Below the waterline

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• Below the waterline?
• How the Community Care Outcomes approach
  articulates with SOAs, NHS HEAT and the National
  Performance Framework

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Content / structure

• An update on progress with embedding the
  Community Care Outcomes Framework measures and
  approach
• Integration top to bottom and back again
• Driving change - culture and practice

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Community Care Outcomes Framework now

• Work to link with SOA Guidance and HEAT
• Links with Scrutiny Care Standards,
  self-assessment for outcomes
• 32 partnership visits autumn 2008
• - 24 partnerships to try Talking Points approach
• - 22 partnerships to use Community Care Outcomes
  Framework
• Definitions for 13 measures published December
  2008

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Community Care Outcomes approach now

• Launch event 17 March 2009 to showcase Early
  Implementer Partnerships Talking Points pilots
• Benchmarking Network led by Midlothian
  Partnership 28 acceptances
• Support to all partnerships with National Minimum
  Information Standards (Assessment, Care Planning,
  Review for people using services and for
  carers) / Talking Points
• Integrated Resource Framework and Commissioning
  for Outcomes

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National Performance Framework

Single Outcome Agreements
Equally Well
Early Years
Community Care Outcomes
Anti - poverty
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Public Reporting and Performance Management

• Scotland Performs reports publicly on progress
  towards high level outcomes (Purpose etc.)
• Each organisation will be responsible for
  ensuring that they have appropriate local
  performance management systems in place to ensure
  the delivery of their particular
  responsibilities.
• Regular (monthly) HEAT information for
  performance management, but will now also be
  reported publicly on an annual basis.

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Strategic Objectives

• Wealthier and fairer
• Smarter
• Healthier - we live longer, healthier lives
• Safer and stronger
• Greener

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Scotland Performs (National Indicators)

• Increase the percentage of people aged 65 and
  over with high levels of care needs who are cared
  for at home performance is improving
• Reduce proportion of people aged 65 and over
  admitted as emergency inpatients 2 or more times
  in a single year performance is worsening

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NHS ScotlandHEAT and Local Delivery Plans

• T8 Increase the percentage of people aged 65 and
  over with high levels of care needs who are cared
  for at home
• T12 By 2010/11, NHS Boards will reduce the
  emergency inpatient bed days for people aged 65
  and over, by 10 compared with 2004/05

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NHS Board LDPs link to SOAs

• Boards will set out planned performance with
  respect to the core HEAT targets in their LDPs
• Boards will also provide summary information on
  their other priorities, either Board-specific, or
  contributions we have agreed to make to SOA Local
  Outcomes.
• This will inform development of 2010/11 HEAT
  targets

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Single Outcome Agreements (2008)

• Strategic focus
• About actual outcomes
• Evidence-based
• Capable of delivery - concept of below the
  waterline
• Continuous improvement
• Community Planning Partnership SOAs by April 2009

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Indicator 29 (R.I.P.)

• Increase the proportion of people needing care
  or support who are able to sustain an independent
  quality of life as part of the community, through
  effective joint working.

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Menu of Local Indicators

• Number of patients waiting more than 6 weeks for
  discharge to appropriate setting.
• Number of emergency bed days in acute
  specialities for people aged 65 per 100,000
  population
• Number of people aged 65 admitted as an
  emergency twice or more to acute specialities,
  per 100,000 population.
• of people aged 65 with intensive needs
  receiving care at home
• of people aged 65 receiving personal care at
  home

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Menu of Local Indicators (December 2008)

• Other proxy measures
• Number of overnight respite weeks provided.
• Hours of daytime respite provided.
• Feeling safe (2) Scottish Household Survey

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What is an Outcome, anyway?

• Only people who use services, and their carers,
  can tell us what outcomes they want or need.
• Services should be improving outcomes for people.

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How can outcomes help us?

• Agreeing outcomes for a service sets out what it
  is trying to do for the people using the service.
• We can measure outcomes, so we can see how well a
  service is doing.

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Community Care Outcomes Framework - development
process

• 60 key stakeholders developed draft set of
  outcomes and measures
• Strong links with academic studies
• Consulted widely virtually 5,600 views

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Community Care Outcomes Framework - development
process

• Engaged directly with key stakeholders,
  ownership in SE/NHSS/COSLA
• Tested over 18 months in Early Implementer
  Partnerships
• Detailed collaborative work to agree final
  definitions

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Community Care Outcomes Framework Key Components

• 4 national outcomes
• 16 performance measures 6 (7) outcomes / 7
  output / 2 process / 2 (1) input
• 6 interlocking themes
• 5 existing targets

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Talking Points Service user-defined outcomes
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Talking Points Carer-defined outcomes
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Community Care Outcomes Framework
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A community care system

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Outcomes driving Community Care

Key to quality
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Outcomes driving Community Care

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Outcomes driving Community Care

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Outcomes driving Community Care

Outcomes Framework
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Outcomes driving Community Care

Outcomes Framework
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Outcomes driving Community Care

Outcomes Framework
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Reflections to date

• Writing good outcome measures is difficult
• Aligning outcome measures and approach is
  difficult
• People get excited about improving outcomes
• Community care policy has struggled to deliver
  perhaps outcomes will make the difference

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Chris Bruce

• Lead on Outcomes (Community Care)
• Partnership Improvement Outcomes Division
• Scottish Government
• 0131 244 5654
• Chris.bruce_at_scotland.gsi.gov.uk