EUROHEALTH

Transforming health services
13
Box 1: Integration Scheme
components
• Engagement of stakeholders
• Clinical and care governance
arrangements
• Workforce and organizational
development
• Data sharing
• Financial management
• Dispute resolution
• Local arrangements for the Integration
Joint Board
• Local arrangements for operational
delivery
Table 2: Integrated partnership arrangements in Scotland
Project Name
Community
Links Project,
Midlothian
Sustaining
tenancy,
sustaining
wellbeing,
Muirhouse
Housing
Association
Edinburgh
Joint Carers’
Strategy
Source: Ref 7
Description
The project aims to provide support for older people (over 65 years), who are
isolated and living in the Midlothian area. It works to enable them to stay connected
with their local community and maintain or build on existing social networks
and opportunities.
This initiatives strives to provide practical assistance to tenants through an
enhanced management service. Run by Muirhouse, it aims to help people maintain
their tenancy, enable them to improve their quality of life, and create the conditions
in which people can address aspects of their health and wellbeing. This initiative
illustrates how housing associations – through extra services – can have a positive
impact on their tenants’ quality of life, health and wellbeing.
The City of Edinburgh Council and NHS Lothian have been working collaboratively
with carer organizations and carers themselves to develop a strategic approach to
commission support services for carers. The development of its three year Joint
Carers Strategy for 2014 – 2017 included a logic model that promotes consultation
with carers on priorities and support required.
• Liability arrangements
• Complaints handling
Source: Ref 5
that is engaged with the community,
those who look after service-users, and
those who are involved in the provision
of health or social care. Furthermore, the
services must take into account the needs
of different service-users; the communities
in which they live; their dignity; the
particular needs of service users as they
vary across the country; and the particular
characteristics and circumstances of
different service users. 7
Integrated partnership arrangements
Each integrated partnership arrangement
(i.e., each of Scotland’s 32 areas) must
propose an Integration Scheme that
facilitates ten key components, as
presented in Box 1.
Currently, 22 joint integration schemes
have been approved by the Cabinet
Secretary for Health, Wellbeing and Sport
and established across Scotland. Ten joint
integration schemes are still currently
undergoing internal review. A number
of policy leaders, financial officers and
solicitors are also involved to ensure that
the integration schemes comply with
legislation.
Implementation of integration in
Perth & Kinross
The recent integration of two services –
the Reablement Service and hospitals – in
Perth and Kinross is one example of how
the reform described above is translating
into the integration of health and social
services. Other examples are provided
in Table 2.
The Reablement Service 9 is a social
service that was launched in 2010 in Perth
to help patients over the age of 65 † regain
their independence upon discharge from
hospital and return home. The service
offers individuals six weeks of support
to plan and implement measures that
promote independence focusing on the
things they would like to be able to do for
themselves. This can include anything
from washing and dressing to preparing
meals. The amount of care and support
someone receives varies depending on
individual needs and if individuals cannot
achieve full independence after the six
week period, on-going care is arranged.
Until 2010, this service was engaged
upon referral by the local authority,
independently from any health care
service or provider.
In 2011, as a means of reducing
bureaucracy and accelerating patient
access to Reablement Service the locality
introduced the Immediate Discharge
† The number of people aged over 65 living in Perth and
Kinross is expected to increase by 74% by 2031.
Service (IDS). The IDS was convened
to directly assist hospital staff to ensure
patients preparing for discharge are
connected with the Reablement Service.
The IDS team consists of a Reablement
Coordinator, twelve new Reablement
Assistants, an occupational therapist
support assistant and a clerical officer.
Achievements
Since the introduction of IDS and by
November 2012, Perth and Kinross
have successfully reduced the number
of hospital bed days for patients over 65
by 50%. The ability of hospital staff to
directly connect with the Reablement
Service though the IDS has also allowed
hospital-based social workers to direct
non-complex cases to the Reablement
Services and redirect hospital social
services to more complicated cases.
Direct collaboration between hospital
and Reablement Service staff has
resulted in improved communication
and collaboration. This is in large part
due to having dedicated clerical staff
to assume administrative and logistical
communication responsibilities allowing
clinicians to focus on clinical discussions
and care plans with patients and the
Reablement Service staff. Such a review
and redesign of the discharge pathway
has led to a robust, efficient multidisciplinary
approach to assist with
building community capacity, reduced
duplication and increased efficiency.
Direct access to the Reablement Service
Eurohealth — Vol.22 | No.2 | 2016