My Health, My Care, My Home - healthcare framework for adults living in care homes: annual progress report September 2023

Introduction

In 2021-22, My Health, My Care, My Home (the framework) was co-produced by Scottish Government and stakeholders from across health and social care with the aim of improving outcomes for adults living in care homes across Scotland.

The document was centred around six core elements, and underpinned by two key enablers, which were felt to be crucial in helping the sector to implement its vision. It also makes several recommendations to reduce the inequalities facing people living in care homes.

A care home is where a person lives, and calls home, and so they should expect the same level of involvement, choice and support for their health and wellbeing as they would if they were living elsewhere in the community. Their requirements go beyond physical health, and include social, psychological, and spiritual care. Unfortunately, healthcare is often fragmented and access to wraparound support is often disjointed. This is evidenced by poorer outcomes across the system that negatively impact people living in care homes and undermine an integrated, rights-based, person-centred approach.

“The Healthcare Framework is really clear. All the answers are in the framework, people just need to take the time to read and understand it.”

Sanctuary, Regional Manager

Although focused on care homes, the “reach” of the framework extends far beyond this setting. It can have a transformational influence on several areas across Scottish Government’s Health and Social Care Directorate and, by consequence, the First Minister's policy prospective with the recovery and reform of our NHS and other vital public services, and help us to achieve the priorities it sets out to drive our decision-making.

NHS recovery/reform and delivering sustainable, person-centred public services that tackles inequalities and ensures people get the right care, at the right time, and in the right place.

The framework is also central to transformational change and social care improvement across the sector. Funding has been provided to Collaborative Care Home Support Teams (CCHST) to maintain, and build on, the whole system multi-disciplinary approach, and to drive improvement by supporting the implementation and embedding of the recommendations made in the framework and the Health and Social Care Standards.

It is encouraging to see, and hear, evidence that a move to a care home is seen as no more than a change of address. This enables the individual to live as active a life as they wish, while still being able to contribute to their community, and retain access to the same services they did when living in their own home.

While we are striving for national improvement, and early indications show improvements are, and can be made, we understand it will take a while to implement them nationally. We also acknowledge that variation in some places will still exist, but the framework has provided a shared vision for everyone in the sector to work towards a common goal.

We have been really heartened by the early adoption and the proactive use of the framework to deliver local change and improvement. As a team we have enjoyed, and continued, positive engagement with professionals, organisations and leaders from across the sector to shape and aid the delivery of the recommendations. By doing so we have seen how positively stakeholders have responded.

Many Health and Social Care Partnerships (HSCP) and Health Boards are undertaking self-assessments to identify priority areas, and introduce a number of improvement initiatives, to deliver better outcomes for people living in care homes. We will highlight a number of these initiatives throughout the document, as well as referencing others that started prior to June 2022 that have since progressed.

NHS Tayside have developed a Supporting Tayside Excellence Programme (STEP) in response to both their experiences of the pandemic and the framework to promote a whole system approach to improving outcomes for care homes. A key component of the programme is the STEP self-assessment tool, which is based on the core elements of the framework and uses the concentric wheels documented in the main document.

By completing the self-assessment every care home has the chance to reflect on their provision of care from a wide range of perspectives and consider the support it provides to its residents. The self-assessment is to be completed prior to an annual STEP visit, during which the team will work with the care home management to develop a plan for improvement and report emerging themes and trends to the various oversight groups that support the sector across Tayside. An initial trial took place across 6 care homes at the end of last year before a more expansive roll out earlier this year. It is expected that the programme, and self-assessment tool will be rolled out across NHS Tayside in 2024.