Maximising Recovery, Promoting Independence: An Intermediate Care Framework for Scotland

8. Policy Context

"Our policy goal is to optimise the independence and wellbeing of older people at home or in a homely setting. This will involve a substantial shift in focus of care from institutional settings to care at home - because it is what people want and provides better value for money."

The development of Intermediate Care is one component of the policy described in Reshaping Care for Older People: A Programme for Change 2001 - 2021³⁰.

This document sets out the Government's headline ambitions for reshaping care for older people across Scotland, along with the first set of key actions required to deliver our ambitions. It sets out the national framework, within which local partnerships will develop joint strategies and commissioning plans and use the Change Fund as a catalyst to reshape care between 2011 and 2015.

Better integrated approaches through Intermediate Care are central to the priorities of the Reshaping Care programme and the need to ensure improved joint working between local authorities and the NHS and other partners. The Reshaping Care programme promotes an extension of Intermediate Care at home, in care homes and housing settings, to support speedier discharge and faster recovery.

Change Plans have been submitted by all health and social care partnerships in Scotland, detailing how they intend to use the new Change Fund to enhance community services and increase preventative support. The majority of Change Plans include the development of Intermediate Care.

Change Plans

Moray:

Establish a Moray wide multidisciplinary Intermediate Care Team which will provide safe, effective community based assessment/rehabilitation/intermediate care to older people across Moray focusing on the identification of frail elderly who have the greatest risk of admission or re-admission to Hospital or long term care.

Falkirk:

Extend the scope of the current enablement approach to work with service users who are aged 65+ years with long-term conditions and/or are frequent fallers who sustain an injury that does not require hospital admission. In addition, it is recognised that education and training professionals, service users, carers and providers will be crucial to ensure the culture shift required to implement reablement approaches.

The Reshaping Care programme aligns with a number of key national policies:

"It is about making measurable improvement in the aspects of quality of care that patients, their families and carers and those providing healthcare services see as really important."

The Healthcare Quality Strategy for NHS Scotland³¹ is a development of Better Health, Better care³² which builds on the significant achievements already made over the last few years. It aims to deliver safe, effective and person centred care, supporting people to manage their own conditions and .making individual outcomes and experience integral to services. The Strategy contains three quality ambitions:

• 1. Mutually beneficial partnerships between patients, their families and those delivering healthcare services which respect individual needs and values and which demonstrate compassion, continuity, clear communication and shared decision-making.
• 2. There will be no avoidable injury or harm to people from healthcare they receive, and an appropriate, clean and safe environment will be provided for the delivery of healthcare services at all times.
• 3. 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.

"Services should strive to support people in managing their own health conditions and remaining independent in their own home rather than being admitted to hospital. Current evidence would indicate that many admissions to hospital or institutional care could be avoided if anticipatory and rehabilitation services were in place."

Co-ordinated, Integrated and Fit for Purpose: The Delivery Framework for Adult Rehabilitation in Scotland, published in February 2007, is a joint document for health and social work. It gives strategic direction and support to all health and social care services and practitioners who deliver rehabilitation or enablement services to individuals and communities. The vision underpinning the framework is the creation of a modern, effective, multi-disciplinary, multi-agency approach to rehabilitation services that are flexible and responsive in meeting the needs of individuals and communities in Scotland.

Re-ablement, recovery and rehabilitation, (the 3Rs) are concepts that are applicable to both older people and those with a long-term condition, across the spectrum of health and social care services. They are integral to the delivery of many of the health and social care policies and work streams, including the Reshaping Care programme, all aimed at enabling individuals to live healthy lives in a homely setting for as long as possible.

A greater emphasis on anticipatory and preventative support in relation to both the carer and cared-for person - which does not have to be complex or expensive - can delay or prevent the need for crisis intervention, and is therefore more cost effective.

Caring Together: The Carers Strategy for Scotland 2010-2015³³ acknowledges the vital contribution carers make to the health and social care system. Included in the actions is the need for training for carers to enable them to remain able to continue in their role. Intermediate Care has the potential to support carers by reducing the number and length of hospital admissions, and providing a range of services which can respond to, or avert, a crisis.

"we also need to do some new things, to do some things differently, to stop wasteful activity, and to focus on evidence-based activities which yield the maximum benefit."

Scotland's national dementia strategy³⁴ The aim of this strategy is to deliver world class dementia care and treatment in Scotland, ensuring that people with dementia and their families are supported in the best way possible to live well with dementia. The Strategy highlights that inappropriate admissions can be reduced by increasing the availability of 'step-up' Intermediate Care services that temporarily offer a higher level of care for someone living at home to cope with a short-term need, instead of the person going into hospital.

These publications set out the principles and strategic direction for our future care services: other national strategies build on these in relation to specific groups or types of need.

"the Intermediate Care Framework will have significant impact on the care provided by community hospitals, especially their links to care homes and home care support."

Community Hospital Strategy Refresh³⁵ builds on the 'Developing Community Hospitals: A Strategy for Scotland and reflects on how current strategic priorities should influence the vision for community hospital development. It seeks to demonstrate, through examples of good practice, how community hospitals can become more effective in the delivery of improved pathways of care, especially with regard to supporting the older population. It contains a number of actions for partners that will 'knit' community hospitals into the fabric of local care and support services, ensuring improved outcomes for patients.

Age, Home And Community: A Strategy For Housing For Scotland's Older People: 2012 - 2021³⁶, published jointly with COSLA in December 2011, sets a clear vision for housing for older people, with the necessary framework for delivery. The strategy is key to supporting a 'shift in the balance of care' and reducing the use of institutional care settings, including partnerships with housing providers to deliver intermediate care. It advocates a range of preventative services, which help older people to live independently, safely and comfortably in their own homes; reduce falls and accidents; and support people to return home from hospital, reducing delayed discharge.