Summary of HIS ihub offerings relating to public health agenda 1. Aim of Paper To provide an overview of the current improvement support work led by Healthcare Improvement Scotland s ihub, that is relevant to the public health agenda. 2. Overview of the ihub Healthcare Improvement Scotland s ihub was launched on 1 st April 2016 and provides support for the redesign and continuous improvement of health and social care services. The following diagram summarises the current range of improvement support offerings. More information can be found at www.ihub.scot. 3. Programmes of work which interface directly with public health agenda This section provides further information on those programmes of work that have a direct interface with the public health agenda. 3.1 Strategic Commissioning Support Unit Healthcare Improvement Scotland s Strategic Commissioning Support Unit is working with the Health and Social Care Partnerships to support their strategic commissioning across pathways of care. This includes providing support to make better use of outcome based commissioning and to develop effective partnerships with the third and independent sector. Produced by: Director of Improvement Support and ihub, HIS Page: 1 of 6 Review Date: 25/01/18
This work interfaces with primary care and mental health in particular looking at new, increasingly person-centred community based models of care. Opportunity Mechanisms Strategic planning should explore the current and future need (rather than demand) of the population and the current and potential assets available to the system (including statutory services and community resources). It then produces redesign proposals that best align the population needs for health and social care with the available assets. In practice, this could see a much wider range of community providers across the public, private and third sector engaged in delivery of more person centred models of care e.g. with leisure and education involved in commissioned mental health provision or new models of primary care provision. The key legislation and policy basis for working differently with greater innovation, partnership working and person centred care is now in place. This includes human rights based collaborative procurement models, self-directed support, locality planning arrangements and market facilitation plans. These mechanisms enable the design of systems of care which make better use of community resources and focus on preventative models of health. A key challenge is now supporting the health and social care system to make use of these mechanisms to best align the assets within their area to meet population need. Produced by: Director of Improvement Support and ihub, HIS Page: 2 of 6 Review Date: 25/01/18
ihub support The Strategic Commissioning Support Unit supports HSCPs to understand their opportunities for redesigning services to better align the population assets with population demand; to co-design new models of care with a wide range of partners including communities, third and independent sector work and to then use the range of mechanisms available to implement the redesigned systems of care. The unit has a central approach working across 4 core specialties: Strategic Planning Service Design Third and Independent Sector Engagement Outcomes Based Commissioning It is underpinned by strong programme management to support matrix working between these specialities and the wider range of work across Healthcare Improvement Scotland and other organisations. 3.2 Child and Adolescent Mental Health Healthcare Improvement Scotland s Child and Adolescent Mental Health (CAMH) Improvement Support work is commissioned by Scottish Government to focus on supporting improved access to CAMH services. There is increasing recognition that this can only be sustainably achieved through a whole system approach that includes a focus on prevention and early intervention. We are currently reviewing our improvement support offering in light of this. In particular, and of relevance to the public health agenda, is the increasing interest in the THRIVE model that has been tested within Ayrshire and Arran. The THRIVE model recognises the emerging and increasingly compelling evidence of a range of social and economic factors that affect mental health. These include poverty, poor housing, neighbourhood cohesion and national income inequality (Friedli, 2009). As part of its overall approach, THRIVE seeks to enhance awareness of the full range of mental health promoting practices (MHPP) and to facilitate a multi-agency approach to their use. For example, implementing the THRIVE approach involves communities (including schools) and families in developing support systems and building resilience at a system level. More information on THRIVE can be found at http://www.implementingthrive.org/implemented or http://www.annafreud.org/media/4817/thrive-elaborated-2nd-edition.pdf. Produced by: Director of Improvement Support and ihub, HIS Page: 3 of 6 Review Date: 25/01/18
Mental Health Access Improvement Support Team (MHAIST) hosted a webex to present the model to CAMHS across Scotland in 2017 which drew interest from several boards. Ayrshire and Arran CAMHS were most interested in the whole system framework as it aligned with their own strategic developments and shared priorities across children s services. Since then MHAIST have support NHS A&A in their improvement programmes and are facilitating a visit to the THRIVE team in London in March 2018. The aim of this visit is to share and learn about the programme supporting children and young people in schools and how CAMHS are involved in promoting resilience. This is the Getting Advice part of the framework. A&A are undertaking significant work in this area and will share some of their case work with the THRIVE team when we visit. MHAIST will then be able to support them further in their improvement work. The MHAIST have the potential to spend some time with the THRIVE leaders to understand their principles, approach and learning and consider this multi-agency framework for mental health promoting practices and what would be the potential for this across CAMHS in Scotland. 3.3 Primary Care Working with NHS National Services Scotland s Local Intelligence Support Team (LIST) we will be supporting the development of Cluster Quality Improvement Plans (QIPs). This work will include supporting GP clusters to undertake a population health needs assessment. The ihub has also worked with Midlothian HSCP to provide evaluation support of the house of care model and well-being service that promotes a holistic approach health and wellbeing. This is intended to help people address the social determinants of health alongside consideration of health care needs. The formal evaluation report is expected early 2018. 3.4 Place Home and Housing The Place Home and Housing (PHH) portfolio aims to support Health and Social Care Organisations and the Housing Sector to optimise the housing contribution to improve the health and wellbeing of individuals and communities with a focus on two high level interventions: 1. Strategic Planning - HSCP housing contribution statements, commissioning evidence/analysis and workforce. 2. Housing Options - focusing on specific areas around mental health, disability and dementia. The portfolio has evolved in response to various policy or system drivers. These have included national strategies for housing (i.e. older people), government guidance (i.e. adaptations, strategic planning, and integration) or specific system issues (i.e. delayed discharge). Another aspect of the programme has been support for knowledge development of the contribution of housing to health and wellbeing. In recognition of the changing context at both national and local level, particularly through health and social care integration, a review of current policy and national strategic context has been undertaken, along with consultation of a broad range of stakeholders. This review will inform the future work programme and subsequent evaluation and measurement framework. Produced by: Director of Improvement Support and ihub, HIS Page: 4 of 6 Review Date: 25/01/18
3.5 Living Well in Communities The LWiC portfolio aims to support Health and Social Care Organisations to test and spread new ways of delivering services that enable more people to spend time at home or in a homely setting that would otherwise have been spent in hospital. The portfolio has five key work streams to support health and social care partnerships: Finding opportunities for improvement Identifying people before a crisis Planning for the future Implementing preventative models of care Building local capacity and capability Work is currently underway to change the delivery model of Living Well in Communities (LWiC) to enable geographical-focused large-scale change. 3.6 Neighbourhood Care Healthcare Improvement Scotland (HIS) has been commissioned by the Scottish Government to support the development and testing of Scottish models of neighbourhood care based on the principles of Buurtzorg, a Dutch model of care delivery that puts an individual at the centre of their care and empowers staff through self-managing teams. The ihub is supporting three test sites to develop their understanding on how Buurtzorg works and how its principles can be applied within their local context. This work includes the development of a national evaluation framework that captures the impact on those who use services, staff and the wider system. 3.7 MCQIC Public Health Activity: Smoking in Pregnancy Interventions The Maternity and Children Quality Improvement Collaborative (MCQIC), which is delivered as part of the Scottish Patient Safety Programme, includes within its remit work with the NHS boards to ensure that those mothers who smoke, or are exposed to smoke, are offered appropriate advice and provided with support tailored to their needs. This has included offering all pregnant women carbon monoxide (CO) monitoring at their first appointment with their midwife (known as booking ) and aiming to refer 90% of those identified as smokers or with a raised CO level (> 4 ppm) to the NHS stop smoking service. A tailored package of care for women who continue to smoke during pregnancy was also developed. This work has involved collaboration between midwives and local smoking cessation services. MCQIC will continue until March 2019 and continues to support NHS boards to adopt a greater focus on the uptake of smoking cessation services. Produced by: Director of Improvement Support and ihub, HIS Page: 5 of 6 Review Date: 25/01/18
4. Summary Healthcare Improvement Scotland s ihub currently leads a number of national improvement programmes that have relevance to the public health agenda. In designing the new public health body, care will need to be taken to ensure effective interfaces are in place with these programmes of improvement support. Further information on any of the above are available on request. Ruth Glassborow Director of Improvement Support and ihub Healthcare Improvement Scotland January 2018 Produced by: Director of Improvement Support and ihub, HIS Page: 6 of 6 Review Date: 25/01/18