Evaluation of Integrated Resource Framework Test Sites

APPENDIX 1. LIST OF PILOT PROJECTS IN THE TEST SITES

Ayrshire and Arran

East Ayrshire: adults with complex needs

The East Ayrshire IRF pilot focused on researching the individual elements of care provided to adults with complex needs. The pilot looked to better understand and describe: the profile of clients within the target group; the range and cost of services provided for the target group; and the provision of joint commissioning of services for the target group. The research produced twenty one high impact recommendations which were developed into a joint action plan for implementation.

North Ayrshire: children with complex needs

The North Ayrshire pilot looked at services delivered to young people with complex needs. The pilot used half day stakeholder events to examine three options: Locality Planning; Integration of Psychology Services; and Integrated Care Pathways for Children with Complex Needs. It analysed resources used by 60 children with complex needs across the three CHP areas. However, the short timescale of the pilot made it difficult to recruit a project manager for this work and progress was slow. Once a member of staff was identified, an action plan was created and this is now being implemented.

South Ayrshire: older people's services

The aim of the South Ayrshire IRF pilot was to use the IRF to facilitate the shifting of the balance of care (SBC) for older people in South Ayrshire and to support the associated shifting of resources. The original approach of the IRF pilot was to consider a system-wide piece of work looking at resources and activity. However, due to the limited timescales for delivering the IRF pilots, the system-wide approach was refocused on four key strands which were more bounded and more easily measured: re-ablement; day services; falls prevention; and hospital discharge.

Pan-Ayrshire: Chronic Obstructive Pulmonary Disease services

The COPD pilot involved work across all three CHPs to improve the COPD service by exploring more integrated pathways which incorporate the principles of self-management - currently being developed within the Co-Creating Health programme. Across all three areas the pilot looked at the use of single shared assessments, care coordinators, Anticipatory Care Planning (ACP), multi-disciplinary working and self-management training.

Highland

Lead agency model

NHS Highland, Highland Council and Argyll and Bute Council initially considered developing local pilots to examine four different financial mechanisms: (i) NHS Board area strategic pilot looking at the total resource applying to the over 75 year old population; (ii) District pilots examining more flexible use of a joint financial envelope for a more local population; (iii) small local examples of change with a focus on innovation (e.g. virtual wards); and (iv) lead commissioning on a pan Highland basis for a single service (e.g. Occupational Therapy). In December 2010 NHS Highland and Highland Council took a decision to commit towards large scale integration using a lead agency model (see Chapter 6). In light of this the pilots were discontinued or subsumed within implementation of lead agency arrangements.

Lothian

City of Edinburgh: Phased implementation of orthopaedic and stroke rehabilitation pathways

The project aimed to shift the balance of care within stroke and orthopaedic rehabilitation pathways, and to achieve a greater proportion of active rehabilitation of patients outwith hospital settings. It focussed on older people, although not exclusively 65+, living in the City of Edinburgh.

East Lothian: Community Based Services for Older People

The pilot covered the East Lothian Council and CHP area. The target population was older people, including adults over 65 years with long term conditions, people with dementia, and adults across all care groups who require support in caring for themselves. The project aimed to develop community services in order to reduce hospital admissions for older people, thereby shifting the balance of care from hospital and residential settings to the community. Hence individuals with increased needs will be able to remain safely at home for longer.

Mid Lothian: Community Based Care and Treatment for Older People

This pilot covered the Midlothian CHP area. There were two target populations: the 500 people with dementia known to, and diagnosed by GPs; and those members of the frail, elderly population at significant risk of requiring hospital admission due to long term conditions. The project aimed to develop community-based services and improve joint working in order to reduce reliance on long-stay care homes and continuing care beds, and minimise admissions to, and length of stay in, acute hospitals.

West Lothian: Early intervention and follow-up of substance misusing parents and their children

The target population was children under 5 living in households where parents are misusing substances, particularly at the pre-birth stage. In 2009, 19 new clients, involving 30 children, reported to the Scottish Drugs Misuse Database in Armadale and Blackridge (areas with high levels of socio-economic deprivation measured by data zones ranked by deprivation).³¹

Note: During 2011, in light of the Change Fund focus on older people, the decision was taken by West Lothian IRF project team members to change the focus of their IRF work to older people.

Tayside

Perth and Kinross: Development of a locality model and consumption fund for Highland Perthshire

Work being pursued by Perth and Kinross Council and Perth and Kinross CHP under IRF aimed to reshape older people's services in line with: the roll out of the re-ablement model; personalisation; housing with care; early intervention and prevention; care at home; and implementation of the Virtual Ward project. The geographic area covered by the proposal was Highland Perthshire, with a focus on the over 65 population, but with benefits also being realised for the under 65 adult population, for example in the area of learning disabilities. The proposal was not restricted to one service, but rather aimed to work towards a transformational health and social care service within this area.

Dundee: Working with frail older people and those with complex needs in Dundee East

Work pursued under IRF by Dundee City Council and Dundee CHP in Dundee East locality focused on older people who were frail or had complex needs and aimed to: provide scaled up and integrated enablement and virtual ward services in the context of the integrated service framework for older people; and to provide quality/sustainable services that enable people to maintain an independent lifestyle. It did this by: increasing the proportion of AHP staff, currently working in inpatient settings, to more community-based work; increasing the proportion of the AHP role devoted to education and prevention; increasing the number of staff working in enablement in order to spend less on care homes, spend less overall and spend less per person; increasing the number of anticipatory hybrid staff; and increasing carer engagement, volunteer resilience and use of the voluntary sector.

Angus: Development of a fully integrated locality model for adult care

The Angus Partnership proposed to develop a fully integrated locality model for the delivery of adult care. Work proceeded in the following areas: care and case management; enablement and rehabilitation; workforce development (new roles and training); shared accommodation/co-location; and the development of Telecare and Telehealth.