National health and wellbeing outcomes framework

7. Purpose of the national health and wellbeing outcomes

The national health and wellbeing outcomes underpin the activities that Health Boards, Local Authorities and Integration Authorities must carry out under the Act to achieve Scottish Ministers intention for integration of health and social care in Scotland. Indeed, Health Boards, Local Authorities and Integration Authorities must have regard to the national health and wellbeing outcomes in certain key aspects of integration activity:

• Health Boards and Local Authorities are to have regard to the national health and wellbeing outcomes when preparing an integration scheme (section 3(2) of the Act).
• Integration Authorities must set out in their strategic plans how arrangements for the delivery of the integrated health and social care services are intended to contribute to achieving the national health and wellbeing outcomes (section 29 (1) (b) of the Act).
• The national health and wellbeing outcomes must be taken into account when reviewing a strategic plan (section 37(2) of the Act).
• A Health Board, local authority or Integration Joint Board, as the case may be, must have regard to the national health and wellbeing outcomes and integration delivery principles when carrying out an integration function, that is when they are delivering integrated health and social care services (section 40 of the Act).
• Scrutiny bodies; Healthcare Improvement Scotland and Care Inspectorate, when inspecting integrated health and social care services must assess the extent to which the service is contributing to the integration delivery principles and the national health and wellbeing outcomes (sections 54 and 55 of the Act).
• Regulations on the performance report require Integration Authorities to report annually on its performance against key measures and indicators in relation to the national health and wellbeing outcomes.

The importance of making a difference to people's lives through integration is a central objective of the Act. It aims to achieve tangible improvements to outcomes for people and to the quality of services across health and social care. By focussing on outcomes, integration aims to maximise the impact of this opportunity to shift the focus of performance improvement onto the achievement of individual personal outcomes for those receiving support and care, and their carers. This in turn will mean that national strategic outcomes within the National Performance Framework^[5] are improved.

It is important that each Integration Authority has a consistent framework against which to plan, report and account for its activities so that the Integration Authority, the Health Board and local authority, Scottish Ministers and the public can assess progress made to improve outcomes locally and in different parts of the country.

An outcomes based approach encourages an examination of the tangible differences support and services make and not just on the inputs or processes. At a local level, a personal outcomes approach requires a new of thinking away from input and process measurement towards focussing on outcomes as experienced by the user of service, and by their carers.

The integration of health and social care represents a major opportunity to bring about improved outcomes for people in Scotland, however, to fully deliver this, will require a shift in culture working towards the common goal of personal outcomes. An outcomes approach can help to provide a common language and shared purpose across and between services, and with people using services and support.

7.1 Development of the national health and wellbeing outcomes

It was important that the national health and wellbeing outcomes were developed in collaboration with the people using health and social care services, as well as those who are responsible for commissioning and delivering the services at a local level.

The Scottish Government was keen to emphasise the importance of outcomes in ensuring services are person-centred, as opposed to focussed on reducing 'bad' numbers, such as "delayed discharges". Equally as important was the need for a robust data-capturing infrastructure to provide us with a comprehensive picture of how we are performing against each outcome.

A national working group^[6] comprised of a broad range of stakeholders provided support and advice and led on the development of the draft national health and wellbeing outcomes. The working group also proposed developing a national health and care survey, built on the existing Patient Experience infrastructure, which forms the largest national survey of the general population that we have in Scotland. The first set of results from this health and care survey^[7] were published in May 2014.

Workshops and events across the country provided a focus on the national health and wellbeing outcomes and the measurement indicators for integrated health and social care. This provided an opportunity to share and explain the policy rational but also, provided the opportunity to hear personal experiences and opinions at a local level, to help shape the national health and wellbeing outcomes. The consensus across the events was that the outcomes and indicators were a positive step forward in putting the service user at the heart of service design and delivery. The feedback received fed into the continuing work on the national health and wellbeing outcomes and associated measurement indicators.

A national consultation^[8] on the draft legislation containing the national health and wellbeing outcomes ran from May 2014 to August 2014. This gave stakeholders an opportunity to feedback their views on the draft regulations. Scottish Government analysed all responses and amended the regulations to reflect, where appropriate, stakeholders views. This led to the Public Bodies (Joint Working) (National Health and Wellbeing Outcomes) (Scotland) Regulations^[9] being finalised, and coming into force on 28 November 2014.

Tariq's Story

Tariq is 20 years old and has just moved into his own flat. Before that he lived with his mother and younger brother and sister. Tariq was born with Down's syndrome and an associated heart condition and visual impairment. His mother has been helping him to eat a healthy diet and take regular exercise. He loves cooking and is currently studying at catering college.

At 15 Tariq and his family, along with the professionals that knew him best began planning for his transition to adulthood. At first he didn't know what he wanted for a career, as he still had a few years left at school. Tariq remembered his friend telling him about support he could get to help him decide what wanted to do and write an action plan for his future. He spoke to his social worker who found a local organisation that offered person-centred planning. This helped Tariq, his family and the professional team around him, to explore his aspirations and skills to work out how he could achieve the future he wanted. Together they developed an accessible action plan.

'Tariq continues to receive support from his community learning disability nurse, social worker, GP and specialist heart and visual impairment nurse. This has helped him to continue to self-manage his conditions and has enabled him to feel confident in being able to live the life that he had planned for.'

During this process Tariq realised that one of his biggest priority was to leave home and get his own flat. His mother was worried if he would be safe living alone and whether he would look after his health properly. While Tariq didn't see why this would be a problem, his social worker arranged for his community learning disability nurse and specialist Heart Nurse to join one of the transition planning meetings to talk through these issues.

Together they found a solution that worked for everyone, concluding that with the right support and use of assistive technology, everyone would feel confident. Tariq also liked the idea of joining a local exercise group and everyone agreed to help him make this happen. They agreed that there were some risks involved for Tariq in leaving home, but that these were worth taking.

Since leaving school two years ago, Tariq has used a personal budget to employ a Personal Assistant (PA) to support him in his daily life. This has enabled him to go to college, look after his flat and go out with friends and family. Tariq's got to know his neighbours and, as well as enjoying chats as they pass in the stair, he has called on them a few times for advice, for example when his washing machine leaked.

Tariq uses a small amount of his budget to pay for membership of a local swimming club, which has helped him to stay fit and resulted in new friendships. This has helped him to grow in confidence and he recently introduced his new girlfriend to his family.