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Argyll & Bute Health & Social Care Partnership Agenda item: Health and Sport Committee inquiry Integration Authorities’ (IAs) approach to engagement with stakeholders. Date of Meeting: 25 th April 2017 Presented by: Christina West Chief Officer The Health and Sport committee is asked to consider and note this response by Argyll and Bute HSCP to this inquiry which covers:
• Guidance from SGHD • Outcome of Argyll and Bute HSCP Strategic Plan Consultation • Establishment of Locality Planning Groups and membership • Development of Fit for Future Quality and Finance Plan 2017-19 • Service Redesign and Transformation project groups • Community Planning and other stakeholder involvement • Assessment
1. EXECUTIVE SUMMARY This report details the arrangements, approach and culture the A&B HSCP is aiming to put in place to incorporate meaningful and robust involvement and engagement by all its stakeholders in Health and Social Care service planning and delivery. The Integration Joint Board of the HSCP has committed to applying SGHD guidance including the use of CEL 4 2010 Informing, Engaging and Consulting People in Developing Health and Community Care Services. This, the IJB view is a very important distinction from the simplistic and misunderstood term “consultation”. Consultation is a formal process to obtain a specific response on a proposal or a single question. The IJB has approved a communications and engagement strategy detailing its approach and expectation for ensuring its staff, communities and stakeholders are involved and engaged in health and social care in Argyll and Bute (Appendix 1) Its arrangements for involvement and engagement have been developed with all stakeholders and all remain committed to further developing and strengthening this so it becomes the norm. The IJB has an aim and objective to develop and support its partnership to embed and achieve the transformation in health and social care service at locality level. Why? - It believes this is the only way it can ensure its has safe,
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sustainable, responsive and affordable services, addressing the geography of this remote rural area and the interface challenges with its care pathways to Glasgow, Whilst our plan and intentions are clear and the structure is in place, the reality on the ground is that the HSCP has just completed its first year of operation following its establishment. These arrangements, relationships and processes are still in the development and norming phase and will continue to take time and resources to become embedded. This is in conflict with the scale and pace of transformational change required within a challenging financial, service viability and political context. 2. DETAIL OF REPORT 2.1 Guidance from SGHD The development of legislation and associated guidance within the Public Bodies Public Bodies (Joint Working) (Scotland) Act 2014further aligned the legacy of stakeholder and public involvement in NHS and Social Care services in Argyll and Bute building on existing partnership working between the council and NHS. The pertinent guidance includes:
• Strategic Commissioning Plans Guidance Dec 2015 • Localities Guidance July 2015 • The Role of Third Sector Interfaces March 2015 • Statutory Guidance to Integration Authorities on their responsibilities to involve
housing services September 2015 2.2 Argyll and Bute Strategic Plan and Locality pla nning
The shadow IJB in 2015 established a strategic planning group with representation from all stakeholders (Appendix 2) to develop its 3 year strategic plan. This was an extensive process, involving all partners and included a pre consultation briefing process for communities, staff and stakeholders, followed by a formal 3 month public consultation process on the strategic plan. The material points coming out of this consultation from respondees were:
• Keep Services Local • Better Patient Transport • More Public & Patient Participation • Increased Focus on Mental Health Services • Communication between NHS and Social Work • More Health Promotion Information & Services • A Higher Quality, Better Paid Care Worker
This enabled the Argyll and Bute HSCP to clearly articulate its vision and objectives and to describe what services will look like in 3 years time.
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The direction from the guidance and outcome of its Strategic Plan consultation included the establishment of 8 Locality groups configured around recognisable communities (below) again with representation of all stakeholders (Appendix 3 details the ToR of the group and membership) Locality Population Locality Description Oban, Lorn & the Isles
17,180
Easdale to Oban, to Port Appin to Dalmally
Mull & the Islands 4,200 Isles of Mull, Iona, Colonsay, Tiree and Coll
Mid Argyll 9,399 Tarbert, Lochgilphead, Ardfern, Inveraray Kintyre 7,741 Southend, Campbeltown, Muasdale,
Carradale, Gigha Cowal 14,489 Lochgoilhead, Strachur, Tighnabruaich,
Dunoon Bute 6,227 Isle of Bute Helensburgh & Lomond 26,163 Helensburgh, Kilcreggan, Garelochead,
Arrochar
What will Services Look like in 3 years time? (Argyll and Bute HSCP Strategic Plan 2016/17 – 2018 /19)
• A single Health and Social Care team will provide more services in your
Community 24/7 (Adults and Children's)
• You will only need to contact one person for all Health and Social care in your community.
• We will prioritise investment for Health Improvement and healthy lifestyle
programmes, to keep you healthy.
• We will become used to using technology to support care at home, by allowing remote monitoring of your condition remote consultations with trained staff
• Your local hospital will continue to co-ordinate and deliver emergency
medical care, with fast access to Glasgow hospitals when necessary.
• GP and other 'front-line' services will continue to be provided locally. However we expect that, through mergers and federations, there will be fewer GP practices. This will provide a greater choice to patients – e.g. a male or female doctors and offer you a range of GPs and nurses with special interests and training.
• Most hospital treatments will not require a stay in hospital, with hospital
beds being used only for those needing more continuous nursing. – Less hospital beds
• With more care delivered in the home, and with more support for carers
(especially family and friends), nursing- and care-home beds will be used for those who need a higher level of care
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The process of supporting the development of each group to undertake involvement and engagement includes the establishment / development of existing communications and engagement groups alongside Health and Care Forums in each locality. 2.3 Fit for Future Quality and Finance Plan 2017-19 IJBs were directed to produce a 3 year strategic plan with the expectation that this would be underpinned by an indicative three year allocations, subject to annual approval through the respective budget setting processes from its host bodies. In reality the 1 year annual cycle is compromising the ability of the HSCP to front load the investment required in community and care services to achieve the shift in the balance of care from acute to community care, at the pace of transformational change required. The Argyll and Bute HSCP recognises that it has to achieve savings in its budget as its funding allocation does not meet all the inflation and demand pressures it has to meet. This is a significant driver for change but it is only one factor alongside service sustainability and safety, recruitment difficulties, independent care sector fragility and well documented population decline, demographic and multi-morbidity challenges. Building on the legacy and lessons learned from 2016/17, the HSCP has used and challenged the Locality planning groups to support the development of its Quality and Finance plan 2017-2019. The input and engagement of all stakeholders and representative on each Locality planning group has produced a range of proposals which are aligned with the Strategic Plan and the Government Health and Social Care Delivery plan. These service change plans are now embedded in the locality and the next step is to support the localities to own their further development and implementation over the next 2 years. In support of this the IJB has acknowledged the need for increased communication and engagement capacity as part of its investment plan. This enhancement has received by national and local political support as a necessity. Getting people to understand the case for change is an absolute necessity if stakeholder engagement is to be meaningful and focussed on coproduction of the necessary service transformational changes and other challenges that lie ahead. The HSCP has commenced this process by issuing a briefing leaflet (Appendix 4) to all communities as well as hosting a number of drop in events to outline proposals. This has also been supported and led by our Argyll and Bute Third Sector Interface partners. The outcome of this “informing” part of engagement has been used by the IJB at its March meeting to approve the Quality and Finance plan proposals but not the budget at this stage. The IJB Quality and Financial plan is attached in Appendix 5 2.4 Service Redesign and Transformation project gro ups The HSCP will be establishing a number of discrete projects and programmes of work to progress its service transformation portfolio. Some of these groups are already established, but all include stakeholder representation including public members. They
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all interface with the Locality Planning Groups and are supported by the communication and engagement groups in each locality. Examples of which include:
• Planning the future for Lorn and Island Hospital • Thomson Court Day Centre & Bute Community Redesign • Struan & Cowal Community Redesign
2.5 Community Planning and other stakeholder involv ement The main aim of the Community Planning Partnership is to deliver the outcomes within the Single outcome agreement (SOA). The introduction of the community empowerment act regulation in April 2016 Places Community Planning Partnerships (CPPs) on a statutory footing and imposes duties on them around the planning and delivery of local outcomes, and the involvement of community bodies at all stages of community planning. Argyll and Bute CPP is in the process of reviewing and confirming its revised arrangement including the role of its 4 CPP Locality Forums which receive updates on locality service redesigns. The HSCP is represented on all of these groups ensuring interfaces and relationships with all CPP. The HSCP is still developing its formal relationships with a variety of other stakeholders but has established arrangements with local housing providers and is a member of the Argyll and Bute strategic housing forum. It is also a member of the West of Scotland NHS regional planning group examining and developing specialist secondary and tertiary service provision 3 ASSESSMENT The pace and scale of transformation required and the resource available to lever this, while taking stakeholders with us is a significant risk for Argyll & Bute IJB. The IJB is attempting to put in place meaningful and practical arrangements and support augmenting capacity and capability to deliver the changes which will improve outcomes for local people, while making best use of available resources. The scale of change required the complexity of the health and social care system and pathways, the financial and political context, coupled with understandable community anxiety and concern are clear barriers to overcome. These barriers are potentially of an order which may delay or undermine delivery and require both national and local support to mitigate. Christina West Chief Officer 10th April 2017
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Appendices
Appendix 1 – Argyll and Bute HSCP Communication and Engagement Strategy Appendix 2 – Argyll and Bute Strategic Planning Group Membership Appendix 3 – Argyll and Bute Locality Planning Group Terms of Reference Appendix 4 – Argyll and Bute HSCP Fit for the Future Briefing Leaflet Appendix 5 – Argyll and Bute HSCP Quality and Finance Plan 2017-19
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ARGYLL AND BUTE
HEALTH AND SOCIAL CARE PARTNERSHIP
Communications and Engagement Strategy
2016 - 2019
Version 0.7 07 June 2016
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Contents Page 1. Foreword by Christina West, Chief Officer 3 Argyll and Bute Health and Social Care Partnership 2. Our purpose 4
3. Communication and Engagement Principles/Objectives 6
4. Our Area / My locality – area wide and locality focused 7 - Roles, responsibilities and support - Key contacts 5. What we will communicate 11
- General key messages - My local areas
6. Who we will communicate with 12 7. How we will communicate and engage 13
- Communications and engagement toolkit 8. Review and evaluation 15 9. Statutory guidance requirements summary 16 10. Role of the Scottish Health Council 18 Appendices Appendix 1: Media protocol Appendix 2: Statutory requirements
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1. Foreword The recent integration of health and social care services is about changing how we work in order to better align our services to meeting the health and social care needs of our communities in ways which are sustainable, flexible and responsive. It is therefore essential that Argyll and Bute Health and Social Care Partnership (HSCP) communicates and engages with our local communities in an effective manner which places the views and priorities of these communities at the heart of everything we do. This Communications and Engagement Strategy outlines the HSCP’s vision to work with local communities, our staff, the Third Sector and stakeholders across Argyll and Bute to improve the health and wellbeing of individuals and their families. This Strategy also sets out how everyone with a part to play in delivering effective communication and engagement can work together so that Together we can transform health and social care to achieve our joint vision for the people of Argyll & Bute “to lead long, healthy and independent lives” .
Christina West Chief Officer Argyll and Bute Health and Social Care Partnership
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2. Our Purpose This Communications and Engagement Strategy will support the delivery of the HSCP Vision by working within the six principles of integration, that the HSCP: More information on the Vision, Mission and Values of the HSCP is available in the Argyll and Bute HSCP Strategic Plan. Copies of the Plan are available on request or can be accessed on our website at: www.tinyurl.com/jrty6a7 As part of our overall communications and engagement with the public, staff, the Third Sector and other stakeholders we will also ensure:
• We are well informed as individuals and staff
• Information and learning is well communicated and shared openly and clearly
• Information flows up, down and across all levels and geographical
areas
• Additional support to make information accessible will be made available if required
• We will build services through an ongoing conversation and dialogue
with individuals
• We will use various methods to have conversations with people and we will build on the good practice that already exists
• We meet the legislation and standards for engaging and
communicating by actively using them and asking the public and staff to feedback
• This strategy is updated on a regular basis to reflect the fact that it is a
working document
1. Is integrated from the point of view of recipients
2. Takes account of the particular needs of different recipients
3. Takes account of the particular needs of recipients in different parts of the area in which the service is being provided
4. Is planned and led locally in a way which is engaged with the community and local professionals;
5. Best anticipates needs and prevents them arising
6. Makes the best use of the available facilities, people and other resources
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We will use engagement with public, staff and our stakeholders to find out:
• Locally what will and won't work • Locally what will or won't be the best use of our resources
This means that we need:
• Effective communications and engagement with everyone involved playing their part (co-ownership)
• Fully informed and actively engaged public and staff working together
through the Locality Planning Groups to plan and deliver health and social care services that meet local needs and deliver the Health and Wellbeing outcomes
• To recognise that there should be a partnership approach to
communications and engagement
• Top develop the relevant resources and structures in place to ensure we deliver on what is outlined in this strategy
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3. Communication and Engagement Principles/Objectives Effective and robust internal and external communication and engagement will play a crucial role in supporting the HSCP to achieve its vision, aims and strategic objectives. Outlined below are some of the key principles and objectives for the HSCP. Explaining the Partnership
• Explain the role and remit of the HSCP • Explain clearly the aims and vision of the HSCP • Raise the profile of the HSCP to make it an organisation that the public
and staff feel belongs to them • Build confidence that the HSCP is a responsive and effective
organisation • Proactively promote HSCP successes, achievements and activities,
both internally and externally, to inspire confidence in local health and social care services
What it means to each of us
• Explain what the HSCP means to the public, service users, staff, the Third Sector and other stakeholders
• Support the improvement of health and wellbeing of people in Argyll and Bute by raising awareness of the role of the individual in achieving long, healthy and happy lives
• Support staff through change on an ongoing basis • Ensure the HSCP utilises the wide range of skills that are available
within the Third Sector, staff and local communities to assist with communications and engagement
What it means for local areas
• Ensure local needs and views help shape future health and social care services through the sharing of information and good practice. This will include ongoing engagement with service users, public and staff.
What it means for communications and engagement wor k
• Learn from best practice in communications and engagement methods • Continually develop innovative and successful ways of communicating
and engaging with our target audiences • Provide feedback to the public on how their views have contributed to
the decision making process through the “You Said We Did” philosophy • Build continuous and meaningful engagement with communities, staff,
service users and carers to help influence the shaping of local services • Facilitate two way communications • Utilise service user experience and opinion to improve quality • Encourage the involvement and engagement of staff
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4. Our Area / My Locality The start of Argyll and Bute Health and Social Care Partnership on 1 April 2016 saw the transfer of responsibility for communication and engagement at a local level to the new 8 Locality Planning Groups. This supports and recognises the aim to empower local communities to become “Locality Planned, Owned and Delivered” health and social care services. In common with many other services within the HSCP, communication and engagement will also need to be matched to varying requirements of the different localities. There will therefore be two levels of activity required:
• Communication and engagement relating to health and social care services as it applies to the whole of Argyll and Bute
• Communication and engagement relating to health and social care
services as it applies to specific localities Locality Planning Groups are also expected to share good practice, learn together and continue to develop their relationship with the HSCP at an Argyll and Bute wide level.
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Roles, responsibilities and support Ensuring those who have a role in informing others will be key to making effective communication and engagement possible. The sharing of information will therefore be vital. Given this requirement and the increasing demand for communications and engagement support from the 8 Locality Planning Groups (LPGs) the final meeting of the Communications and Engagement workstream agreed that rather than continue with the workstream approach an account manager approach would be used by the communications and engagement officers of the NHS and Council. This approach would mean that each LPG would be allocated a communications and engagement officer as their point of contact for advice and support. The expertise of the other representatives on the communications workstream, who all possess a wide range of communication and engagement skills, would link in directly with their LPGs. Further each locality management group is responsible for ensuring the mechanisms and administration type resource is in place to support local communications and engagement. This is normal business. There is no new or additional resource for this therefore localities must look to work creatively with partners and through initiatives to make best use of communications and engagement funding and skills
The information below sets out initial proposals on how this approach will operate and how those with an informing role will themselves be informed.
HSCP Wide communication Who Communicating what Informed by Supported by Comments David Ritchie
Jane Jarvie Caroline Champion
Aims and vision of the HSCP and issues that relate to all local areas
Information that supports employees to make the HSCP a success for all Communication through internal and external communication channels
Feedback from and to IJB
Feedback from and to Strategic Management Team Feedback from and to Locality Planning Groups Feedback from and to staff and public
Communication and Engagement Strategy
Media protocol (see Appendix 1) Scottish Government guidance (see Appendix 2) £11k (non recurring)
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Locality Communication
Who Communicating what Informed by Supported by Comments Locality Planning Groups Information relating
specifically to their locality Carrying out local communications and engagement activities as appropriate to support progress of the delivery of services in line with the Strategic Plan
Feedback from and to IJB Feedback from and to Strategic Management Team Feedback from and to Account managers Feedback from and to staff and public
Communications and Engagement Strategy Media protocol (see Appendix 1) Communications and Engagement Toolkit (see Section 7) Locality admin support
Key account manager contacts Locality Planning Group
Communications Involvement / Engagement
Contact details
Oban & Lorn Jane Jarvie, Communications Manager
Caroline Champion, Public Involvement Manager
[email protected] 01436 655040 [email protected] 01546 605680 [email protected] 01546 604323
Mid Argyll Kintyre Islay / Jura Mull & the Islands
David Ritchie, Communications Manager
Cowal Bute Helensburgh / Lomond
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Key Contacts Scottish Health Council The Scottish Health Council will provide advice for localities in developing understanding and putting into practice Scottish Government guidance on engaging and consulting with communities and it will also provides advice and support when required across the HSCP. Contact: Alison McCrossan ([email protected]) Health Care Forums Health Care Forums are an important forum for people living in each locality to be actively involved in how local services are planned and they are an important partner in representing the community within the HSCP. Contacts: to follow Third Sector Interface (TSI) The Third Sector Interface is represented on the Integration Joint Board. At a locality level a TSI rep will be aligned to each locality planning group to provide advice and support on how its third sector members and their service users can be involved in and contribute to outcomes. Contact: Lynda Syed ([email protected]) Communications and Engagement Officers Contacts: David Ritchie (NHS), Caroline Champion (NHS), Jane Jarvie (Council)
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5. What We Will Communicate Key messages for communication and engagement will develop as part of the transformation of health and social care services – subject to those with an informing role being informed. They may vary from locality to locality and they may change and develop over time. It is also important to recognise that the HSCP needs to inform and engage and at the same time listen to the public and our staff. This is at the heart of how we build and develop our services. Generic messages appropriate to this stage are outlined below. General Key Messages
• Health and Wellbeing is about moving from a reactive health and social care service to an anticipatory maintaining person centred service
• We need to ensure members of the public can share ‘their stories’ and experiences of using local services so we can continuously improve
• We are changing how we work to ensure we can continue to provide a safe and sustainable service that people need now and into the future
• We understand the different needs of local communities and will design and plan services that reflect these needs
• We will listen to our local communities
• We will be flexible so that we can develop or change services as local
needs change
• We will highlight that the HSCP has limited resources My Local Area
• We will match services to local area need through making best use of local skills, capacity and workforce across all partners
• To do this we need the public, staff, carers, Third Sector and our other stakeholders to get involved in Locality Planning Groups and their work
• This input from our local communities will support the Locality Planning Groups and will generate debate and dialogue for the continuous improvement and innovation of services
• Support people to take more control over their Health and Wellbeing by
ensuring they have the most up to date information
• By following guidance and good practice
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6. Who We Will Communicate With Our general audiences are those listed below. This is not an exhaustive list and there may be times when the HSCP communicates with one sector or all sectors depending on the issue being communicated.
• Service Users • Carers • Public representatives • Health and Care Forums • Employees • Partner and Third Sector Organisations • Local community groups • Voluntary organisations • General public • Elected Members • Scottish Health Council • Staff • IJB • Wider community • Other agencies such as NHS Greater Glasgow & Clyde and the
Scottish Ambulance Service
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7. How We Will Communicate and Engage Continually improving services through listening to service users, carers, staff and stakeholders is a key responsibility for Locality Planning Groups. This needs to be a priority for the HSCP and LPGs and should be based on good practice and reflects the vision, aims, objectives and 6 areas of focus in the Strategic Plan. A Communications and Engagement Toolkit will provide guidance and a reference tool for the HSCP and in particular for Locality Planning Groups. The Toolkit will provide a framework, direction, ideas, resources, support, facilitation and signpost to where to find people/resources for support. It will also ensure compliance with Statutory Guidance, relevant legislation and Codes of Practice. The toolkit will be a working document that will be developed and contributed to on an ongoing basis as the need arises and will take into account the sharing of best practice (what works/what doesn’t) across localities. The initial toolkit (which will be available at the end of July) will include advice on the following: Communication
• Succinct description for explaining integration, why it’s needed and the benefits for service users
• Roles and responsibilities of the various groups within the HSCP such as the LPGs, IJB etc
• Media protocol
• How to write in ‘Plain English’
• Non-jargon descriptions of phrases used in relation to integration
• FAQs that cover: o An explanation of the links between LPGs and others within the
HSCP (i.e. information flow and links)
o Roles and responsibilities
o Dealing with the media – who does what, who are spokespeople, where to refer media enquiries (see media protocol in Appendix 1)
• Options for publicising and disseminating information (e.g. partners
who can help with distribution)
• An introduction to carrying out engagement, including lessons learned
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• Sign off process for producing information for issue
• How to produce leaflets/posters
• Social media – how and when to use it
• A guide to what and when to communicate
• Networking information i.e. partners who can help distribute
information, provide support and training Engagement
• Informing, engaging and consulting as and when appropriate
• Signposting to methods for effective engagement e.g. running a conversation café, engaging with service users e.g. young people
• Support for engagement activities e.g. facilitation, training and resources
• Sign off process for producing information for issue
• Monitoring and evaluation e.g. After Action Reviews
• Resourcing your engagement
• Locality engagement grab bag – holding all tools and information to
support e.g. drop in event
• Feedback to those who have taken the time to contribute / share their views – “You Said, We Did” philosophy
• Engagement log template to evidence depth and types of engagement
process conducted
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8. Review and Evaluation This strategy has 2 key roles:
• To support and develop the capacity and capability of Locality Planning Groups in delivering effective communications and engagement at a local level
• To deliver effective communications and engagement as required at
HSCP wide level It will therefore be evaluated on:
• How well it supports the Locality Planning Groups
• How well it facilitates effective communications and engagement
Evaluation of support for LPGs will be done by:
• Six monthly feedback by LPG chairs
• Review of progress against the strategy objectives detailed in Section 3 Evaluation of effectiveness of communications and engagement will be done by:
• Evaluation of engagement activities on an event by event basis
• Level of attendance, participation and involvement at meetings/events
• Surveys where appropriate
• After Action Reviews conducted by the Scottish Health Council where appropriate
• Frequency of news releases, social media interactions, patient and
service user experience
• Number of staff and partners trained in and using communication methods
• Identification and alignment of communication resources from initiatives
and other projects/programmes e.g. Technology Enabled Care (TEC)
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9. Statutory Requirements There are a number of Statutory Duties placed on the NHS and Councils, along with appropriate Codes of Practice. The following provides a brief description of each (see Appendix 2 for a more detailed outline). CEL 4 (2010) Informing, Engaging and Consulting People in Developing Health and Community Care Services The principles of this Scottish Government guidance must be applied, proportionally, to any service change proposed by a Health Board, including any changes considered to be ‘major’. The guidance:
• Sets out the relevant legislative and policy frameworks for involving the public in the delivery of services
• Provides a step – by – step guide through the process of informing, engaging and consulting the public on service change proposals
• Explains the decision making process with regard to major service change and the potential for independent scrutiny
• Clarifies the role of the Scottish Health Council Patients Rights (Scotland) Act 2011 A key ambition for NHS Scotland is that it is person-centred and provides services that put people at the heart of service provision. The Act:
• Aims to improve patients’ experience of using health services and to support them to become more involved in their health and healthcare
• Acknowledges the important role of carers
• Encourages responsible use of NHS services and resources
• Recognises that NHS staff and all providers of NHS services should be treated with dignity, have their views valued, and supported to do their jobs well
CEL 8 (2012) Guidance on Handling and Learning from Feedback, Comments, Concerns and Complaints about NHS Health Care Services The Patient Rights (Scotland) Act 2011 introduced the right to give feedback, make comments, raise concerns and to make complaints about NHS services and it also places a responsibility on the NHS to encourage, monitor, take action and share learning from the views they receive. It should be noted that feedback, comments and concerns are not complaints. Complaints must be handled in accordance with NHS and Argyll and Bute Council procedures.
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Participation Standard The Standard sets out what NHS Boards need to do to make sure that people have a say in how health services are developed and delivered. While there will be no Participation Standard assessment process, NHS Boards must use their 2015- 2016 Feedback, Comments, Concerns and Complaints annual reports to demonstrate improvements in the handling of complaints and feedback and how the learning is used to make improvements. National Standards for Community Engagement The National Standards for Community Engagement sets out best practice guidance for engagement between communities and public agencies. Equality Act 2010 The Act includes a key measure introducing the Public sector Equality Duty which came into force on 5th April 2011 and which is referred to as the General Equality Duty. The General Equality Duty has three main aims. It requires public bodies to have due regard to the need to: • Eliminate unlawful discrimination, harassment, victimisation and any other
conduct prohibited by the Act; • Advance equality of opportunity between people who share a protected
characteristic and people who do not share it; and • Foster good relations between people who share a protected characteristic
and people who do not share it Community Empowerment (Scotland) Act 2015 The Community Empowerment (Scotland) Act provides a significant step towards communities having greater influence or control over things that matter to them. In particular, the Act emphasises the need to address disadvantage and inequality. National Care Standards The National Care Standards explain what you can expect from any care service used, written from the point of view of the person using the service. The National Care Standards are currently being reviewed. Further detail about the current Care Standards is provided at Appendix 1.
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10. Role of the Scottish Health Council The Scottish Health Council (SHC) was established by the Scottish Executive in April 2005 to ensure NHS Boards meet their Patient Focus and Public Involvement (PFPI) responsibilities, and to support them in doing so. The Scottish Health Council is a committee of Healthcare Improvement Scotland with a distinct identity. The SHC promotes Patient Focus and Public Involvement in the NHS in Scotland. A key aspect of the role of the SHC is to support NHS Boards and monitor how they carry out their Statutory Duty1 to involve service users and the public in the planning and delivery of NHS services. The Scottish Health Council has several core functions:
• Community Engagement and Improvement Support – providing proactive and tailored support for NHS Boards
• Participation Review – reviewing and evaluating NHS Boards' approaches to involvement through the Participation Standard
• Service Change – supporting NHS Boards to meet the requirement to
involve people when planning or changing local services
• Participation Network – a centre for the exchange of knowledge, support, development and ideas.
The SHC is also responsible for providing secretariat and support services for Independent Scrutiny Panels. These are expert panels set up by the Scottish Government to consider proposals for major changes in local NHS services in Scotland. By ensuring that NHS Boards listen and take account of people's views, the SHC aims to achieve a "mutual NHS" where the NHS works in partnership with service users, carers and communities. Based on an understanding of the needs of those using local services, their life circumstances and experiences, Argyll and Bute Health and Social Care Partnership must ensure that service users, carers and the public are able to influence the planning and delivery of NHS services, and monitor how well services are performing.
1 CEL 4 (2010) Informing, Engaging and Consulting People in Developing Health and Community Care Services
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Appendix 1
Joint Media Protocol
Argyll and Bute
Health and Social Care Partnership
1. Introduction
The integration of health and social care introduces a whole new way of
working for NHS Highland in Argyll and Bute and Argyll and Bute Council.
This Joint Media Protocol is designed to ensure publicity and communications
activity for both organisations as the Partnership is co-ordinated, clear and
consistent and provides both partners with clear guidance to follow when
dealing with the media.
It includes guidance and best practice for managing both proactive and
reactive media activity including news releases, media enquiries, photo
opportunities and out-of-hours media activity.
It is predicated on statutory requirements that Partnership communications
and media support will be provided by the existing communications teams
within both host organisations (Council and NHS), based on the current set-
up. However, this may be subject to change as arrangements for supporting
services will be developed through a Service Level Agreement.
For the purposes of the protocol, these teams are collectively described as the
Partnership communications team. In practice, this will involve each of the
existing communications teams taking the lead at different times, depending
on the nature of the media activity, and linking with other members of the
Partnership communications team as appropriate.
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2. Role of Locality Planning Groups in dealing with media
In order to support Locality Planning Groups and allow them to settle into their
roles, the Partnership communications team will deal with all media enquiries.
If a LPG requires media coverage, or receives media enquiries, they will
contact their Account Manager to progress accordingly.
The Partnership will however keep this arrangement under review and will
work closely with LPGs to investigate what opportunities are available for
LPGs to build up their relationships, capability and capacity with local media.
3. Aims and objectives
The protocol establishes the level of communications support that will be
provided by the Partnership communications team in dealing with the media
and is designed to support and complement the overall objectives of the
Partnership’s approved communications strategy.
It should be noted that these cannot be achieved by communications or media
activity in isolation, and will be influenced by the Partnership’s engagement
activity in terms of user and public involvement, as well as the operational
work undertaken to deliver integrated services across Argyll and Bute.
The broad communications objectives are to deliver consistent, accurate
information that supports understanding of and involvement with the
development of Partnership objectives.
4. Roles and responsibilities
The media has a crucial role to play in helping ensure target audiences
(defined in the communications strategy) are well informed about the
Partnership, its services, priorities, values and activities.
The Partnership communications team is the key contact between the
partnership and the media.
Any media contact directed elsewhere within a Partnership should be referred
to the communications team immediately for appropriate action.
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Integration Joint Board members who are contacted directly by the media for
a comment on Partnership business and activities should contact the
communications team for advice, support and guidance before responding, in
line with existing protocols within the partner organisations.
5. Principles
• The Partnership communications team will work together to effectively
promote the HSCP and its services in local and national media through
a planned and sustained programme of activity.
• The Partnership communications team will provide a professional
public relations and media management service that is consistent with
legislative requirements, policy and best practice.
• The Partnership communications team will be responsible for dealing
with the media, with a focus on promoting the work of the HSCP and
protecting its reputation.
• Any media enquiries received by staff or members should be directed
to the Partnership communications team immediately.
• Close links will be maintained between the Partnership
communications team and the Partnership senior management teams
and IJB to ensure they are kept up-to-date with partnership business,
decisions and issues that could impact on media activity and interest.
• When speaking to the media on behalf of the Partnership, official
spokespeople – whether elected members or not – must reflect the
Partnership’s position in relation to all issues at all times.
• Communication with the media on health and social care issues will
always be open and honest, and provide information in a clear, simple
and user-friendly way.
6. Proactive Media Handling
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During normal office/working hours, the Partnership communications team will
liaise on all proactive joint and/or cross-organisational media regarding
integrated services.
Media releases
A communications schedule will be prepared for the Partnership, setting out
planned communications activity – including media activity – over a rolling 6
months period.
The Partnership communications team will liaise on all aspects of
communication planning for the Partnership and be clear on who is
undertaking what tasks and when.
This will help ensure that media activity is planned in advance as far as
possible, researched and drafted by the Partnership communications team,
and circulated to appropriate partners for consideration, comments and final
sign-off before issue on a scheduled date.
Spokespeople and process
Media releases will be produced in line with existing communication
practices/protocols, with quotes provided as follows:
• The Chair of the IJB will be the principal spokesperson for major policy
decisions relating to the Partnership and will be pictured and quoted
accordingly. The Vice Chair will be quoted when the Chair is not
available.
• The Chief Officer will be quoted on operational issues. If the Chief
Officer is not available the spokesperson will be the most relevant
senior clinician or manager (depending on topic).
• Many proactive releases may also quote the individual delivering a
piece of work, even if they are not in a senior position – for example,
stories about smoking cessation. In all cases, proactive or reactive, all
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releases are approved by the relevant senior manager or their
nominated deputy.
All media releases should be copied to board members, the senior
management team and the partnership communications team for information
when issued. The releases should also be posted on all relevant partner
websites and social media feeds.
Photo opportunities
Photo opportunities are a good way to help enhance media interest in and
coverage of a proactive news story.
The Partnership communications team will be responsible for organising
photocalls and photo opportunities in conjunction with the relevant manager.
Representatives from the HSCP should be invited to attend as and when
required and invites will be issued in line with existing practices within the
individual organisation.
Photography support will be arranged or commissioned by the Partnership
communications team.
Photography permissions/consents must be in place for anyone appearing in
photographs that will be issued to the media. Where this is not feasible – for
example, due to large numbers in attendance at an event – clearly visible
notices must be in place to advise that photographs will be taken.
Photography used to highlight sensitive or controversial issues must have the
explicit permission of those featured that it can be used for that purpose.
7. Reactive Media Handling
During normal office/working hours, the communications teams for both
organisations will liaise on all reactive joint and/or cross-organisational media
regarding integrated services.
Media enquiries
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A response will always be provided to media enquiries about the Partnership.
Media enquiries will be answered as quickly as possible – ideally within 24
hours or within the journalist’s deadline, whichever is sooner.
Partnership services are required to support the communications teams to
ensure the Partnership can provide an accurate and appropriate response
within the required deadline.
Responses will never say ‘no comment’ – where we are unable to comment,
the response should say this and explain why.
Quotes must be signed off by the person they are attributed to – or an
appropriate substitute, in line with standard practice – before issue.
Responses should only be issued to the media outlet that logged the enquiry.
Media enquiries about the Partnership that are deemed to be political will be
discussed with the lead elected member for the Partnership to determine if
they would like to respond politically.
All media enquiries must be recorded and logged in line with existing
practices.
Media responses will be produced in line with existing practices, with
quotes/interviews generally provided as follows:
• The Chief Officer of the Partnership will be the principal spokesperson
for all media enquiries.
• Where required, the spokesperson will be the most relevant senior
clinician or manager (depending on topic).
8. Media Handling Out of Hours
Outwith normal office/working hours (which vary slightly for each
organisation), the communications team will provide an on-call media handling
service in line with current arrangements. This will be restricted to urgent or
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emergency media enquiries only and should not be used for routine media
handling.
To manage urgent or emergency media enquiries, the relevant
communications contact will liaise with their corresponding on-call duty
officers (for Health, the senior manager on call) to jointly prepare an agreed
statement.
The on-call communications contact for the other partner should be kept
informed of the enquiry and a copy of the final issued statement circulated to
the senior management team and the communications team in each partner
organisation.
When pre-planned out-of-hours media activity is taking place, the Partnership
communications team will liaise to ensure appropriate staff cover is provided.
9. Events and Official Visits
For events and official visits, the Partnership communications team will liaise
to ensure there is appropriate representation from partners and current
protocols and practices are followed at all times.
10. Media advertising
The Partnership communications team will continue to place media
advertising in line with existing practices.
The finalisation and signing-off of content and creative for any media
advertising for Partnership services or activities must be agreed by all relevant
partners.
11. Filming requests
Filming requests relating to Partnership services will be managed by the
Partnership communications team in line with existing practices.
12. Media monitoring
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The Partnership communications team will monitor media coverage relating to
the Partnership and its services and will take action to address any
inaccuracies in the reported information.
Monitoring of the media coverage will be used to inform future
communications planning and activity for the communications schedule.
13. Partnership communications team contacts
NHS Highland
David Ritchie
Communications Manager
Office: 01436 655040
Mobile: 077764 80406
Out of hours: 01463 655040 (Raigmore Hospital switchboard, ask for duty
press officer)
Argyll and Bute Council
Jane Jarvie
Corporate Communications Manager
Office: 01546 604323
Mobile: 07769 138830
Out-of-hours: 07768 556 247
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APPENDIX 2
STATUTORY GUIDANCE / LEGISLATION CEL 4 (2010) Informing, Engaging and Consulting Peo ple in Developing Health and Community Care Services Scottish Government issued this guidance to assist NHS Boards in their engagement with service users, the public and stakeholders on the delivery of local healthcare services. The principles of the guidance must be applied, proportionally, to any service change proposed by a Board, including any changes considered to be ‘major’. The guidance:
• Sets out the relevant legislative and policy frameworks for involving the public in the delivery of services
• Provides a step – by – step guide through the process of informing, engaging and consulting the public in service change proposals
• Explains the decision making process with regard to major service change and the potential for independent scrutiny; and
• Clarifies the role of the Scottish Health Council Whilst decisions regarding the provision of NHS services remain a matter for NHS Boards (with the exception of major service change), the guidance ensures a consistent and robust approach is adopted when Boards consider and propose new services or changes to existing services. The guidance is also considered alongside associated guidance prepared by the Scottish Health Council on major service change (‘Guidance on Identifying Major Service Changes’) and the Options Appraisal process (‘Involving patients, Carers and the Public in Option Appraisal for Major Services Changes’). It is against CEL 4 (2010) and supporting guidance on major service change that the Scottish Health Council monitors compliance. For any proposed services changes considered to be major, the Board, when submitting its final proposal to the Minister for approval, must enclose a report from the Scottish Health Council which assesses whether the Board has involved people in accordance with the expectations set out in the guidance. Patients Rights (Scotland) Act 2011 A key ambition for NHSScotland is that it is person-centred and provides services that put people at the heart of service provision. The Patient Rights (Scotland) Act 2011 supports the Scottish Government’s vision for a high
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quality NHS that respects the rights of patients, their carers, and all the people who deliver NHS services. The Act:
• Aims to improve patient’s experience of using health services and to support them to become more involved in their health and healthcare
• Acknowledges the important role of carers
• Encourages responsible use of NHS services and resources
• Recognises that NHS staff and all providers of NHS services should be treated with dignity, have their views valued, and supported to do their jobs well
Providers of NHS services throughout Scotland practice the principles of good patient care every day. The Patient Rights (Scotland) Act 2011 sets out these principles in law. The Act details what patients in Scotland have a right to expect of their health services, no matter whether they are delivered by NHS staff or on behalf of the NHS by independent contractors and their staff. Everyone who works for NHS Scotland wants to ensure that the experience of patients is the best it can be. In turn, staff have to be supported to do their jobs to the best of their ability. The Act also recognises that carers have an important role in supporting patients, and that their views must be taken into account when planning and providing care and treatment. The Act does not undermine the importance of clinical judgement, effective and efficient use of the NHS and its resources, or any other rule of law. For the first time, patients have a legal right to give feedback on their experience of healthcare and treatment, and to provide comments or raise concerns or complaints. In line with the national NHS Complaints Procedure, NHS Boards and independent contractors must publicise their own complaints processes and encourage patients to give feedback. All staff who have contact with patients should be trained to deal with feedback, comments, concerns and complaints. This may involve responding to feedback or signposting patients to relevant support. Employers should provide staff with the relevant training they need to enable them to respond appropriately, effectively and efficiently. The Patient Rights (Scotland) Act 2011 introduced a new independent
“Our vision is that whatever the setting, care will be provided to the highest standards of quality and safety, with the patient at the centre of all decisions about their health care.” Nicola Sturgeon MSP, 2012
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Patient Advice and Support Service (PASS). The role of PASS is outlined in Section 6. People can also share their stories about local health and care services through Patient Opinion and Care Opinion (see Section 6). CEL 8 (2012) Guidance on Handling and Learning from Feedback, Comments, Concerns and Complaints about NHS Health Care Services We know that the NHS in Scotland already provides excellent care but we also know that sometimes things do go wrong. The Patient Rights (Scotland) Act 2011, together with supporting Secondary Legislation2, introduced the right to give feedback, make comments, raise concerns and to make complaints about NHS services and it also places a responsibility on the NSH to encourage, monitor, take action and share learning from the views they receive. The Guidance supports relevant NHS bodies and their health service providers (including Primary Care Service providers) in handling feedback, comments, concerns and complaints. The aim is to continually develop a culture that values and listens to the views of service users, carers and stakeholders to help inform and improve the development and delivery of person – centred quality health care. A culture where all staff, who can potentially be the first point of contact, value all of the views expressed whether these are good or bad in order to learn from peoples’ experiences and make improvements. A culture where people feel comfortable about expressing their views of the NSH without fear of this affecting the treatment or service they receive or their relationship with the health care provider. Important provision within the legislation includes “the requirement to demonstrate what learning and improvement has taken place as a result of feedback, comments, concerns and complaints”. Service user experience is already helping to shape excellent clinical/care services and fostering high levels of clinical/care performance. The HSCP must, however, do more to encourage people to share their “stories”, make it ‘safe’ for them to do so. Achieving the aim of continuous improvement in the quality of care and services at the point of delivery is reliant on this service user experience as it allows the service to target and focus improvements appropriately. Continuous service improvement through the experiences of service users and carers is a core responsibility for Locality Planning Groups (LPGs)
2 Secondary Legislation issued under CEL 7 (2012) in relation to the handling of feedback, comments, concerns and complaints, namely the Patient Rights (Complaints Procedure and Consequential Provisions) and the Patient Rights (Feedback, Comments, Concerns and Complaints) (Scotland) Directions 2012 (“ the Complaints Directions)
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(Section 5), embedding this into the day to day business of the HSCP and within a performance and accountability framework. The legislation places a clear responsibility on the relevant NHS bodies and health care providers to record the data they receive in relation to feedback, comments, concerns and complaints. It should be noted that feedback, comments and concerns are not complaints. Complaints must be handled in accordance with NHS and Argyll and Bute Council procedures. Participation Standard Better Health, Better Care: Action Plan stated that establishment of a Participation Standard would enable the collection of systematic, comparable information on participation from across the NHS in Scotland. The Standard set out what NHS Boards need to do to make sure that people have a say, and a sense of ownership, both in their own care and in how health services are developed and delivered. When the Participation Standard was introduced, it covered three aspects of participation which were set out in three Standard Sections:
o Standard 1 Patient Focus
o Standard 2 Involving People in Service Planning
o Standard 3 Corporate Governance NHS Boards were required to carry out a self – assessment against the Participation Standard annually. However, in 2015, the Participation Standard assessment process was changed and focussed on Health Boards’ Feedback, Comments, Concerns and Complaints annual reports for 2014-20153. At the end of the last year’s revised process, the Scottish Health Council reported that Health Boards had welcomed the opportunity to review approaches and highlight any gaps in their procedures for handling complaints and feedback. As the focus was different from previous years, it was agreed that the 2014-2015 self-assessment would provide a baseline for complaints and feedback handling, offering the opportunity to demonstrate future improvement and that any levels previously attained through the Participation Standard process would not be applicable for this assessment. In line with established NHS Participation Standard procedure, 2015 – 2016 will be an improvement year and no formal assessment is planned. NHS Boards must focus on delivering the improvements identified for them in the
3 Participation Standard 2015 – 2016, Scottish Health Council letter to NHS Board Chief Executives dated 16th March 2016
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2014-2015 assessment and reported in their individual assessments and in the Scottish Health Council’s National Overview Report. While there will be no Participation Standard assessment process, NHS Boards must use their 2015-2016 Feedback, Comments, Concerns and Complaints annual reports to demonstrate improvements in the handling of complaints and feedback and how the learning is used to make improvements. The annual reports should follow the guidance issued by the Scottish Government in May 2014. The Scottish Health Council will carry out an analysis on NHS Boards improvement outcomes, including noting the progress made on previously identified improvements. This is not the same thing as a Participation Standard assessment. There must be a sustained focus on feedback and complaints in the coming years, both with the development of a model complaints handling process for the NHS in Scotland, and in terms of developing an integrated approach to handling feedback and complaints in health and social care. The Scottish Health Council will be engaging with NHS Boards and participation leads to review other standards to ensure that the opportunity for closer alignment across health and social care participation standards is fully explored. The Scottish Health Council will also examine the implications in terms of measuring the impact of Our Voice. National Standards for Community Engagement The National Standards for Community Engagement sets out best practice guidance for engagement between communities and public agencies. The National Standards provides a useful understanding of how to implement good practice in engaging with communities at a local level, and can be used to evaluate and measure the impact of engagement. The Standards for Community Engagement are a good practice tool:
• developed through community and agency engagement
• tested in practice
• setting out mutual commitments between agencies and communities
• promoting equality
• celebrating diversity
• building skills and confidence
• providing indicators of best quality performance
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• driving continuous improvement
• embedded at the heart of what government promotes in Scotland
The 10 National Standards for Community Engagement are :
Standard 1 The Involvement Standard
We will identify and involve the people and organisations with an interest in the focus of the engagement Standard 2 The Support Standard
We will identify and overcome any barriers to involvement Standard 3 The Planning Standard
We will gather evidence of the needs and available resources and use this to agree the purpose, scope and timescale of the engagement and the actions to be taken Standard 4 The Methods Standard
We will agree the use methods of engagement that are fit for purpose Standard 5 The Working Together Standard
We will agree and use clear procedures to enable the participants to work with one another efficiently and effectively Standard 6 The Sharing Information Standard
We will ensure necessary information is communicated between the participants Standard 7 The Working With Others Standard
We will work effectively with others with an interest in the engagement Standard 8 The Improvement Standard
We will develop actively the skills, knowledge and confidence of all the participants Standard 9 The Feedback Standard
We will feedback the results of the engagement to the wider community and agencies affected Standard 10 The Monitoring and Evaluation Standard
We will monitor and evaluate whether the engagement meets its purposes and the national standards for community engagement
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Equality Act 2010 The Equality Act 2010 replaced the previous anti-discrimination laws with a single Act. A key measure included within the Act was the introduction of the Public Sector Equality Duty which came into force on 5 April 2011 and which is referred to as the General Equality Duty. The General Equality Duty has three aims. It requires public bodies to have due regard to the need to:
• eliminate unlawful discrimination, harassment, victimisation and any other conduct prohibited by the Act;
• advance equality of opportunity between people who share a protected characteristic and people who do not share it; and
• foster good relations between people who share a protected characteristic and people who do not share it.
The duty to have due regard to the need to eliminate discrimination also covers marriage and civil partnership. The Equality Act also gives Ministers the power to impose specific duties through regulations. The specific duties are legal requirements designed to help those public bodies covered by the specific duties meet the General Duty. Following a government consultation, the Equality Act 2010 (Specific Duties) Regulations 2011 were laid before Parliament for approval, and came into force on 10 September 2011. The specific duties for Scotland were laid before the Scottish Parliament on 21 March 2012 and came into force on 27 May 2012. The regulations will promote the better performance of the Equality Duty by requiring the publication of:
• equality objectives, at least every four years
• information to demonstrate their compliance with the Equality Duty, at least annually
National Care Standards The Care Inspectorate regulates and inspects care services to make sure they meet the right standards. When the Care inspectorate checks the quality of care, it does so against the National Care Standards. The National Care Standards are a set of standards for care services in Scotland. The current National Care Standards were created by the Scottish Government under the Regulation of Care (Scotland) Act 2001. National Care Standards were developed with people who use care services and what good quality of care service should be like. The National Care
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Standards explain what you can expect from any care service used, written from the point of view of the person using the service. They also help people raise concerns or complaints. There are six main principles behind the National Care Standards: The National Care Standards are currently being reviewed. Scottish Social Services Council (SSSC) - Code of P ractice for Social Service Workers and Code of Practice for Employers of Social Service Workers
Dignity
• Be treated with dignity and respect at all times • Enjoy a full range of social relationships
Privacy
• Have your privacy and property respected • Be free from unnecessary intrusion
Choice
• Make informed choices, while recognising the rights of other people to do the same
• Know about the range of choices
Safety
• Feel safe and secure in all aspects of life, including health and well – being
• Enjoy safety but not be over – protected • Be free from exploitation and abuse
Realising Potential
• Achieve all you can • Make full use of the resources that are available to you • Make the most of your life
Equality & Diversity
Live an independent life, rich in purpose, meaning and personal fulfilment
• Be valued for your ethnic background, language, culture and faith • Be treated equally and be cared for in an environment which is
free from bullying, harassment and discrimination • Be able to complain effectively without fear of victimisation
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The Codes of Practice for Social Service Workers and Code of Practice for Employers of Social Service Workers describes the standards of conduct and practice within which they should work. The Codes outlines what they are for and what they mean as a social service worker, employer, service user or member of the public. The two Codes are referenced to together as they are complimentary and mirror the joint responsibilities of employers and workers in ensuring high standards, and contribution to continuing to raise standards of social services. The Code of Practice for Social Service Workers is a list of statements that describe the standards of professional conduct and practice required of social service workers as they go about their daily work. The purpose of the Code is to set out the conduct that is expected of social service workers and to inform service users and the public about the standards of conduct they can expect from social service workers. It forms part of the wider package of legislation, practice standards and employers’ policies and procedures that social service workers must meet. The Code of Practice for Social Service Workers includes the following selected statements: The Code of Practice for Employers of Social Servic e Workers sets down the responsibilities of employers in the regulation of social service workers. It is a list of statements that describe the standards of professional conduct and practice required of social service workers as they go about their daily work. The intention is to confirm the standards required in social services and ensure that workers know what the standards of conduct employers, colleagues, service users, carers and the public expect of them. The purpose of the Code of Practice for Employers of Social Service Employers is to set down the responsibilities of employers in regulating social service workers. The purpose of workforce regulation is to protect and promote the interests of service users and carers. Employers are responsible
Social service workers must
1. Treat each person as an individual
2. Respect and, where appropriate, promote the individual views and wishes of both service users and carers
3. Support service users’ rights to control their lives and make informed choices about the services they receive
4. Communicate in an appropriate, open, accurate and straightforward way
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for making sure that they meet the standards set out in the Code, provide high quality services and promote public trust and confidence in social services. The Code of Practice for Employers of Social Service Employers includes the statement that social service employers must: Both Codes are intended to reflect existing good practice and anticipates workers and employers will recognise in the Codes the shared standards to which they already aspire. Community Empowerment (Scotland) Act 2015 The Community Empowerment (Scotland) Act provides a significant step towards communities having greater influence or control over things that matter to them. In particular, the Act emphasises the need to address disadvantage and inequality. The Act as a whole is highly ambitious and commits government and public services to engage with, listen to and respond to communities, easing the way towards communities having greater influence over how land and buildings are managed and used. Its detailed provisions set out many opportunities for communities, offering consultation on programmes and priorities, involvement in local outcomes improvement processes, reporting on progress of various kinds and, importantly, making support available to communities. With careful consideration of the links between the Act and supporting guidance and regulations, the principles underpinning the Public Bodies (Joint Working) (Scotland) Act 2014 and recent regulations for community learning and development4, there is an unprecedented opportunity to position community participation more sustainable in a very wide range of local initiatives and plans. There are three major elements of the Act that communities should be aware of: 4http://www.educationscotland.gov.uk/communitylearninganddevelopment/about/policy/regulations.asp
Promote the Codes of Practice, making service users and carers aware of the Codes, and informing them about how to raise issues through local policies / procedures.
• The strengthening of community planning to give communities more of a say in how public services are to be planned and provided
• New rights enabling communities to identify needs and issues and request action to be taken to these, and
• The extension of the community right to buy or otherwise have greater control over assets
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The Act formalises the role of Community Planning Partnership (CPPs). The purpose of community planning is defined by the Act as “improvement in the achievement of outcomes resulting from, or contributed to by, the provision of [public] services.” Public services are a key factor in the quality of like for many people so it is important for communities to think about how they can take advantage of the legislation and engage with public services to highlight needs and issues, participate in developing plans and proposals and, where appropriate, play a part in providing services or projects. Community planning partners must now include the whole range of public services that engage and work with communities. Public partners include Health Boards, Health and Social Care Partnerships, Integration Joint Boards, Local Authorities, Third Sector and Independent Sector.
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Appendix 3
Prescribed Membership of Strategic Planning Groups
Integration Authorities are obliged to establish a Strategic Planning Group for the area covered by
their Integration Scheme for the purposes of preparing the strategic plan for that area. The group
must involve members nominated by the Local Authority or the Health Board, or both. In effect,
this provides for the partners who prepared the Integration Scheme, and are party to the
integrated arrangements, to be involved in the development of the strategic plan.
In addition, the Integration Authority is required to involve a range of relevant stakeholders. These
groups must include representatives of groups prescribed by the Scottish Ministers in regulations
as having an interest.
The table below identifies the initial membership for the Argyll and Bute HSCP Strategic Planning
Group.
Representative Other
Chief Officer HSCP 1
At least 1 member of NHS Highland Board 1
At least 1 Elected member of Argyll and Bute Council 1
Health Professionals (GP, Consultant RGH & MH, AHP, + others) 10
Social Care Professionals 2
Users of Health and Social Care 2
Carers of users of Health and Social Care 2
Commercial providers of health care 0
Non-commercial providers of health care 1
Commercial providers of Social care 1
Non-commercial providers of Social care 1
Non-commercial providers of Social housing 1
Third sector bodies within the Local Authority carrying out activities
related to health or social care
1
Locality Representatives * 4
Representative of NHSGG&C * 1
Total 29
ToR Locality Planning Group v0.3 April 2016 Page 1
ARGYLL AND BUTE HSCP LOCALITY PLANNING GROUP
TERMS OF REFERENCE
1.0 Purpose The purpose of the xxxxx Locality Planning Group is to be the engine room in achieving the vision of the Argyll and Bute HSCP
People in Argyll and Bute will live longer, healthi er independent lives Its mission for the 3 year strategic plan period is to work in partnership with local communities to offer services that are: • Easily understood. • Accessible, timely and of a high quality • Well-coordinated. • Safe, compassionate and person-centred. • Effective and efficient, providing best value The following are the key values to which those employed or contracted by the Partnership, or who are stakeholders in it, will be expected to adhere: • Person centred • Integrity • Engaged • Caring • Compassionate • Respectful
2.0 Role and Remit 2.1 Role The Locality Planning Group role is to govern and account for delivery of the strategic plan objectives at locality level Its focus and objectives over the plan period determined by the Integration Joint Board are the following six areas:
• Promote healthy lifestyle choices and self-management of long term conditions • Reduce the number of avoidable emergency admissions to hospital and minimise the time
that people are delayed in hospital. • Support people to live fulfilling lives in their own homes, for as long as possible.
ToR Locality Planning Group v0.3 April 2016 Page 2
• Support unpaid carers, to reduce the impact of their caring role on their own health and wellbeing.
• Institute a continuous quality improvement management process across its service driving out “waste, harm and variation”
• Support staff to continuously improve the information, support and care that they deliver. • Efficiently and effectively manage all resources to deliver Best Value
2.2 Remit The locality planning groups remit is to develop, engage, communicate and enact the implementation of the 3 year Strategic Plan, at locality level by : • Developing an annual Locality implementation plan that accords:
o With the 6 areas of focus and strategic objectives of the Argyll and Bute HSCP o Delivers against the road map of “what we expect to look like in 2018/19” o Transformation to a health and well being organisation o Financial and service sustainability
• Assess progress against the locality plan which will be implemented by locality management
utilising performance management processes
• Review the locality plan on an annual basis in line with the strategic plan review cycle and provide an annual report.
• Achieve a “Locality Planned, Locality Owned, Locality Delivered” service portfolio with person
centred care and outcomes at its heart. Exclusions : Not to address current day to day Staff & Management operational issues. 2.3 Capability To undertake its role the locality planning group will be established and developed over the 3 years of the plan period as follows. • Membership (as per Appendix 1 prescribed by guidance) with the Locality Manager as Joint
Chair • “Tooling up” the localities capacity and capability in the areas of:
• Locality Public Health and inequality profiles and information • National and local Outcome targets and performance • Workforce planning and performance (sickness absence, locum/agency costs, capability
development targets) o Statutory o Partners
• Public and User/Carer involvement and feedback shaping service delivery and continuous improvement
• Continuous improvement – enhancing quality by driving out “ Waste, Harm and Variation” focusing on the patient/care pathway
• Budgets and resource prioritisation and allocation • Financial and Resource performance- efficiency, savings and productivity • Commissioning – analyse, plan, deliver and review, health and care services • Scope out and update the profile and arrangement of locality services, resource and assets • Ensuring appropriate communications and engagement strategy / plan/ process is in place
ToR Locality Planning Group v0.3 April 2016 Page 3
• Identify service, workforce, OD, financial, clinical and care governance risks to inform the organisational risk register.
Responsibility of members Roles and responsibilities of representatives: i.e. members of the public and Community Councillors, third sector etc. Roles will be to:
• Ensure the views of service users, carers and the local community are sought • Ensure you inform service users, carers and the local community of any service options or
any recommendations for service change etc • Contribute to the public engagement communication plan. This plan is required to encourage
ongoing dialogue and engagement between the HSCP and the local community. Responsibilities will be to:
• Familiarise yourself with the background to the group and all information relating to the group as it continues its work.
• Attend meetings and drop in events relating to the work of the group. • Ensure the views of your local community, sector etc are represented and taken account of a
group meetings. • Work in partnership, as a full member of the group, with the other members of the group to
enable decisions to be made. • Abide by the rules of confidentiality with regard to sensitive issues or documents discussed
by the group. Public representatives should also:
• Have an interest in Health and Social care • Understand the issues which the service being considered by the group raise, for your local
community. • Be able to express the views of service users, carers and the community. • Ensure that your sub group is considering all views, both the majority and minority views.
Role of Health Care Forum
• To support and facilitate representatives as necessary to enable them to fulfil the above roles and responsibilities.
• Wherever possible, concerns or difficulties should also be expressed to the Chairs of the group.
• HCF will endeavour to match inexperienced public representatives with experienced public representatives.
• HCF will arrange any training or additional support required by public representatives to enable them to fulfil their roles.
Role of the HSCP
• The HSCP has governance (clinical, financial and safety) and budgetary responsibility to ensure provision of a Health and Care Service to the population of Argyll & Bute prioritising health promotion and ill health prevention as well as treatment.
• The HSCP is responsible for achieving performance targets and outcomes against national Board and council policy, standards and targets
• The HSCP is responsible for ensuring the delivery of high quality services which are accessible, sustainable, and efficient and deliver value for money and will undertake reviews and redesign of service to maintain and improve services.
• The HSCP is required to ensure meaningful public engagement and involvement in the provision and/or review of service and will put in place processes and systems accordingly complying with CEL 4 (2010).
ToR Locality Planning Group v0.3 April 2016 Page 4
What is confidentiality? • That considered by the group which must not be relayed out with the group without the
consent of the group. • Trust, Respect, Standards, Consent, Due Process. • Entrusted (With Information) – Disclosure versus Non Disclosure. (Confidence knowing what
can/ cannot be shared) Roles and Responsibilities of Group/ sub groups or Work stream members
• Summary at end of meeting. Salient points, as agreed by the group and report back to Locality Planning group.
• Summaries of the Sub Groups are included in the Project Review Group Minutes. Declaration of interest of Group Members
• Each member will give a declaration of interest in the process This declaration will form part of these terms of reference (Appendix 2)
3.0 Reporting and Accountability The Locality Planning Group Reports to the locality management team The locality management team is accountable to the Strategic Management team on the locality plan performance 4.0 Joint Chairs Locality Manager & Nominated Representative 5.0 Membership (see Appendix 1 for guidance as to w ho should be on the group) This should build on any existing groups but should not be simply a merger. Designation Name 6.0 Quoracy The Locality Planning Group will be quorate subject to 50% of standing membership being present. 7.0 Meeting cycle The meeting cycle for the Locality Planning Group will initially be monthly until September 2016. Thereafter its frequency will be reviewed
ToR Locality Planning Group v0.3 April 2016 Page 5
8.0 Voting 9.0 Agenda Setting The agenda will comprise agreed standing items and relevant agenda items submitted 5 working days prior to any meeting. 10 Administrative Arrangements Administrative support will be provided from within the Locality Planning Group 11 Work Programme Date Regular Business Special Items Jan 2016 Establish LPG, membership and ToR
Feedback SPG Consultation – Locality Level Public Health Profile presentation
communication and engagement for public and staff
Feb 2016 Review Transformation priorities for year 1 identify indicative action plan Review “tooling up” Information/resources
communication and engagement for public and staff
March 2016 Review Indicative Action plan with timescales for 2016/17
communication and engagement for public and staff
April 2016 Sign off Action plan for 2016/17 communication and engagement for public and staff
May to Sept Review and progress action plan and support capability and capacity development of LPG
Monthly report to Locality management group
Oct- March 2017 Review Locality Plan progress / performance
Support development of service transformation proposals
April 2017 onwards
Assess progress on implementation of locality plan and development of performance monitoring reports
Date TOR Agreed: Review Date:
ToR Locality Planning Group v0.3 April 2016 Page 6
Appendix 1 – Membership
Argyll and Bute Locality Planning Group Member, Des cription & Role
Member Group Representative
GP General Practice. The GMS contract makes provision for every GP practice to nominate an integration liaison, which provides a starting point for GP engagement
Locality Lead GP to be indentified
Public Communities. People living locally must have a meaningful role in localities. Existing Public Participation Forums and local patient participation groups can play a valuable role as communities of interest, such as Community Councils. Methods to support hard to reach groups must also be identified
Health Care forum, PPG representatives and methods of involvement enacted –children’s, hearing impaired, autism etc
Carers Carer Representative – 2 representatives networked into local or A&B wider carers groups
Carer groups
Primary Care – pharmacy, Dental, Optometrist etc
Primary Care. Each profession in the wider primary care team should have the opportunity to participate in the development of the locality plan and local decision making that affects their profession,
Either via membership of the locality or via a clear mechanism that enables them to feed into and be made aware of the decision making process.
Acute Service
Scottish Ambulance Service
Secondary Care. - A rrangements in this respect will vary local Managed Clinical Network and Community Hospital arrangements will provide a starting point for secondary care SAS – essential role will require their formal involvement in locality planning via liaison groups and initiatives
Clinicians and representatives from unscheduled care as & when appropriate Area manager representation as and when required
Housing Housing- input from people who have responsibility for housing, given the focus within integration on supporting people, as far as possible, to stay in their own homes and building healthy, resilient communities
ACHA or other housing reps
Social Work Social Work and Social Care. Social workers, and people working in social care more generally, play an important role in helping people to maintain their independence; their input will be critical to effective locality arrangements
Locality SW- Adults and Children
Carer representatives
ToR Locality Planning Group v0.3 April 2016 Page 7
Member Group Representative
Independent Sector
Independent sector Care providers have an essential role in provision of a profile of care services. Commissioning of care requires development of market capability and capacity to meet new arrangements
Independent Sector representative
Third Sector Voluntary sector – foundation of community resilience, and innovation as well as access to specialist and independent services/support e.g. Marie curie, Alzheimer’s, Red cross as well as local resources, etc. Their involvement will vary in intensity but communication and links vital via TSI.
3rd sector representation
Public Health and planning support
Public Health/ Planning Improvement resource - public health and health promotion is vitally important to support the evidence base of what each locality areas challenges are and to assist in making the biggest impact on inequalities. Planning and improvement skills to facilitate change provide local capacity and capability, and drive continuous improvement and best value.
Public health representative
Planning representative
Operational Service Manager
Senior operational manager Health and social care – Responsible and accountable for delivery of services in the locality they have a key role in managing this process and driving change through collaborative working with other partners
Locality Manager Health and Social Care (Adults and Children)
ToR Locality Planning Group v0.3 April 2016 Page 8
Appendix 2 - Register of Declaration of Interests –
XXXXXXX Locality Planning Group Members Declaration of Interest The NHS and Council Code of Accountability and good governance practices requires project or planning group members to declare interests which are relevant and material to the work being conducted. XXXXX Locality planning group members have declared relevant interests and these are formally recorded below Members are also asked to declare interest at any agenda item and undertake an objective test of resilience of this
Name Job title Declared Interest Date of
Declaration/
confirmation Company or Organisation
Interest
Argyll and Bute Health and Social Care Partnership (HSCP)
F I T F O R T H E F U T U R E Q UA L I T Y & F I N A N C E P L A N 2 0 1 7 / 1 8 & 2 0 1 8 / 1 9
The Argyll and Bute Health and Social Care Partnership (HSCP) came into being in April 2016. Our Strategic Plan 2016—2019 sets out our local priorities for the next three years in response to the national policies of the Scottish Government. It also takes account of what you have said you have said you have said you have said
is important to youis important to youis important to youis important to you.
You told us You told us You told us You told us that you want your local services to :
• reduce the need for emergency or urgent care, or a crisis response (anticipatory care)
• prevent ill health—increase confidence and improve skills to support us to live life to the full and
maximize independence
• maintain health and wellbeing – provide the support to look after ourselves and stay well
What have we achieved? What have we achieved? What have we achieved? What have we achieved?
In the last year, we have done a lot. We have successfully established a local kidney dialysis unit in kidney dialysis unit in kidney dialysis unit in kidney dialysis unit in CampbeltownCampbeltownCampbeltownCampbeltown with the support of the community there. Mental health inpatient services Mental health inpatient services Mental health inpatient services Mental health inpatient services will soon be moving into the Mid Argyll Hospital providing a higher standard of care in a more caring environment for our patients. We have community day responder services community day responder services community day responder services community day responder services which support people in their homes and allow unpaid carers to have a break from their caring role. We have invested money and recruited more staff to invested money and recruited more staff to invested money and recruited more staff to invested money and recruited more staff to
maintain our 24 / 7 casualty (A&E) maintain our 24 / 7 casualty (A&E) maintain our 24 / 7 casualty (A&E) maintain our 24 / 7 casualty (A&E) departments in our local hospitals.
We need to do moreWe need to do moreWe need to do moreWe need to do more
The Scottish Government Health and Social Care Delivery Plan (December 2016) http://www.gov.scot/Publications/2016/12/4275/downloads says we need to change services more quickly. The focus on preventing ill health, early intervention and supported self—management mirror our local priorities but we
know we need to do a lot more than we are now.
Pressures on providing servicesPressures on providing servicesPressures on providing servicesPressures on providing services
We are having problems recruiting key medical and care staff. This means we are paying for locums and agency staff which costs us a significant amount of money. A number of care homes have closed as they have been unable to meet appropriate care standards, are unable to recruit care staff and the cost of
providing services has proved too much.
Our unprecedented challengeOur unprecedented challengeOur unprecedented challengeOur unprecedented challenge
We are required to get value for money and use our resources more efficiently and effectively, and we must be honest about that. In the next 2 years we need to save £22million (8.5%) on our annual budget of £257 In the next 2 years we need to save £22million (8.5%) on our annual budget of £257 In the next 2 years we need to save £22million (8.5%) on our annual budget of £257 In the next 2 years we need to save £22million (8.5%) on our annual budget of £257 million. million. million. million. This is due to cost and inflation pressures and the level of funding given to us by NHS Highland and
Argyll and Bute Council. It is challenging but with your assistance we can do it.
This is where we need your help to identify what services are important to you and tell us where you think
we can make savings.
What is the Timeframe? What is the Timeframe? What is the Timeframe? What is the Timeframe? At it’s meeting on 29th March, the Integration Joint Board (IJB) will be presented with the budget plan which will outline how we aim to achieve £22 million savings. We want to hear your views and ideas on this over the next few weeks. This does not mean your involvement will end. We will
continue to speak to you so you are involved in how services are delivered in the coming months.
A R G Y L L & B U T E HSCP—O U R F I R S T Y E AR
Craobh Haven, Argyll
February 2017 Page 2
A R G Y L L & B U T E HSCP—WH AT ’ S NE X T?
What is happening? What is happening? What is happening? What is happening?
Our Strategic Plan outlines our priorities for health and social care services across Argyll and Bute http://www.nhshighland.scot.nhs.uk/OurAreas/ArgyllandBute/Documents/SP%202016-
2019%20%20Final.pdf
Our priorities are in response to national policies as set out by the Scottish Government but also based on what you have said is important to you. When we consulted with you in the past, you said “you said “you said “you said “We want to live a long, healthy, happy and independent life supported by health and social care services when we need them.” You said You said You said You said “We want to stay at home for as long as possible.” We want We want We want We want to support you to
achieve this.
What does this mean for you? What does this mean for you? What does this mean for you? What does this mean for you? This means that we can no longer provide services as we do now. If we carry on as we are, we will not be able to support the growing number of people who will need our support
in the future.
Our staff pride themselves on ensuring our service users receive high quality care and in a way that treats them as individuals. We know you value your local services and how important it is to ensure you have
the right service, in the right place, at the right timethe right service, in the right place, at the right timethe right service, in the right place, at the right timethe right service, in the right place, at the right time.
Our challenges Our challenges Our challenges Our challenges are no different to anywhere else in Scotland or indeed nationally. You will have seen in the newspapers, on TV and on Social Media that the NHS and Social Care system is under increasing pressure. Services are becoming overwhelmed by the increasing number of people who need our support
and are struggling to deliver the high quality care that we want to provide.
How has this happened and what are we doing about it?How has this happened and what are we doing about it?How has this happened and what are we doing about it?How has this happened and what are we doing about it? Have a look at the short video Audit Scotland—How We Can Transform Health and Care Services, it explains what we are facing and what we must do to
get us back on track https://www.youtubeyoutubeyoutubeyoutube.com/watch?v=2nqp9bZzK28
Financial ChallengeFinancial ChallengeFinancial ChallengeFinancial Challenge————£22 Million Savings£22 Million Savings£22 Million Savings£22 Million Savings
Our citizens and staff have said they understand the need for change, they know we need to make significant savings. In the next 2 years we need to save £22 million. Why? The cost of delivering services as we do now, the cost of inflation and the level of funding given to us by NHS
Highland and Argyll and Bute Council to deliver health and social care services.
We Want Your Views!
Our vision is to build on the excellent services currently provided across Argyll and Bute. We want to ensure
that your local services will support you to live a long, healthy, happy and independent life. However, we
need to change how services are delivered in the future and make significant savings.
We want to hear your views on how we can meet our financial challenge. Do you have any ideas? Come
along to one of our events, see back page or look out for adverts in your area.
Your feedback is important. We will be using what you say to consider how we can redesign
and improve services so they are fit for the future but with the money available to us.
Oban
Duart Castle, Isle of Mull
Email Email Email Email You can email us at
[email protected]@[email protected]@nhs.net
Feedback forms Feedback forms Feedback forms Feedback forms
will be available at your local event or you can phone for one. You can also download the form from our website www.tinyurl.com/www.tinyurl.com/www.tinyurl.com/www.tinyurl.com/
jqgp8j6jqgp8j6jqgp8j6jqgp8j6
Information & Information & Information & Information &
Engagement eventsEngagement eventsEngagement eventsEngagement events Feedback forms will be available at the
events.
Ask us to your Ask us to your Ask us to your Ask us to your
meetingsmeetingsmeetingsmeetings
We can come to you - phone us! Telephone
01546 60568001546 60568001546 60568001546 605680
Fi t For The Future—Qua l i t y & F inance P lan 2017 / 18 & 2018 / 19
Your local Communications and Engagement Group is responsible for the engagement plan for changes
proposed for your local area. These groups are made up of public, third sector, union, NHS and Council Staff.
The Scottish Health Council provide guidance and support. Our plans for the next few months are to :
Inform you - we need to share information about the services, their costs, the needs our communities have
now and in the future, our resources, and other background information
Engage with you - we need the time to discuss all this information with you. We will be holding a number of
events across Argyll and Bute during March for both our citizens and staff. See back page for details of the
events already planned. These are the first in a series of events to keep you updated on what is happening
locally and keep you involved.
Reporting on what you say - we need to gather what people say and report that back to the Integration Joint
Board (IJB)
If there are other ideas about how to develop services according to good practice, but within the budget of
the Health and Social Care Partnership, we want to hear about them
Page 3
INVOLV ING
YOU We need to ensure we have the right services in the right place at the right timethe right services in the right place at the right timethe right services in the right place at the right timethe right services in the right place at the right time. We are committed to keeping your local hospital at the heart of your community and will ensure we retain the high quality level of care and safety which they provide, when people need it. But we also know we can no longer provide
services as we do now.
You said You said You said You said “We want to stay at home for as long as possible.” To support people to live in their homes for as long as possible, we need to provide more community based services and aim to do this by investing an additional
£2 million in these services.
This means we can reduce the number of beds in our hospitals but we will not compromise safety of patients and there will always be sufficient beds for those who do need a stay in hospital. Fewer people will need to be cared for in a
nursing or care home.
What we are proposing will be a new way of organising and delivering care. This will have an impact on everyone in Argyll and Bute, both our citizens and our staff. We understand how anxious you are about the proposed changes and we
want to work with you during this difficult time.
CCCCOMMUNICAT IONOMMUNICAT IONOMMUNICAT IONOMMUNICAT ION & E& E& E& ENGAGEMENTNGAGEMENTNGAGEMENTNGAGEMENT WITHWITHWITHWITH YOUYOUYOUYOU
• Children and Families ServicesChildren and Families ServicesChildren and Families ServicesChildren and Families Services—reduce the number of children placed out of area
• Services in the CommunityServices in the CommunityServices in the CommunityServices in the Community————review how we provide some services which will enable us to invest £2 million new money in more community care teams (nursing, care services), improving health and anticipating care needs
• Hospital and Care Home Services Hospital and Care Home Services Hospital and Care Home Services Hospital and Care Home Services – prevent people staying in hospital longer than they need to and use our resources to support more community based services (Balance of Care)
• Corporate or Support Services Corporate or Support Services Corporate or Support Services Corporate or Support Services – reduce the number of buildings we operate from, co-locate with the Council in Lochgilphead, centralise
appointment booking, and integrate social work and health administration
WWWWHATHATHATHAT AAAAREASREASREASREAS AAAARERERERE WWWWEEEE LLLLOOK INGOOK INGOOK INGOOK ING AAAA TTTT????
WWWWHATHATHATHAT AAAARERERERE WWWWEEEE PPPP LANN INGLANN INGLANN INGLANN ING TTTTOOOO DDDDOOOO????
Westpoint Beech
Kintyre
Argyll and Bute Health and Social Care Partnership (HSCP)
CONVERSATION CAFÉS We are holding a number of drop in events (conversation cafés) for local communities and staff to come and join us in discussion. Here you can share your views, tell us if you have any ideas on where we can save money and ask questions.
Events for March have been arranged as follows :
Remember, you can ask us to come to your group or m eeting!
Further events will be organised for April and May, look out for details in the local paper or social media
Kyles of Bute
“WE WILL LISTEN TO YOU, LEARN FROM YOUR EXPERIENCES
AND USE THIS INSIGHT TO GUIDE WHAT WE DO”
Come and join us for a
chat and a cuppa
If you have any questions, would like
to receive this leaflet in an alternative format
or a different language, please
contact
Jackie Harvey
Admin Support to Public Involvement
Manager
01546 605680
or
jackie.harvey@ nhs.net
For more information visit our webpage
www.tinyurl.com/www.tinyurl.com/www.tinyurl.com/www.tinyurl.com/
jqgp8j6jqgp8j6jqgp8j6jqgp8j6
Rest & Be Thankful, Argyll
LOCATION DATE TIME
Conference Room, Corran Halls, Oban
1st March 2pm—5pm,
6pm—8pm
Village Hall, Craignure, Isle of Mull
2nd March 12noon—3pm
Community Centre, Lochgilphead
3rd March 2pm—5pm,
6pm—8pm
Community Centre, Campbeltown
8th March 2pm—5pm,
6pm—8pm
Columba Centre, Bowmore, Isle of Islay
9th March 2pm—5pm
Conservatory, Cowal Community Hospital, Dunoon
13th March 2pm—5pm,
6pm—8pm
Pillar Room, Victoria Halls, Helensburgh
16th March 2pm—5pm,
6pm—8pm
Green Tree Café, Rothesay, Isle of Bute
15th March 12noon —3pm
APPENDIX 2
Argyll and Bute Health and
Social Care Partnership
Quality and Finance Plan
2017-18 to 2018-19
March 2017
CONTENTS
Page
Introduction to Plan 1
Case for Change 2
National Priorities 3
Our Approach 3
Pace of Change 4
Integrated Budget – Key Facts 5
Understanding the Financial Challenge 7
Proposed Quality and Finance Plan 9
Investment Plan 11
Next Steps 11
APPENDICES:
Annex A- Quality and Finance Plan 2017-18 to 2018-19 12
Annex B- Investment Plan 20
Introduction to the Plan
The Argyll and Bute Health and Social Care Partnership (HSCP) came into being in April 2016. The Health Board and Local Authority have delegated the responsibility for planning and budgeting for service provision for health and social care services to the Integration Joint Board. The Integration Joint Board are responsible for directing a total resource of £256m. Our Strategic Plan 2016—2019 outlines our ambitions and our local priorities for the next three years which will ensure that we deliver our vision that:- “People in Argyll and Bute will live longer, healthier, happier independent lives”. The Argyll and Bute Health and Social Care Partnership has identifed six areas of focus in delivering our vision:
In December 2016, the Scottish Government published the Health and Social Care Delivery Plan which highlights the urgent need to address the rising demand being faced across health and social care services and the changing needs of an ageing population. Critical to this is shifting the balance of where care and support is delivered from hospital to community care settings, and to individual homes, when that is the best thing to do. This provides a clear
Vision
People in Argyll and Bute will live longer,
healthier, happier independent lives
Reduce avoidable emergency
admissions to hospital and
minimise the time people are delayed
Support people to live fulfilling lives in
their own homes for as long as
possible
Support unpaid carers to reduce
the impact of their caring role on their
own health and wellbeing
Implement a continuous
improvement approach
Support staff to continuously improve the information,
support and care they deliver
Efficiently and effectively manage
all resources to deliver Best Value
Page 1
impetus to the wider goal of the majority of the health budget being spent in the community by 2021.
Our Quality and Finance Plan 2016-19 is key to supporting the delivery of the strategic plan and setting out our plans to deliver a shift in the balance of care. The ability to plan based on the totality of resources across the health and care system to meet the needs of local people is one of the hallmarks of integrated care. Financial planning is key to supporting this process and identifying the transformation which is required to provide safe and sustainable services to the local community over the medium term.
Case for Change Argyll and Bute Health and Social Care Partnership is facing significant challenges as a result of our ageing population, challenges of recruitment and a reduced workforce, the cost of implementing new legislation and policies and financial pressures. If nothing else changes spend would need to increase by 11% by 2020. While not a new set of challenges for Argyll and Bute, the scale and pace of change which is required over the next two years is unprecedented, with a reduction in costs of £20 million required over the next two years. The recent Report on Social Work in Scotland (Social Work in Scotland, Accounts Commission Sept 2016) recognised that current approaches to delivering health and social care are not sustainable in the long term. The report highlighted the significant level of challenges faced by Health and Social Care Partnerships because of the combination of financial pressures caused by a real-terms reduction in funding, increased demographic pressures and the cost of implementing new legislation and policies. Audit Scotland concluded that if Health and Social care Partnerships continued to provide services in the same way, spending would need to increase by 16-21% by 2020. Increased demand for services linked to constraints in public sector funding and changing demographics are the most dominant challenges. It is estimated that between 2010 and 2035 the population of Argyll and Bute will decrease by 7% overall, the number of working age adults will decrease by 14%, whilst the number of people aged 75+ will increase by 74%. This leads to reduced Scottish Government funding allocations for both the Health Board and Local Authority, reduced workforce capacity and increased demand for services. Within this local and national context it is essential that the Partnership develops and maintains a Quality and Finance plan to enable it to direct resources at the services which will deliver the greatest impact, support a shift in the balance of care and will set the context for annual budgets. Some difficult decisions and choices need to be made which will understandably cause concern if people don’t understand or accept the case for change.
Page 2
National Priorities The Scottish Government have outlined expectations from the integration of services which include:
Commitment to shift the balance of care, so that by 2021-22 more than half of the
NHS front line spending will be in Community Health Services
Invest in prevention and early intervention, particularly in early years, with the
expectation that work will continue to deliver 500 more health visitors by 2018
Produce plans to minimise waste, reduce variation and duplication
Reduce medical and nursing agency and locum expenditure as part of a national drive
to reduce spend by at least 25% in-year
Reduce unplanned admissions, occupied bed days for unscheduled care and delayed
discharges therefore releasing resources from acute hospital services
Shift the balance of spend from institutional to community services
Health and Social Care Partnerships are required to measure performance against nine National Health and Wellbeing Outcomes and for Argyll and Bute there are 23 sub indicators which sit below these outcomes to demonstrate the performance of the Partnership. In addition to these the Scottish Government will track:
1. Unplanned admissions 2. Occupied bed days for unscheduled care 3. A&E performance 4. Delayed discharges 5. End of life care; and 6. The balance of spend across institutional and community services
There is a focus on integrated services to deliver real change to the way services are being delivered, with a realism that the care system is broken and delivering services in the same way is not a viable option.
Our Approach
In considering these challenges the Partnership must redesign care, services and ways of working to ensure we deliver safe, high quality services which are sustainable and affordable. It is clear from the scale of the financial challenges faced that the current models of care are not sustainable. This will be a major challenge as doing more of the same will not deliver the scale of change required.
You said “We want to stay at home for as long as possible.” To support people to live in their homes for as long as possible, we need to provide more community based services and aim to do this by investing an additional £1.1 million in these services. This alongside the continuation of investment of specific funding allocations to drive forward integration work including the Integrated Care Fund, Technology Enabled Care and Delayed Discharge will lead to a total investment in transformational change of £3.5m.
Page 3
This means we can reduce the number of beds in our hospitals but we will not compromise safety of patients and there will always be sufficient beds for those who do need a stay in hospital. Fewer people will need to be cared for in a nursing or care home as we provide a higher level of care to support people within their own homes. Ensuring local access to care in the face of workforce challenges means urgently reviewing our use of technology to support people to access care and reduce the need for travel.
While service redesign and change is high profile, a focus on eliminating the waste and inefficiency in our systems is another way in which we can ensure the most effective use of both our workforce and our budget. Within the Partnership we are building our capacity and capability to use the tools of lean and quality improvement, while recognising that it is wholescale adoption of these approaches which will have maximum impact. There are minimum requirements for the services delegated to Integration Joint Boards, which are broadly adult social care services, adult community health services and a proportion of adult acute services. In Argyll and Bute all health and social care services have been included in the delegations to the Integrated Joint Board, including children’s services and all acute hospital services. This leaves the Argyll and Bute Integration Joint Board with full responsibility and resources for the whole of the care pathway. This puts us in a unique position to influence and take decisions based on a whole system approach and this is something that can be capitalised on when developing and implementing the Quality and Finance Plan, particularly when shifting the balance of care from hospitals or institutional settings to the community.
Pace of Change We need to do more. The Scottish Government Health and Social Care Delivery Plan (December 2016) says we need to change services more quickly. The focus on preventing ill health, early intervention, reducing health inequalities and supported self—management mirror our local priorities but we know we need to do a lot more than we are now. Across the country and beyond the challenges to bring in new models of care that are sustainable from both clinical and financials view points are significant. Here in Argyll and Bute we also face some additional pressures due to the remoteness and ruraility of some of our communities plus we have a higher proportion of older people. Many of our communities are therefore fragile. As an important partner in maintaining the social and economic vibrancy, concerns around health service quality or service changes can and do generate considerable attention from communities, local and national politicians as well as staff. While there appears to be a general understanding and acceptance that the models of care have to change there are many views on what and where these changes should be. The biggest challenge we face is needing to speed up the pace of change while at the same time taking staff, communities and partners with us.
Page 4
This plan sets out our committment to continue to transform care to deliver the best possible outcomes for the people of Argyll & Bute. Our transformational journey includes moving towards more people being cared for at home. These aspects will be delivered through a combination of prevention and anticpatory care, better use of technology and developing and embedding new models of care. It will also very much be a collaborative approach working with our statutory partners, voluntary and third sectors as well as our staff and local communities. Clearly wider work delivered through public health, primary care, children’s services are ongoing and will shape improved outcomes in the longer term. There are risks around the pace and scale of change being insufficient or delivery of change being compromised which may result in:
No or little reduction in health inequalities, especially for those in poverty who experience the poorest health
Continued focus on more acute care which will not reduce the numbers of people aquiring long term conditions
A missed opportunity to improve the quality of life of those with long term conditions.
Integrated Budget – Key Facts
How do we spend our money just now?
£58m - Hospital Services in Greater Glasgow and Clyde
23%
£50m - Adult Social Care Services (Care at
home, care homes etc)20%
£46m - Hospital Services in Argyll and
Bute18%
£26m - Community Services (Public
Health, nursing, OT etc)10%
£20m - Childrens Services (Social Care,
Maternity, Mental Health etc)
8%
£19m - Prescribing in Argyll & Bute
7%
£15m - GP Services in Argyll & Bute
6%
£13m - Dentists, Opticians & Chemists
5%
£6m - Management and Corporate Costs
2%
£4m - Other Commissioned
Services1%
Page 5
This is summarised below:
In Argyll and Bute a relatively small number of service users account for much of the activity
and resource consumption in the health and social care system, with 50% of the resource
spent on hospital and prescribing costs to provide services for 2% of the population. Across
Scotland less than 4% of all service users account for 50% of total expenditure in health
services, so this is consistent with the national picture. A better understanding of this group
of service users and how they interact with health and social care services will help the
Partnership better manage and commission services in the future and ensure an improved
care experience and outcome for these people.
There is a clear direction from the Scottish Government that the integration of health and
social care has been introduced to change the way key services are delivered, with greater
emphasis on supporting people in their own homes and communities and less inappropriate
use of hospitals and care homes. By 2018 the national aim is to reduce unscheduled bed days
in hospital care by up to 10 percent (i.e. by as many as 400,000 bed days) by reducing delayed
discharges, avoidable admissions and inappropriate long stays in hospital. Actions taken by
Integration Joint Boards to deliver on these targets will assist to reduce the growth in the use
of hospital resources, support balance across NHS Board budgets and give clear impetus to
the wider goal of the majority of the health budget being spent in the community by 2021.
Hospital Services 40% £103m
Adult Social Care Services 20% £50m
Community Services 10% £26m
Prescribing 7% £19m
GPs, Dentists, Opticians and Chemists 11% £28m
Everything else 12% £30m
Page 6
Understanding the Financial Challenge
Funding
The Health and Social Care Partnership is funded through delegations from the Council and
Health Board, the estimated funding for 2017-18 is illustrated below:
Partner contributions to the Health and Social Care Partnership are contingent on the
respective financial planning and budget setting processes of the Council and Health Board
and the financial settlements that they receive from the Scottish Government. There is
uncertainty around funding available from 2018-19 onwards as both partners will set one year
budgets for 2017-18 and the impact of the Scottish Government budget allocation and local
spending decisions is not known. However funding assumptions can be made around the
ongoing reductions to public sector funding and priorities.
Cost and Demand Pressures
A detailed analysis of the cost and demand pressures has been undertaken for the Partnership
and assuming nothing else changes an additional £17m would be required to meet current
and anticipated costs and demand over the next two years. These are illustrated below:
56.4
202.5
£millions
Argyll and Bute Council NHS Highland
2.6 9.1 2.5 3.1
Financial Pressures 2017-19 (£millions)
Pay Inflation Demographic and Volume Non Pay Inflation Living Wage
Page 7
The assumptions for pay inflation costs reflect the current inflationary assumptions of
both partner bodies and the cost of the apprenticeship levy
Demographic and volume pressures reflect increases across all service areas including
amongst other areas healthcare packages, new medicines funding, growth in
prescribing demand, growth in adult care services, younger adult supported living
services and continuing care for children
Non pay inflation includes anticipated increases to third party payments, including the
expected uplift to NHS GG&C for acute services and cost increases for prescribing
The Living Wage pressures include the full year implications of moving to the Living
Wage from October 2016 and the increased rate for 2017-18, with an assumption the
rate will increase year on year to reflect the national commitment to reach a national
living wage of £9.00 per hour by 2020.
There are significant cost and demand pressures across health and social care services and
these are expected to outstrip any funding uplifts and have a significant contribution to the
overall budget gap for the Partnership.
The Budget Gap
The Integration Joint Board has a responsibility to set a balanced budget and to delegate
resources back to the Council and Health Board for the delivery of services. The funding and
cost estimates are prepared for each partner separately but these are consolidated and
viewed as one integrated budget with one bottom line position for the delivery of health and
social care services.
Taking into account the estimated funding and the pressures in relation to costs, demand and
inflationary increases the estimated budget gap for the Partnership for the two years to 2018-
19 is outlined below:
2017-18 2018-19
£m £m
Baseline Budget 256.1 258.9
Cost and Demand Pressures 7.9 4.7
Inflation 2.0 2.6
Total Expenditure 266.1 266.2
Total Funding (258.9) (257.3)
Budget Gap 7.2 9.0
Impact of 2016-17 Position 3.8 0.0
In-Year Budget Gap 11.0 9.0
Cumulative Budget Gap 11.0 20.0
Page 8
The overall budget gap for the delivery of Health and Social Care services is £11m for 2017-
18 and a further £9m in 2018-19, a total of £20m over the two years. The Quality and Finance
Plan requires to outline service changes which will achieve these savings together with
delivering on strategic objectives and outcomes.
Proposed Quality and Finance Plan 2017-18 to 2018-19
The Quality and Finance Plan has been in development since October 2016 when the process
started with Locality Planning Groups identifying priority areas for service change to deliver
on the strategic objectives and the required savings to deliver a balanced integrated budget
for the two years 2017-18 and 2018-19.
The areas of focus identified as part of this process are illustrated below:
The Quality and Finance Plan is included as Annex A, this provides the detail around plans to
change services in line with the areas of focus identified.
The key principles that have been identified through the process are:
Requirement to plan over a longer period and produce a two year plan in line with the
remainder of the Strategic Plan
£20m savings
Community Model of Care
NHS Greater Glasgow and Clyde Acute Services
Care Homes
Lorn and the Islands Hospital
Mental Health Services
Learning DisabilIty
Children's Services
Corporate Services
Page 9
Build on lessons learned from the current year where there are a number of service
changes that haven’t progressed as planned
Staff costs account for a significant proportion of the budget, we need to reduce our
budget but also need to retain the staff skills and experience we have and implement
service changes through workforce flexibility to deliver services in a different way
View the budget gap as one bottom line position and develop plans around that, no
assumption that same level of resource will be allocated back to partners for Health
and Social Care services
Acknowledge that an investment plan is required to build capacity in Community
Teams to shift the balance of care and that project management support is required
to drive forward the change agenda
The Quality and Finance Plan 2017-18 to 2018-19 builds on the service changes aimed at
shifting the balance of care that commenced in 2016-17.
There are savings totalling £3.1m from 2016-17 which have not been delivered on a recurring
basis and these will remain on the plan. In addition efficiency savings totalling £2m have been
identified that can be removed from service budgets without any impact on front line service
delivery.
The savings identified on the plan total £11.6m, with £8.2m planned to be delivered in 2017-
18 and a further £3.4m in 2018-19.
The Quality and Finance Plan does not fully address the estimated budget gap with a shortfall
in identified savings of £2.8m in 2017-18 and a further £5.6m in 2018-19, there will be a
requirement for further service changes to be identified to bridge the remaining budget gap.
There is a significant financial risk to the Health and Social Care Partnership and the Council
and Health Board partners of not fully identifying savings. There is a risk that any further
service changes may impact on the delivery and safety of services and the ability of the
Integration Joint Board to meet strategic objectives and national expectations around service
delivery.
Risks
There are major risks associated with the scale and pace of change required to deliver the
service changes and recurring savings from the Quality and Finance Plan. There are a number
of specific identified risks:
Project management skills and capacity are not sufficient to deliver in the required
timescales
Evidence base and communications and engagement is insufficient to convince
communities of the case for change in required timescale
Demands on leadership and management capacity to lead transformational change
while maintaining current services
Page 10
Evidence base and communications and engagement is insufficient to convince staff
of case for change in required timescale
Scale of efficiency requirements means some plans may not be in line with the Health
and Social Care Partnership’s strategic objectives
Investment Plan
The Argyll and Bute Health and Social Care Partnership has an ambitious strategic plan. In
order to facilitate this additional funding has been provided by the Scottish Government
which can be used to help transform services and to support integration. This additional
funding is now recurring baseline funding for the Partnership. It is important to note that
whilst the allocation of this funding is extremely useful in directing resource specifically to
delivering the strategic plan, the totality of the HSCP budget is available to transform health
and social care services.
The total investment resource available is £3.5m, which consists of £1.8m Integrated Care
Funding, £0.6m Delayed Discharge Funding, £0.5m Technology Enabled Care and £0.6m set
aside for community investment, from the additional £250m of Scottish Government funding
allocated in 2017-18. £1.1m of this funding has been set aside specifically to deliver on the
service changes outlined in the Quality and Finance Plan. The investment plan is included as
Annex B. The ongoing allocations from the Integrated Care Fund and Delayed Discharge
funding are currently being reviewed and will be included when allocations for 2017-18 and
2018-19 have been finalised.
The investment plan includes resource requirements for additional programme management
support to deliver the service changes. One of the lessons learned from the current year is
that there is limited capacity within service teams to deliver on the scale of service change
required together with continuing to have a focus on operational service delivery. This
investment will ensure that there is dedicated support to ensure the delivery of service
changes and ultimately recurring budget savings.
Next Steps
This Quality and Finance Plan is a step in developing the Health and Social Care Partnership’s
strategy to meet the challenges of health and social care integration. The plan has been
aligned to the objectives of the Strategic Plan and the performance outcomes and objectives.
There will be a requirement to further develop the plan to add further savings to address the
remaining budget gap. This work has already started and all services and the Integration Joint
Board will be involved in developing plans to ensure we have a financial plan which is
sustainable over the longer term.
Page 11
Re
fD
es
cri
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on
Pro
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s R
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P
os
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it w
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rvic
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dg
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tern
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Exte
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sid
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are
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Min
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he
use
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exte
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lace
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nts
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th
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ore
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od
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ch
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ack a
ll 1
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ye
ar
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do
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we
ne
ed
:
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wo
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tern
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ere
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ity.
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rgyll
an
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ute
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Arg
yll
allo
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ter
acce
ss t
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s a
s t
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y g
row
old
er.
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elie
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are
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st
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o s
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o in
cre
ase
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ed
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rvic
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o m
ee
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row
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s p
lace
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us b
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ct.
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ha
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5%
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in
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If
re
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will
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e
co
st
of
co
ntin
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are
fo
r 1
6,
17
an
d 1
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lds.
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nt
co
sts
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r co
ntin
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in
20
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nd
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o b
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sin
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de
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uld
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re
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y £
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20
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an
d a
fu
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00
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in 2
01
8-1
9.
So
cia
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ork
wo
rkin
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ith
hig
he
r n
ee
d y
ou
ng
pe
op
le
imp
acts
on
Po
lice
, E
du
ca
tio
n a
nd
SC
RA
.
Vo
latile
Bu
dg
et
ba
se
d o
n n
ee
d a
nd
in
flu
en
ce
d b
y d
ecis
ion
s
ma
de
by o
uts
ide
bo
die
s,
po
ten
tia
l to
ove
r sp
en
d.
La
ck o
f ca
pa
city t
o u
nd
ert
ake
re
de
sig
n o
f se
rvic
e.
Fu
nd
ing
is r
eq
uire
d t
o s
et
up
th
e p
ilot,
with
ou
t th
e p
ilot
an
d
a n
ew
mo
de
l o
f ca
re w
e w
ill b
e u
na
ble
to
fu
lfil
ou
r sta
tuto
ry
du
ty f
or
co
ntin
uin
g c
are
un
de
r th
e C
YP
Act.
Po
ten
tia
l risk im
pa
ct
un
ab
le t
o f
ulfill
ou
r sta
tuto
ry d
uty
to
de
live
r co
ntin
uin
g c
are
fo
r 1
6-2
5 y
ea
r o
lds if
red
esig
n
incre
ase
s t
he
nu
mb
er
of
pla
ce
me
nts
ris
ks c
an
be
re
du
ce
d
sig
nific
an
tly.
300
400
CF
02
Re
de
sig
n s
taff
ing
str
uctu
re a
cro
ss
Ch
ildre
n a
nd
Fa
mili
es s
erv
ice
to
co
pe
with
du
ty u
nd
er
CY
P A
ct
an
d
go
ve
rnm
en
t in
itia
tive
s w
ith
in N
HS
.
Sco
pin
g o
f ch
ildre
n a
nd
Fa
mili
es s
taff
ing
re
qu
ire
me
nts
as
ca
se
lo
ad
in
cre
ase
s d
ue
to
th
e r
eq
uire
me
nts
of
the
Ch
ildre
n a
nd
Yo
un
g P
eo
ple
(S
co
tla
nd
) A
ct
the
se
rvic
e w
ill
be
lo
okin
g a
fte
r ch
ildre
n f
or
lon
ge
r.
Fo
r th
e n
ext
8 y
ea
rs
the
re w
ill b
e a
ste
ad
y in
cre
ase
on
ly le
ve
llin
g o
ut
in 2
02
6.
Incre
me
nta
lly t
he
se
rvic
e w
ill r
eq
uire
5 a
dd
itio
na
l so
cia
l
wo
rke
rs.
He
alth
vis
itin
g p
ath
wa
y r
eq
uire
s a
dd
itio
na
l H
ea
lth
Vis
ito
rs,
ad
ditio
na
l se
rvic
es f
or
ch
ildre
n in
dis
tre
ss a
re
req
uired
. R
eq
uirem
en
t to
sco
pe
an
d c
ost
a n
ew
sta
ffin
g
str
uctu
re t
hro
ug
h c
on
su
lta
tio
n w
ith
sta
ff a
nd
th
ose
wh
o u
se
the
se
rvic
e,
we
will
de
ve
lop
a p
rog
ram
me
bo
ard
an
d lo
ok
at
fro
nt
line
sta
ff a
nd
ma
na
ge
me
nt
str
uctu
re t
o f
urt
he
r
de
ve
lop
in
teg
rate
d t
ea
ms.
Re
vie
win
g w
ork
loa
ds a
nd
su
pp
ort
ing
th
ird
tie
r se
cto
r to
un
de
rta
ke
so
cia
l ca
re t
asks.
Se
rvic
e s
ho
uld
be
be
tte
r e
qu
ipp
ed
to
de
al w
ith
se
rvic
e
de
ma
nd
s a
nd
le
gis
latio
n.
Se
rvic
es p
ote
ntia
lly w
ill b
e d
eliv
ere
d b
y t
he
th
ird
se
cto
r o
n
be
ha
lf o
f th
e h
ea
lth
an
d s
ocia
l ca
re p
art
ne
rsh
ip in
lin
e w
ith
3 y
ea
r H
SC
P s
tate
gic
pla
n
Ma
na
gin
g t
ran
sfo
rma
tio
na
l ch
an
ge
wh
ile m
ee
tin
g t
he
cu
rre
nt
de
ma
nd
s p
lace
s r
isks o
n s
erv
ice
de
live
ry
Re
de
sig
ne
d s
erv
ice
as w
ell
as t
hird
se
cto
r p
rovid
ing
se
rvic
es t
rad
itio
na
lly p
rovid
ed
by h
ea
lth
an
d s
ocia
l ca
re
pa
rtn
ers
hip
.
Ma
na
gin
g t
ran
sfo
rma
tio
na
l ch
an
ge
wh
ile m
ee
tin
g t
he
cu
rre
nt
de
ma
nd
s p
lace
s r
isks o
n s
erv
ice
de
live
ry
Ca
pa
city t
o u
nd
ert
ake
re
de
sig
n o
f se
rvic
e
Re
pu
tatio
na
l risk if
third
se
cto
r d
o n
ot
de
live
r a
pp
rop
ria
te
se
rvic
e.
Re
du
ctio
n in
pu
blic
se
cto
r w
ork
forc
e
Incre
ase
d u
se
of
third
se
cto
r p
art
ne
rs
Re
du
ctio
n is s
uita
bly
qu
alif
ied
sta
ff w
ill im
pa
ct
on
ab
ility
to
de
live
r h
ea
lth
vis
itin
g,
NH
S,
So
cia
l W
ork
Se
rvic
es h
ow
eve
r
this
ris
k c
ou
ld b
e m
igta
ted
by u
nd
ert
akin
g r
evie
w o
f a
ll
ch
ildre
ns s
erv
ice
s w
he
re s
taff
, yo
un
g p
eo
ple
an
d f
am
ilie
s
will
he
lp t
o d
eve
lop
a n
ew
mo
de
l o
f se
rvic
e d
eliv
ery
.
100
200
CF
03
Sch
oo
l H
oste
ls -
Exp
lore
th
e
op
po
rtu
nitie
s t
o m
axim
ise
ho
ste
l in
co
me
.
Ma
y b
e o
pp
ort
un
itie
s t
o a
ctive
ly m
ark
et
acco
mm
od
atio
n
ove
r h
olid
ay p
erio
ds a
nd
use
an
ne
xe
acco
mm
od
atio
n t
o
att
ract
locu
ms a
t a
re
du
ce
d c
ost.
A
lth
ou
gh
we
ha
ve
an
inco
me
bu
dg
et
tha
t w
e c
urr
en
tly d
o n
ot
ach
ieve
we
wo
uld
ho
pe
to
ove
r re
co
ve
r in
co
me
.
Op
po
rtu
nity t
o u
se
HS
CP
asse
ts t
o g
en
era
te in
co
me
in
lin
e
with
3 y
ea
r sta
teg
ic p
lan
La
ck o
f U
se
N
o r
isk t
o s
tatu
tory
se
rvic
e.
010
CH
ILD
RE
N'S
SE
RV
ICE
S:
Qua
lity
and
Fina
nce
Plan
201
7-18
to 2
018-
19AN
NEX
A
Page 12
Re
fD
es
cri
pti
on
Pro
po
se
d A
cti
on
s R
eq
uir
ed
P
os
itiv
e I
mp
ac
t o
n Q
ua
lity
an
d O
utc
om
es
an
d F
it w
ith
Str
ate
gic
Pri
ori
tie
s
Ris
ks
an
d O
the
r Im
pa
ct
Imp
ac
t o
n S
tatu
tory
Se
rvic
es
2017-1
8
Bu
dg
et
Re
du
cti
on
£0
00
2018-1
9
Bu
dg
et
Re
du
cti
on
£000
AC
01
Lo
rn a
nd
th
e I
sla
nd
s H
osp
ita
l F
utu
re
Pla
nnin
g t
o im
pro
ve t
he local serv
ices
an
d e
ng
ag
e s
pe
cia
list
se
rvic
es
appro
priate
ly t
o d
eliv
er
best
possib
le
ca
re.
LIH
gro
up
esta
blis
he
d w
ith
re
pre
se
nta
tio
n f
rom
pu
blic
,
co
mm
un
ity,
third
an
d in
de
pe
nd
en
t se
cto
r w
ork
ing
jo
intly t
o
de
sig
n s
erv
ice
s t
ha
t w
ill m
inim
ise
or
avo
id a
ll d
ela
ye
d
dis
ch
arg
es,
off
er
exce
llen
t q
ua
lity lo
ca
l ca
re
co
mp
lem
en
ted
by s
pe
cia
list
ca
re o
ut
of
are
a a
s r
eq
uire
d.
Pre
ve
ntio
n o
f a
dm
issio
ns t
o b
e a
ch
ieve
d b
y s
hfitin
g t
he
ove
rall
ba
lan
ce
of
ca
re a
nd
sta
ff t
o e
nsu
re a
nticip
ato
ry c
are
pla
nnin
g in p
lace.
Work
ing w
th t
he L
IH g
roup t
o e
xplo
re
clin
ica
l o
ptio
ns a
nd
off
er
co
ntin
ue
d,
co
nsis
ten
t a
pp
rop
ria
te
ho
sp
ita
l ca
re.
Da
ta c
olle
ctio
n a
nd
scru
tin
y t
o in
form
th
e
se
rvic
e d
esig
n.
Re
cru
itm
en
t a
nd
re
ten
tio
n s
tra
teg
ies t
o
su
pp
ort
th
e s
erv
ice
.
Imp
rove
d d
ata
co
llectio
n a
nd
scru
tin
y w
ill m
ee
t
pe
rfo
rma
nce
crite
ria
fo
r sa
fety
, q
ua
lity a
nd
su
sta
ina
bili
ty
wh
en
co
nsid
ere
d a
lon
gsid
e t
he
sh
ift
in t
he
ba
lan
ce
of
ca
re
an
d c
om
mitm
en
t to
qu
alit
y o
utc
om
es f
or
pa
tie
nts
. P
ositiv
e
ou
tco
me
s r
ela
te t
o H
&S
C D
eliv
ery
Pla
n a
nd
HS
CP
Str
ate
gic
Pla
n.
Imp
rove
d c
linic
al ca
re s
ho
uld
exp
ed
ite
dis
ch
arg
es.
Ba
lan
ce
of
ca
re in
th
e c
om
mu
nity w
ill r
ed
uce
acu
te a
dm
issio
ns.
LIH
pla
nn
ing
gro
up
will
pro
du
ce
ra
ng
e o
f o
ptio
ns f
or
wid
er
co
nsu
lta
tio
n,
with
co
mm
itm
en
t to
24
/7 e
me
rge
ncy c
are
. L
IH
Gro
up
will
exa
min
e s
urg
ica
l a
nd
me
dic
al p
rovis
ion
s,
the
sh
ift
in b
ala
nce
, a
nd
in
fu
ll kn
ow
led
ge
of
GG
&C
pla
ns a
s
we
ll a
s lin
ks w
ith
lo
ca
l h
osp
ita
ls.
No
ne
an
ticip
ate
d.
347
647
AC
02
Fu
rth
er
imp
rove
me
nt
an
d in
ve
stm
en
t in
the
sco
pe
of
OL
I C
om
mu
nity W
ard
s t
o
off
er
qu
alit
y s
erv
ice
s a
nd
su
pp
ort
o
n
dis
ch
arg
e a
nd
tim
ely
asse
ssm
en
t a
nd
rea
ble
me
nt.
Co
mm
un
ity s
taff
fu
rth
er
up
skill
ed
th
rou
gh
tra
inin
g a
nd
un
de
rsta
nd
ing
of
sco
pe
of
se
rvic
es.
Re
so
urc
e t
o e
nsu
re
tha
t 'v
irtu
al w
ard
s' fe
el a
nd
giv
e a
se
rvic
e w
hic
h is
pe
rce
ive
d a
s r
ea
l a
nd
mo
re e
ffe
ctive
th
an
lo
ca
tio
n b
ase
d
se
rvic
es.
Th
is s
up
po
rts C
linic
al S
tra
teg
y,
HS
CP
Str
ate
gic
P
lan
,
H&
SC
P D
eliv
ery
Pla
ns.
Ma
jor
sh
ift
in c
om
mu
nity b
ase
d
ca
re in
clu
siv
e o
f a
ll se
cto
rs w
ork
ing
jo
intly t
o d
eliv
er
imp
rove
d c
are
an
d e
xp
erie
nce
an
d t
o m
inim
ise
de
laye
d
dis
ch
arg
e.
Sh
iftin
g t
he
ba
lan
ce
fo
ca
re w
ill r
eq
uire
en
ga
gm
en
t, t
rain
ing
an
d d
ialo
gu
e w
ith
co
mm
un
ity s
taff
to
de
ve
lop
wa
ys in
wh
ich
a 2
4/7
co
mm
un
ity w
ard
ca
n b
e d
eliv
ere
d t
o b
en
efit
pa
tie
nts
. A
lon
gsid
e t
he
LIH
gro
up
will
co
nsid
er
an
en
ha
nce
d c
on
su
lta
nt
role
eg
fo
r a
sse
ssm
en
ts.
Sh
iftin
g c
are
in
to t
he
co
mm
un
ity h
as p
ositiv
e o
utc
om
es f
or
pa
tie
nts
an
d u
se
rs o
f se
rvic
es,a
s w
ell
as S
G I
nte
gra
tio
n
Pe
rfo
rma
nce
me
asu
res e
g u
np
lan
ne
d a
dm
issio
ns,
un
sch
ed
ule
d c
are
, d
ela
ye
d d
isch
arg
es a
nd
A &
E
pe
rfo
rma
nce
.
inclu
de
d a
bo
ve
inclu
de
d a
bo
ve
AC
03
Pu
ttin
g e
nviro
nm
en
t, in
de
pe
nd
en
t liv
ing
an
d s
erv
ice
use
r ch
oic
e a
t th
e h
ea
rt o
f
ca
re s
up
po
rt b
y r
evie
win
g t
he
cu
rre
nt
build
ings a
nd c
are
serv
ice e
mplo
yed b
y
Ard
fen
aig
an
d E
ad
er
Gly
nn
to
de
live
r a
n
imp
rove
d e
nviro
nm
en
t, b
ett
er
ch
oic
e a
nd
co
ntr
ol.
Ide
ntify
all
op
tio
ns w
ith
pa
rtn
ers
to
be
tte
r p
rovid
e s
up
po
rt
wh
en
ca
re a
t h
om
e is n
o lo
ng
er
po
ssib
le.
Se
ek
en
ga
ge
me
nt
to r
evie
w a
ll o
ptio
ns w
ith
fu
ll re
ga
rd f
or
ch
oic
es a
nd
co
ntr
ol o
f p
eo
ple
wh
o u
se
th
ese
se
rvic
es.
Prio
rity
is t
he
ch
oic
e a
nd
qu
alit
y o
f ca
re p
rovis
ion
to
th
ose
usin
g s
erv
ice
s,
an
d t
o f
ully
utilis
e a
sp
ects
of
sh
iftin
g
ba
lan
ce
of
ca
re t
o a
ho
me
ly s
ett
ing
in
a s
afe
an
d c
arin
g,
su
sta
ina
ble
en
viro
nm
en
t.
En
ga
ge
me
nt
will
assis
t in
sta
ke
ho
lde
r u
nd
ers
tan
din
g o
f
op
tio
ns o
f ca
re a
va
ilab
le a
nd
of
the
ch
oic
es o
f se
rvic
e
use
rs.
Lo
ng
te
rm p
lan
wh
ich
co
nsu
lts a
pp
rop
ria
tely
at
all
sta
ge
s.
Po
ten
tia
l fo
r la
ck o
f in
tere
st
fro
m e
xte
rna
l
pro
vid
ers
. L
en
gth
y t
ime
sca
le.
Fu
ture
po
ten
tia
l ch
an
ge
s t
o r
eg
istr
atio
n s
tatu
s a
nd
sco
pe
of
wo
rk (
eg
ou
tre
ach
). I
nve
stm
en
t w
ou
ld b
e in
im
pro
ve
d
en
viro
nm
en
t.
053
AC
04
Ide
ntifie
d d
em
an
d f
or
gre
ate
r ch
oic
e o
f
su
pp
ort
ca
re o
n T
ire
e,
cu
rre
ntly a
nd
fo
r
futu
re p
lan
nin
g.
.
Isla
nd
de
ma
nd
to
be
qu
an
tifife
d,
an
d p
rovis
ion
re
vie
we
d in
line
with
cu
rre
nt
an
d e
me
rgin
g d
em
an
ds.
Ba
se
d o
n o
lde
r p
eo
ple
's v
iew
s,
ad
va
nce
th
e s
hift
in
ba
lan
ce
of
ca
re t
o s
up
po
rt in
de
pe
nd
en
ce
an
d
em
po
we
rme
nt.
Pa
rtn
er
wo
rkin
g w
ith
Cu
ram
to
ach
ieve
be
st
ou
tco
me
s.
En
ga
ge
me
nt
an
d u
nd
ers
tan
din
g w
ith
sta
ke
ho
lde
rs a
nd
clo
se
in
vo
lve
me
nt.
Fu
ture
po
ten
tia
l ch
an
ge
s t
o r
eg
istr
atio
n s
tatu
s a
nd
sco
pe
of
wo
rk.
Imp
rove
d e
nviro
nm
en
t, p
ote
ntia
l g
rea
ter
su
pp
ort
in
the
pe
rso
ns h
om
e.
046
AC
05
Re
de
sig
n o
f L
ea
rnin
g D
isa
bili
ty s
erv
ice
s
inclu
din
g d
ay s
erv
ice
s a
nd
su
pp
ort
at
ho
me
fo
r a
du
lts a
cro
ss A
rgyll
an
d B
ute
,
the
prio
rity
ne
ed
s t
o b
e g
ive
n t
o s
erv
ice
use
r n
ee
d a
nd
de
ma
nd
in
ea
ch
lo
ca
l
are
a.
Utilis
e le
arn
ing
fro
m H
ele
nsb
urg
h r
ed
esig
n,
an
d e
ng
ag
e
with
sta
ke
ho
lde
rs.
Fu
ll a
cco
un
t o
f se
rvic
e u
se
r vie
ws a
nd
the
cu
rre
nt
an
d e
me
rgin
g n
ee
ds,
en
co
ura
gin
g
ind
ep
en
de
nce
an
d s
hiftin
g t
he
ba
lan
ce
of
ca
re.
Re
de
sig
n t
he
se
rvic
e t
o m
axim
ise
th
e in
de
pe
nd
en
ce
of
se
rvic
e u
se
rs.
Th
is s
ho
uld
de
live
r a
be
tte
r se
rvic
e a
nd
imp
rove
th
e v
alu
e f
or
mo
ne
y.
S
hiftin
g t
he
ba
lan
ce
of
ca
re
in lin
e w
ith
Str
ate
gic
Pla
n a
nd
H&
SC
De
lvie
ry P
lan
, in
to
co
mm
un
ty s
ett
ing
s w
hic
h d
eve
lop
in
de
pe
nd
en
ce
an
d
ch
oic
e f
or
se
rvic
e u
se
r.
Fa
mili
es,
ca
rers
an
d lo
ca
l su
pp
ort
gro
up
s m
ay r
esis
t th
e
pla
nned c
hanges w
ithout
a f
ull
unders
tanin
g o
f th
e
red
esig
n.
Th
ere
ma
y b
e a
de
trim
en
tal im
pa
ct
on
exis
tin
g
sta
ff in
th
eir c
urr
en
t ro
les.
Re
de
sig
n m
ust
inclu
de
en
ga
ge
me
nt
an
d u
nd
ers
tan
din
g o
f fa
mili
es,
ca
rers
, su
pp
ort
gro
up
s a
nd
sta
ke
ho
lde
rs.
Sta
ff t
o b
e c
on
su
lte
d a
nd
engaged a
s t
he w
ork
pro
gre
sses a
nd a
ll sta
kehold
ers
kept
fully
in
form
ed
. R
ed
esig
n s
ee
ks t
o im
pro
ve
use
r o
tuco
me
s
wh
ilst
ad
dre
ssin
g o
ve
rsp
en
ds f
rom
a s
erv
ice
no
lo
ng
er
fit
for
pu
rpo
se
.
Po
ten
tia
l ch
an
ge
s t
o t
he
typ
e o
f re
gis
tra
tio
n w
ith
th
e C
are
Insp
ecto
rate
.
Po
sitiv
e im
pa
ct
on
su
pp
ort
ing
in
de
pe
nd
en
t
livin
g a
nd
im
pro
ve
d e
nviro
nm
en
t.
175
325
AC
06
Re
pa
tria
te t
op
15
hig
h c
ost
yo
un
g a
du
lt
ca
re p
lace
me
nts
fro
m o
utw
ith
Arg
yll
an
d
Bu
te.
Th
is in
clu
de
s s
erv
ice
use
rs w
ho
are
in
re
sid
en
tia
l ca
re a
nd
so
me
wh
o a
re
rece
vin
g s
pe
cia
list
su
pp
ort
ed
liv
ing
se
rvic
es o
utw
ith
th
e a
rea
.
Ide
ntify
th
en
re
vie
w t
op
15
ad
ults o
utw
ith
th
e a
rea
cu
rre
ntly
an
d u
nd
ert
ake
re
vie
w w
ith
a v
iew
to
brin
gin
g t
he
ir c
are
pa
cka
ge
ba
ck t
o A
rgyll
an
d B
ute
. N
ee
d t
o lin
k w
ith
ho
usin
g
pro
vid
ers
an
d s
ocia
l ca
re p
rovid
ers
to
id
en
tify
ca
pa
city a
nd
co
st
to b
rin
g a
du
lts b
ack t
o s
ha
red
te
na
ncy a
rra
ng
em
en
ts.
Re
turn
ing
se
rvic
e u
se
rs t
o t
he
ir o
wn
co
mm
un
itie
s,
clo
se
r to
the
ir r
oo
ts a
nd
fa
mili
es.
De
live
rin
g b
est
va
lue
an
d s
up
po
rt
the
lo
ca
l e
co
no
my b
y b
rin
gin
g H
SC
P s
pe
nd
ba
ck t
o A
rgyll.
Fa
mili
es m
igh
t b
e r
elu
cta
nt
to m
ove
se
rvic
e u
se
rs a
wa
y
fro
m w
he
re t
he
y h
ave
be
en
liv
ing
. T
he
pa
rtn
ers
hip
ma
y n
ot
be
ab
le t
o a
cce
ss t
he
ra
ng
e o
f se
rvic
es r
eq
uire
d t
o lo
ok
aft
er
the
se
pe
op
le in
Arg
yll
or
ma
y b
e u
na
ble
to
so
urc
e
appro
priate
housin
g.
No
an
ticip
ate
d im
pa
ct.
73
194
AC
07
Su
pp
ort
ed
liv
ing
is c
ate
go
rise
d in
to f
ou
r
ca
teg
orie
s.
Critica
l (P
1)
an
d s
ub
sta
ntia
l
(P2
) n
ee
ds w
ill b
e m
et
an
d o
the
rs w
ill b
e
sig
np
oste
d t
o s
elf-h
elp
an
d c
om
mu
nity
reso
urc
es.
Re
vie
w e
xis
tin
g s
up
po
rte
d liv
ing
ca
re p
acka
ge
s t
o e
nsu
re
tha
t ca
se
s m
ee
t th
e p
rio
rity
of
ne
ed
fra
me
wo
rk.
Pro
mo
te
use
of
SD
S.
In
tro
du
ce
Are
a R
eso
urc
e G
rou
ps t
o s
cru
tin
ise
ad
ult c
are
su
pp
ort
ed
liv
ing
an
d d
ela
ye
d d
isch
arg
e
pa
cka
ge
s.
En
su
rin
g t
ha
t ca
re p
acka
ge
s a
re t
ailo
red
to
me
et
the
ne
ed
s
an
d m
axim
ise
th
e in
de
pe
nd
en
ce
of
se
rvic
e u
se
rs a
s w
ell
as d
eliv
er
va
lue
fo
r m
on
ey a
nd
de
live
r se
rvic
es in
lo
ca
l
co
mm
un
itie
s.
In
tro
du
cin
g n
ew
Lo
ca
lity M
on
ito
rin
g
Gro
up
s
to e
nsu
re e
qu
alit
y in
th
e d
eliv
ery
of
su
pp
ort
ed
liv
ing
fo
r
ca
teg
orie
s P
1 &
P2
.
Fa
mili
es,
ca
rers
an
d lo
ca
l su
pp
ort
gro
up
s m
ay r
esis
t th
e
pla
nned c
hanges.
Where
the d
ecis
ion t
o m
ake c
hanges t
o
pa
cka
ge
s is e
xte
nd
ed
to
ca
rers
an
d f
am
ilie
s,
exp
erie
nce
su
gg
ests
th
at
ch
an
ge
is u
nlik
ely
to
be
ag
ree
d.
Ris
k in
term
s o
f d
eliv
era
bili
ty o
f sa
vin
gs,
sa
vin
gs a
re u
nd
ers
tate
d
as t
he
re is a
cu
rre
nt
ye
ar
ove
rsp
en
d t
o b
e a
dd
resse
d
be
fore
sa
vin
gs c
an
be
re
lea
se
d.
No
an
ticip
ate
d im
pa
ct.
0460
AC
08
Re
vie
w t
he
de
live
ry o
f se
rvic
es f
or
old
er
pe
op
le t
o c
on
sid
er
alte
rna
tive
wa
ys o
f
de
live
rin
g s
erv
ice
s f
or
old
er
pe
op
le.
En
su
re a
ll n
ew
pa
cka
ge
s a
dh
ere
to
Va
lue
fo
r M
on
ey
prin
cip
les.
Co
nsid
er
alte
rna
tive
wa
ys t
o d
eliv
er
su
pp
ort
/me
et
the
asse
sse
d o
utc
om
es o
f se
rvic
e u
se
rs.
To
ma
inta
in p
eo
ple
at
ho
me
fo
r a
s lo
ng
as p
ossib
le.
to
sp
rea
d t
he
lim
ite
d r
eso
urc
es a
va
ilab
le t
o t
he
HS
CP
acro
ss
as m
an
y s
erv
ice
use
rs a
s p
ossib
le.
De
live
r va
lue
fo
r
mo
ne
y.
No
n s
up
po
rt o
f fa
mili
es.
A s
hift
in p
ractice
to
en
su
re w
e
de
live
r co
nsis
ten
cy in
ou
tco
me
s f
or
ind
ivid
ua
ls a
nd
fam
ilie
s.
Co
nsis
ten
t a
pp
roa
ch
ad
op
ted
acro
ss a
ll lo
ca
tio
ns
with
in A
rgyll
an
d B
ute
.
No
an
ticip
ate
d im
pa
ct.
200
200
CA
RE
HO
ME
S:
LO
RN
AN
D T
HE
IS
LA
ND
S H
OS
PIT
AL
:
LE
AR
NIN
G D
ISA
BIL
ITY
:
CO
MM
UN
ITY
MO
DE
L O
F C
AR
E:
Qua
lity
and
Fina
nce
Plan
201
7-18
to 2
018-
19AN
NEX
A
Page 13
Re
fD
es
cri
pti
on
Pro
po
se
d A
cti
on
s R
eq
uir
ed
P
os
itiv
e I
mp
ac
t o
n Q
ua
lity
an
d O
utc
om
es
an
d F
it w
ith
Str
ate
gic
Pri
ori
tie
s
Ris
ks
an
d O
the
r Im
pa
ct
Imp
ac
t o
n S
tatu
tory
Se
rvic
es
2017-1
8
Bu
dg
et
Re
du
cti
on
£0
00
2018-1
9
Bu
dg
et
Re
du
cti
on
£000
AC
09
Re
de
sig
n t
he
pro
vis
ion
of
sle
ep
ove
rs
pro
vid
ed
by t
he
HS
CP
.
Sh
ift
to n
ew
mo
de
l o
f ca
re u
sin
g t
ele
ca
re/o
ve
rnig
ht
resp
on
se
te
am
s.
Wo
rk w
ith
ca
re p
rovid
ers
to
re
de
sig
n
un
avo
ida
ble
sle
ep
ove
r p
rovis
ion
an
d lo
ok f
or
op
po
rtu
nitie
s
to s
ha
re p
rovis
ion
acro
ss m
ultip
le s
erv
ice
use
rs.
En
co
ura
gin
g s
erv
ice
use
rs t
o b
e in
de
pe
nd
en
t w
hils
t
ma
xim
isin
g t
he
op
po
rtu
nity t
o k
ee
p p
eo
ple
liv
ing
in
th
e
co
mm
un
ity f
or
as lo
ng
as p
ossib
le.
De
live
r b
est
va
lue
.
Ch
an
ge
to
a n
ew
mo
de
l o
f ca
re p
rovis
ion
th
at
is s
afe
, b
ut
pe
rso
n c
en
tre
d a
nd
im
pro
ve
d in
de
pe
nd
en
t liv
ing
.
Fa
mili
es,
ca
rers
an
d lo
ca
l su
pp
ort
gro
up
s m
ay r
esis
t th
e
pla
nned c
hanges.
Where
the d
ecis
ion t
o m
ake c
hanges t
o
pa
cka
ge
s is e
xte
nd
ed
to
ca
rers
an
d f
am
ilie
s,
exp
erie
nce
su
gg
ests
th
at
ch
an
ge
is u
nlik
ely
to
be
ag
ree
d.
We
ha
ve
a
cu
rre
nt
ove
rsp
en
d a
nd
th
at
ne
ed
s t
o b
e a
dd
resse
d a
s w
e
mo
ve
ah
ea
d.
No
an
ticip
ate
d im
pa
ct.
200
200
AC
11
Inve
stm
en
t in
'N
eig
hb
ou
rhoo
d T
ea
m'
ap
pro
ach
to
de
live
ry o
f ca
re a
t h
om
e f
or
the
co
mm
un
ity a
cro
ss M
id A
rgyll,
Kin
tyre
an
d isla
y.
Pu
ttin
g s
erv
ice
use
rs a
t th
e
he
art
of
se
rvic
e d
esig
n.
Mo
re r
esp
on
siv
e a
nd
pe
rso
n c
en
tre
d a
pp
roa
ch
to
de
live
ry,
be
tte
r m
ee
tin
g n
ee
ds.
A b
est
pra
ctice
mo
de
l, w
hic
h is t
ruly
pe
rso
n c
en
tre
d,
ma
inta
ins in
de
pe
nd
en
ce
an
d r
eco
gn
ise
s
dig
nity a
lon
gsid
e in
de
pe
nd
en
ce
, a
nd
im
pro
ve
d o
utc
om
es.
Sh
ift
fro
m t
ime
an
d t
ask/s
ilo w
ork
ing
to
te
am
ba
se
d
ap
pro
ach
to
ca
re p
rovis
ion
. In
lin
e w
ith
clin
ica
l str
ate
gy,
He
alth
an
d S
ocia
l C
are
De
live
ry P
lan
an
d H
SP
Str
ate
gic
pla
n.
De
ve
lop
ed
wo
rkin
g w
ith
th
ird
an
d in
de
pe
nd
en
t
se
cto
rs t
o d
eliv
er
ca
re.
De
vis
ed
on
be
st
pra
ctice
mo
de
ls o
f
pe
rso
n c
en
tre
d c
are
.
IT s
up
po
rt r
eq
uire
d f
or
co
mm
un
ity b
ase
d m
od
els
.
Sig
nific
an
t sta
ff H
R im
plic
atio
ns a
nd
org
an
isa
tio
na
l ch
an
ge
.
Un
like
ly t
o d
eliv
er
an
y e
arly s
avin
gs h
ow
eve
r p
rio
ritise
s
reso
urc
es t
o s
up
po
rt p
rim
ary
ca
re a
nd
de
live
r se
rvic
es
mo
re e
ffic
ien
tly a
nd
eff
ective
ly in
itia
lly,
to t
he
n g
ain
eco
no
mie
s o
f sca
le f
rom
in
teg
rate
d t
ea
ms.
Su
pp
ort
s s
hift
in b
ala
nce
of
ca
re t
o a
ge
nu
ine
ly p
ers
on
ce
ntr
ed
se
rvic
e w
hic
h v
alu
es t
he
use
rs a
nd
pu
ts t
he
n a
t
the
he
art
of
de
sig
n.
Su
pp
ort
s in
de
pe
nd
en
ce
, d
ign
ity,
an
d
assis
ts r
ed
uctio
n u
np
lan
ne
d a
dm
issio
ns.
Bu
ilt o
n lo
ca
l
kn
ow
led
ge
to
im
pro
ve
ou
tco
me
s f
or
ad
ult p
rote
ctio
n a
nd
ca
rer
su
pp
ort
. A
C1
2In
ve
stm
en
t in
'N
eig
hb
ou
rhoo
d T
ea
m'
ap
pro
ach
to
de
live
ry o
f ca
re a
t h
om
e f
or
the
co
mm
un
ity a
cro
ss O
ba
n L
orn
an
d
the
Isla
nd
s.
Pu
ttin
g s
erv
ice
use
rs a
t th
e
he
art
of
se
rvic
e d
esig
n.
Mo
re r
esp
on
siv
e a
nd
pe
rso
n c
en
tre
d a
pp
roa
ch
to
de
live
ry,
be
tte
r m
ee
tin
g n
ee
ds.
A b
est
pra
ctice
mo
de
l, w
hic
h is t
ruly
pe
rso
n c
en
tre
d,
ma
inta
ins in
de
pe
nd
en
ce
an
d r
eco
gn
ise
s
dig
nity a
lon
gsid
e in
de
pe
nd
en
ce
, a
nd
im
pro
ve
d o
utc
om
es.
Sh
ift
fro
m t
ime
an
d t
ask/s
ilo w
ork
ing
to
te
am
ba
se
d
ap
pro
ach
to
ca
re p
rovis
ion
. In
lin
e w
ith
clin
ica
l str
ate
gy,
He
alth
an
d S
ocia
l C
are
De
live
ry P
lan
an
d H
SP
Str
ate
gic
pla
n.
De
ve
lop
ed
wo
rkin
g w
ith
th
ird
an
d in
de
pe
nd
en
t
se
cto
rs t
o d
eliv
er
ca
re.
De
vis
ed
on
be
st
pra
ctice
mo
de
ls o
f
pe
rso
n c
en
tre
d c
are
wh
ich
ma
inta
ins in
de
pe
nd
nce
an
d
dig
nity.
IT s
up
po
rt r
eq
uire
d f
or
co
mm
un
ity b
ase
d m
od
els
.
Sig
nific
an
t sta
ff H
R im
plic
atio
ns a
nd
org
an
isa
tio
na
l ch
an
ge
.
Un
like
ly t
o d
eliv
er
an
y e
arly s
avin
gs h
ow
eve
r p
rio
ritise
s
reso
urc
es t
o s
up
po
rt p
rim
ary
ca
re a
nd
de
live
r se
rvic
es
mo
re e
ffic
ien
tly a
nd
eff
ective
ly in
itia
lly,
to t
he
n g
ain
eco
no
mie
s o
f sca
le f
rom
in
teg
rate
d t
ea
ms.
Po
sitiv
e s
hift
in b
ala
nce
of
ca
re a
nd
su
pp
ort
ing
pe
op
le t
o
rem
ain
at
ho
me
an
d r
ed
ucin
g u
np
lan
ne
d a
dm
issio
ns t
o
ho
sp
ita
l. I
mp
rove
d le
ve
rag
e o
f lo
ca
l kn
ow
led
ge
to
im
pro
ve
ad
ult p
rote
ctio
n a
nd
ca
rer
su
pp
ort
.
AC
14
Mo
de
rnis
e c
om
mu
nity h
osp
ita
l ca
re in
Ca
mp
be
lto
wn
esta
blis
hin
g a
cro
ss
ag
en
cy 'P
lan
nin
g f
or
the
Fu
ture
' g
rou
p,
to
active
ly r
evie
w r
an
ge
of
be
d s
pa
ce
use
s
an
d o
ptio
ns.
Aim
to
ach
ieve
co
mm
un
ity
ba
se
d,
an
d c
om
mu
nity f
ocu
sse
d h
osp
ita
l
mo
de
l lin
kin
g s
ea
mle
ssly
with
en
ha
nce
d
co
mm
un
ity s
erv
ice
s.
Re
vie
w g
rou
p t
o id
en
tify
an
d e
ng
ag
e w
ith
sta
ke
ho
lde
rs o
n
be
st
use
of
be
d s
pa
ce
s t
o m
ain
tain
a q
ua
lity a
nd
resp
on
siv
e s
erv
ice
24
/7 w
hic
h s
up
po
rts p
atie
nts
appro
priate
ly a
nd t
imeously
. Im
pro
vin
g c
om
munity f
ocus
an
d h
osp
ita
l crite
ria
aim
s t
o r
ed
uce
or
ne
ga
te
de
laye
d
dis
ch
arg
es,
imp
rove
pre
ve
ntio
n a
nd
an
ticip
ato
ry c
are
pla
nnin
g.
Pote
ntial fo
r gre
ate
r jo
ined u
p w
ork
ing w
ith o
ther
ho
sp
ita
ls,
an
d e
ffe
ctive
use
of
da
ta a
ssu
me
d.
Enablin
g p
eople
to liv
e independenty
in t
heir o
wn h
om
es,
an
d a
vo
id d
ela
ye
d d
isch
arg
es is k
ey t
o im
pro
vin
g
co
mm
un
ity b
ase
d c
are
. A
lon
gsid
e b
ett
er
wo
rkin
g w
ith
th
ird
an
d in
de
pe
nd
en
t se
cto
rs t
o e
nsu
re p
ers
on
ce
ntr
ed
ap
pro
ach
an
d q
ua
lity o
uto
co
me
s,
alig
ns w
ith
HS
CP
Str
ate
gy a
nd
H&
SC
De
live
ry P
lan
.
Imp
rove
me
nts
to
IT
su
pp
ort
un
de
rpin
im
rpo
ve
d c
om
mu
nity
ca
re.
Re
qu
ire
s e
ng
ag
me
nt
with
all
sta
ke
ho
lde
rs t
o a
ch
ieve
sh
are
d a
ims a
nd
un
de
rsta
nd
ing
.
Nil
an
ticip
ate
d232
232
AC
15
Imp
rove
me
nts
to
co
mm
un
ity f
ocu
sse
d
ca
re in
Mid
Arg
yll,
with
fo
cu
s o
n
imp
rovin
g t
he
mo
de
l o
f d
eliv
ery
an
d
se
rvic
e
in M
AC
HIC
C.
Imp
rove
d
resp
on
siv
e c
om
mu
nity s
erv
ice
s a
ble
to
rep
so
nd
24
/7 s
up
po
rtin
g p
atie
nts
in
th
eir
ow
n h
om
es.
Sh
iftin
g t
he
ba
lan
ce
of
ca
re
an
d e
nsu
rin
g e
ffe
ctive
an
d e
ffic
ien
t u
se
of
ho
sp
ita
l se
rvic
es.
Imp
rove
me
nts
an
d e
xp
an
sio
n o
f co
mm
un
ity b
ase
d
se
rvic
es in
Mid
Arg
yll
to a
ch
ieve
re
du
ce
d o
r n
ill d
ela
ye
d
dis
ch
arg
es,
gre
ate
r p
reve
ntio
n a
nd
an
ticp
ato
ry c
are
pla
nnin
g t
o e
nable
people
to liv
e in t
heir o
wn h
om
es,
or
retu
rn t
o t
he
ir o
wn
ho
me
s a
s q
uic
kly
asp
ossib
le.
Pe
rso
n c
en
tre
d,
co
mm
un
ity f
ocu
sse
d a
nd
ma
xim
isin
g o
ur
resro
uce
s t
o r
esp
on
d t
o w
ha
t p
eo
ple
te
ll u
s m
att
ers
to
the
m.
Sh
iftin
g b
ala
nce
of
ca
re a
lign
s w
ith
HS
CP
Str
ate
gic
Pla
n a
nd
H&
SC
De
live
ry P
lan
.
Imp
rove
me
nts
to
IT
su
pp
ort
un
de
rpin
im
pro
ve
d c
om
mu
nity
ca
re.
Re
qu
ire
s e
ng
ag
me
nt
with
all
sta
ke
ho
lde
rs t
o a
ch
ieve
sh
are
d a
ims a
nd
un
de
rsta
nd
ing
.
Nil
an
ticip
ate
d170
170
AC
16
Co
ntin
ue
with
th
e r
evie
w a
nd
re
de
sig
n
in-
pa
tie
nt
wa
rd in
Co
wa
l C
om
mu
nity
Ho
sp
ita
l cu
rre
ntly r
evie
win
g t
he
acu
te
ob
se
rva
tio
n b
ed
s,
sh
ort
te
rm
asse
ssm
en
t b
ed
s,
de
laye
d d
isch
arg
es,
pre
ve
ntio
n o
f a
dm
issio
ns a
nd
A&
E
bre
ech
es.
Th
e r
evie
w w
ill in
clu
de
co
nsid
erin
g e
nh
an
ce
d c
om
mu
nity c
are
to
pre
ve
nt
ad
mis
sio
ns.
Co
ntin
ue
th
e c
urr
en
t re
vie
w a
nd
co
nsid
er
ho
w w
e d
eliv
er
co
mm
un
ity s
erv
ice
s in
Co
wa
l to
pro
vid
e 2
4/7
re
sp
on
se
to
su
pp
ort
pa
tie
nts
at
ho
me
.
Ab
ility
to
ma
inta
in p
atie
nts
at
ho
me
in
clu
din
g s
om
e w
ho
wo
uld
ha
ve
be
en
ad
mitte
d t
o h
osp
ita
l, in
lin
e w
ith
str
ate
gic
dire
ctio
n a
nd
de
ve
lop
ed
wo
rkin
g w
ith
th
ird
an
d in
de
pe
nd
en
t
se
cto
rs.
Th
e d
eliv
ery
of
IT s
up
po
rt f
or
co
mm
un
ity t
ea
ms is a
co
nsid
era
tio
n.
Re
cru
itm
en
t is
su
es f
or
rura
l a
rea
s
reco
gn
ise
d a
s a
n issu
e.
537
537
AC
17
Co
ntin
ue
with
th
e r
evie
w a
nd
re
de
sig
n
GP
in
-pa
tie
nt
wa
rd in
Vic
toria
Ho
sp
ita
l
cu
rre
ntly r
evie
win
g t
he
acu
te o
bse
rva
tio
n
be
ds,
sh
ort
te
rm a
sse
ssm
en
t b
ed
s,
de
laye
d d
isch
arg
es,
pre
ve
ntio
n o
f
ad
mis
sio
ns a
nd
A&
E b
ree
ch
es.
Th
e
revie
w w
ill in
clu
de
co
nsid
erin
g e
nh
an
ce
d
co
mm
un
ity c
are
to
pre
ve
nt
ad
mis
sio
ns.
Re
de
sig
n o
f co
mm
un
ity s
erv
ice
s in
Bu
te t
o p
rovid
e 2
4/7
resp
on
se
to
su
pp
ort
pa
tie
nts
at
ho
me
. C
om
mu
nity a
nd
sta
ff e
ng
ag
em
en
t.
Ab
ility
to
ma
inta
in p
atie
nts
at
ho
me
in
clu
din
g s
om
e w
ho
wo
uld
ha
ve
be
en
ad
mitte
d t
o h
osp
ita
l, in
lin
e w
ith
str
ate
gic
dire
ctio
n a
nd
de
ve
lop
ed
wo
rkin
g w
ith
th
ird
an
d in
de
pe
nd
en
t
se
cto
rs.
IT s
up
po
rt f
or
co
mm
un
ity t
ea
ms.
Re
cru
itm
en
t. S
take
ho
lde
r
un
de
rsta
nd
ing
.
250
250
AC
18
Imp
rove
an
d e
xp
an
d c
om
mu
nity b
ase
d
ca
re o
n I
sla
y t
hro
ug
h in
ve
stm
en
t in
pre
ve
nta
tive
me
asu
res t
o a
dd
ress
de
aly
ed
dis
ch
arg
e a
nd
re
du
ce
ad
mis
sio
ns.
Sh
iftin
g t
he
ba
lan
ce
will
inclu
de
ma
kin
g b
ett
er
use
of
Isla
y
Ho
sp
ita
l a
nd
Go
rta
nvo
gie
Ca
re h
om
e t
o
me
et
co
mm
un
ity c
are
de
ma
nd
s.
Re
vie
w u
se
an
d n
ee
d o
f co
mm
un
ity s
erv
ice
s o
n I
sla
y t
o
be
tte
r su
pp
ort
pe
op
le t
o liv
e a
t h
om
e w
ith
qu
alit
y s
erv
ice
s.
En
ha
ncin
g c
om
mu
nity b
ase
d c
are
in
clu
din
g u
sin
g
tech
no
log
y w
he
re a
pp
rop
ria
te,
an
d c
on
sid
er
use
of
alte
rna
tive
bo
okin
g s
yste
ms.
Su
pp
ort
fro
m a
nd
en
ga
gm
en
t
with
bo
th c
om
mu
nitie
s a
nd
sta
ff t
o h
elp
sh
ift
ba
lan
ce
.
Po
sitiv
e m
ea
su
res e
na
ble
pe
op
le t
o liv
e a
s in
de
pe
nd
en
tly
as p
ossib
le,
in t
he
ir o
wn
ho
me
s o
r a
ho
me
ly s
ett
ing
an
d t
o
pro
vid
e c
are
with
ou
t u
nn
ece
ssa
ry t
rave
l o
r h
osp
ita
lisa
tio
n.
Me
ets
Sco
tish
Go
ve
rnm
en
t p
erf
orm
an
ce
me
asu
res.
Re
qu
ire
s r
ecru
itm
en
t, e
ng
ag
me
nt
with
sta
ke
ho
lde
rs
inclu
din
g lo
ca
l co
mm
un
ity a
nd
im
pro
ve
d I
T f
or
sta
ff.
Su
cce
ss o
f co
mm
un
ity c
are
an
d s
up
po
rt m
ay in
fu
ture
req
uire c
ha
nge
of
reg
istr
atio
n s
tatu
s.
330
330
Qua
lity
and
Fina
nce
Plan
201
7-18
to 2
018-
19AN
NEX
A
Page 14
Re
fD
es
cri
pti
on
Pro
po
se
d A
cti
on
s R
eq
uir
ed
P
os
itiv
e I
mp
ac
t o
n Q
ua
lity
an
d O
utc
om
es
an
d F
it w
ith
Str
ate
gic
Pri
ori
tie
s
Ris
ks
an
d O
the
r Im
pa
ct
Imp
ac
t o
n S
tatu
tory
Se
rvic
es
2017-1
8
Bu
dg
et
Re
du
cti
on
£0
00
2018-1
9
Bu
dg
et
Re
du
cti
on
£000
AC
19
Re
vie
w o
f A
HP
Ou
t-p
atie
nt
se
rvic
e
de
live
ry
Co
nsid
er
incre
asin
g p
roto
co
l d
rive
n r
evie
w o
f fo
llow
-up
an
d
do
mic
ilarr
y v
isits.
Use
of
tech
no
log
y lik
e V
C a
nd
Flo
.
Re
vie
w w
he
the
r A
HP
s c
ou
ld o
ffe
r re
vie
w in
ste
ad
of
trip
s t
o
GG
&C
to
se
e c
on
su
lta
nts
. E
xte
nsio
n o
f ro
les lik
e
Ort
ho
pa
ed
ic t
ria
ge
an
d 'F
irst
Co
nta
ct' in
pu
t in
to G
Ps.
Su
pp
ort
re
pa
tria
tio
n a
ctivity a
nd
re
du
ce
tra
ve
l a
nd
inco
nve
nie
nce
fo
r p
atie
nts
. R
ed
uce
GP
/co
nsu
lta
nt
ap
po
intm
en
t 'rig
ht
clin
icia
n,
rig
ht
tim
e,
rig
ht
pla
ce
'.
Th
is
revie
w m
ay r
ele
ase
sa
vin
gs b
ut
ma
y b
e m
ore
ap
pro
pria
te
to u
se
re
lea
se
d r
eso
urc
es f
or
inve
stm
en
t in
ne
w in
itia
tive
s
de
taile
d e
g in
cre
ase
d s
up
po
rt t
o G
Ps.
En
su
rin
g t
he
rig
ht
clin
ica
l skill
s o
f clin
icia
ns t
o o
ffe
r
exte
nd
ed
ro
les a
nd
en
su
rin
g p
atie
nt
co
mp
lian
ce
or
ou
tco
me
s a
re n
ot
imp
acte
d.
AC
20
Se
ek t
o e
nsu
re c
are
at
ho
me
se
rvic
es
off
er
fle
xib
ility
an
d c
ho
ice
an
d a
re p
ers
on
ce
ntr
ed
an
d f
it f
or
pu
rpo
se
. C
urr
en
t in
-
ho
use
se
rvic
es a
re r
estr
icte
d a
nd
re
vie
w
wo
uld
en
ab
le o
ptio
ns t
o b
e e
xp
lore
d w
ith
exte
rna
l p
rovid
ers
to
im
pro
ve
We
st
Arg
yll
se
rvic
e.
Ne
igh
bo
urh
oo
d t
ea
ms w
ith
exte
rna
l p
rovid
ers
giv
e f
lexib
ility
an
d s
ho
uld
be
co
nsid
ere
d w
ith
in o
ptio
ns f
ollo
win
g p
erio
d o
f
ma
rke
t te
stin
g.
Wo
uld
re
qu
ire
in
pu
t fr
om
pro
cu
rem
en
t a
nd
co
mm
issio
nin
g s
taff
to
exp
an
d a
nd
im
pro
ve
th
e c
urr
en
t
ca
re a
t h
om
e s
erv
ice
.
Ca
re a
t H
om
e s
erv
ice
s a
re n
ot
fully
ab
le t
o m
ee
t d
em
an
d
pa
rtic
ula
rly in
ru
ral a
rea
s.
Be
tte
r o
ptio
ns r
eq
uire
to
be
ide
ntifie
d in
vo
lvin
g w
ho
le r
an
ge
of
pro
vid
ers
to
re
vie
w,
test
an
d im
ple
me
nt
ch
an
ge
. P
ositiv
e im
pa
ct
on
ou
tco
me
s
off
erin
g p
ers
on
fo
cu
sse
d s
erv
ice
acro
ss in
pa
rtic
ula
r
Kin
tyre
are
a,
with
a d
eve
lop
ing
an
d e
nh
an
ce
d lo
ca
l
se
rvic
e.
Clie
nts
to
be
en
ga
ge
d a
nd
co
nsu
lte
d a
nd
he
lpe
d t
o
un
de
rsta
nd
wh
ere
a c
ha
ng
e o
f p
rovid
er
ma
y o
ccu
r, w
hils
t
be
ne
fitt
ing
fro
m a
n im
pro
ve
d s
erv
ice
. S
om
e r
isk o
f sta
ff
lea
vin
g p
rio
r to
an
y t
ran
sfe
r a
nd
th
us s
taff
ne
ed
be
ke
pt
info
rme
d a
nd
co
nsu
lte
d.
Wh
ilst
so
me
sa
vin
gs c
an
be
ach
ieve
d,
the
cu
rre
nt
se
rvic
e is f
aili
ng
its
clie
nts
an
d n
ot
su
sta
ina
ble
.
Re
du
ce
d n
um
be
rs o
f in
ho
use
re
gis
tere
d s
erv
ice
s.
0160
AC
25
In o
lde
r p
eo
ple
da
y r
eso
urc
e c
en
tre
s
imp
rove
an
d a
dd
ress issu
es o
f h
igh
leve
ls o
f m
an
ag
em
en
t str
uctu
re t
o
inte
gra
te a
nd
co
nso
lida
te s
erv
ice
s w
ith
in
rea
listic o
pe
nin
g h
ou
rs b
ase
d o
n c
lien
t
de
ma
nd
.
Re
vie
w t
he
ma
na
ge
me
nt
at
HS
CP
op
era
ted
da
y s
erv
ice
s.
Co
nsid
er
a r
ed
uctio
n in
op
en
ing
ho
urs
of
ad
ult d
ay
se
rvic
es.
Evid
en
ce
in
dic
ate
s s
ho
rte
r o
pe
nin
g h
ou
rs w
ou
ld
be
ap
pro
pria
te a
nd
acce
pta
ble
in
da
y s
erv
ice
s.
Mo
reo
ve
r,
the
re is a
hig
h m
an
ag
em
en
t re
so
urc
e w
hic
h is c
ap
ab
le o
f
ratio
na
lisa
tio
n.
En
ga
ge
me
nt
an
d c
on
su
lta
tio
n w
ith
se
rvic
e
use
rs a
nd
with
sta
ff t
o a
lign
ne
ed
s a
nd
de
ma
nd
s.
Se
rvic
e b
eco
me
s m
ore
eff
icie
nt,
an
d is a
n e
ffe
ctive
use
of
reso
urc
e.
Se
rvic
e h
ou
rs w
ill r
efle
ct
the
ne
ed
s a
nd
de
sire
d
otu
co
me
s w
hils
t m
ee
tin
g d
em
an
d,
Evid
en
ce
su
pp
ort
s t
his
,
an
d w
ill b
e f
ully
exp
lore
d w
ith
se
rvic
e u
se
rs a
nd
sta
ff.
Org
an
isa
tio
na
l ch
an
ge
wh
ich
ma
y t
ake
tim
e t
o a
ch
ieve
an
d
ma
y n
ot
de
live
r sa
vin
gs in
giv
en
tim
esca
le.
Ca
refu
l
co
nsid
era
tio
n t
o b
ala
nce
ris
k o
f re
du
ce
d h
ou
rs w
ith
po
ten
tia
l h
om
e c
are
ne
ed
, re
vie
w s
ho
uld
hig
hlig
ht
this
.
Nil
50
208
AC
21
Imp
rove
co
mm
un
ity b
ase
d s
up
po
rt a
nd
se
rvic
es f
or
de
me
ntia
to
ach
ieve
sh
ift
in
ba
lan
ce
of
ca
re a
nd
re
sp
on
d t
o n
ee
d a
nd
de
ma
nd
in
pe
rso
n c
en
tre
d s
erv
ice
.
Imp
lem
en
t fu
ll re
vie
w a
nd
sco
pe
d o
ptio
ns f
or
co
mm
un
ity
mo
de
ls w
hic
h m
ee
t u
se
r d
em
an
d,
su
pp
ort
ca
rers
an
d
pe
rso
n c
en
tre
d o
tuco
me
s.
Ap
pra
ise
ne
igh
bo
urh
oo
d m
od
el
an
d s
co
pe
op
tio
ns w
hic
h s
hift
ba
lan
ce
of
ca
re.
De
me
ntia
Str
ate
gy is k
ey t
o a
ch
ievin
g a
ims w
hic
h s
up
po
rt
the
sh
ift
in b
ala
nce
of
ca
re,
an
d o
ffe
r p
ers
on
ce
ntr
ed
se
rvic
es a
s c
lose
to
ho
me
as p
ossib
le.
Mo
de
ls o
f ca
re,
on
ce
re
vie
we
d r
eq
uire
sta
ke
ho
lde
r
en
ga
gm
en
t a
nd
co
nsu
lta
tio
n,
an
d u
nd
ers
tan
din
g o
f
op
tio
n(s
).
Po
ten
tia
l va
ria
nce
in
fu
ture
le
ve
ls o
f sp
ecia
list
ca
re a
s y
et
un
rese
arc
he
d.
Po
ten
tia
l im
pa
cts
fo
r su
pp
ort
fro
m d
ete
ntio
n a
nd
me
nta
l
he
alth
off
ice
rs.
250
250
AC
22
De
live
r im
pro
ve
d m
en
tal h
ea
lth
co
nsu
lta
nt
su
pp
ort
an
d c
rea
te d
ed
ica
ted
co
nsu
lta
nts
to
ea
ch
lo
ca
lity C
om
mu
nity
Me
nta
l H
ea
lth
Te
am
, a
nd
a d
ed
ica
ted
co
nsu
lta
nt
for
inp
atie
nts
. B
ett
er
sh
arin
g
of
on
ca
ll se
rvic
es,
ad
ditio
na
l lo
ca
lity
clin
ics a
nd
su
pp
ort
fo
r crisis
re
sp
on
se
an
d p
lace
s o
f sa
fety
.
CM
HT
se
rvic
es a
nd
pa
tie
nts
wo
uld
be
ne
fit
fro
m t
he
red
esig
n t
o s
up
po
rt a
n im
pro
ve
d m
od
el. L
oca
lity
co
nsu
lta
tio
n a
nd
with
CM
HT
's t
o s
up
po
rt c
ha
ng
e,
an
d
ach
ieve
be
tte
r o
utc
om
es.
Th
is w
ill a
ch
ieve
co
nsis
ten
t ca
re m
an
ag
em
en
t w
hic
h in
tu
rn
ca
n r
ed
uce
ho
sp
ita
l sta
ys,
asse
ssm
en
t a
nd
re
vie
w w
ou
ld
be
im
pro
ve
d a
nd
lo
ca
lity s
erv
ice
s b
en
efit
fro
m d
ed
ica
ted
su
pp
ort
. J
oin
t a
nd
pa
rtn
ers
hip
wo
rkin
g is a
n in
teg
ral p
art
of
imp
rovin
g p
atie
nt
ou
tco
me
s a
nd
th
ese
ch
an
ge
s w
ou
ld
ach
ieve
th
is.
No
ma
jor
risks,
wo
rk t
o e
nsu
re r
eco
gn
ise
d c
are
pa
thw
ays
an
d e
ffe
ctive
co
mm
un
ica
tio
n is im
ple
me
nte
d a
nd
ma
inta
ine
d t
hro
ug
ho
ut.
Nil
an
ticip
ate
d
AC
23
Ste
ps t
o e
nsu
re a
nd
ma
inta
in p
atie
nt
an
d
co
mm
un
ity s
afe
ty w
ill b
e t
ake
n b
y
red
esig
na
tin
g a
nd
ma
inta
inin
g a
se
cu
re
locke
d e
nviro
nm
en
t fo
r th
ose
with
th
e
mo
st
fra
gile
me
nta
l h
ea
lth
re
qu
irin
g
extr
a c
are
. T
his
is b
ase
d o
n t
he
ne
ed
s o
f
se
rvic
e u
se
rs,
an
d e
xp
erie
nce
fro
m
cu
rre
nt
Inte
nsiv
e P
atie
nt
Ca
re U
nit.
Actio
ns r
eq
uire
d p
ert
ain
to
le
gis
latio
n r
ele
va
nt
to s
erv
ice
de
lvie
ry,
wh
ich
will
be
str
ictly f
ollo
we
d.
Wo
rk w
ith
sta
ff t
o
ma
ke
ch
an
ge
s t
o o
ve
rall
esta
blis
hm
en
t a
nd
wo
rkin
g
pra
ctice
s a
nd
to
ag
ree
e r
ob
ust
ad
mis
sio
n c
rite
ria
. S
om
e
wo
rk w
ith
GG
&C
sh
ou
ld n
ee
ds a
rise
fo
r a
dd
itio
na
l se
rvic
es.
No
ch
an
ge
to
se
cu
re a
nd
sa
fe lo
cke
d e
nviro
nm
en
t fo
r
tho
se
ne
ed
ing
th
is s
erv
ice
.
Dis
cu
ssio
ns w
ith
GG
&C
wh
ere
a r
are
ne
ed
arise
s w
hic
h is
ch
arg
ea
ble
, e
g w
ith
fo
ren
sic
ca
re.
Alig
ns w
ith
sp
ecia
list
se
rvic
es (
eg
acu
te s
urg
ica
l) p
rovid
ed
by c
en
tra
l sp
ecia
list
pro
vis
ion
.
100
200
AC
24
Fu
rth
er
en
ha
nce
me
nt
to c
om
mu
nity
ba
se
d c
are
to
en
su
re t
ho
se
with
me
nta
l
he
alth
issu
es h
ave
th
e s
am
e
op
po
rtu
nitie
s a
nd
ch
oic
es.
To
in
clu
de
co
nsid
era
tio
n o
f a
ste
p u
p /
ste
p d
ow
n
mo
de
l fo
r L
och
gilp
he
ad
an
d a
rea
se
rvic
e
use
rs.
Ad
op
t co
mm
un
ity f
ocu
sse
d a
pp
roa
ch
, a
nd
use
te
ch
no
log
y
wh
en
po
ssib
le,
to r
evie
w u
se
of
Ro
ss C
resce
nt
to m
ake
this
ap
pro
pria
te f
or
a m
od
ern
ise
d m
en
tal h
ea
lth
se
rvic
e.
En
su
rin
g p
atie
nt
ch
oic
e a
nd
vie
ws a
re a
t th
e c
en
tre
of
se
rvic
e p
rovis
ion
, w
ith
in
de
pe
nd
en
ce
en
co
ura
ge
d a
nd
su
pp
ort
ed
.
Fu
ture
ne
ed
s s
ho
uld
re
fle
ct
less d
ep
en
den
ce
on
hig
h c
are
pa
cka
ge
s,
an
d g
rea
ter
fou
s o
n c
om
mu
nity b
ase
d s
up
po
rt.
Acce
ss t
o 'ste
p u
p' w
he
n n
ee
de
d is m
ain
tain
ed
.
Pre
dic
tio
n o
f m
en
tal h
ea
lth
ne
ed
s c
an
be
difficu
lt,
bu
t u
se
of
rea
ble
me
nt
an
d c
om
mu
nity r
eso
urc
es e
ffe
ctive
ly s
ho
uld
ove
rco
me
an
y p
ea
ks w
ith
in d
em
an
d.
No
ne
an
ticip
ate
d.
45
45
ME
NT
AL
HE
AL
TH
SE
RV
ICE
S:
CO
RP
OR
AT
E S
ER
VIC
ES
:
Qua
lity
and
Fina
nce
Plan
201
7-18
to 2
018-
19AN
NEX
A
Page 15
Re
fD
es
cri
pti
on
Pro
po
se
d A
cti
on
s R
eq
uir
ed
P
os
itiv
e I
mp
ac
t o
n Q
ua
lity
an
d O
utc
om
es
an
d F
it w
ith
Str
ate
gic
Pri
ori
tie
s
Ris
ks
an
d O
the
r Im
pa
ct
Imp
ac
t o
n S
tatu
tory
Se
rvic
es
2017-1
8
Bu
dg
et
Re
du
cti
on
£0
00
2018-1
9
Bu
dg
et
Re
du
cti
on
£000
CO
RP
1F
ron
t lin
e h
ea
lth
an
d s
ocia
l ca
re s
taff
wo
rkin
g t
og
eth
er
in s
am
e lo
ca
tio
ns,
an
d
mo
ve
co
rpo
rate
an
d s
up
po
rt s
taff
.
Co
-lo
ca
te s
taff
in
to u
nu
se
d s
pa
ce
in
ou
r h
osp
ita
ls,
clo
se
the
co
rpo
rate
su
pp
ort
HQ
bu
ildin
g in
Lo
ch
gilp
he
ad
, m
ove
to o
the
r site
s in
Lo
ch
gilp
he
ad
in
clu
din
g c
ou
ncil
off
ice
s.
Sa
vin
gs e
xp
ecte
d t
o b
e a
ch
ieve
d f
rom
a r
an
ge
of
de
pa
rtm
en
tal b
ud
ge
ts in
clu
din
g;
fin
an
ce
, p
lan
nin
g,
IT,
HR
,
ph
arm
acy m
an
ag
em
en
t, m
ed
ica
l m
an
ag
em
en
t, le
ad
nu
rse
an
d e
sta
tes.
Fro
nt
line
se
rvic
es s
ho
uld
be
ne
fit
fro
m a
mo
re jo
ine
d u
p
ap
pro
ach
an
d a
sin
gle
po
int
of
co
nta
ct
fro
m s
up
po
rt
se
rvic
es.
Th
ere
wo
uld
ultim
ate
ly b
e r
ed
uce
d w
ork
forc
e b
ut
this
is o
ffse
t b
y m
ore
eff
icie
nt
pra
ctice
s (
se
e C
orp
2 &
5)
red
ucin
g d
up
lica
tio
n a
nd
im
pro
vin
g c
om
mu
nic
atio
n
No
t a
ll su
pp
ort
se
rvic
es a
re d
ire
ctly w
ith
in t
he
HS
CP
’s
co
ntr
ol. T
he
re is a
ris
k t
ha
t p
art
ne
rs (
Co
un
cil
an
d N
HS
Hig
hla
nd
) w
ill n
ot
su
pp
ort
an
y c
ha
ng
es t
o t
he
cu
rre
nt
arr
angem
ents
as t
hese a
re o
uts
ide t
he s
cope o
f th
e
inte
gra
tio
n s
ch
em
e.
Nil
an
ticip
ate
d335
335
CO
RP
2In
teg
rate
he
alth
an
d s
ocia
l w
ork
ad
min
istr
atio
n,
imp
lem
en
t d
igita
l
tech
no
log
y a
nd
ce
ntr
alis
e a
pp
oin
tme
nt
syste
ms.
Fo
llow
on
fro
m c
o-lo
ca
tio
n C
OR
P 1
, a
ta
rge
ted
pie
ce
of
wo
rk w
ou
ld c
om
me
nce
in
20
17
-18
to
exte
nd
th
e r
evie
w o
f
so
cia
l w
ork
ad
min
istr
atio
n a
nd
me
dic
al re
co
rd k
ee
pin
g.
Th
e im
ple
me
nta
tio
n o
f e
lectr
on
ic s
olu
tio
ns t
o im
pro
ve
eff
icie
ncy a
nd
a m
ove
to
ele
ctr
on
ic m
ed
ica
l re
co
rds w
ou
ld
be
re
qu
ire
d.
Mo
vin
g t
o c
en
tra
l b
oo
kin
g a
nd
ele
ctr
on
ic r
eco
rds w
ou
ld
red
uce
th
e n
ee
d f
or
as m
uch
lo
ca
l m
an
ag
em
en
t.
Re
du
ce
d
wo
rkfo
rce
fo
r a
dm
in s
up
po
rt,
bu
t sh
ou
ld b
e a
cco
mm
od
ate
d
fro
m w
ith
in a
mo
re e
ffic
ien
t p
roce
ss,
syste
ms a
nd
ne
w
str
uctu
re.
Th
ere
will
be
a r
eq
uire
me
nt
for
pro
fessio
na
l le
ad
ers
hip
an
d
pro
ject
ma
na
ge
me
nt
reso
urc
e f
or
fixe
d p
erio
d.
Th
is w
ill
incu
r a
co
st.
Nil
120
325
CO
RP
3M
an
ag
em
en
t /P
rofe
ssio
na
l L
ea
de
rsh
ip
Re
vie
w
Re
vie
w t
he
ove
rall
ma
na
ge
me
nt
str
uctu
re.
Cu
rre
nt
str
uctu
re h
as b
ee
n in
pla
ce
fo
r a
pe
rio
d o
f tim
e.
A
revie
w c
ou
ld r
esu
lt in
a r
ed
uctio
n in
ma
na
ge
me
nt
ca
pa
city
an
d c
ap
ab
ility
.
Ma
y n
ot
be
sig
nific
an
t sa
vin
gs,
red
uce
d m
an
ag
em
en
t
ca
pa
city c
ou
ld r
ed
uce
ab
ility
to
im
ple
me
nt
str
ate
gic
de
ve
lop
me
nt,
to
ma
na
ge
ch
an
ge
in
th
e c
ultu
re,
op
era
tio
na
l
inte
gra
tio
n,
wo
rkfo
rce
pla
nn
ing
an
d d
eliv
ery
, sta
ff
pa
rtn
ers
hip
an
d p
ub
lic a
nd
po
litic
al e
ng
ag
em
en
t a
nd
co
mm
un
ica
tio
n a
nd
re
alis
e f
ina
ncia
l a
nd
pe
rfo
rma
nce
targ
ets
.
An
y r
ed
uctio
n t
o t
he
ma
na
ge
me
nt
str
uctu
re c
ou
ld le
ad
to
red
uce
d c
ap
acity a
nd
ca
pa
bili
ty t
o f
ulfil
sta
tuto
ry d
utie
s.
tbc
tbc
CO
RP
4R
atio
na
lisa
tio
n o
f E
sta
tes/P
rop
ert
y-
linke
d t
o C
OR
P’s
1 a
nd
2.
Re
vie
w o
f cu
rre
nt
pro
pe
rty p
ort
folio
an
d o
pp
ort
un
itie
s t
o
ratio
na
lise
th
is.
Re
vie
w t
he
cu
rre
nt
lea
se
s in
pla
ce
an
d f
ind
alte
rna
tive
acco
mm
od
atio
n t
o r
ed
uce
co
sts
.
Cu
ltu
ral ch
an
ge
im
pa
ct
on
sta
ff a
nd
se
rvic
e u
se
rs.
M
ay
be
a p
erio
d o
f d
isru
ptio
n if
sta
ff a
re d
isp
lace
d.
An
y p
rop
ose
d c
ha
ng
es t
o a
cco
mm
od
atio
n w
ou
ld r
eq
uire
to
follo
w a
bu
sin
ess c
ase
ap
pro
ach
to
en
su
re t
he
be
ne
fits
of
an
y c
ha
ng
es a
re t
ran
sp
are
nt.
R
eq
uire
s d
iscre
te e
xp
ert
ise
an
d p
roje
ct
ma
na
ge
me
nt
reso
urc
e.
Th
at
ma
y b
e a
co
st.
Nil
75
75
CO
RP
5Im
ple
me
nt
Lyn
c/S
kyp
e f
or
Bu
sin
ess
Imp
lem
en
t S
kyp
e f
or
Bu
sin
ess (
Mic
roso
ft L
yn
c)
co
mm
un
ica
tio
ns p
latf
orm
, th
is w
ill r
ed
uce
te
lep
ho
ne
an
d
tra
ve
l co
sts
an
d im
pro
ve
co
mm
un
ica
tio
n a
nd
co
llab
ora
tio
n.
Bu
sin
ess c
ase
is d
ue
to
be
fin
alis
ed
It is r
eq
uire
d t
o m
axim
ise
be
ne
fits
in
Co
rp 1
an
d C
orp
2.
Will
ma
ke
op
era
tio
ns m
ore
eff
icie
nt
with
le
ss t
ime
sp
en
t
tra
ve
llin
g,
an
d w
ith
IT
co
mm
un
ica
tio
n s
erv
ice
s b
ein
g m
ore
eff
icie
nt
acro
ss b
oth
he
alth
an
d s
ocia
l ca
re.
Sa
vin
gs b
oth
in c
ost
an
d in
pro
du
ctivity c
lea
rly e
vid
en
ce
d in
oth
er
org
an
isa
tio
ns.
Th
is w
ill b
en
efit
se
rvic
es a
cro
ss t
he
pa
rtn
ers
hip
Th
e in
fra
str
uctu
re is n
ot
in p
lace
, a
nd
bu
sin
ess c
ase
be
ne
fits
ma
y b
e d
ifficu
lt t
o q
ua
ntify
as e
ffic
ien
cie
s w
ill b
e
acro
ss t
he
wh
ole
of
the
HS
CP
.
Ris
k t
ha
t fin
an
cia
l b
en
efits
ma
y n
ot
be
ach
ieve
d in
th
e s
ho
rt t
erm
, w
ith
in
itia
l
inve
stm
en
t a
nd
a c
ultu
ral sh
ift
req
uire
d t
o f
ully
re
alis
e
po
ten
tia
l.
Nil
00
CO
RP
6C
ate
rin
g a
nd
Cle
an
ing
an
d o
the
r
An
cill
ary
Se
rvic
es
Re
du
ctio
n in
bu
ildin
gs o
ccu
pie
d a
nd
op
po
rtu
nitie
s t
o w
ork
with
ou
r p
art
ne
r o
rga
nis
atio
ns,
take
op
po
rtu
nitie
s t
o r
ed
uce
co
sts
fo
r ca
terin
g a
nd
do
me
stic s
erv
ice
s.
S
ign
ific
an
t
op
po
rtu
nitie
s t
o s
ha
re s
erv
ice
s a
nd
re
du
ce
co
sts
.
Th
is c
ou
ld r
esu
lt in
sig
nific
an
t ch
an
ge
s t
o w
ork
forc
e
roste
rin
g,
op
era
tio
na
l d
eliv
ery
an
d q
ua
lity o
f se
rvic
e a
nd
str
ate
gic
pa
rtn
ers
hip
acro
ss p
ub
lic s
ecto
r su
pp
lyin
g a
nu
mb
er
of
org
an
isa
tio
ns c
ate
rin
g r
eq
uire
me
nts
at
loca
lity
leve
l.
Th
is w
ill r
eq
uire
a f
orm
al p
roje
ct
pro
ce
ss,
ce
ntr
alis
ing
resp
on
sib
ility
, w
ith
pro
fessio
na
l le
ad
ers
hip
ove
r a
fix
ed
period.
Nil
505
505
CO
RP
7V
eh
icle
Fle
et
Se
rvic
es
Exp
lore
op
po
rtu
nitie
s f
or
the
ce
ntr
alis
atio
n o
f sh
are
d f
lee
t
se
rvic
e (
as in
pa
rt o
f N
HS
Gra
mp
ian
), lo
ok t
o s
ha
re
ve
hic
les w
ith
pa
rtn
ers
, a
nd
a r
evie
w o
f th
e p
rovis
ion
of
se
rvic
es.
Mo
re e
ffic
ien
t fle
et
se
rvic
e,
be
tte
r a
lign
ed
to
se
rvic
e
req
uirem
en
ts.
Diffe
ren
t g
ove
rna
nce
arr
an
ge
me
nts
with
pa
rtn
ers
an
d lo
ss
of
loca
lity d
ire
ct
resp
on
sib
ility
.
Ma
y n
ot
be
an
y s
ign
ific
an
t
sa
vin
gs.
Nil
CO
RP
8T
he
ag
ree
me
nt
with
NH
S G
rea
ter
Gla
sg
ow
& C
lyd
e (
NH
SG
G&
C)
pro
vid
es
ho
sp
ita
l se
rvic
es o
uts
ide
Arg
yll
an
d B
ute
.
Inve
st
in c
om
mu
nity s
erv
ice
s a
nd
IT
to
re
du
ce
de
laye
d
dis
ch
arg
es a
nd
pa
tie
nts
le
ng
th o
f sta
y in
NH
S G
G&
C
ho
sp
ita
ls,
an
d c
om
mis
sio
n N
HS
GG
&C
to
re
du
ce
re
turn
ap
po
intm
en
ts a
nd
fo
llow
up
ra
tes.
Activity t
arg
ets
to
be
ag
ree
d b
ase
d o
n n
atio
na
l ta
rge
t fo
r S
co
tla
nd
to
fre
e u
p
40
0,0
00
occu
pie
d b
ed
da
ys.
Fro
nt
line
se
rvic
es w
ill b
en
efit
by o
nly
pro
vid
ing
acu
te
se
rvic
es in
ho
sp
ita
l a
nd
en
ha
ncin
g s
erv
ice
s in
co
mm
un
itie
s
by f
acili
tatin
g r
ap
id a
sse
ssm
en
t a
nd
su
pp
ort
an
d d
isch
arg
e
to c
om
mu
nity/h
om
e w
ith
su
pp
ort
. A
ny r
ed
uctio
n in
th
e
ag
ree
me
nt
with
GG
& C
wo
uld
bu
ild c
ap
acity f
or
co
mm
un
ity
an
d c
are
se
cto
r to
exp
an
d t
o m
ee
t w
ork
loa
d,
an
d r
ed
uce
be
ds in
lo
ca
l h
osp
ita
ls.
Tim
esca
le f
or
de
live
rab
ility
sta
rts 1
Ap
ril 2
01
7 w
he
n G
G&
C
will
re
ch
arg
e u
s f
or
extr
a a
ctivity.
Th
ere
ma
y b
e o
the
r
de
ma
nd
an
d c
ost
pre
ssu
res f
rom
acu
te s
erv
ice
s.
We
reco
gn
ise
a p
ote
ntia
l d
ifficu
lty b
y N
HS
GG
&C
to
ch
an
ge
to
me
et
ou
r co
mm
issio
nin
g in
ten
tio
ns.
Nil
TB
CT
BC
CO
RP
9C
ap
ita
l p
roje
cts
- D
un
oo
n G
P p
ractice
s
ne
w b
uild
, B
ute
He
alth
an
d c
are
ca
mp
us,
Ca
re H
om
e r
ed
esig
n,
an
d n
ew
mo
de
l o
f
ca
re r
elo
ca
tio
n o
f S
ale
n S
urg
ery
to
Cra
ign
ure
& e
lem
en
ts o
f C
OR
P 4
Fo
rma
l ca
pita
l d
esig
n p
roje
cts
at
larg
e a
nd
sm
all
sca
le,
latt
er
to b
e c
oste
d b
y M
arc
h 2
01
7 f
or
inclu
sio
n in
ca
pita
l
pro
gra
mm
es f
or
ne
xt
2 y
ea
rs.
La
rge
sca
le p
roje
cts
re
qu
ire
form
al p
roce
sse
s a
nd
re
so
urc
e.
Fro
nt
line
se
rvic
es w
ill b
en
efit
bo
th a
s o
pe
ratio
na
l sin
gle
po
int
of
co
nta
ct
an
d c
o-lo
ca
tio
n a
dva
nta
ge
s.
Ne
w
de
ve
lop
me
nts
with
su
ita
ble
acco
mm
od
atio
n w
ith
gre
ate
r
en
erg
y,
utilis
atio
n e
ffic
ien
cy r
atin
g e
tc a
nd
oth
er
co
st
red
uctio
ns.
We
re
qu
ire
to
ce
ntr
alis
e t
he
ca
pita
l p
lan
nin
g f
un
ctio
n w
ith
fin
an
cia
l su
pp
ort
an
d c
lea
r p
roje
ct
ma
na
ge
me
nt
pro
ce
sse
s.
Tim
esca
le f
or
de
live
rab
ility
de
pe
nd
s o
n t
he
ava
ilab
ility
an
d
acce
ssib
ility
of
ca
pita
l
fro
m t
he
Co
un
cil,
NH
S a
nd
Ho
usin
g a
sso
cia
tio
ns.
No
ne
at
pre
se
nt
as lo
ng
er
term
pro
jects
00
Qua
lity
and
Fina
nce
Plan
201
7-18
to 2
018-
19AN
NEX
A
Page 16
Re
fD
es
cri
pti
on
Pro
po
se
d A
cti
on
s R
eq
uir
ed
P
os
itiv
e I
mp
ac
t o
n Q
ua
lity
an
d O
utc
om
es
an
d F
it w
ith
Str
ate
gic
Pri
ori
tie
s
Ris
ks
an
d O
the
r Im
pa
ct
Imp
ac
t o
n S
tatu
tory
Se
rvic
es
2017-1
8
Bu
dg
et
Re
du
cti
on
£0
00
2018-1
9
Bu
dg
et
Re
du
cti
on
£000
CO
RP
10
Alc
oh
ol a
nd
Dru
gs P
art
ne
rsh
ipT
he
AD
P w
ill lo
ok t
o r
evie
w a
nd
re
du
ce
co
sts
be
ing
incu
rre
d in
de
live
rin
g a
lco
ho
l b
rie
f in
terv
en
tio
ns,
su
pp
ort
ing
the
vo
lun
tary
se
cto
r a
nd
th
e A
BA
T s
tatu
tory
se
rvic
e s
ecto
r.
Th
e r
ed
uctio
n in
17
-18
eq
ua
tes t
o 8
% o
f th
e t
ota
l b
ud
ge
t
for
AD
P.
Mo
re e
ffic
ien
t u
se
of
reso
urc
es.
Ris
k t
ha
t A
DP
ca
nn
ot
red
uce
co
sts
in
lin
e w
ith
re
du
ce
d
su
bsid
y.
100
150
4,4
94
6,5
07
TO
TA
L
Qua
lity
and
Fina
nce
Plan
201
7-18
to 2
018-
19AN
NEX
A
Page 17
Quality and Finance Plan 2017-18 to 2018-19 ANNEX A
PREVIOUSLY APPROVED 2016-17 Q&F PLAN: Previous
Ref Description 2017-18
£000 2018-19
£000
STILL TO BE DELIVERED:
1 Prescribing 100 100
5 Redesign of the Out of Hours Service for Cowal 300 300
13 Closure West House 100 100
14 Closure AROS 150 150
15 Kintyre Medical Group 25 25
27 Kintyre Patient Transport 25 25
45 Ardlui 10 10
51 Supporting Young People Leaving Care 17 17
52 Consultation Support Forum 5 5
59 Bowman Court Progressive Care Centre 80 80
61 Internal Mental Health Support Team 60 60
62 Assessment and Care Management 12 12
63 Assessment and Care Management 30 30
914 914
FULL YEAR IMPACT:
55 Struan Lodge (paused)* 0 175
56 Thomson Court (paused)* 0 10
58 Tigh a Rhuda 22 22
22 207
ADDITIONAL DELIVERABLE SAVINGS:
1 Prescribing 700 1,400
3 Further Savings from closure of Argyll and Bute Hospital 282 282
4 Kintyre Patient Transport 25 75
5 Redesign of the Out of Hours Service for Cowal 29 29
10 NHS GG&C contract / services 100 100
1,136 1,886
* Decision taken at the IJB meeting on 2 November 2016 to pause implementation of these service redesigns to
allow for additional period for consultation and engagement. No formal decision taken to reverse decision,
therefore for financial planning purposes assume that full year saving will be realised in 2018-19. This position
will be updated following outcome of communications and engagement process.
Page 18
Quality and Finance Plan 2017-18 to 2018-19 ANNEX A
NEW EFFICIENCY SAVINGS:
Ref Description 2017-18
£000 2018-19
£000
1 Commissioned Services 500 500
2 General Medical Services - Enhanced Services 64 64
3 Budget Reserves 350 200
4 Equipment Depreciation 30 30
5 Increased Patient Services Income 50 50
6 Community Dental Services 20 20
7 Review of Podiatry Services Budgets 20 20
8 Helensburgh & Lomond Locality - recurring underspends 20 20
9 Medical Physics Department - supplies budget underspends 45 45
10 Energy Costs for Health Buildings (excluding A&B Hospital & AROS) 50 50
11 Oban, Lorn & Isles Locality - patients' travel 40 40
12 Review of Radiography Services Budgets 50 50
13 Mental Health Bridging Funding 0 400
14 HEI Budget - requirement will reduce in line with beds 0 50
15 Mid Argyll Social Work Office 10 10
16 Admin - Travel Reduction 3 3
17 Planning 51 51
18 Review MAKI Management Structure 130 250
19 Children and Families Service Efficiencies 40 40
22 Adult Services Fees and Charges 50 50
24 Adult Services Charging Order - Long Term Debt Adjustment 25 25
25 Social Work Utility Costs 33 33
26 Mull Medical Group - reduction in use of GP locums 50 50
1,631 2,051
Page 19
Investment Plan – Quality and Finance Plan ANNEX B
Theme Investment Details 2017-18
£000 2018-19
£000
Implement New Community
Based Models
Argyll and Bute Area Teams - Mobile devices
471 632
Argyll and Bute West Sector - Develop capacity Neighbourhood/Community Team models
Helensburgh and Lomond Anticipatory/Emergency Nurses
Reablement update for providers
Cowal and Bute - Nurse Practitioner, admission prevention
Investment in Early Intervention
Co-location of Teams
Co-location of staff in Cowal and Bute
260 - Co-location of staff in Kintyre
Co-location of staff in Islay
Communications and Engagement
Communications
106 45 Public Involvement Manager
Planning Support
Project Management
Adult Service Redesigns
300 322
Catering and Cleaning Services
Medical Records and centralised booking
Administration Services
Children's Services Redesigns
HR Support - organisational change
1,137 999
Page 20
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