integration a model for success garry coutts chair, nhs highland convener, scottish social services...
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IntegrationA model for success
Garry Coutts Chair, NHS Highland Convener, Scottish Social Services Council
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Recessions I have known
• Early 1980s – Thatcher’s recession 5.8% drop in GDP
• Early 1990s – Major’s recession 2.5% drop in GDP
• Late 2000s – Brown’s recession 7.1% drop in GDP
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How do we deal with recessions?Make cuts
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Raise the bar
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Increase charges
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It’s pants!
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This is different
• Length of time • Banks not lending• Size of deficit• Few political alternatives being offered
But.......• Record levels of investment in the public
sector over the last 20 years
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– The majority of over-65s have 2 or more conditions– The majority of over-75s have 3 or more conditions
Multimorbidity is common in Scotland
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If we always do what we have always done we will get what we
always got
And it is not good enough
So we need a different approach
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Fatuous saying of the moment
“We don’t need to work harder, we need to work smarter”
Aye, right!
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“Every system is perfectly designed to achieve exactly the results it gets”
Don Berwick
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So we need to change the system
And support staff, providers, service users, carers and governors to become effective change agents
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Changes in Highland
• Social Care staff to NHS Highland = 1,500• Health staff to The Highland Council = 250• Budget to NHS Highland = £90m• Budget to The Highland Council = £8m• Partnership agreement = 400 pages!• Legislative and regulatory changes• New management and governance structures
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Family &Friends
OT
Care Home
Day Services
Acute Hospital
NeighboursHome Carers
Respite Care
Physio
GP
Day Services
Consultants
Residential care
Social Workers
PharmacyDistrict Nurse
Voluntary
Community Hospital
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Family &Friends
Care Home
Day Services
Acute Hospital
Neighbours
Home Carers
Respite Care
PhysioGP
Day Services
Consultants
Residential care
Social Workers
Pharmacy District Nurse
OT
Voluntary
Community Hospital
Care Co-ordinator
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Key questions to check if you have an effective system
• Does your system have single budgets?• Does your system have single management?• Does your system have single governance?• Is there a process for service improvement
and redesign?• Do you have measures in place to monitor
improvement?• Are you involved in improvement?