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

Implementation

As mentioned in the previous chapter, the framework can have a transformational influence on several areas of Government, including Primary Care, Population Health, Social Work, and Health and Social Care Workforce.

This is why we have been building strong, positive networks with policy teams across Government, to integrate the framework as a policy making tool, which delivers common policies and programmes, and ensures that the vision of the framework is threaded through a number of different strategies and action plans. To date this has included:

• Dementia Strategy
• Palliative and End of Life Care Strategy, and
• Value Based Healthcare Action Plan

We have also made connections with cross-portfolio programmes of work such as Getting It Right For Everyone (GIRFE), Anticipatory and Future Care Planning, Dementia and Primary Care Access. This will help ensure that care homes are not considered in isolation and are part of the overall policy making discussions.

We have also immersed ourselves across the breadth of the sector to develop a clear and robust understanding of the existing challenges across the social care landscape. This has helped us to gain an awareness of the work being done across localities to implement our vision.

Our increased engagement with those living and working in care homes has also enabled us to hear about what matters to them and gain a better understanding of the local challenges they are facing. We have always encouraged an open approach to enable families and those working in, and with, care homes to contact us, at formal arranged meetings, events or via email and social media.

We have been reflecting on our processes of engagement throughout the development of the framework, reviewing where engagement has gone well and identifying areas for improvement to ensure that we continue to engage with the right people in the most effective and inclusive ways. As part of this process, we worked with an independent academic who carried out a research study to explore people’s experiences of being involved in the framework development process.

The findings of this research are summarised in the box below and a full research report will be published later in the year. We are actively using these research findings to inform how we continue to engage effectively across the sector as we implement and evaluate the framework.

Dr Jenna Breckenridge, ESRC Policy Fellow from the University of Dundee carried out a qualitative research study to explore how different types of evidence contributed to the design of the framework.

She interviewed 20 stakeholders involved in its development, including: social care representatives (n=5), care home owners/managers (n=4), health representatives (n=3), policymakers (n=5), and government professional advisors (n=3). Interviews lasted approximately one hour and took place between November 2022 and February 2023. Participants were asked to talk about their experiences of being involved in the framework design.

What participants liked about how we developed the framework:

• Our openness to different perspectives and willingness to listen to people from across social care and healthcare
• Our focus on ‘good’ practice and recognition of the excellent work already happening in care homes across Scotland
• Our commitment to sharing good practice examples to facilitate cross-sector learning and to inspire and motivate others.

What participants wanted us to improve on:

• Keeping a strong focus on social care values, practice and evidence
• Including a broader diversity of voices, particularly from people living in care homes and from under-represented groups
• Making sure that people living and working in care homes continue to be involved collaboratively in implementing and evaluating the framework, without increasing engagement burden.

To support implementation, and to raise awareness of what the vision of the framework looks like in practice, we worked with Scottish Care, Alzheimer’s Scotland, and a care home provider to produce two short animations detailing the life of ‘Bill’, a fictional character, who moves into a care home following a decline in health.

In the first animation we see how Bill is supported in his move to the care home, with the care home staff taking time to develop a personal care plan and how the wider MDT support Bill and his wife, Jean, to develop an anticipatory future care plan that reflects their preferences for care.

The second animation is set some time later when Bill’s health has deteriorated. We see how his anticipatory future care plan is used to ensure that his care reflects his wishes and how the care home team provide compassionate palliative and end of life care.

We have also produced and distributed posters to all care homes in Scotland, to help raise awareness of the key pillars of the framework and to promote MDT working. These were sent to care homes for display and to encourage discussion with staff, residents and their families. These can be found on our website.

Over the winter of 2022/23 we held a series of webinars to raise awareness of the core elements of the framework and to shine a light on a number of local initiatives which are addressing local challenges and improving outcomes for people living in care homes. Our full programme of webinars, including speakers, can be found at Annex A.

Feedback from participants was positive, with those involved commenting that it had been really interesting to see how others were interpreting the framework and the practical improvements being made to meet the recommendations.

“It was good to see how it had all moved forward ….to see the innovative work in the care home environment …. how it is developing and what support they all have. The innovation in some areas was amazing.”

“It reinforced the approach we are taking ….. made me proud of care homes in my area and care homes support team.”

“The session on relatives’ experience of visiting during COVID…..very emotional and thought provoking.”

Most recently we have established an ‘Implementation Advisory Group’ to support implementation. The group will provide strategic direction on how to deliver local and national improvement as well as raising awareness of good practice taking place across the country. The group will also align the framework with SG policies, national outcomes and other workstreams across the health and social care system. A list of the organisations who make up the group’s membership is provided at Annex B.

Lastly, we are working across DG Health and Social Care to develop a monitoring and evaluation programme, which will enable us to introduce a mixture of qualitative and quantitative methods to measure the impact the framework is having. We will touch on this in more detail in the Monitoring and Evaluation chapter.