Ministerial statement on Delivering a Joint Future
Lewis Macdonald MSP, Depute Minister for Health
Introduction
Good afternoon ladies and gentlemen. Thank you for inviting me to your conference to talk about 'Delivering a Joint Future', in which the housing sector is of course a key player.
I know Rhona Brankin will have spoken this morning about progress towards our goal of providing everyone in Scotland with access to good quality, warm and affordable housing, and about what we can do to bring that goal even closer to fruition. I know that her announcement of additional funding for affordable housing in the North East will be particularly welcome in and around Aberdeen, in the context of our national housing strategy.
Joint Future is also a national strategy, and we developed Joint Future to mainstream joint working. It created new partnerships between the NHS and local authorities to take holistic decisions on the planning, delivery and resourcing of community care services. It is a Scottish solution to Scottish circumstances. The political ownership is reflected in the unique national partnership of the Executive, the NHS and COSLA that provides leadership to the Joint Future policy.
Joint Future, too, is about delivering better results for people – through improved joint working across health, housing and social care.
In the beginning the focus of Joint Future was on getting the right structures and systems in place, to encourage better working across organisational and professional boundaries.
But partnerships did not like being judged on processes. So over the last three years we have moved to measure outcomes, and to seek to develop a performance management framework based on delivering better outcomes for service users and carers.
Significant progress has been made in implementing Joint Future in many areas. But over the piece we are still looking for more. We want now to take the outcomes agenda to the next level, through a new approach based on a suite of national outcomes, performance measures and targets. I will come back to that in a moment.
Today I want to focus on three things:
- How Joint Future fits into the bigger picture
- the changing shape of joint working, particularly from a housing perspective
- and last, but by no means least Outcomes, by which I mean the positive impact our services have on the quality of life of those that use them.
Bigger Picture
The theme today is 'Joint Future'. That approach directly reflects the approach to public services taken by Scotland's devolved government since we were first elected in 1999. We want all our policies and strategies to work together to deliver better outcomes.
Our ambition is to have world class public services that provide the people of Scotland with the best possible platform on which to build better lives for this generation and future generations.
Since devolution, we have been modernising public services across Scotland. Educational standards are going up, we have more responsive and effective policing, and health service waiting times are coming down.
And in public health initiatives like the smoking ban, in community care, on information sharing and, indeed, our approach to outcomes, we are giving a lead to other parts of the UK.
The main context for change going forward is Public Service Reform. The Outcomes agenda will drive Public Service Reform by ensuring that services:
- are more focused and personalised;
- drive up quality;
- are efficient, productive and focused on outcomes;
- are joined up; and
- are accountable to the service user.
From a health perspective, Andy Kerr and I laid out a wish for the future of the NHS and health care in Scotland when we published Delivering for Health some eighteen months ago.
Delivering for Health envisages:
- More care being provided in the community;
- People with a long-term condition playing an increasing role in managing the condition themselves;
- Older, frail people, at risk of hospital admission, getting co-ordinated care provided in the community; and
- Helping people to stay well.
Our social work strategy, Changing Lives is also centred on outcomes. It envisages social work services that:
- focus on the needs of people service users;
- actively address prevention and earlier intervention;
- support vulnerable people and promote social wellbeing; and
- are assessed on the outcomes for people who use services, their carers and communities.
And why last week, we announced our new strategy for Older people 'All Our Futures: Planning for a Scotland with an Ageing Population' which covers all areas of life, including housing, health and well-being.
And in housing, the focus is increasingly not on the house but on the people who live in it. In Supporting People, with which most of you are already familiar, outcomes are very much to the fore. The crux, which you recognise, is to be able to demonstrate how peoples lives have changed as a result of that support. That is a real test for all of us in community care.
Though these policies have different starting points and use different language, they are basically moving in the same direction, and complementing one another on the way. They are about care at home, early support and intervention, personalised care, integration and, above all, outcomes.
The common theme is achieving this through joint working. The challenge for you and your partners is to develop a corporate vision across these strategies that adds real community value.
The fact that all these policies aim to support people in their own homes or in the community reinforces the value of appropriate housing.
Perhaps the issue is seen too often as being about what housing can do for health and social care. I am very clear that the agenda works both ways. It is not just a case of housing simply "adding value" to the health and social care goals. It is about how health, housing and social care reinforce one another to benefit the individual and the community.
So we have policies that support one another and point in the same broad direction, to outcomes. The policy context is therefore positive. To support that, Joint Future is often said to be an example of community planning in action. Its joint working philosophy underpins information sharing among agencies, the development of joint services centred on the needs of individuals, and increasingly the emphasis on outcomes.
A good, practical example of the impact this approach can make is delayed discharge from hospital. We have made dramatic improvements over the last 4 years, reducing the levels of delayed discharge by 71% – from well over 2,000 to around 600. This has only been possible by health, housing and social care working effectively together, with a focus on the challenge and a determination to make real improvements.
So Joint Future shows in community care what we are trying to do on a much wider basis across Scotland. More directly, it provides the means to enable agencies to deliver better results through more integrated forms of working.
Changing the Culture of Joint Working
The task now is to change joint working in community care to achieve the better outcomes we want. The starting point is recognising that no one agency can deliver its agenda without others' input.
People with more complex needs are living longer at home, they want fulfilling lives in the community, and to have employment and social opportunities. This extends across the community care spectrum, from older people to people with drug and alcohol problems.
We need increasingly to use whole systems responses to meet these needs. So agencies have to look to those around them to help provide the better quality of life that people are looking for.
To do that they need to look beyond traditional, single agency services, to a modern, holistic alternative. Conceptually, that is a major change, but it is happening. I know that in many areas there is some way to go to bring housing, health and community care closer together. This is not, however, about structures.
I believe a more effective way to encourage and achieve real integration is to share the practical benefits arising from good joint working. Identifying them will promote mutual dependence, and more effective services, whether in tackling homelessness, health improvement or reducing delayed discharges. Perhaps I could illustrate that with a few examples.
The first is the Telecare Development Programme. It shows how joint working improves the quality of the individual services, to enable people to be supported more effectively and for longer at home.
As some of you will know, Telecare can:
- delay entry to a care home;
- reduce repeat hospital admissions;
- require fewer care and support staff;
- make better use of reactive services such as 'out of hours' ;
- reduce accidents ; and
- support informal or family carers.
But we are looking in this initiative for more than just new Telecare kit. We allocate the £8m against how health, housing and social care partnerships demonstrate improved service delivery in a strategic and measurable way. To reinforce that, Community Planning Partnerships must own individual proposals before they can be approved. So we are linking a new resource to more integrated action on the ground.
The second example relates to homelessness. Homelessness is often perceived as just a housing issue, but our commitment to eradicate homelessness by 2012 will mean addressing health, social and economic circumstances, alongside housing issues. This means partnerships working together to deliver broader outcomes, not simply dealing with homelessness as a housing issue.
This encourages changes of role. Health has tended to focus on enabling access to health services by those facing homelessness. And social work has tended to deal with social impact and the consequences of homelessness. They are vital services, but they are largely reactive.
Increasingly, however, partnerships need to focus on a proactive, whole systems approach that anticipates and intervenes to address the causes of homelessness. This can only happen through effective partnership working.
Housing too is changing. Staff in housing management increasingly see themselves less as property managers, and more as providers of person-based services, helping individuals, families and communities to manage their lives, not just their tenancies.
Local authorities support of home owners is also changing. There is more help with adaptations, greater integration through shared assessment, and more help with tackling practical and financial barriers. That more personalised delivery, building on the success of Care and Repair, will help more vulnerable people stay in their own homes. Supporting People has contributed greatly to that cultural shift, and we very much welcome that.
Housing is therefore not just delivering on its own agenda but is also a key player in achieving the better outcomes for community care, and for the community as a whole.
I hope that holistic approach will be carried in to the forthcoming review of sheltered housing. I would welcome it being seen as part of the redesign of the wider spectrum of accommodation, and helping to underpin changes in the balance of care.
The review should therefore recognise the mutual dependency across sheltered housing, care homes, NHS continuing care provision and intensive home care.
And lastly in this section on improving integration, how do we offer practical help? I have already referred to Telecare, but let's look at a few other examples. I have emphasised today that recognising housings input is important. Engaging fully with housing in connecting up services was the central theme of our guidance Essential Connections which the Joint Improvement Team, CIH and NHSScotland developed together.
And to help the move from vision to delivery, we have developed, again jointly, a joint commissioning toolkit and guidance to commissioners of services on 'Understanding the Funding Maze' for health, housing and community care services. Effective joint commissioning is vital if we are to deliver a shift in the balance of care away from acute hospital settings to more home and community settings.
The relationship among housing, health and social work services is maturing, and moving in the right direction. But we need to make sure that partners engage with each other appropriately across the community care spectrum. The development of joint visions, joint outcomes, joint commissioning, joint services and joint reporting all add momentum. And nationally, we need to make sure that we continue to give the right leadership across central government and with our partners at national level.
Our ambition of modernised public services focus on outcomes and on achieving them through more joined up, efficient and innovative approaches, all need to engage housing. The examples I have given show how it can be done, and how we have sought to help it on its way.
National Outcomes
I now want to turn to the developing outcomes agenda in community care. In my introduction I said that outcomes are the core of what we need to do, and must drive the agenda. Only then will we be able to show that people are receiving speedy, responsive, high quality services from health, social work and housing and, where that is not the case, that we are doing something about it.
Outcomes used to be the by-product of the rest of the system. In future, they will be the key to delivering the results we want. They will drive the changes that we need to improve services. After all, outcomes are what the people who use our services care about – not who provides the services. And we all recognise that by working together health, housing and social work can improve these outcomes.
We originally introduced outcomes in Joint Future three years ago. That revolved around a combination of four national high level outcomes underpinned by Local Improvement Targets set by partnerships themselves. While a number of partnerships have shown good progress, it is not consistent across Scotland.
To improve performance generally and to secure greater consistency, the national partnership of COSLA, NHS Scotland and the Executive has established a national outcomes project, chaired by Tim Davison, Chief Executive of NHS Lanarkshire. It will develop a suite of national outcomes, performance measures and targets to drive joint performance in community care.
We have made a lot of progress in a short time on developing this new approach to outcomes. Engaging with stakeholders, including those in housing, is an important part of this journey.
That started with a 2 day event in November, attended by 60 senior managers from health, housing and social work, together with representatives of service users and carers and the voluntary sector.
That event identified four high level national outcomes:
- improved health;
- improved wellbeing;
- improved social inclusion; and
- improved independence and responsibility.
It also identified 18 draft performance measures mostly outputs/outcomes, to underpin these four national outcomes. We have continued to involve stakeholders in the refinement of these measures through extensive consultation. We have also since looked at what targets might look like.
Some stakeholders have expressed concern about the pace of this project. But we need to take this forward quickly if we are to change from what we believe is an outmoded performance assessment system.
I want to stress that this is a journey: we are only at the start of it, and the work so far provides a platform to move forward. We will use the next few months to work with partnerships on how best to do that.
But outcomes are here to stay. We are looking to transform how we apply them to community care. It is how we do that, hopefully making a start in 2007/08, that we want to discuss with partnerships.
It is also important to make clear that the new measures should not be an added burden on partnerships. On the contrary, we are looking at how we can streamline other reporting streams such as the Statutory Performance Indicators for local authorities, the HEAT targets for health boards, and the Joint Performance Information and Assessment Framework which reports on joint performance in community care.
It is worth noting that our approach to outcomes in community care is being pursued also both in housing and in partnerships more generally. In Supporting People, we are also developing an outcomes model which can be integrated into existing assessment and support planning arrangements.
This will enable service users, as well as their care commissioners and providers, to see how support has changed and enriched their lives. You will want to know that there is considerable synergy between this and the community care approach.
And looking more widely, the outcomes-led approach is behind the development of a range of pathfinder outcome agreements, some within local authorities, others across the community care spectrum. The outcomes in community care will be helping to drive results in these areas.
And so the focus on outcomes I referred to earlier is very much part of what we are doing in Joint Future. Indeed, the Joint Future outcomes are playing straight into some of that other work. That is very positive.
But the real point is that users and carers expect partnerships to be judged on their outcomes; and partnerships themselves see that as the right way forward. The challenge is to change the culture to enable that to happen.
The work so far in community care looks very positive. We now need to work closely with partnerships to make that happen, to change the cultures and to use outcomes to drive performance.
Conclusion
Joint Future has been the catalyst for a cultural shift in which joint working is now the norm. But partnerships are not there yet, they have not yet delivered that Joint Future! We recognise we need to find better ways of doing that.
Measuring outcomes provides that approach. It fits within the bigger picture and will, I believe, make a real difference to joint performance in community care. We are only at the start of that journey – but we have high hopes of success.
One constant is that housing is an integral part of delivering a joint future. As I have illustrated, relationships are maturing and under the outcomes approach housing will continue to have a key role in securing the desired results. I encourage you to make sure you are part of the Joint Future.
I want to finish by reminding you again of the vision we have for public services – quality services that are focused, personalised, joined up and accountable to the service user. Outcomes are how we will measure this. Better outcomes are how we will demonstrate achievement. Better outcomes are what the people in our communities have the right to expect, and it is our job to make sure they get them.
Thank you.