time limited Change Fund spend and we intend to mainstream these so that they are available to all who need them. The report by the Audit Commission on Glasgow Community Planning Partnership of April 2014 highlighted the need to ensure effective joint working around health and social care integration in planning and delivering services on a locality basis. Both NHS GGC and Social Work Services have a well-developed complaints procedure that enables people to raise issues either directly or through an intermediary such as locally elected representatives. Reports are routinely made available to senior managers regarding complaints management performance and any themes requiring management action.

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1.2 Improvements in the health and well-being and outcomes for people, carers and families

Main areas • Improvements in outcomes for individuals and carers in health, wellbeing and quality of life.

The Reablement service provides an example of where the partners have worked together to deliver improvements in the health and well being of older people and their carers. Investment by the Change Fund has delivered a service reform programme whereby Community Rehabilitation Service, Social Work Occupational Therapists (OTs) and Cordia home care staff work together to optimise individuals' independence following illness or injury. A goal planning approach involving service users and carers is pivotal to the success of this initiative. To date this has successfully enabled 3,521 older people to live more independently in their own homes. For those older people leaving reablement services, Social Work and Cordia have developed a community connections pathway into “Good Move” health and well being services delivered by Glasgow Life, supported financially by NHS Health Improvement. Anticipatory care planning approaches have been tested and the Council and CHP are currently looking at the development of a model that sits best with a GP led approach. For the year 2013/4, 5,542 anticipatory care plans were completed by GP practices participating in the Quality Outcomes Framework. The completion of ACPs contributes crucial information to Key Information Summaries for out-of-hours services. Over the past year the Health Board has actively encouraged GPs to move to Section 17C of the contract to support and enable better targeting of resources towards the most vulnerable patients and to reduce health inequalities. Twenty-six practices in Glasgow have moved to this new arrangement in 2014. The Falls Prevention Service continues to support older people who experience a first fall and links have been developed with the Community Rehabilitation Service. Currently, the service provision for fallers is under review with a view to improving pathways and assessment processes. The revised falls policy is currently out for consultation. Discussions have taken place on the important relationship between promotion of Power of Attorney (POA) and the Carers Emergencies Plan with a view to ensuring all of these documents are promoted within the ACP. The introduction of a single point of access to the carer’s services via a self assessment and Carers Information Line has resulted in a significant rise in the number of carer assessments. In 2012/13 there were 860 carer assessments rising to 1488 in 2013/14. Self evaluations within the Council’s Direct Services have included Older People's Day Care (2008) and Older People's Residential Services (2012). There are continuous improvement plans in place for both these services. The Council’s modernisation programme will see the development of 5 new care homes and 6 new build day care facilities across the City. These new buildings will replace the existing 16 residential care homes, including one physical disability care home. Social Work is also carrying out a review of the provision of BME specific day care for older people. The partners have worked together very effectively to respond to a number of quality and

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Adult Support and Protection (ASP) issues in independent sector care homes over the past 2-3 years. Examples include risk management planning following the collapse of Southern Cross and management of the closure of Torbrae Care Home earlier this year. Recent reports by Health Improvement Scotland (HIS) regarding inpatient care of older people in Glasgow hospitals like the Mansionhouse, has resulted in an action plan that is currently being implemented. The completion of the new South Glasgow University Hospital in 2015 will see the creation of a 16 bedded assessment unit for older people which, linking with community resources will make a significant contribution to admission avoidance and shortening length of stay. The partners are seeking to build joint work with Registered Social Landlords (RSLs) to support delivery of the Joint Commissioning Strategy. Examples include the establishment of a Housing, Health and Social Care Strategy Group by the Council’s housing strategy arm, Development and Regeneration Services (DRS), health and social work membership of the Strategic Housing Investment Programme (SHIP) Forum, the One Glasgow project at 415 Nitshill Road, and Change Fund support for a number of housing-led initiatives to support older people to remain living at home.

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2. Getting help at the right time Key features This area is about the experience and feelings of individuals, how they understand and appreciate the services provided to them. Individual’s perceptions may differ from how the partnership evaluates itself.

2.1 Experience of individuals and carers of improved health, well being care and

support Main areas • Partner agencies have an integrated approach at the most appropriate time to promote and maintain individuals’ health, safety, independence and wellbeing. • There is joint action to support individuals capacity for self-care and self-management • There is joint action to support managing long term conditions • Systems are in place to obtain feedback about individuals’ experiences of using health and social work services. • Individuals receiving support are enabled and supported to make decisions throughout their care experience. • Individuals who are subject to the partnership’s adult protection procedures, are safer as a result.

The Reshaping Care Joint Commissioning Plan process included a comprehensive and systematic engagement plan, including older people and their carers. The RCOP Community Capacity Building work stream facilitated by GCVS has been awarded Change Fund investment through a Transformation Fund to build community capacity for older people and their carers through co-production approaches. There was a city wide mapping exercise which informed the allocation of funding from the Transformation Fund and provided a useful resources directory and baseline information. The RCOP housing work stream is also a good example of improving health and well being with Change Fund investment providing a voice for older tenants and funding to co-produce a range of social, cultural and leisure activities. Unmet needs identified by carers in the city have been addressed through the Carers Emergency Planning Service, Carer Nurses, short breaks budgets and dedicated Older Carer Development staff. These services have been developed through funding from Change Fund, CIS and Scottish Government's Time to Live Fund. Glasgow City Council (GCC) introduced a Carers Privilege Card providing a range of discounts, including Glasgow Life gym membership, cinema entry, parking, and a range of other services and access to GCC staff benefits. Over 7000 have been distributed to carers across the city. Glasgow Life, through the Active Health team deliver a number of programmes aimed at supporting older adults to become more physically active. These include Silver Deal Active which provides free, regular, coach-led physical activity, Vitality classes designed for patients with long-term medical conditions and include health walks which are free, local and volunteer led in parks and communities citywide. These services have recently been re-branded and re-launched as “Good Moves” and receive funding support from the CHP’s Health Improvement Team. Glasgow City Council invests in 40 lunch clubs across the city and provides a range of telecare, equipment and adaptations services.

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The 415 project in south west Glasgow is a product of the CPP One Glasgow approach delivered in partnership with Glasgow Housing Association. It promotes a partnership approach to prevention and early intervention for older people centred on housing. This includes the First Through the Door initiative designed to encourage all agencies to take a proactive approach to identifying older people who may be vulnerable and would benefit from some level of support. It is an excellent example of a range of statutory services, housing providers and third sector organisations coming together to develop initiatives that will assist older people who are “just coping”. All of the initiatives and projects described above have had the active involvement of older people and carers in their planning and design. Both health and social work partners jointly commission and monitor advocacy services for older people. Carer Centres provide low level advocacy and support to assist carers to navigate health and social work systems and processes.

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2.2 Prevention early identification and intervention at the right time Main areas • The partnership has a clear strategy and services in place to support prevention and early and timely intervention. • Individuals are able to timeously access a range of preventative, rehabilitative and enabling services, which are suitable for their needs.

Glasgow is unique in having direct ordering of home care by hospital staff. This model ensures that circa 70% of older people are able to be discharged home from hospital with home care services capable of being in place within 4 hours of discharge. The volume of discharge must be appreciated; 33,431 Glasgow citizens over the age of 65 were discharged in 2013/14. The responsiveness of this service delivers enormous efficiency to the acute sector. Direct ordering from home care is also available to rehabilitation staff and is currently being considered for extension to out of hour’s district nursing staff. Glasgow has a comprehensive community rehabilitation service supporting discharge and admission avoidance services through a single point of access. A rapid response service to support admission avoidance is available in the four A&E sites and is also available to GPs. In-reach services have been further enhanced by elderly care assessment nurseries in acute hospitals who facilitate early discharge. A step up service, supported by the Change Fund, has been developed in the north east of Glasgow to provide GPs with an alternative to emergency admission to hospital. The development of the Rapid Response and Resettlement Service in partnership with the Red Cross assists older people to be taken home from A&E. Running from 2pm to 2am seven days per week it supports older people to be resettled in their home with a follow up service provided the following day. A Locally Enhanced Service (LES) for medicines management and polypharmacy has been developed for GP practices in order to promote safe, effective, evidence based use of medicines in patients considered most at risk of adverse effects. In addition to the LES, there are also a number of GP practice clinical pharmacists who provide input into the multidisciplinary medication review process and also deliver medication reviews for at risk patients groups including patients that are resident within residential care homes. A whole systems joint approach to the management of falls and the development of assessment pathways is ongoing in Glasgow drawing on expertise from social work, telecare, falls service, rehabilitation service and the Scottish Ambulance Service. The reablement service actively promotes service user participation in care planning and personal goal setting. This is the case whether the service is health or social care led. The rehabilitation service has patient focussed goal planning embedded within the service which actively seeks patient engagement and feedback. Identifying carers at the point of diagnosis is a key objective of the Glasgow Carers Partnership with the Carers Self Assessment, routinely promoted by health staff in a range of community health services. Evidence to date highlights a reduction in carers presenting in a crisis or emergency situation. A training programme is delivered by Cordia through a team of skilled trainers who work with its home care staff and now Glasgow carers are able to access this. Carer Centres identify the carers and support them to attend through provision of short breaks and/or transport as required.

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We can demonstrate progress in dementia pathways. Glasgow was a test site for Post Diagnosis Support (PDS) service and the learning from this has informed the city wide roll out. Building on this support, Glasgow has been awarded test site status for the Dementia Strategy 8 Pillars approach. The PDS approach, including early identification of carers and providing access to carers’ education from Alzheimer Scotland is aimed at increasing confidence in caring roles and peer support. A HEAT target for the CHP is achieving the 18 week target for referral to treatment for Psychological Therapies. Older People’s Mental Health (OPMH) Services provide assessment, intervention and support for people with functional disorders, including meeting the needs of people who require access to a Psychological Therapy. A number of initiatives have commenced, funded by the Change Fund, aimed at improving access to psychology and psychological therapies. These include the setting up of a sub-group aimed at developing options for increasing access to psychological therapies for older people; and the provision of psychology personnel within OPMH Liaison teams. Improving the Cancer Journey is a partnership between the Council, NHS and McMillan Cancer Support designed to ensure that all people with a diagnosis of cancer will routinely be signposted to a holistic needs assessment service by medical staff. Evidence tells us that the risk of cancer increases with age and as such this is a valuable resource to support older people with benefits, housing, employments, money matters etc. to ensure needs beyond the clinical are being identified and met. Anticipatory care planning approaches were tested and GP led services are being developed across the city. Discussions have taken place on the important relationship between promotion of POA and the Carers Emergencies Plans with a view to ensuring all of these documents are linked to the ACP where appropriate. The recent review of Community Addiction Team services has determined that services will now be extended to include all older adults. Two particular challenges emerge from this: individuals who are growing older and are in receipt of long-term opiate replacement therapy; and, an increase in numbers of people who are "older drinkers". Addiction services have seen an increase in referrals for the second group, requiring the service to review treatment approaches. Currently work is ongoing with Addaction who have been commissioned to look at alcohol provision for the over 65s.

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2.3 Access to Information about support options, including self-directed support Main areas • Partners ensure that readily accessible information is available about supports and services, including self-directed support • Individuals are provided with full information about their needs/condition and any care or treatment they require and their right to consent. • At the point of diagnosis of a long term condition, partners provide early information on appropriate supports and services to individuals and their carers

The partners aim to promote concepts of personalisation, choice and control across all of our services. Copies of care plans and patient held records are held by patients and service users. The implementation of Self Directed Support for Older People in Glasgow commenced on 1st April 2014. The Council is resolved to ensure that Social Work functions effectively as a targeted service, which prioritises early intervention and prevention by providing support to older people proportionate to their needs and only for the time that support is required. In respect of personalisation that will mean an emphasis on avoiding unnecessary escalation of social care support and reducing or discontinuing that support in line with reductions in presenting need. In keeping with this rationale Social Work will adopt a targeted approach to personalisation for older people based on a model that optimises the 4Rs - recovery, rehabilitation, reablement and recuperation. In so doing a distinction will be drawn between those with non-complex and complex social care needs, as per the Social Work Eligibility Criteria approved by the Council’s Executive Committee on 23 January 2014. Non-complex referrals will be responded to through early, 'purposeful' interventions that are preventative in nature and which meet the person's immediate social care needs whilst supporting them to regain and sustain the highest level of independence they can. These individuals will not be subject to intensive personalisation processes, which would be disproportionate to their needs and increase the risk of unnecessary Social Work intervention in their lives. Typical support services for these individuals will include reablement, home care, telecare, lunch clubs and housing support. Those presenting with more complex needs will be subject to a full personalisation assessment, will be allocated an individual budget and have an outcome-based support plan put in place. There are currently 72 older people using Direct Payments and 43 service users in receipt of an individual budget, where funds are paid directly to a Provider. This arrangement preceded the SDS Act and the supports are a mix of what is now described as Option 2 and 3. There are safeguards to protect those in receipt of DPs these include a written worker review and financial auditing on an ongoing basis to ensure that this money is used to purchase care and there is no abuse. There is a single point of contact for access to referral and advice on occupational therapy, home care, ASP and care management through Social Care Direct. This also offers a signposting service through the portal Your Support Your Way. This portal is also available to professionals and the public through the internet.

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Glasgow Life has public access points in most of the libraries and has plans to have these city wide. These public access points are also used by “Improving the Cancer Journey” services to encourage services users to engage with community services. There is a wide range of information about support options on the Council, CHP and NHS's websites and a range of leaflets displayed in Council offices and health settings. Glasgow CHP and Acute have made good progress with SOLUS screens in public waiting areas as a source of information. There is joint information on a range of services including carers, reablement and step down care. There is a DVD “It's okay to ask for help” featuring Glasgow carers funded by CIS. This is widely distributed in dementia services with the Carers Information booklet and self assessment form. There are Patient Information Centres in Victoria and Stobhill hospitals providing information hubs for people attending hospital appointments or visitors. These work in close partnership with the voluntary sector to organise specific information events, including Carers Week and National Dementia Week. Reablement, PDS and Rehabilitation and the range of condition specific services are all underpinned by a self management approach, with a focus on rehabilitation, recovery, reablement and recuperation where appropriate. Income maximisation and financial inclusion services are co-funded and promoted within health and social work services. All social work services users and carers are routinely offered advice. The Glasgow Advice and Information Network (GAIN) is available for the public for a range of money and other matters and there are a range of condition specific organisations providing income maximisation services. Glasgow Housing Association and the Registered Social Landlords in the city also provide these services. Glasgow City Council contracts with 22 RSLs to provide 86 sheltered and 16 very sheltered housing support services for older people. A further 8 floating housing support services are also available within mainstream housing. Overall these supported accommodation services assist more than 3,500 older people. This service is currently subject to review with the intention to reform. Social Work Services has also commissioned more specialist care and support within a Supported Living model for around 170 older people. These are usually based within very sheltered accommodation or purpose built housing. There are 7 Deep End GP practices in the city that have employed Link Workers via the national project to coordinate non medical support services for vulnerable people. These practices located in the most deprived areas of the city will receive funding to ensure GPs can spend more time with vulnerable patients, including older people and can more easily and effectively access local community resources.

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3. Impact on Staff Key features This area is about what employees think and feel about working in the partnership. This is about the staff view point rather than the initiatives or measures that managers have put in place.

3.1 Staff Motivation and Support Main areas • Staff are motivated and committed to providing high quality support and services. • Staff feel well supported and managed, and their workload is managed to enable them to deliver positive outcomes for individuals and their carers. • Staff feel that teamwork is effective, including within joint teams. • Staff understand and are supportive of organisational priorities. They have good opportunities for professional development and to contribute to change planning and change management.

Social Work Services Staff are motivated in many ways from individual one to one sessions about their role to encouraging involvement in working groups, feedback groups and communication champions. There are staff awards in various categories that highlight and publicises the efforts staff go to in providing high quality services. On a regular basis supervision and direct support from peers and managers enables staff to perform to the best of their ability. Tailored training around coaching skills and motivational interviewing has enabled staff to have the confidence to develop sensitive care plans in consultation with service users and their carers. Staff also have the opportunity to shadow senior managers and to put questions directly to the Executive Director. Facing the Future Together, launched in November 2011, is the NHS Greater Glasgow and Clyde strategy encouraging the whole organisation to work better together to continually improve patient care. Developing a highly motivated staff group who feel positive about what they do is a critical component of this. Managers within Social Work Services are trained in all aspects of Leadership and there are various established programmes in place to achieve this. Managers are encouraged to take peer and team feedback. The supervision model enables staff to discuss cases and agree positive outcomes for service users. A staff action plan was implemented following the staff survey that addressed key areas around communication, training and leadership. Staff were fully involved in the development of the action plans through small working groups and communication champions. Workload is allocated fairly across teams and again is discussed through supervision. Staffing levels meet care service standards. An annual survey of NHS staff provides information regarding how staff feel about their work and information for managers to use for improvement planning. More recently a workplace stress survey was carried out across the whole city which raised some issues in particular services. Sectors are in the process of pulling together action plans to address identified issues. Joint working is essential to delivering effective care and many service users will have a range of professionals involved in their care plans. Social Work staff work with all care professionals, case conferences are structured to include all key personnel in decision making. Joint training has been highly successful in motivating staff to work together. Many staff are also co-located across services and joint communications are established. Team working is recognised and there are strong bonds within teams and especially those providing direct interventions in day centre and residential units. Work is also

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underway for further joint communications and training as the implementation plan for the Glasgow integrated partnership develops. Protected learning is being rolled out and allows teams to have time together to work on both personal and team development. It is an ideal forum for gelling teamwork and to invite guest speakers. The team also has the opportunity to suggest topics that are beneficial to them. A high rate of attendance at work is a high priority for the NHS and managed is through the Attendance Management Policy. For 2012/13 the city absence figures sat at an average of 5.5%. The target is 4%. Family friendly and flexible working policies support a work-life balance approach and staff turnover is also monitored. For 2012/13, the turnover rate was 7.09 %. Similarly, Social Work Services applies various polices to support and maximise staff attendance at work, which has improved markedly over recent years to around 95%. This is managed through the application of Glasgow City Council’s Absence Policy, combined with the Worklife Balance and Flexible Working Procedure. Staff can also access or be referred to both the Council’s Employee Assistance Provider and Occupational Health. Staff absenteeism, sickness and turnover records are monitored though the implementation of corporate policies. The overall turnover rate for Social Work Services is 3%.

Social Work vision, aims and values are structured around providing high quality services that promote independence and deliver positive outcomes for Glasgow citizens. This is used as a platform for supervision, care plans and for personal development. Staff understand their roles and responsibilities through effective training and clear performance targets and care standards.

Social Work Services staff are fully involved in the change management process through staff forums, team briefings and working groups. There is a formal supervision and personal development process in place that adheres to National Standards for their job role and function. This includes training around Adult Support and Protection, professional qualifications and training in softer skills to help gain a greater understanding of the changing needs of service users

Some further examples are: • training opportunities both on line and face to face from Social Work Learning and

Development Team • Regular supervision and reflective learning • Personal Development Plans • Staff forums • Team briefings / feedback • All Social Work / All Council messages

The NHS Workforce Change Policy forms a foundation for ensuring staff involvement in any significant service review or change. District nursing and care homes’ liaison staff involvement in respective service reviews evidences proactive and appropriate use of this policy. In the NHS professional development is taken seriously and supported through the personal development programme, e-KSF (Knowledge & Skills Framework) and supported with further education through the bursary awards scheme. There is a fast-

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track programme for high performers ready to be developed for promoted roles. Mentoring and executive coaching is also available. Social Work Services have a current programme of assisted self evaluations. Currently we are evaluating Staff Supervision with a particular consideration of the impact of our staff management processes on outcomes for service users.

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4. Impact on community Key features This area is about the activities used to promote positive community capacity and engagement. This will look at evidence that the characteristics of local communities are understood and there is evidence of community participation.

4.1 Public confidence in community services and community engagement Main areas • The partnership is committed to engaging with and involving local communities in meeting the health and social care needs of the adult population. • There are joint strategies to promote and develop community involvement and community capacity. • The community is involved in a wide range of identification, early intervention, and support activities such as volunteering, befriending, independent advocacy and time banking. • Individuals and community groups value the supports and services provided by the partnership and believe they are effective. • Individuals and community groups are positive about how the partnership engages with the public.

The partnership can demonstrate its commitment to community engagement and involvement in planning and delivery of health and social care services. There are a range of structures, committees and forums with representation from the public, patients, service users and carers. These include Public Partnership Forums (PPFs), Glasgow Carer Reference Group and Voices for Change. All of these operate at a local and city wide level and represent different population groups including disabled people, woman and BME groups. We can evidence a co-production approach to the development of the Joint Strategic Commissioning Plan (JSCP), working through community and voluntary sectors to engage with a wide range of older people and unpaid carers and their organisations across the city. The RCOP Partnership produced an easy read version of the JSCP “Let’s Make Glasgow a Great Place to Grow Old” as part of the Joint Commissioning Strategy process, setting out our plans for improving older people’s services and to encourage that older people to respond to the consultation. This was accompanied by a series of well attended engagement sessions of older people and carers which informed the plan. A training programme is delivered by Cordia through a team of skilled trainers who work with its home care staff and now Glasgow carers are able to access this... Carer Centres identify the carers and support them to attend through provision of short breaks and/or transport as required. A self evaluation carried out by the PPF across Glasgow for the period 2012-13 found that overall there was satisfaction with the relationship with CHP. It identified that improvements could be made with primary care contracted services. The appointment of primary care development officers will assist in addressing this short-fall. We can also evidence wider community engagement and partnership working with Glasgow Council for Voluntary Services, Social Care Ideas Factory and strong links with Glasgow Community Planning Partnership's Vulnerable Older People's work stream. The Dementia Friendly Glasgow Group (DFGG) has been established in order to develop a bid to the Life Changes Trust during 2014 to fund a major work programme to support a broad range of agencies and organisations to establish the city as a Dementia Friendly Community (DFC) over the period 2014 – 2019. The Change Fund has provided funding

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to support a joint bid to the Life Changes Trust and a tender is under way to secure a consultant. There are also strategic discussions with the Council as to the city becoming an active member of the Age Friendly Cities network.

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5. Delivery of Key Processes Key features This indicator focuses on the extent to which all staff recognise that an individual is in need of care and support. It considers how well information is shared between partners and is used to make decisions. It looks at the timeliness and effectiveness of the help and support provided in preventing difficulties arising or increasing. This will include anticipatory care planning, re-enablement, rehabilitation and self-management.

5.1 Access to Support Main areas • The partnership has clear procedures and pathways about how supports and services can be accessed that support achievable outcomes. This includes clearly articulated arrangements for referrals between partners. • These procedures and pathways take account of the need for prevention, early identification and intervention at the right time. • The partnership has criteria for accessing services in place, which are consistently and equitably applied. Charging policies are clear • The partnership informs individuals and carers who do not meet its criteria for accessing services of possible alternative sources for advice and support and of what to do if their circumstances change.

We are committed to promoting public understanding of and accessibility to our services and can demonstrate appropriate activity. There is a range of public information regarding joint social work and health support available on Council and CHP websites, including post-diagnostic support, carers, re-ablement and step-down care. SWS has developed a single point of access through Social Care Direct (SCD) for partner agencies, service users, carers and the general public as described in section 2. Social Work services introduced eligibility criteria for access to adult services consistent with the Scottish Government guidance in April 2014 after a lengthy consultation process. These are published on the Council's website. Eligibility Criteria are applied based on need and risk and they include time scales for service responses. All carers are offered a level of assessment relevant to needs and risk as we aim to identify carers early in their caring role. Glasgow SWS are unique in that they have dedicated Carer Assessment and Care Management teams who work in partnership with carer centres and condition specific organisations and a range of health and other universal services through a whole systems approach. An integrated pathway has been developed for carers of older people and there is a dedicated staff funded by the Change Fund providing health needs assessments to carers... The signposting service is offered to people not eligible for a social work service and people are advised to get back in touch should their circumstances change. Signposting to the GAIN network for income maximisation services is routinely offered to callers, while social work clients have access to internal income maximisation services. The Your Support Your Way portal is used by SCD for signposting to a range of services and is available to the public via the internet. There are clear eligibility criteria for relevant community health services with service response times. The CHP Rehabilitation Service has a single point of access within each sector and individual patients can self-refer. It provides a rapid response service within an hour for GPs and for A+E. For urgent cases there is a response time of 1 – 6 hours. All services are organised to ensure that high priority cases are seen within required timescales. A key focus of the service is maximising independence, including through self management. The district nursing led anticipatory care service assesses people 65 plus

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on discharge to stabilise their care and minimise hospital readmissions. All older people with a life-limiting condition have access to palliative/ end-of-life care and support co-ordinated by their GP, attached district nursing team, in partnership with the Marie Curie Home Support Service. Integrated pathways with joint eligibility criteria have been developed across joint initiatives including, reablement and Intermediate Care. Services all have clear targets in relation to service response times and how need is prioritised. In the Reablement Service an individual’s assessment is screened to ensure that support needs are led by either the Council, Cordia or the CHP, depending on which service best meets the needs of the individual. A Carers’ Information Line is commissioned from the voluntary sector, supported financially by SWS and CHP through CIS funding and this provides a single point for carers to access services through the carer’s assessment process. GPs have a target to provide patient appointments more than 48 hours in advance. City performance is 82.8% against target of 90%. The development of a mobile app provides a range of information to GPs enabling them to find the right type of support when required. It is in its early stages and is under review. Feedback is positive and consideration is being given to how it can be extended to other services. Social Care Direct is currently under review, part of which will explore opportunities to develop this as a single point of access for health and social care services.

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5.2 Assessing need, planning for individuals and delivering care and support. Main areas • Effective systems are in place for the assessment of individuals’ needs. These systems work effectively on a single and multiagency basis. • Effective information sharing between partners underpins an approach to assessment, care planning and service delivery which is person centred and focused on individual outcomes. • Individuals and carers are fully involved in their assessments and in planning and participate in the co-production of the supports and services they receive. • The care and support which individuals and carers receive meets the desired outcomes and assessed needs. • Partners jointly review the care and support which individuals and carers receive to ensure that this is achieving the desired outcomes.

A shared strategic priority for social work, CHP and Acute is the development of an integrated care pathway across the City’s 3 sectors. A senior manager has been directed to lead this work. A priority will include leading an integrated unscheduled care team and further expansion of intermediate care. There are effective single and multi agency systems in place around assessment and care management/coordination for individuals and carers. The sharing of information between partners is supported by the Data Sharing Protocol. A single shareable assessment was jointly developed a number of years ago but was never formally adopted as it could not be supported by ICT. Social Work has a single recording system, whilst there are a variety of separate IT systems within primary and acute care and community health. A Support Needs Assessment and outcome based support planning tool underpins the personalisation process for older people. These will go live in October 2014 when the IT system is able to support these. All health and social work staff involved in supporting hospital discharge are aware of the revised key systems performance measures, including targets for allocation, assessment complete and person discharged. This is monitored jointly though the use of EDISON information. Across acute, social work and community health we are examining ways to optimise use of multi-disciplinary assessment. Social Work has a suite of procedures and guidance intended to promote and enable good professional practice, including recording. These are regularly reviewed. The Social Work Professional Governance Board has an oversight role in respect of all matters of professional practice. The Carer Assessment Policies are being revised for staff as all the carer assessment and outcome based support plans are now available as forms on CareFirst6. Other examples where there is a joint approach to how we assess need and deliver care and support include: • Step Down Care • Managed Medication Service – in partnership with Cordia • Post-diagnostic support service for dementia – has been delivered in partnership

with the social work and third sector • Fast -track palliative care service which is a targeted service to patients at the point

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of discharge to assist and support end of life care at home. This is currently being piloted in the North West,

• Core skills training for nursing staff in commissioned care home services • EquipU Joint Store Protocols • Telecare and Alarm Services There is currently no systematic recording of outcomes to measure the effectiveness of health and social care interventions. The introduction of SDS for older people will help progress to be made in this respect. Mechanisms to enhance patient /service user patient feedback are also being explored. Care planning review activity was highlighted as an area for improvement through the Social Work Organisational Performance Review (OPR) process. The carer assessment process is outcome focused, reflecting Talking Points and outcomes information is evidenced through reviews and case studies.

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5.3 Shared Approach to protecting individuals who are at risk of harm, assessing

risk and managing and mitigating risk Main areas • Clear guidance processes and tools support all staff in assessing and managing risk. Competent risk assessments and associated risk management plans are prepared for all individuals subject to risks, and individuals who are subject to significant non-protection type risks that health and social work services have a responsibility to manage. • Systems are in place to assess risk to individuals who are receiving self-directed support (direct payment recipients and personal budget holders). • Adult protection partners effectively work together to robustly investigate adult protection concerns, and subsequently take action to keep individuals who are at risk of harm safe. • Joined-up approach to managing risk, which includes systems to evaluate and learn from practice, even when things have gone wrong.

There are clear ASP procedures, processes and tools to support all staff in managing and assessing risk. Revised procedures were agreed by the Social Work Governance Board in September 2014. The Adult Protection Committee (APC) meets on a regular basis with good multi agency representation and produces a bi-annual report to ensure an analysis and debate within the APC, the Chief Officers’ Group and Council Committee. The APC has considered two Significant Case Reviews (SCRs) concerning older people with another underway. The lessons learned have been disseminated through multi agency LMRs, Police Scotland, GCC and NHS GGC. The Glasgow SCR protocol has been revised and we await new guidance for SCR. The APC commissioned a piece of research into the views of service users and this will report later this year. An advocacy provider has been commissioned to support individuals through the ASP processes. The APC has agreed to use the (Professor) Hogg model to evaluate the impact of our shared approach to adult protection over the next few months. A Social Work training group has developed risk management guidance and training to complement peer support supervision and management. A multi agency training group considering the wider needs of the ASP partners has been set up. An audit of practice in 2011 identified areas for improvement. Ongoing local audits in the last year have identified no confusion over roles and responsibilities in relation to ASP practice. A staff audit was complete in 2014 this included a staff survey and focus groups, and an action plan was agreed by the Social Work Leadership Team. A senior member of staff is being recruited to lead on operational improvements. Within localities there are Practitioner Forums; Assistant Service Manager (ASM) meetings and a multi agency steering group which reports into the APC and a city wide ASM forum. Social Work Services have developed a single point of contact through Social Care Direct for all ASP referrals. Regular liaison between social work and police takes place to consider referrals and NHS colleagues are engaged as required. All staff are aware of the importance of effective recording and communication between agencies. Our auditing suggests this is good.

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The ASP policy indicates that AP3 are used to articulate the risk management plan with a view to improving the consistency of practice in risk assessment and recording. Risks are assessed by qualified staff and training is used to support staff development in risk practice. Those cases where significant risks are identified conferences are chaired by experienced ASMs. Incident reports from care and health services are highlighted by health and social care professionals via the service concern for purchased services protocol and/or the AP1 Protocol. There is effective and systematic use of 13ZA as evidenced through audit activity. 314 social work staff have been trained in adult protection. The CHP have endeavoured to take a systematic approach to adult support and protection. Between 2011 and June 2014, 3152 CHP staff have received training, relevant to grade, and training targets have been established across services. In recognition of the low numbers of referrals coming from Health (which reflects the national picture) an ASP trigger has been built into the Board's incident reporting system (Datix). This asks staff to consider ASP as part of an incident report and whether a referral should be made to the Council. Individuals continue to be supported both in terms of AWI and MHC&T legislation. Evidence of this is obtained in case recording, assessment and care planning. Mental Health Officers are based within each adult care group. Details of welfare proxies including Power of Attorney and guardianship orders are detailed on Social Work Services’ IT system with a copy of powers in case files. In March 2013, NHS GGC and GCC held a major conference to look at deprivation of liberty, guardianship and the effects of delayed hospital discharge on adults with incapacity. Discussion focussed on the Adults with Incapacity (Scotland) Act 2000 and the need for this to be updated to respond to the challenges experienced by adults with incapacity, their carers and the professionals providing services to them. The conference had extensive and detailed input from a range of legal, health, social work, advocacy and safeguarding perspectives.

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5.4 Older People & Personalisation Main areas • Listening to individuals and working with them to create personalised approaches to meet their needs. • Evaluating individuals’ experiences of services and adjusting services responses in the light of these. • Support individuals using services to make decisions which allow them to co-produce their supports.

The Council's Executive Committee approved the roll out of Self Directed Support on 7 October 2010 in a staged approach covering Learning Disability, Physical Disability, Young People in Transition and Mental Health. The Social Care (Self Directed Support) (Scotland) Act 2013 came into effect on 1 April 2014 and required local authorities to facilitate a personalised approach for older people in receipt of social care. Glasgow City Council has embraced Self Directed Support. The policy aspiration is to give individual users of services greater freedom over how they live their own lives by giving them greater choice and control. Individual budgets have been introduced to service users as a tool to direct and choose their own support arrangement or to take as a cash payment to purchase their own support. Implementation within older people (OP) services has focused on two groups i) existing OP service users in receipt of a Direct Payment (DP) or a social care support service and ii) individual OP presenting to social work services who require a complex assessment. This work is at the early stages of implementation with regular stakeholder engagement facilitated via existing structures; e.g. Personalisation Sub Group, Carers Reference Group. The first cohort of older people service users are now going through the personalisation process. The partner's advocacy service will provide support to older people going through personalisation process where requested.

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6. Policy development and plans to support improvement in services Key features This area is about organisational and strategic management across the partnership and evidence gathered will show the extent that strategies and plans reflect properly the vision of the service. This will show how purposefully you involve individuals and carers in service development. It also covers quality of services and how quality management drives improvement.

6.1 Operational and strategic planning arrangements Main areas • There is a shared vision for services, which is informed by a whole-systems approach and is set out in comprehensive, joint strategic plans for services. These contain strategic objectives, measurable targets and timescales. • There are processes and guidance to implement the joint vision, strategies and policies. • There is a systematic approach between health and social work managers, which evidences effective management of services and resources across the whole system of care. • Priorities set at partnership, team and unit levels reflect jointly agreed plans and priorities.

In its Vulnerable People and Thriving Places themes, the City’s CPP Single Outcome Agreement (SOA) 2014 clearly embeds the principle of partnership working to achieve best outcomes for older people in Glasgow. The One Glasgow approach promoted in the SOA offers a framework for community planning partners to explore and develop new models of care and shift the balance away from institutional care towards care at home, with greater emphasis on early intervention and prevention. In addition, the CPP Integrated Grant Fund Vulnerable Adults Programme highlighted in the SOA actively promotes the funding of additional support services which help increase the number of older people to live safely and well in their own homes. The combined aspirations of the Council, the CHP, Acute and their partners are amalgamated in the Reshaping Care for Older People, Joint Strategic Commissioning Plan 2013 -16. This sets out Glasgow’s vision for service delivery to older people and a programme of change. This plan was developed in partnership with older people, carers and partner agencies. A full consultation process supported this, from which feedback has further supported the development of strategic thinking and direction. The first plan is currently being refined to reflect the latest information on financial planning, progress on actions plus changes in key areas such as unscheduled care, health improvement and carers. Monitoring the delivery of the joint strategy sits with the RCOP Strategy Group which receives monthly progress reports from the Joint Research & Intelligence work stream. These reports include progress against Key Performance Indicators and updating the Glasgow Needs Analysis as required. Quarterly progress reports on all Change Fund projects and services are prepared by the Change Fund Project Manager and considered by the Strategy Group. The Reshaping Care structure is complemented by a joint health and social care structure to manage planning, performance and service delivery across Acute, CHP and Social Work at City and sector levels. This provides the operational context for frontline teams. Partnership arrangements also include the quarterly primary/secondary interface sessions which bring acute, primary care, community health and social work managers and clinicians together to progress joint strategic planning and shared service delivery for older people.

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This vision is mirrored in the CHP’s Development Plan 2013 -16 which signals reductions in the number of NHS continuing care beds, geriatric medicine inpatient beds and care home provision. The Social Work Services Annual Service Plan and Improvement Report (ASPIR) 2014- 2015 provides a progress report on the delivery of the Council Strategic Plan, Single Outcome Agreement (SOA) and major service priorities, including those for older people's services. The aim of the ASPIR is to review targets set for the period 2013 -2014 and provide contextual and statistical evidence about how well Social Work has performed in meeting its objectives. The development of reablement and step down services has resulted in the creation of joint standard operational policies and procedures which clearly outline the roles and responsibilities of partner agencies. Within the CHP there is a robust governance structure at city and sector levels covering all aspects of clinical care. This is overseen by clinical directors and supported by professional leads and service managers. The current redesign process of the Board-wide Nursing Homes Medical Practice will offer a locally enhanced GP service to every nursing home across Glasgow supported by a robust nursing, AHP and pharmacy provision.

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6.2 Partnership development of a range of early intervention and support services Main areas • All partners collaborate to promote and maintain individuals’ health and independence. • There is a range of integrated interventions and policies that can evidence the integrated approach to support individuals’ capacity for self-care and self-management including mitigation of risk and the support for long-term conditions. Partners can evidence the effectiveness of their support for individuals to remain within their own communities.

There are a number of examples of positive partnership working within Glasgow that promote appropriate support at an early stage for older people. As described in section 2, the One Glasgow initiative is an example. The Glasgow Carers Partnership brings together Glasgow City Council, Glasgow CHP, Acute Division of NHS Greater Glasgow & Clyde, voluntary sector carers centres and condition-specific organisations. These partners have worked together to re-shape carer services, making best use of available resources to develop one stop shop access to support services. Carer support is a shared strategic priority of the Council and NHSGGC. It is in this context that investment in carer services has increased by 150% from £1.1M per annum in 2011 to £2.7M in 2014. This additional funding includes investment from Social Work Services, NHS GGC Carer Information Strategy, Reshaping Care for Older People and the Scottish Government’s Time to Live and Better Breaks Fund. The Carers Information Line is a partnership between Social Work, CHP and South East Carers Centre who manage the line. This provides a single point of access for carers and professionals for information and advice and access to carer supports via the self assessment process. The re-branded Glasgow Life and Glasgow CHP Health improvement initiatives “Good Move” services both offer a range of physical exercise and social engagement opportunities to older people and these services are a key component of the Active & Health Ageing Plan. The Community Capacity Working Group is led by GCVS and, with an allocation of Change Fund, has been actively promoting the development of third sector initiatives to enable older people to be supported more effectively in the community. The Rapid Response and Resettlement Service has been developed in partnership with the British Red Cross is described elsewhere in this position statement. Another example of joint planning approaches includes anticipatory care planning services. South sector CHP was a Scottish Government test site for post-diagnostic support services for people with dementia, a partnership of the CHP and Alzheimer’s Scotland, based on the 5-pillars model of support. This service has now been evaluated and the service rolled out across the city. The Reablement Service has been planned and developed through a steering group comprising representation from Social Work, Cordia and the CHP. Other partnership arrangements to support people with long terms conditions include Home Care including Direct Ordering from hospital, Telecare and Community Response Services, Equipment and adaptation services in partnership with EquipU, Intermediate Care, Transformation Fund, PDS. EquipU is an exemplar model for partnership working.

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A further example of long term conditions support are the different community respiratory models being tested in each of the three sectors and supported by the Change Fund, . working closely with acute services to proactively manage people with COPD. Evaluation is in progress but in the case of North West is showing statistically significant evidence of efficacy. The Govan Project will test the development of an integrated model involving GPs, social work and the third sector, based around GP populations. Scottish Government funding will enable this model to be tested within four Govan practices with one of the target population groups being patients over 75 years. It is currently in early stages of development with work focussing on identifying target outcomes.

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6.3 Quality Assurance, Self–Evaluation and Improvement Main areas • There are joint performance management and quality assurance systems in place. • There are clear reporting arrangements for performance information. • Joint information systems, which are effective in supporting service development. • Key strategic partners involve voluntary and private sector partners, carers and users groups in monitoring the quality of services. • Joint performance management and quality assurance drive continuous improvement systems and there are clear plans, which prioritise and implement improvements agreed by partners

Both organisations have single agency performance management systems but an integrated performance framework will be developed as part of the integration process. Both health and social work are subject to regular OPRs within their respective organisations. The Social Work Organisational Performance Review (OPR) process is a ‘whole systems’ approach to assess how the service is performing in each Social Work local area and Direct Services. It aims to focus on each Area’s contribution to the achievement of the Social Work Services’ overall objectives as set out in the ASPIR, the Service Reform programme, the Council Strategic Plan and other City-wide strategic plans. OPRs are held twice yearly and aim to highlight good performance or progress, share good practice and identify variations in performance and areas of concern. Where performance is below what is expected the OPR process allows for discussion and agreement on improvement action where necessary. The NHS OPR process comprises six monthly reviews of progress against national and Board-wide targets and indicators and actions in the CHP Development Plan, with the NHS Board Corporate Team. After each OPR the Board CEO writes to the CHP Director outlining actions agreed, which are then followed up at the next OPR. Within the CHP, the Performance Scrutiny Group reviews CHP and Sector level performance as well as OPR actions and submissions and receives updates on the Development Plan, service improvement activity, financial matters and workforce planning. This is reported regularly to the CHP Committee. All purchased social work services are required to comply with the council’s Contract Management Framework (CMF). The CMF sets out the expectations of all service providers and allows the Council to monitor a range of information. It is the primary vehicle for measurement of the quality of purchased OP services. Information prior to the launch of the CMF in 2013 was shared with third sector partners via the bi-annual purchased service provider event held in conjunction with the Social Care Ideas Factory (SCIF). Social Work Services have a current programme of assisted self evaluations, undertaken with the support of the Care Inspectorate including older people's day care service and directly provided Residential Care. Voices for Change facilitated focus groups for the Day Care Self Evaluation. Currently Social Work is evaluating staff supervision with a particular consideration of the impact of staff management processes on outcomes for service users. Social Work Services have an annual programme of practice audits. In recent years this has included significant scrutiny of older people’s services including admission to care and home care. Practice Development Plans have been developed in response to these audits by the Effective Practice Development Group. The admission to care criteria have

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been revised to provide clear direction to staff in managing levels of risk with the aim of shifting the balance of care. The CHP ensures that practice standards regarding record keeping, medication practice and pressure ulcer prevention are regularly audited and monitored within community nursing and older people’s mental health on a monthly/ quarterly basis.

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6.4 Involving service users, carers and other stakeholders Main areas • There is systematic and comprehensive engagement with individuals who use services, carers, providers and other relevant stakeholders. • Planning processes (operational and strategic) incorporate the views of individuals, carers, providers and other relevant stakeholders. • Processes are in place to ensure the views of those who are considered hard to reach are gathered and reviewed. • Individuals who use services and carers are included in planning services, and consulted about changes in policies. • Providers and other relevant stakeholders are involved in planning services.

Engagement with a wide range of stakeholders underpinned development of the Joint Commissioning Strategy. Feedback from the consultation has been considered by the RCOP Strategy Group and actions agreed with feedback to consultees. The Public Partnership Forum (PPF) in Glasgow contributes to decision making about local health services through involvement, discussion and debate with the Community Health Partnership (CHP) and its partners. It helps to make sure that local people are informed about the range of available services and provides a vehicle for consultation on service changes and new developments. The PPF is actively supported to participate in national and local consultations, most recently on Reshaping Care for Older People and the Public Bodies (Joint Working) (Scotland) Act 2014. PPFs comply with the Scottish Health Council Participation Standard and have been active in raising awareness of the The Patients Rights (Scotland) Act 2011 with both patient groups and front line staff. There are three PPFs with a total of 70 Executive Group members, participating in a range of steering groups ranging from the Clinical Services Review to Locality Planning Groups to Project Boards for new health centres. The PPF Network has links to more than 500 individual patients, service users, carers, community bodies and voluntary sector organisations through the 3 PPFs covering North East, North West and South Glasgow. Social Work Services regularly consult with service users and carers through a range of channels. Voices for Change (VfC) is a service user and carer organisation funded by the Council and supported by community development staff. VfC represents services users and carers at local and city wide levels. VfC have contributed to the recent consultation on Eligibility Criteria, supported self evaluations and provide representation to the Council's Personalisation Sub Group. VfC and other service user representatives were involved in the recent joint tendering exercise for Advocacy Services. A service user and carer group has been established by the APC and a representative of this attends the APC. Three area based carer forums and a city wide Carers Reference Group (CRG) have been developed through the Carers Planning & Implementation Group, supported by the Community Development team. The CRG are currently actively involved in the Evaluation of the Glasgow Carers Partnership. This will include their assessment of their overall engagement within carer service planning and delivery against the Community Development Standards.

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We can also evidence wider community engagement and partnership working with Glasgow Council for Voluntary Services, Social Care Ideas Factory, Scottish Care and strong links Glasgow CPP's Vulnerable Older People's work stream, recognising the common agenda of supporting all older people to maximise independence and building community capacity.

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6.5 Information & Evidence of Commissioning Arrangements Main areas • Joint strategic commissioning strategies are in place, that identify partnership priorities and resource contribution. • Commissioning by partners is able to deliver increasingly personalised services. • The views and preferences of individuals and carers inform commissioning. • Best value and best outcomes for individuals determines the balance between direct provision and purchased services. • There are sound monitoring and review systems, including effective collaboration with regulators and scrutiny bodies.

Glasgow City Reshaping Care Partnership Joint Strategic Commissioning Plan 2013 – 16 (JSCP) was published in February 2013. The draft JSCP is predicated on a joint strategic needs analysis and explores in detail the considerable challenges in delivering improved services for older people in the Glasgow, responding to the projected increase in the number of people living into old age and marked health inequalities. In order to support greater numbers of individuals to live for as long as possible within their own homes a significant shift in the current balance of care is required. The JSCP commits to doubling the proportion of funding spent on prevention and anticipatory care over the life of the plan. This shift will be informed by the evaluation of projects funded by the Change Fund to ensure their targeted use and will see a reduction in the resources allocated to hospitals and long term care home placements. Commissioning activity will support shifting the balance of care by focusing on the following key areas: • reduction in the number of purchased care home placements to meet projected future

requirements. • ensuring that resources currently committed to Care at Home are utilised to deliver

higher volumes of support with improved outcomes for individuals through the promotion of independence and self-management.

• development of Intermediate Care to facilitate early discharge from hospital and return to own home as alternatives to hospital.

• decommissioning of hospital beds. • supporting the integrated car pathway. • investment in early intervention and prevention such as Good Moves. The values of Self-Directed Support (choice, empowerment etc) underpin the commissioning approach for older people in Glasgow. The JSCP recognises that the prevalence of dementia is increasing and that there are various stages of the condition. We want to ensure that support is focused on the presenting need of each individual and that a proportionate strategy is adopted to ensure that this need is met across a wide range of service provision. A key element to date has been the commissioning of services from Alzheimer Scotland to support delivery of the one year Dementia Post Diagnosis Support target. Significant progress has been made on key aspects of the RCOP commissioning plan. The projected future requirement for Care Home placements has been identified and steps taken to proactively engage with the provider sector to establish a local commissioning arrangement to facilitate these placements. Step Down care has been operational for some months with a service specification, based on the experience

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gained, under further development. It is anticipated that a procurement exercise will be utilised to increase the number of Step Down beds over coming months. Social Work Services have procedures and policies that support the commissioning and contract management of social care services. The implementation of these procedures in the day-to-day contract management of services involves a significant level of interaction with stakeholders, including providers, service users, carers, and officers of other agencies such as Care Inspectorate and Mental Welfare Commission. In addition to this regular provider forums are held where relevant issues are discussed. The Executive Committee of the Council has endorsed a proposal to revise the current contractual arrangements in respect of home care delivered by Cordia (Services) LLP. This is intended to ensure that these resources are optimised with a view to supporting as many individuals as possible to live at home. In addition to the above the planned roll out of personalisation for older people has begun with all those in receipt of a direct payment prioritised for review. All Social Work service reform activity is overseen by the Service Reform Implementation Group (SRIG). Almost all (96%) of the Health Improvement purchasing budget is commissioned, with 75% of contracts being awarded to the third sector. Eight of the large contracts are targeted towards services for adults, including older people. A tendering process was recently concluded for the Rapid Response and Resettlement Service resulting in the British Red Cross securing the contract. The recent review of the Nursing Homes' Medical Practice will result in a commissioning process to secure local medical support arrangements with assisting and other GP practices. GCC SWS & NHSGG&C tendered the provision of Independent Professional Advocacy Services in 2012/13 focussing on three aspects of Independent Professional Advocacy, Adult Mental Health, Older People & Physical Disability and Learning Disability providing difference models of advocacy across a range of care groups including ASP.

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7. Management and support of staff Key features This area is about how staff are supported and managed within the workforce. It also looks at how staff are supported to learn and develop in their roles and in a changing culture how the partnership approaches joint workforce planning and deployment.

7.1 Recruitment and retention Main areas • A joint workforce strategy sets out priorities, identifies possible staffing shortfalls and outlines measure to address shortfalls. • Partners evaluate measures to address areas of particular staff shortages and pressures. This is done on a single agency basis and a multi-agency basis. • Partners apply safer recruitment practises in order to protect service users. • Partners have clear and agreed objectives for shared posts and jointly monitor the posts to ensure that their objectives are fulfilled. • Partners are aware of the need for succession planning and are jointly aware of its implications for partnership working. • Partners have a culture of valuing, supporting and retaining staff and take appropriate opportunities to harmonise human resource arrangements.

Within the CHP and Social Work Services there are clear written policies and processes which support the safe recruitment and retention of staff. Recruitment polices and processes are supported by guidance which supports good practice, equality and diversity. Appropriate checks are made of staff in terms of Protection of Vulnerable Groups (PVG) and registration with SSSC and other required bodies. Recruitment practice is extended Council policy in terms of references and including service users in the process within residential and day care. Clearly defined role profiles, job descriptions and person specifications exist for all roles. Overall retention of staff is improved with staff’s ability to work flexibly, apply for adjusted working hours via the Work Life Balance scheme, take Career Breaks and have the ability to buy additional annual leave. The future development of agile working will give further flexibility to staff. Workforce plans are separate in terms of staffing numbers and roles however the function they carry out is determined by joint operational policies and priorities. Currently the Reshaping Care for Older People programme includes a joint working group reviewing the staffing numbers and type to produce a joint workforce plan that will assist in identifying skills and qualification shortages, training and development needs across all organisations in the short and long term. Both GCC and NHS have processes which consider the requirements to fill posts as vacancies occur and discuss service reform plans and options. On the NHS side, this is by the way of the CHP Job Shop process and in GCC the Workforce Planning Board. Monitoring of vacancies and age profile is carried out annually to determine potential gaps in the future. Succession planning is being discussed regularly with set plans around the movement of social workers to team leaders being an area for development which is actively being pursued through PDP and a planned discussion session for staff. A 10 year programme of training our para-professionals as social workers is nearing completion. This has assisted with staff retention and allowed re-modelling of the staffing resource in Fieldwork. The Modern Apprentice scheme has been extended to older people’s day care and the residential sector will also be included over the coming years. Social Work Services runs a 3 day induction programme for all new social workers.

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7.2 Deployment, joint working and team work Main areas • Staff are deployed effectively within and across services to achieve priorities and objectives set out in strategic plans. • There is an appropriate employee mix in teams within and across services with an appropriate breadth of skill and experience within and across services. • Supervision and employee development systems link individual performance to service objectives. • Clear systems for line management and access to professional support. • There are clear job descriptions. Community nursing staff and rehabilitation teams are deployed in relation to population needs and aligned with GP practices in order to facilitate multidisciplinary team working particularly around anticipatory care, rehabilitation and palliative care needs of patients. Joint working between health and social work staff has been developed through reablement, where occupational therapists and NHS Rehab teams work with homecare staff to improve and maintain the ability of older people to manage daily tasks. Rehabilitation teams working in step down service are enabling care homes staff to ensure that residents achieve their maximum level of independence within that setting. The district nursing workforce has undergone Releasing Time to Care (RTTC) training which focuses on better time management, team work and improved patient facing time. Within GCC the staff groups within frontline fieldwork services are allocated on a Resource Allocation Model based on population and other indicators. Each Area of the City has a Carers Team. The level of staff is maintained via annual Social Worker recruitment. This staff group has a low turnover rate and there are no recruitment and retention issues. The numbers of qualified social workers and occupational therapists is regular monitored. In terms of residential and day care recruitment is regular to maintain the required numbers per unit based on registration requirements. Additional staffing is added when required depending on service users needs. Again this area has a low turnover rate. Workforce Plans exist for all these groups and a service wide Modernisation Programme is ongoing which includes deployment of staff to new units. A Resource Allocation Model (RAM) methodology is also applied within NHSGG&C to distribute resources weighted according to population need for community health services including, district nursing, community rehabilitation and Equip-u. NHS GGC has three forms of annual review for staff. Senior managers have a performance management system medical staff undergo an annual job planning meeting and all other staff are covered by the e-KSF review process. NHS GGC Staff Governance Committee takes six monthly reviews of work against the agreed local Staff Governance Plans. This includes staff demographics. GCC has a Personal Development Plan (PDP) process as well as supervision and a new Performance Improvement Framework is currently being implemented which is closely linked to improved supervision.

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7.3 Training, development and support Main areas • Employees across services receive appropriate management and professional training and development. • Joint training is strategically developed and implemented and is open to all partners. • There are effective employee development and supervision systems in place. • Staff are involved in the strategic planning of training and development.

To ensure that employees across Social Work Services receive appropriate management and professional training and development, a calendar of learning and development events is routinely available on Connect and our Learning and Development Team are working to update that. Similarly, the CHP has a training and development plan. There is an induction programme for staff that is centrally monitored for registered and health care support workers. Adult support and protection training is in place for all staff and offered at different levels depending on what role the staff member has and their level of responsibility. CHP employees have access to Learnpro modules covering a range of subjects both mandatory and advisory. This supports staff learning and development, and ensures that mandatory training (such as moving & handling, health & safety) is up to date. Completion of modules is monitored. District nursing services have a learning and development group which links to the Board wide review of district nursing services. A Promoting Excellence in Dementia Care workforce development plan now exists for Glasgow, overseen by a workforce development group. Within acute services, there are nurses who have become dementia champions via the NES training model. Employee development and supervision takes place within a defined framework in both Social Work and Health. The PDP / KSF processes support the development of staff across the partner organisations. Supervision is carried out in professional teams in line with best practice. Social Work Services training aims to maintain an appropriate level of training to meet the demands arising from legislative, policy, practice and procedural changes. In the development of programmes the Learning & Development team engage with practitioners to ensure accuracy and currency in content. Staff are also involved in the strategic planning of training and development through completion of post-course evaluations, the feedback from which supports identification of potential enhancements to existing training packages, and development of additional training modules which may be required. At this early stage of integration the principal focus of SWS Learning and Development has been in Organisation Development (OD) as opposed to individual staff training and development. There is a strong connection between OD in GGCNHS and GCC Learning & Development which will be used to build a robust connection to NHS GGC Learning & Education service. This relationship forms a cornerstone to the development of the OD transitional plan as a key part of the preparations for the new HSCP.

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8. Partnership Working Key features This area is about how finances and resources are managed across the partnership and whether there is a whole systems approach where areas such as business support and ICT support the delivery of the right outcomes for individuals and for the respective members of the partnership.

8.1 Management of Resources Main areas • There is an increasingly integrated approach between health and social work services which results in effective management and future planning of the range of services and resources across the whole system of health and care. • Health and social work services work closely and effectively with other key partners to ensure the best use of the range of existing resources and to plan future resource use in line with agreed shared strategic priorities. • Priorities set at partnership, team and unit levels reflect jointly agreed plans and priorities. • There is joint financial reporting of all services by key strategic partners.

Under Reshaping Care a Joint Resources Group has been established to develop and monitor the joint financial frameworks for each of the partnership's care groups, including older people. This group is responsible for providing the joint financial framework to support the Joint Commissioning Strategy, producing joint budget monitoring information reports to highlight pressure areas and ensuring that appropriate resources can be re-directed to deliver the balance of care agenda. There is collaboration between health and social work to effectively manage resources to support older people's services in Glasgow. This work has been developed through the joint strategic commissioning and planning process. The Joint Strategic Commissioning Plan highlights the NHS and Social Work Services operational budgets available to support older people. This analysis is still at an early stage and in order to get a compete picture we need to add in the third and independent sector resources to this as well as other services such as housing. Work has been done to analyse these budgets by the five components of the reshaping care pathway. This exercise has been instrumental in highlighting that currently 44% of our resources are spent on hospitals and care homes and 5% spent on preventative care. This provides a baseline whereby we can measure our progress against our stated intention to shift spend towards anticipatory care. We closely report and monitor Change Fund spend through joint financial reporting. The profile of this spend reflects our starting point where a high level of investment was needed to fund care home placements in response to the pressures from delayed discharge. We also fund a range of alternative services to prevent admissions, speed up discharge and delay the need for permanent home placements. All of these decisions were taken jointly. The Reshaping Care Strategy Group receives regular financial information on these matters and considers the allocation of Change Fund spend to optimise achievement of objectives. In terms of the integrated resource framework which seeks to map the totality of health and social care resources, this may provide us with potentially valuable information as to where most resources are consumed and by whom. In terms of physical resources, a new integrated residential care facility has recently opened in Possilpark. Four other similar facilities are in hand across the city, and there is a continued emphasis in planning on the joint use of these resources.

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Social Work reports annually to Council on its achievement of performance targets and setting of future targets via the ASPIR (Annual Service Plan and Improvement Report). This report also contains information on financial performance, including service reform efficiencies, budget changes and investment. Social Work, CHP and Acute work together to manage joint pressures around delayed discharges and have affected the transfer of resources to that end. Within restricted budgets Social Work administers its care homes spend within planning assumptions around both admissions and discharges. Any deviation from these planning assumptions (mainly discharges which are out with our control) may impact on delayed discharges within hospitals. Glasgow CHP and sectors report quarterly on performance against a range of key indicators to the CHP Committee. This format is based upon the style of the report produced for the Health Board’s Quality and Performance Committee and it enables comparisons to be made across areas and over time. Currently our CHP and SW budget cycles are not aligned we expect this will be addressed with the new formation of the HSCP. Nonetheless we are collaborating closely on individual financial planning to ensure consistency as far as possible. To this end we have had three financial planning sessions and, to develop a joint financial plan, a further session is planned for September as part of the process to align our forward financial planning for input to the forthcoming Board and Council budget planning. The performance report contains both HEAT and local performance indicators. The Health Board’s performance nationally is measured against targets. HEAT targets are agreed between the Scottish Government and the Health Board, then disaggregated to CHP and/or the Acute Sector, with targets agreed for each organisation.

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8.2 Information Systems

Main areas • There is a joint ICT strategy with effective information sharing and shared assessment protocols. This includes a coherent strategy to gather and use data to improve outcomes. • Health and social work services staff have arrangements and share appropriately, information on individuals who use services that is held on the health ICT system and the social work services ICT system. • Practitioners and managers use information systems to record performance against a range of key outcomes. • IT systems communicate with each other and share information at both an individual and strategic level. • Information systems have permissions and security to protect sensitive data. • Information systems provide accurate profiles of need and the range of care, treatment and support options.

The Joint Information and Health Systems Group is a long established group for Greater Glasgow and Clyde including representation from Health and the six Local Authorities. This provides governance for joint ICT projects across the Greater Glasgow and Clyde Area. Examples of the output of this group include the board wide Single Shared Assessment and Information Sharing Protocol (ISP). The group is also contributing to the development of a national ISP. One of the current key priorities is the rollout of information sharing facilitated by use of the Health Portal. The national eCare programme has been replaced by more localised data sharing arrangements, governed by the national Information Sharing Board. In NHSGG&C the agreed approach is data sharing facilitated by use of the Health Portal. This is being piloted in Renfrewshire and West Dunbartonshire before rollout across the Local Authorities in the NHSGG&C area. An ICT Strategy for Health and Social Care Partnerships is being developed by this group. In Glasgow there is an ICT work stream of the Integration Steering group which provides support to other work streams and a range of tactical and strategic ICT solutions linked with other strategic initiatives such as mobile working. • Over the last few years Glasgow has invested significantly in the upgrade of the

careFirst system to support the delivery of service improvements such as Personalisation and Home Care reform. This includes the ability to record outcome focussed assessments, reviews and outcome based support plans. The system was designed to meet new process and recording requirements and the implementation included significant practice, process and system training.

• Outcome focused assessments were introduced as part of the Personalisation process. This process and recording have recently been reviewed and re-issued to take account of personalisation for older people.

• A range of reports are provided to careFirst system users to assist them to monitor work and performance. Some of these are provided directly from the system, some emailed to staff and some made available via reporting software.

• A number of managerial reports are in use Board wide and by the Partnership. These are linked via the PAS/ Clinical systems in use and utilise the national return standards. Work is progressing around the development of live management dashboard reporting systems across a number of service areas.

• A project is underway to facilitate the linking of Health and Social Work data using the Health Clinical Portal. A range of Health staff currently have direct access to careFirst related to local strategy and working arrangements. We are working with ISD on the data to be shared at a national level in relation to Health and Social Care Integration.

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• Social Work Services and Health conduct regular Operational Performance reviews which monitor performance and there are a range of other monitoring meetings.

• There are a range of protocols and processes in place to protect data in careFirst. There is a range of Information Management and Information Security training available to staff – mainly briefings and eLearning.

NHSGGC has a number of IT and Information Governance (IG) policies in place to protect patient information, ranging from email and mobile working policies to IT security and Clinical Portal RBAC procedures. IG training materials are available to staff via Board eLearning systems and a programme of continuous IG training operates throughout aiding the professional training for example: junior doctors and student nurses. • Staff in Social Work and Health are required to carry out assessments and reviews

in line with statutory requirements and local policy and to record details to evidence decision making in relation to needs and outcomes. The Your Support Your Way website has been developed to give staff and members of the public easy access to information about the range of available services.

• Edison is a web based system used across Scotland to record and report on delayed discharges. In Glasgow City, the information arising from Edison is used as part of a single agency and joint agency review process to manage individual patient discharges. This is currently under review as part of an overall review of the performance against delayed discharge management.

• Electronic Key Information Summaries (e-KIS), containing an extract of a patient's medical history and condition are available to health out-of-hours services and hospital A&E. Anticipatory Care Plans are now accessible via this record.

Partnership development is driven through the links between the Integration Steering Group and the ICT work stream, and the links with the NHSGG&C wide Joint Information and Health Systems Group and the national Information Sharing Board and relevant parts of the Scottish Government.

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8.3 Partnership arrangements Main areas • Partnerships are strategic and focus on delivering key strategies, plans, and initiatives including self-directed support and early and intervention. • Partners regularly evaluate partnership working – and measure partnership benefits in outcomes attained for individuals. • There is extensive, effective and well-supported involvement of individuals who use services and carers. • There are joint systems for reporting on outcomes.

The establishment of the Joint Partnership Board, Adult Services Executive Group and the Adult Services Joint Planning structures in 2010 after the demise of the CHCPs in Glasgow provided opportunities to improve joint planning, service development and delivery and performance management of health and social care services. RCOP in 2011 provided the necessary focus within these structures to develop and implement the vision for older people reflected in this strategy and this was supported by investment from the Change Fund. The RCOP partnership includes third and independent sectors through GCVS and Scottish Care and has widened further to include housing and carers representatives. As previously evidenced in this paper there are a range of ways in which the partners manage and monitor joint performance, including joint financial monitoring and reporting. The Joint Strategic Commissioning Plan 2013-16 is reviewed and updated annually. Progress on targets and indicators in the plan are routinely reported to the Strategy Group as part of the performance management arrangements. The plan was also the subject of an extensive and rolling consultation and engagement exercise in 2013. The plan was also the subject of an Equality Impact Assessment. The RCOP partners are currently evaluating the partnership governance arrangements in light of experience and future requirements including contributing to the strategic plan for the HSCP. In addition to the RCOP, other partnerships exist and are being developed in the city to improve the level and quality of care for older people. These have been referenced elsewhere in this position statement and include carers, RSLs, care home providers, Glasgow Life, CPP, third sector providers and SAS. The Glasgow Health & Social Care Partnership is in its shadow year with the Chief Officer Designate appointed in June 2014. Readiness for integration has been greatly assisted by the experiences of joint planning structures highlighted above over the last 3-4 years. To support integration a project management structure has been established under an executive group. In addition, a joint executive team formed of the CHP and Social Work Services management teams has been formed replacing the former Adult Services Executive Group.

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9. Leadership and direction that promotes Partnership Key features This area is about the quality of leadership and the contribution of corporate leadership to drive the vision, culture and communicate this with the workforce and the wider population. Effective leadership of strategic and cultural change and improvement that is driven by effective practice and better outcomes for individuals.

9.1 Vision, values and culture across the partnership Main areas • There is a clear vision for adult and older people’s services with a shared understanding of the priorities. The vision is reflective of national priorities and translates into locally determined outcomes. All are able to articulate local priorities, inclusive of Board & Elected members. • There is a supportive and respectful culture with explicit shared values which all staff and managers are engaged. • High standards of professionalism are promoted and supported by all professional leaders elected members and Board members. • Partners can evidence clear links between the vision and the strategic plans.

The vision for older people's services was set in the 2013 Joint Strategic Commissioning Plan. It reflects national priorities and was developed following extensive consultation and engagement with older people, staff and partners throughout the city. The vision guided the production of the strategic plan and is fully supported by all of the partners. The plan including the vision was discussed and approved by the Joint Partnership Board, the CHP Committee and Council’s Executive Committee. Reports on progress on the main actions identified in the plan are regularly presented to the governing bodies. The vision and plan are central to the continuing process of engagement and development. Within the Community Planning Partnership improving the quality of life for older people is one of its priorities reflected in the Single Outcome Agreement and forms part of the One Glasgow approach. This in turn will continue to be reflected in the Joint Commissioning Strategy. It has been recognised that as we move into integration a joint vision for integrated partnership must be developed that is consistent with this strategic vision. Throughout 2013/14 we have held a series of joint leadership events between Social Work and Glasgow CHP to begin the process of defining our vision for integration, our values and the culture we wish to develop. An organisational development programme has been developed to facilitate buy-in from staff at all levels to the vision, values and culture we aspire to as a partnership, and joint sessions have taken place with the Shadow Integration Joint Board, senior management and operational staff, with further sessions planned through 2014/15. There have also been regular joint newsletters issued to all staff within both Social Work and Glasgow CHP. With regard to developing Locality Planning arrangements within our emerging HSCP we held a workshop for health, social care and community planning staff on 24 June at the Campanile. Discussions focused on identifying the most valuable aspects of engagement, reviewing examples of existing and previous engagement structures and processes that worked well and exploring the features of successful engagement. A report from the workshop was placed on Staffnet and the Council website. We have now started related discussions with a broad range of stakeholders including voluntary sector, independent sector, service users and carer representatives, GPs and other primary care colleagues. We are keen to hear how they would like to engage and

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participate in the development of Locality Planning within the HSCP. We are planning a number of engagement events and workshops during October and November. Within the current CHP arrangements we have developed an OD approach, Facing The Future Together (FTFT) with the overall aim: "To improve how we support each other to do our jobs, provide an even better service to patients and communities and improve how we all feel about NHS Greater Glasgow & Clyde as a place to work". A number of tools, techniques and opportunities are offered to staff and teams to support work around the key themes of ‘Our Culture’, ‘Our Leaders’, ‘Our Patients’, ‘Our People’ and ‘Our Resources’. Examples include tools to develop a health service that is sensitive to inequalities, a number that release time to lead and an online self assessment tool that allows staff to assess their values and behaviours.

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9.2 Leadership of strategy and direction Main areas • Senior managers promote collaboration between social work services and health teams and external partners. • There are good examples of partnership working, roles and responsibilities are clear and understood. Elected members and Board members promote partnership working. • Leaders of health and social work services have a high level awareness of future trends and joint strategic commissioning. • Social work services and health services are aligned with community planning priorities. • There is effective clinical & professional leadership for the development and delivery of integrated services and improving outcomes for individuals. • Preparedness for health and social care integration.

Collaboration in the planning, development and delivery of older people's services is extolled and promoted by senior managers across community health, social work and acute care at city, sector and local levels. Examples include the Reshaping Care Strategy Group, joint older people's executive group, integrated unscheduled care team, sector local implementation groups, hospital multi-disciplinary working and individual care planning. In terms of clinical leadership this exists in the form of GP fora / committee in each of the three sectors which discuss, comment and advise on issues concerning primary care in relation community care and hospital care. In addition there are quarterly sessions of the primary secondary care interface group involving primary and secondary care clinicians which shares, reviews and informs needs analysis, and service planning, development, delivery and audit across health and social care. Both of these mechanisms have been influential in shaping for example, communication between clinicians, development of intermediate care and joint working. In addition we continuously seek to develop new partnerships where these will improve care of older people. These include with the third sector through the likes of Alzheimer's Scotland, Marie Curie and Red Cross; with housing via the Change Fund and review of housing support; developing local engagement mechanisms with the many housing associations to shape and influence the strategic housing investment programme; and, with the Scottish Ambulance Service to support redirection of non injured fallers away from A&E. Our senior managers and clinicians are regularly kept up to date with the most recent information on changing needs, new analyses, performance and audit results across health and social care as well as shared financial analysis and projections. In this way we try to manage the complexities across health and social care and primary and secondary care to ensure that our forward plans are aligned and synergised to deliver the aims of the JSCP. This involves all of the Reshaping Care partners. In terms of preparations for the new HSCP the principal actions taken to date are: • appointment of the Chief Officer designate • the formation of the Integration Joint Board with voting and non-voting membership

and the scheduling of shadow meetings including to discuss the vision and values of the new partnership

• the setting up of a integration project management structure reporting to both Chief Executives and comprising a number of Individual work streams to advance preparations for integration consistent with legislation and guidance including governance, finance, localities, care and clinical governance and communications.

• the drafting of the integration scheme

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• designing the process and structure to deliver the new strategic plan building on the progress of existing planning and implementation groups such as the Reshaping Care strategy Group

• holding a series of joint leadership events of senior managers to address past experience, future aspirations and the basis of the vision, values and culture of the new partnership

• developing our OD transition plan for use with staff, partners, users/patients, carers and trade unions

• developing a basis of joint financial management and reporting • the forming of the Joint Executive Team of senior social work and health managers

to manage current business on a more aligned and converged basis • drafting of an approach to use of the Integrated Care Fund • regular progress bulletins to staff

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9.3 Leadership of people across the partnership Main areas • Senior managers and other leaders model and promote a positive and respectful engagement with the public and staff. • Leadership which promotes high professional standards. • Leadership which promotes the development and empowerment of staff at all levels. • Other key agencies within the partnership or working on behalf of the partnership are supported in developing strong leadership.

The partners recognise that good communication is fundamental to effective leadership of people. There have been a number of management events in both Health and Social Work as well as a number of regular briefings and newsletters to keep staff informed and engaged in the development of our partnership. Integration has been a feature of routine engagement of the wider staff group; for example Social Work’s Assistant Director routinely meets with groups of front line staff from across the city to allow issues such as integration to be discussed in relatively informal settings. Similarly, CHP Directors also hold meetings with local staff to discuss a range of issues including integration. A joint group has been established to support effective communication of information relating to the development of integrated arrangements in Glasgow. Robust leadership is also facilitated by our joint management structure, with key messages from the Shadow Integration Joint Board, Chief Officer Designate and senior management disseminated through the organisations as required. Staff are able to communicate their views via a ‘Have Your Say’ and the Facing The Future Together area of the respective staff intranets, and directly to their manager, senior manager or Head of Service. The expected role of staff and their contribution to ensuring high quality care and response to the needs of older people is emphasised by the management structure from senior managers down through heads of service and team leaders to teams and individuals. It is reinforced by performance scrutiny and appraisal at service and individual level and by the existence and application of clinical (and care) protocols. It is also confirmed by analysis of user/patient feedback and of complaints. Staff are encouraged to take a holistic approach to meeting the needs of older people and empowered to develop close working relationships with staff of other services and agencies where they can meaningfully contribute to the improved care of an older person and to operate as part of multi disciplinary teams.

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9.4 Leadership of change and improvement Main areas • All partners secure improvement in services through rigorous self-evaluation and self-assessment that evidences improved outcomes for individuals • Leading continuous improvement through effective change management • Working with all partners and stakeholders e.g. individuals who user services, carers, voluntary and private sector to achieve effectiveness for the delivery of present and future services

Both Health and Social Work are presently engaged in extensive service reform/redesign programmes aimed at delivering improvements in practices, systems and resources supporting older people. Together these reforms comprise a programme of transformational change in the care of older people in the city. In the NHS these include for older people: • support to care homes which will see revised medical, nursing, AHP and

prescribing services provided into all nursing homes in the City supported by a knowledge skills framework to improve the competencies of care home staff and a stronger role for the local authority.

• a new service specification for district nursing supported by more agile working to

increase time spent with patients, improvements in management information system, stronger leadership of bigger teams and a better structured out of hours service as a gateway to accessing other services.

Major reform areas for Social Work include: home care, transition to local commissioning of purchased care home care, strategic review of day care, review of housing support services, implementation of personalisation for older people and the re-provisioning of the Council’s care homes and day care. The Glasgow RCOP partnership has sought to learn from other places, principally in relation to the management of unscheduled and community care. This has led to exchange visits with Edinburgh, Dundee, Aberdeenshire, Renfrewshire and Wales. Visits have also been made to Darlington, Liverpool and Manchester to learn from their experiences of shifting the balance of care and developing intermediate care models. Professor John Bolton, a leading expert on integration and older people’s care has also been retained as an expert adviser to the Partnership. Similarly we have sought advice through the Joint Improvement Team on best practice for example on planning, partnership and engagement. We also engage in internal learning through for example the action learning sets. All of this has supplemented our own routine performance analysis in which we selectively benchmark with areas as well as against national or local targets. We celebrate success. Both the CHP and Social Work operate a service awards scheme which recognises staff initiative and leadership, good practice and improved performance. These schemes are widely canvassed and the results extensively communicated. The awards have come to be highly prized by staff. Social Work’s Executive Director also routinely acknowledges good work by staff.

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10. Key Areas for Improvement / Development 1. Significantly shift the current balance of care in line with a model promoting

prevention and early intervention, optimising the use of “purposeful interventions”. 2. Building upon existing service reform initiatives, implement a programme of

transformational change capable of meeting health and social care need in the city into the future.

3. Develop a culture of risk acceptance and risk management in line with the above by investing in the development of our workforce at a time of significant change and challenge for them.

4. Agree funding and effectively implement the delayed discharge reduction plan, including the programme for expanded intermediate care.

5. Finalise a sustainable city-wide model for anticipatory care planning. 6. Successfully implement personalisation for older people. 7. Develop a more systematic, integrated, outcome focused performance framework. 8. Secure longer-term funding commitment for “Good Moves”. 9. Strengthen housing voice within RCOP at city and sector levels and develop an

accommodation-based strategy that optimises the contribution the housing sector can make to shifting the balance of care.

10. Develop integrated service delivery for rehabilitation/ reablement, intermediate care and out-of-hours services.

11. Implement the 8-pillars approach based on learning from the pilot initiative, optimising health and social care input.

12. Embed community patient/ user engagement, feedback and response as standard practice in operational service delivery as well as strategic planning.

13. Review and promote integrated pathways across community health, social care, acute and intermediate care, examining current approaches to care planning.

14. Confirm a future joint training programme for staff working with older people. 15. Further develop shared financial planning and decision-making, including

alignment of budget cycles. 16. Enable use of Health Clinical Portal to share agreed health and social care data. 17. Confirming and communicating the vision, values and culture of the new HSCP

following engagement with the IJB, staff and partners. 18. Establish a continuous improvement programme of self evaluation of individual

services across health and social care, building upon existing audit activity. 19. Significantly expand the application of assistive technology in relation to both

health and social care, building upon the opportunities presented by personalisation.

20. Building upon the success of recent years, continue to develop new and innovative models of support to carers to help them sustain their caring roles.

21. Improve the overall “customer experience” of the health and social care system; e.g. through single points of contact and information sharing across the system wherever possible.

22. Learning from the experience of children’s services in Glasgow, develop a programme of evidence-based practice that demonstrates evidence of “what works”.

23. Learn the lessons from the RCOP experience to further develop partnership working with non-statutory partners, particularly with regard to evidence-based prevention and early intervention models of support.

24. Remain outward looking and looking to learn from and benchmark with other health and social care partnerships.

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25. Support elected members and non-executive members of the Health Board to adjust to their new integrated roles and to manage the political challenges associated with a programme transformational change.

Summary of how the Partnership operates strategically Since the dissolution of CHCPs in 2010 decision-making at a political/ non-executive Health Board level has been co-ordinated at Partnership level through the Joint Partnership Board, jointly chaired by the chair of the Community Health Partnership and Executive Member for Social Care. The JPB comprised equal representation of councillors and non-executive members of the Health Board and considered all relevant matters of strategy relating to health and social care, not only older people. In line with the new legislation the JPB has been replaced with a new Shadow Board, which has now begun to meet. Where decisions require to be escalated beyond this level they can be directed to the Executive Committee of the Council and the Health Board. Over the past 4 years there have been no instances where positions adopted by the JPB/ Shadow Partnership Board have been overruled. At officer level the JPB was supported by the Adult Services Executive Group (ASEG) jointly chaired by the Executive Director for Social Care and Director of the Community Health Partnership. Membership of this group comprised senior managers from both the NHS and Social Work. This group had a particular remit to support the work of the JPB. Again in line with the new legislation the ASEG has been replaced by a new officer executive meeting, the Health and Social Care Partnership Executive Group. This group has only relatively recently been established under the chairmanship of the Chief Officer Designate and again comprises representatives from Social Work, community health and Acute. Beyond the integrated management arrangements for health and social care there are the joint planning arrangements in relation to RCOP that have been described elsewhere. All of the above is reflected in the evidence submission accompanying this position statement.

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Joint Inspection of Older People’s Services

Quality Indicators 1. KEY PERFORMANCE OUTCOMES 1.1 Improvements in partnership performance in both health and social

care 1.2 Improvement in the health and wellbeing and outcomes for people,

carers and families 2. GETTING HELP AT THE RIGHT TIME 2.1 Experience of individuals and carers of improved health, wellbeing,

care and support 2.1 Prevention, early identification and intervention at the right time 2.2 Access to information about support options including self directed

support 3. IMPACT ON STAFF 3.1 Staff motivation and support 4. IMPACT ON THE COMMUNITY 4.1 Public confidence in community services and community engagement 5. DELIVERY OF KEY PROCESSES 5.1 Access to support 5.2 Assessing need, planning for individuals and delivering care and

support 5.3 Shared approach to protecting individuals who are at risk of harm,

assessing risk and managing and mitigating risks 5.4 Involvement of individuals and carers in directing their own support 6. POLICY DEVELOPMENT AND PLANS TO SUPPORT

IMPROVEMENT IN SERVICE 6.1 Operational and strategic planning arrangements 6.2 Partnership development of a range of early intervention and support

services 6.3 Quality assurance, self-evaluation and improvement 6.4 Involving individuals who use services, carers and other stakeholders 6.5 Commissioning arrangements

7. MANAGEMENT AND SUPPORT OF STAFF 7.1 Recruitment and retention 7.2 Deployment, joint working and team work 7.3 Training, development and support 8. PARTNERSHIP WORKING 8.1 Management of resources 8.2 Information systems 8.3 Partnership arrangements 9. LEADERSHIP AND DIRECTION THAT PROMOTES

PARTNERSHIP 9.1 Vision, values and culture across the partnership 9.2 Leadership of strategy and direction 9.3 Leadership of people across the partnership 9.4 Leadership of change and improvement 10. CAPACITY FOR IMPROVEMENT 10.1 Judgement based on an evaluation of performance against the

quality indicators