Drivers for Change. The following section details the need for change as identified in the Strategic Assessment (included in Appendix 1) and Initial Agreement (IA) as approved by the Scottish Government Capital Investment Group in October 2018. The project team have reviewed the drivers for change in the context of the existing situation and confirmed that these remain valid. Increased future service demand due to population growth East Calder is experiencing significant population growth and the Medical Practice cannot meet the service requirements of the growing population. The practice is already experiencing population growth from the Calderwood development and this is predicted to increase significantly. Time from Initial Agreement to occupation of a new facility will take circa 4 years. Services cannot be delivered locally based on local patient demand, but instead will need to be based on where beyond the local community it is possible to deliver services. NHS Lothian will fail to provide treatment for all patients in the future unless this is planned for. Pressure on existing staff, accommodation and services will inevitably increase. Sustainability of primary care is a key priority for the IJB and NHS Lothian There is a need to plan to provide a sustainable service for the future Poor functionality and space restrictions in existing accommodation Some consulting rooms are very small and don’t meet current standards due to the conversion of small rooms/ store cupboards. These can be very restrictive/ unsuitable for patients and staff. No further scope exists to reconfigure service design or the existing building to improve the experience. Poor patient and staff experience. Do not meet current recommended standards. Not DDA compliant The building is not fully DDA compliant - discriminating between the experiences of service users. Service arrangements do not support the existing workforce Staff accommodation is restricted with staff working in suboptimal conditions – these impacts poorly on staff morale. There is a need to plan to provide suitable facilities for the future, especially as staff numbers will continue to increase as the practice requires to expand and the Primary healthcare team is further developed Existing There is no scope for enhancing the Pressure on accommodation and arrangements do not support the transfer of healthcare services to primary care primary care services provided in the existing accommodation including transferring the right care closer...
Drivers for Change. The Caithness economy is fragile, with 12% dependent on the former Nuclear Power Station, Dounreay, which is now undergoing decommissioning with a loss of up to 2,000 jobs over the next 15 years. There are pockets of high deprivation, and 10% of the population lives in the most deprived 20% of areas in Scotland. In remote and rural Caithness there are pockets of disadvantaged individuals and households who live at some distance from service access points and struggle to access health and social care. A consequence of deprivation and poverty is generally poorer health and an increased demand for health and social care services. The population is ageing, and younger people of working age are migrating to urban areas, adding to our workforce pressures. In 2018 there were 26 people of working age for every 10 people over 65 years. By 2041 this is projected to reduce markedly to 15 people of working age for every 10 people over 65 years. Recruitment of nursing and social care staff in Caithness is challenging, with only two-thirds of posts filled on first advert. Locum and agency use is high, accounting for a significant overspend, and in Highland overall nearly 10% of consultant posts were vacant (March 2020). Half of the 600 staff employed in the Caithness area are over the age of 50.
Drivers for Change. 2.1 The existing broadband provision in the county is currently failing to deliver the national universal service commitment of 2Mbps to 23.8% of premises in Herefordshire (Ofcom1 2011) with the same data revealing that there is no access to Superfast Broadband in Herefordshire (though BT have announced superfast deployment for Hereford as part of a commercial roll-out).
2.2 Herefordshire faces particular challenges because of the limited amount of existing telecommunications infrastructure and its relatively low population spread over a large area making premises costly to reach compared to more urban areas. Without public sector funding, telecommunications companies would not invest in the wholesale Broadband 1 Communications Infrastructure Report 2011 network across the rural areas because of the limited return on investment, even in the long term. Consequently without public sector intervention, rural areas will increasingly become digitally excluded with businesses losing competitive advantage and residents unable to take advantage of the financial, educational, social and health benefits of being on-line.
Drivers for Change. For a number of years the IW Council has grant funded the voluntary sector to deliver advice, information and guidance (AIG). This arrangement has helped independent organisations support people who face a range of problems including debt, housing, employment, consumer rights and welfare benefits. Together with information and advice services provided by the council, advice providers assist and empower people to resolve their problems, which in turn prevents unnecessary distress and/or otherwise unnecessary demand for public services. Provision of independent information and advice services is therefore most effective when it is aligned to the IW Council’s corporate priorities and those of other public sector organisations. In recent years there has been a notable increase in levels of demand for community based advice, information and guidance. This can be attributed to the current economic environment and concomitant increases in household debt, changes to welfare benefits and pressures on housing. Further increases in demand should be expected following the introduction of Universal Credit and the Care Act 2014. To address these increased pressures a partnership of voluntary sector agencies was formed in 2013 following a national programme to make services more robust through local partnerships. The ‘Isle Help’ consortium successfully competed for Advice Services Transition Fund (ASTF) money from the Big Lottery to introduce a range of shared services to improve outcomes for clients and improve sustainability. Since the Isle Help project began it has introduced a shared advice services hub, increased digital and telephone service delivery for clients, and provided a networked referral system assisting clients to always make contact with the agency that best meets their needs. Isle Help has produced its own three year strategy which is both ambitious in terms of intended outcomes for clients and connected in terms of its correlation with the council’s own three year plan. This ensures further alignment with major changes in the way that public services on the Island will be provided arising from pressure on public funding and new more collaborative ways of delivering public services. IW Council grants to key local voluntary and community AIG providers ended in March 2015. The funding of AIG providers could be discontinued as the services are discretionary. However, the council recognises the potentially costly implications of a loss of independent provis...
Drivers for Change. There has been a long standing ambition to shift more health care from the acute sector to settings closer to people’s homes, and from reactive care to prevention and proactive models based on early interventions The new pathway model components are: Prevention and early intervention Assessment and triage Support for people with long term health conditions It is envisaged that to deliver this ambition integrated community teams working with GPs, specialist services and the voluntary sector will assist those people living in their communities who have long term conditions or are frail due to disability or age. A first key step will be to remove complexity by delivering a simple pattern of services delivered by a multi- disciplinary team based around localities and primary care supported by specialist services from the community and hospital setting. This will offer Island residents a more complete and less fragmented service. The model needs to include both health and social care. To be successful each locality will need to undertake systematic, targeted case-finding using risk stratification tools. The ambition of this Agreement is to enable the creation of a Partnership Agreement which enables the delivery of integrated care.
Drivers for Change. The Isle of Wight NHS Trust and Isle of Wight Council are investing in new models of health and social care that will be better able to meet the current and future needs of Island people, communities and visitors. Integration of services will enable partners to benefit from the limited resources across health services, social care, and related public services., A single point of public access is intended to contribute to these efficiencies through integrating multiple organisations under one management structure that will pursue common person-centred goals. There is a need for public access and triage that will provide a fast and effective response. Integration is intended to bring together various emergency and non-emergency services in a seamless and efficient way. Further integration of contact centre services will build on the experience and benefits of the current co-location of health and social care services such as 999 / 111 service, Adult First Response (Social Care) and district nursing coordination. Although currently co-located in a shared hub, these services continue to be managed within their own respective organisational management structures. There is now a need to remove organisational barriers and implement a single management structure and the sharing of technologies and processes currently used by single services. This is intended to lead to a more holistic, co-ordinated and consistent point of contact for all people needing services. The benefits of integration must include:
1. A consistent triage process that ensures that service users are referred to the most appropriate service, regardless of whether this is delivered by the statutory, voluntary or independent sector.
2. A reduction in the rate of unnecessary admissions to hospital, nursing and residential care, and improved use of out of hours care, whilst ensuring the service meets the needs of people.
3. Reduced cost of contact centre provision and related corporate overheads, a significant contribution to the development of new models of care and more efficient and effective services in host and partner organisations.
4. The replication of learning and continued investment in improved and more efficient services, as part of the Isle of Wight’s contribution to a national investment in new models of care.
Drivers for Change. Cause of the need for change: Effect of the cause on the organisation: Why action now:
Drivers for Change. A variety of national strategies outline the way forward for Health and Social Care Services and have been considered in the development of local Fife Strategies.
