My Health, My Care, My Home - healthcare framework for adults living in care homes

About This Framework

This framework will examine how the health and healthcare of people living in care homes should be optimised, supported, and delivered. It will also enhance the assessment, monitoring and response to the forever-changing health and healthcare needs of people who live in care homes.

It is clear, however, that a person's health is enabled by both our 'social care' and our 'healthcare' workforce. Therefore, throughout this document, the term healthcare refers to the health needs of the individual in their broadest sense. It will be made clear where there is an intention to specifically refer to the healthcare or social care workforce.

Through active engagement and participation, this framework and its recommendations has been developed in collaboration with various key stakeholders from across the sector. This includes people who live in care homes and their families, care home providers, representatives and staff, Health and Social Care Partnerships (HSCPs), our health and social care workforce, academics, and policymakers.

The recommendations draw on the diverse experience and feedback shared during the engagement and consultation process aiming to ensure consistent high-level healthcare for everyone who is living in a care home.

Aims

• Examine how the health and care should be supported, and delivered
• Enhance the health of people living within a care home
• Improve the way we assess, monitor and respond to healthcare needs
• Work with healthcare and social care professionals, HSCP & care home providers
• Promote a consistent approach to support people to remain as healthy as possible
• Challenge professionals, services and systems to work effectively
• Enable the provision of seamless, personalised care at all times

The majority of people in care homes are living with more than one significant long term medical condition which may not improve and will often be progressive. Provision of a consistent and enhanced approach to care will enable people to remain as healthy as possible, therefore encouraging them to live their best life. It challenges professionals, services and systems to work effectively to support this, and therefore provide seamless, personalised care at all times.

With this in mind, a key element of this framework is to ensure a proactive focus on the fundamental components of what we need to live well. For example, by ensuring that our fundamental needs of fluid, nutrition and movement are met, we can reduce or delay the need for wound care. Similarly, by ensuring a person has the opportunity and support to connect, engage and express their needs, we can alleviate distress and anxiety.

The wider determinants of health and wellbeing have also been examined and explored. This, coupled with our extensive programme of engagement, has helped to centre the framework around the following six core elements:

1. nurturing environment

2. the multi-disciplinary team

3. prevention

4. anticipatory care, supporting self-management and early intervention

5. urgent and emergency care

6. palliative and end of life care

Importantly, the core elements are underpinned by both 'a sustainable and skilled workforce' and effective use of 'data, digital and technology'. These areas are seen as key enablers that will help the sector to implement the recommendations within this framework. Other enablers are realistic medicine and ethical commissioning:

Practising and applying the six principles of Realistic Medicine will ensure decisions about healthcare are made in partnership with people and their families and will deliver care of greatest value to them. These six principles are:

• shared decision making
• personalised approach to care
• managing risk better
• reducing harm and waste
• reducing unwarranted variation
• innovating and improving

These take account of an individual's approach to risk and their decisions about the care they feel is right for them. In addition, when practising Realistic Medicine, we strive to reduce waste, harm and unwarranted variation in pathways of care, enabling optimal use of our precious health and social care resources. We call this value-based healthcare. Value-based healthcare is not focused on saving money or delivering efficiencies. It is about working with people to consider whether a treatment or an investigation is going to be of value, based on what matters to them.

In March 2021, the Scottish Government and COSLA issued a joint statement of intent outlining how they would work together to deliver the key foundation pillars set out in the Independent Review of Adult Social Care in Scotland. This will lead to shared ethical commissioning principles and establishment of core requirements for ethical commissioning which will ensure that going forward, fair work requirements and principles are met and delivered consistently across Scotland. Ethical commissioning and procurement standards will allow the Scottish Government to focus on those important issues that will affect how care is planned, designed, sourced, delivered, and monitored. Components in the commissioning cycle that are important to achieving the vision in this framework. It will also allow the Scottish Government to spotlight critical areas were we have limited legislative levers to take action through NCS accountability and governance structures. By taking action now to embed ethical commissioning and procurement principles, the Scottish Government can help public bodies and providers to fully engage in the new and changing responsibilities for a NCS.

The remaining chapters of the framework will describe what we have heard from those living and working in the sector, and our recommendations for the future. This is a pivotal building block in improving outcomes as we move towards the establishment of the National Care Service.