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Localities Project Update Introduction Section 6 within the “Health and Social Care Integration Project Action Plan” identifies the need to look at 3 aspects of Integrated Management Structures, namely;

• Multidisciplinary Locality Service Teams, • Joint Director of Health and Social Care, and • Professional and Clinical Governance.

This paper outlines progress to date with the Localities Project which is being taken forward to address the Multidisciplinary Locality Service Teams aspect of this area of work. For the other two aspects, the Joint Director of Health and Social Care post was actioned in February 2014 with the appointment of Mr Bokor-Ingram to this role. A separate working group comprising the Director of Community Health and Social Care, Medical Director, Director of Nursing & Acute Services (with professional responsibility for Nursing and Allied Health Professionals) and the Chief Social Work Officer has been established to take forward the work on Professional and Clinical Governance. Localities Project In May 2014, I presented to the Executive Manager and Team Leader levels in the Community Health and Social Care Directorate an outline of how we planned to progress the Localities project. Discussion by those present identified some additional aspects to consider within the plan and overall support for the project was achieved. A copy of this presentation is attached (see Appendix 1). The objectives of the Localities pilot projects are stated as to

• streamline service delivery in order to achieve optimum benefits to people requiring support in our communities.

• avoid duplication of effort and drive out potential inefficiencies. • promote the use of anticipatory care planning across services to prevent

unnecessary admission to hospital and ensure quick return to the community from hospital when acute medical need has passed.

• maintain/ enable robust multi agency and community support arrangements in localities that will deliver sustainable outcomes for the people in those communities.

Through the project it is planned to explore

• How services can integrate to provide better outcomes for people; • Identify potential for efficiencies across health and social care as a result of

locality management; • How the model can be replicated in other localities throughout Shetland.

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This exploration should consider integration options in terms of opportunities in • Working practices – clarifying roles and responsibilities, streamlining working

practices, eg documentation, • Staffing structure – development of a more integrated staffing structure, • Service Model – enhanced multidisciplinary team approach, • Shared Buildings – co-location of staff teams

Since May a milestone chart has been developed to outline the key steps in progressing the project over the remainder of 2014/2015. The milestone chart can be seen in Appendix 2. The chart has taken into account the additional items raised at the previous Directorate Team meeting. Update on Progress to Date The following areas of work have been progressed: Project Leads – in order to support progress on the project, Ms Lisa Watt, Service Manager Primary Care has been identified as the second Project Lead to work with the Chief Nurse on this project. Directorate Team Meetings – a schedule of Directorate Team meetings is in development and an update on progress will be shared at each meeting. This paper will provide an update for the August Directorate Team meeting. Staff Communication A briefing will be issued across NHS, Local Authority and Voluntary sector partners once this paper has been considered at the Integration Board, Senior Management Team and Directorate Team meetings. Briefing will now be issued at the beginning of September 2014. Health and Care Data A range of data (Clinical, Financial, Quality, Workforce and Infrastructure) is in the process of being gathered and will be considered at relevant points as the project moves forward. Project Charters Project Charters for the Lerwick and North Isles pilot sites are in development. The Lerwick Project Charter has been agreed but the North Isles Project Charter cannot be finalised until we receive further information from IRISS. Mr Bruce McCulloch, Service Improvement Advisor, will be the main Service Improvement support for this project and has identified via the team the equivalent of 40days worth of time for the project. The Project Charter can be seen in Appendix 3. Mr McCulloch is currently commencing the process mapping phase of the Lerwick pilot by liaising with key staff and teams involved in the admission and discharge of patients to and from the Gilbert Bain Hospital to home or residential care.

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Institute for Research and Innovation in Social Services (IRISS) Initial discussions with representatives from IRISS had been very positive regarding what support could be provided for the localities project. However, a visit from the project manager identified that they have limited support to offer to the teams locally (in terms of 4 site visits to work with staff) and that they require local staff to undertake a number of key roles to support the project locally. We are awaiting confirmation from the Project Manager as to what support IRISS can provide in terms of locally based work with teams and what support they need from the teams in order to make this effective as we are conscious that there is limited capacity within teams to take on additional work. A decision will be made on the involvement of IRISS once we receive this information. Staff Engagement Whilst staff engagement will be initially limited to key individuals/groups that are being asked to contribute to the development of the process map. Wider engagement with staff across primary, secondary and community care will be held in the workshop session planned for September. Briefings will then be developed to communicate key messages and update on progress with the project. It is also expected that progress with the project will be discussed at key staff team meetings across the Directorate. All Managers/Professional Leads across the Directorate have a responsibility to ensure that they share /discuss the progress of the Localities project within their respective areas of responsibility. The importance of engaging key clinical staff in the work of the Localities Project, eg GPs, is noted and discussions are in progress as to how best their involvement can be gained. Engagement with Local Councillors Councillor Gary Cleaver, who is also Vice-Chair of Social Services Committee , is one of the Councillors for the North Isles. Councillor Cleaver has been identified as the nominated Councillor for this project. Meetings have been scheduled with Councillor Cleaver on a fortnightly basis. We are very pleased to have the support and enthusiasm of Councillor Cleaver in this project. Other Councillors will be kept informed of progress with the project through regular updates to the joint CHP/Social Services Committee. Engagement with the Public Following discussions with Councillor Cleaver and with the Scottish Health Council we have agreed to commence engagement with individuals, carers, and members of the wider public once we have completed the mapping process with staff. Union Representation/Staff Side Engagement As both organisations have a different approach to the involvement of staff side representation we will seek advice from the respective Human Resources Directors as to how to best address appropriate staff engagement in this process, seeking their assistance in putting this in place.

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Community Planning A meeting with Ms Vaila Simpson, Executive Manager Community Planning and Development has been scheduled for early September. Risks The main risk to delivery of this project is in terms of the capacity of the Project Leads to have sufficient time to devote to the Project. Both Project Leads have operational duties as well as being actively involved in other areas of work, some of which do have synergies with the Localities project eg Primary Care Strategy but are significant pieces of work in their own right. Whilst monies are available to support partial backfill of the individual postholders normal roles, difficulties have been encountered in trying to find suitable backfill arrangements and thus it is not imminently possible to have backfill in place. Attempts will continue to be made to identify possible solutions but consideration may need to be given within the NHS to reprioritisation of other areas of work in order to enable this project to be progressed in a timeous way. This risk has already been raised at CHP /Social Services Committee by one of the non-executive NHS Board members. Recommendation The Integration Project Board, NHS Senior Management Team and Directorate Management Team members are asked to

• Note progress to date on commencing the Localities project; • Comment on proposed milestone chart as presented; • Advise on union representation/staff side engagement in the project; • Advise on any perceived omissions or areas of concern noted; and • Consider and advise on frequency of update reports required.

Edna Mary Watson Chief Nurse – Localities Project Leader Directorate of Community Health and Social Care 8 August 2014

Integrated Working in Localities

Edna Mary Watson, Chief Nurse & Ruby Whelan, Executive Manager

Directorate of Community Health and Social Care

Introduction

• Project • Scope • Plans for pilot • Comments

Scope

• Explore : • How services can integrate to provide better

outcomes for people; • Identify potential for efficiencies across health

and social care as a result of locality management;

• How the model can be replicated in other localities throughout Shetland.

Objectives • Objectives of the pilot : • to streamline service delivery in order to achieve optimum

benefits to people requiring support in our communities. • to avoid duplication of effort and drive out potential

inefficiencies. • promote the use of anticipatory care planning across

services to prevent unnecessary admission to hospital and ensure quick return to the community from hospital when acute medical need has passed.

• to maintain/ enable robust multi agency and community support arrangements in localities that will deliver sustainable outcomes for the people in those communities.

Progress to Date

• Health and Social Care Integration PID • Test a model of locality management within 2

discrete areas – North Isles (Yell and Unst) and Lerwick

• Project Leaders – Ruby Whelan – Edna Mary Watson

Locality Management Pilot

• Management and the single management model in the context of locality management - consider implications of a single management model for staff working in localities.

• Governance at a locality level – sub group established to take this work stream forward.

Exploring integration in terms of opportunities • Working practices – clarifying roles and

responsibilities, streamlining working practices, eg documentation,

• Staffing structure – development of a more integrated staffing structure,

• Service Model – enhanced multidisciplinary team approach,

• Shared Buildings – co-location of staff teams

Lerwick pilot

• Focus on – interface between hospital and community

settings, – focussing on supporting hospital admission

avoidance (unless clinically necessary) and – early supported discharge from hospital.

• Informing working relationship between the acute sector and community/primary care services for a Shetland wide basis in the future

Northern Isles pilot

• Focus on – development of an integrated service model – transferable to all rural areas across Shetland.

• NB need to take account of/link to the work undertaken to look at staffing within Northern Isles project being led by Housing

Key Steps • Process Map/review cases of current working practices

between health and care services; • Identify any areas of duplication; • Identify opportunities to enhance process and

patient/client experience by working differently; • Identify what needs to be done to make change work/trial

it. • Consider wider aspects of service delivery in terms of • Professionals required/available in the area – create

service model • Bases – principle of co-location (where sensible and

possible to do so) • Team structures • Management Structure

Project Leader Functions • Project leaders

– maintain current roles and responsibilities; – continue to lead on Individual projects which we are

responsible for, eg Closure of Viewforth, Setting up of Intermediate care/Rapid Response Team;

– undertake normal line management functions for their respective staff groups;

– work together to provide leadership and support to project, facilitating exploring different ways of working and implementing “tests of change” to trial different processes as identified

Timeframe • May to October 2014 • Recommendations for an integrated locality

based method of working - November 2014.

Next Steps

• Project Plan • Communication • Engagement of /with staff • Understanding of current service provision /

“getting to know people/services” • Process mapping / workshops

EMWatson/ Lisa Watt Page 1 Date last printed:

Milestone Chart – Localities Project Appendix 2 August 2014 – March 2015 Programme Name

Milestones/Objectives Action Owner

07/14 08/14 09/14 10/14 11/14 12/14 01/15 02/15 03/15

Presentation given to Directorate Team Meeting (DTM)– Team Leaders in both health and social care – May 2014 Update sessions to be held at each DTM (schedule estimated - still to be confirmed)

X X X X

Identify all key staff (multi-disciplinary/Interagency) to be involved in project in both Lerwick and Yell/Unst (ensuring contact details and distribution list current)

X

Develop and circulate staff briefing regarding project – to project areas and to wider CH&SC Directorate /Acute sector/ web page

X

Develop regular briefing to share across services via Team Brief (NHS)/Heads of Depts meetings

X - NHS X - NHS X - NHS X - NHS

EMWatson/ Lisa Watt Page 2 Date last printed:

Milestones/Objectives Action Owner

07/14 08/14 09/14 10/14 11/14 12/14 01/15 02/15 03/15

Gather health and care data relevant to service provision in each of the areas in terms of

• Clinical • Financial • Quality • Workforce • Infrastructure

X

Develop project charter and secure service improvement support

X

Liaise with IRISS regarding “innovation” support Visit Shetland Scope support for project - ?also inform/support Primary Care Strategy Engage participation in project at right stage

X X

X

Ensure staff engagement methods/routes available for those involved in pilot sites and also for wider health and social care teams eg briefings, open sessions, workshops, Team meetings, ?electronic “wordpress”

X

Discuss plans with nominated Councillor (Gary Cleaver) and agree way forward/ involvement/leadership

X

EMWatson/ Lisa Watt Page 3 Date last printed:

Milestones/Objectives Action Owner

07/14 08/14 09/14 10/14 11/14 12/14 01/15 02/15 03/15

Consider public involvement/engagement with process - ??Local Community Council or “island” meetings / PPF session (s)

X X X

Schedule regular review meetings with DCH&SC, Councillor Cleaver, Lisa Watt and EMW

X X X X X X X X X

Agree feedback/ update report schedule for “Integration Board”, CHP Strategic group/ Acute Services Strategic Group/SMT/CHP Committee

31 – CHP Committee

5- CHP Strategic 11 – Integration Board 13 - SMT 20 - ASSG

6- CHP Strategic 14 - ASSG

2- CHP Strategic 9 - ASSG

Host staff workshops to process map current state in relation to Lk (admission and discharge to/from hospital link to social care resources – care home and support at home) Yell/Unst (working practices in terms of health and social care staff working in multidisciplinary team approach – patients at home, in care home - respite and permanent)

X X

EMWatson/ Lisa Watt Page 4 Date last printed:

Milestones/Objectives Action Owner

07/14 08/14 09/14 10/14 11/14 12/14 01/15 02/15 03/15

Review current state with value stream data, identify bottlenecks, non-value adding steps, streamline processes

X

Implement changes in current processes using improvement methodology eg PDSA,

X X

Liaise with Community Planning regarding community planning structure in local areas, communication with integrated health and social care partnership, feed to Community Planning Partners

X

Liaise with NHS and SIC HR services to agree staff side engagement in process

X

Review staffing structure necessary within area to support new ways of working – consider “team” structure

X

Consider staff bases – aiming for principle of co-location where it is possible and sensible to do so

X

Consider management structure necessary to support new ways of working

X

Host workshops for DMT, CHP Strategic group/ Acute Services Strategic Group/SMT/CHP Committee

X

EMWatson/ Lisa Watt Page 5 Date last printed:

Milestones/Objectives Action Owner

07/14 08/14 09/14 10/14 11/14 12/14 01/15 02/15 03/15

Host Community Council, Open Public meetings in Northern Isles / Lerwick

X

Host PPF session X

Draft service model for future – to be included in Integration Scheme

X

Develop Implementation plan for roll out Shetland wide

X X X

Implement new structure April 15

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Project Charter: Localities – Health and Social Care Integration

Aims statement: what are we trying to accomplish?

To determine the current discharge pathways accessed by service users across Health and Social Care in the Lerwick area. This includes hospital, care homes and the clients home environment. Business Case

To support NHS Shetland achieve its Corporate Objectives:

- To improve and protect the health of the people in Shetland

- To provide quality, effective and safe services, delivered in the most appropriate setting for the patient

- To redesign services where appropriate, in partnership, to ensure a modern sustainable local health service

- To provide best value for resources and deliver financial balance

- To ensure sufficient organisational capacity and resilience

Purpose

Key Areas for improvement:

- To comply with new Legislation around integration of Health and Social Care.

- To Ensure that we provide the best possible care for Shetland users of our services.

- To maximise the investment of both Health and Social Care

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Improvement Plan?

Measures that will be used to monitor the impact of this improvement effort

- Creation of current state process maps which illustrate the discharge planning

procedures in the Lerwick area. This will include hospitals, care homes and the home environment including the work of the intermediate care team.

- The high level process maps will be used to facilitate discussion with key stakeholders to determine strengths and areas where improvements should be trialled or could be made.

- Please note this may be out with the scope of this charter but if time allows, develop an ideal state (value stream) in partnership with key stakeholders.

Project Scope

- Existing pathways and processes

- Working patterns and practices

- Roles and responsibilities

Project team

Role (examples only) Name Time available

Executive Lead Simon Bokor-Ingram

Operational Lead Edna Mary Watson / Lisa Watt

Andy Glen Service Improvement Lead

Bruce McCulloch Improvement Advisor

Tuesdays-Thursdays

David Kerr Data Analysis

Total Amount of CSI time (assuming 4 projects in Mental Health/Localities) for this project is

Andy - 8 days

Bruce – 24 days

David – 8 days