Health and care experience survey 2017 to 2018: national results

4. Context

There have been wide reaching programmes of reform to health and social support services in recent years, which are consistent with the wider principles of Public Service Reform ^[8] . This chapter provides an overview of the key developments.

This survey supports and informs all of these developments, by describing their impact from a user perspective. It is worth noting, however, that this survey relates to care experiences in 2017, which is while some of these programmes were at the early stages of implementation.

The 2020 Vision

In 2011, the Scottish Government set out a 2020 Vision ^[9] for achieving sustainable quality in the delivery of healthcare services across Scotland, in the face of the significant challenges of Scotland's public health record, our changing population and the economic environment. All healthcare policy in Scotland drives the delivery of this Vision, which states:

By 2020 everyone is able to live longer, healthier lives at home or in a homely setting, and that we will have a healthcare system where:

• We have integrated health and social care;
• There is a focus on prevention, forward planning and supported self-management;
• Where hospital treatment is required, and cannot be provided in a community setting, day case treatment will be the norm;
• Whatever the setting, care will be provided to the highest standards of quality and safety, with the person at the centre of all decisions;
• There will be a focus on ensuring that people get back into their home or community environment as soon as appropriate, with minimal risk of re-admission.

The Vision will be delivered according to three Quality Ambitions ^[10] :

• Safe: There will be no avoidable injury or harm to people from healthcare, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all time.
• Person-centred: Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrates compassion, continuity, clear communication and shared decision-making.
• Effective: The most appropriate treatments, interventions, support and services will be provided at the right time to everyone who will benefit, and wasteful or harmful variation will be eradicated.

Scotland's Chief Medical Officer articulated her vision for delivering care in this context through her Annual Reports ' Realistic Medicine' ^[11] and ' Realising Realistic Medicine' ^[12] . She said:

You should expect the doctor (or other health professional) to explore and understand what matters to you personally and what your goals are, to explain to you the possible treatments or interventions available with a realistic explanation of their potential benefits and risks for you as an individual, and to discuss the option and implications of doing nothing. You should expect to be given enough information and time to make up your mind. You should consider carefully the value to you of anything that is being proposed whether it be a treatment, consultation or diagnostic investigation and be prepared to offer challenge if you feel it appropriate.

Recent Changes to Health and Social Care Policy

The Integration of Health and Social Care is one of Scotland's major programmes of reform and is central to the achievement of the 2020 vision and Public Sector Reform priorities described above. At its heart, health and social care integration is about ensuring that those who use services get the right care and support whatever their needs, at any point in their care journey. It places a greater emphasis on community-based, more joined-up, anticipatory and preventative care which aims to improve care and support for those who use health and social care services.

All Health and Social Care Partnerships became fully operational on 1 April 2016, bringing together NHS and local council care services under one partnership arrangement for each area.

The National Health and Wellbeing Outcomes ^[13] provide the strategic framework for the planning and delivery of health and social care services. They focus on the experiences and quality of services for people using those services, carers and their families.

They are supported by a Core Suite of Integration Indicators which provide an indication of progress towards the outcomes that can described at Partnership and Scotland level. Nine of this suite of indicators draw on questions from the Health and Care Experience Survey.

Self-directed Support ^[14] embeds a new approach to social care which gives adults, children and carers more choice, control and flexibility over how their care and support is delivered. The primary contribution Self-directed Support makes to delivering the Health and Wellbeing Outcomes is empowering people to have greater choice and control of their lives.

The Health and Wellbeing Outcomes also includes a specific outcome (Outcome 6) relating to carers, although some of the other outcomes will also be relevant to those with caring responsibilities. The Carers (Scotland) Act 2016 ^[15] took effect on 1 April 2018. The Act extends and enhances the rights of carers. The new legislation will help ensure better and more consistent support for both adult carers and young carers so that they can continue to care, if they so wish, in better health and to have a life alongside caring.

As set out in the Health and Social Care Delivery Plan ^[16] , the Scottish Government's vision for the future of primary care services is for multi-disciplinary teams, made up of a variety of health professionals, to work together to support people in the community and free up GPs to spend more time with people in specific need of their expertise. It aims to ensure that people who need care are more informed and empowered, with access to the right person at the right time, and remaining at or near home wherever possible. Six primary care outcomes ^[17] have been developed to support this vision.