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Indicators of Progress

Please describe the extent to which your Change Fund activity to-date has changed the spend profile
of the total resource envelope for Older People in your area, and whether it has led to any

1. The Total resource envelope on health and social care support for older people in the Western Isles is
   £46,432,763 annually (based on IRF 2010/11). The IRF mapping of 2011/12 is being progressed. In
   relation to the Change Fund we have taken the approach of funding proportionately across all
   workstreams. We anticipate a return on our investment in 2013/14 however this will not yet be
   captured within IRF data.

   We are able to demonstrate that, in relation to mainland placements in 2012, the costs have reduced
   from £1.7m to £1.59m.

   The partnership is continuing to deliver services across the spectrum to an increasingly ageing
   population within the same cost envelope.

                 % Change       2009      2010      2011     2012      2013      2014

                 65+             5435       1.2%     1.4%     0.3%       5.3%      1.9%
                 75+             2472       2.0%     0.4%     3.1%       0.7%      0.6%
                 85+               609      4.1%     1.6%    27.8%     -20.3%      0.3%

   At a national level the Western Isles compares favourably in relation to the shift from Acute/Care Home
   bed spaces to community settings. This has been the result of the ongoing strategic programme of bed
   reduction which has been adopted to shift the balance of care from care homes and hospital settings.
   Since 2005 the NHS have reduced hospital bed spaces from 150 to 97 , while care homes have been
   reducing bed spaces since 2008 (55 reduced to 46) through a programme of refurbishment and
   reconfiguration. This trend will continue through our programme of modernising services including
   mental health services and the review of community based assets.

    This strategic approach has led to an increase in intensive care packages to those most at need within
   the community. The steady decline in the number of long stay residents in care homes accompanied
   by an increase in intensive home care packages has resulted in a gradual reduction in the number of
   home care packages to those aged 65-74. There has been a commensurate increase in home care
   packages to those aged 85 plus, thereby delivering home care at the point of most need.

2. Early deliverables that have impacted on the efficiencies and reallocation of resources are outlined

    Analysis of 20 cases display an estimated cost to the acute sector of £41,212 if these patients had
       been admitted/not discharged.

Community Nursing
Releasing time to care
       An analysis from one team can evidence 5.2 weeks WTE nursing hours annually which is being
        reinvested into patient facing time. Site visits were carried out by NES and HIS in December who
        commended progress to date.
Digital pen
     New IT systems have been installed in each community nursing area. Following the Annual
      review and presentation of digital pen technology the health minister has provided funding for
      electronic systems across community nursing in Scotland. Patient Facing Time will be increased
      upwards from 28%. Workload tool data available end March 2013.
Unscheduled Care
      In the first two months following service redesign the team responded to 4/5ths of domiciliary visits
       after NHS 24 calls releasing GP capacity to work out of hours in the acute sector.

Community Equipment
    Increase the capacity of the Community Equipment Service to have readily available equipment to
       care for people in their own homes and prevent admission to a care home or hospital. This
       included items such as specialist tissue viability equipment, toileting and bathroom equipment.
      Extension of Community Equipment contract to include the following equipment, The number of
       emergency equipment replacement deliveries reduced from average of 10 per month to zero.
       Within two weeks of the contract initiation, 20 air mattresses which had been waiting for repairs
       between 6 to 18 months, were repaired, and back into circulation - £ 28,400 of equipment back
       into stock, reducing the need to buy new stock. Reduction in the amount of funding required to
       procure equipment to replace items waiting for repair. £20,000 spent in 2011/2012. £28,400 of
       equipment now in circulation.

Call Confirm Live
An evaluation of the pilot has commenced and completed by September 2012. There is evidence of
fewer emergency call outs:
    Baseline August 2011 - 52 emergency callouts to August 2012 - 30 emergency callouts
    Allocation of overtime by home care workers has reduced by 5/6

Patient Transport Service
      Analysis of 6 months of pilot project evidenced that for a small investment of £2,500 – an
       estimated 246 bed days were avoided.

3. There is a planned Acute Visioning Day in April 2013 which will include discussions on future service
   model and the redeploying of resources to the partnership.
Please describe your approach to determining the long term sustainability of your Change Fund
investments. Please provide summary information on any investments for which clear evidence as to
their sustainability is available.

The Change Team developed their approach to Change Fund allocation with a clear strategic vision of
what were agreed local priorities that fit within national strategic drivers.

The approval process for Change Fund allocation ensures that bids are aligned and can evidence long
term sustainability and that this is one of the criteria for funding.

To ensure sustainability the strategic approach taken by the change Team was to consider requirements
within our infrastructure, and utilise the Change Fund for intensive periods of staff support to deliver
change , these are as follows:

      2 year post Career Pathway – future of care at home, to transform homecare services and move
       away from time oriented service to task, process of cultural and staff change and move towards
       generic working and integrated teams.

      A 2 year post to look at our asset infrastructure to ensure this is fit for purpose and our changing
       demographic profile;

      Call Confirm Live – investing in technology linked to new payroll systems and real time
       management of staff resource

      Review Team – review of all homecare packages, this has meant a full reassessment of
       homecare packages to ensure package of support is tailored to individual need

      Dallas – as part of the Living It Up team develop the national strategic direction activities and
       priorities for telehealth and telecare to make recommendations to NHS 24 and Scottish
       Government, ensuring the needs and aspirations of service users are a fundamental
       consideration within developments.

      A 2 year post to drive forward the mental health review, moving away from acute hospital based
       services to community based closer to the point of need

      Update technology to adapt and improve working practices, to meet advances in technology.
       Purchase of hardware, pens forms, software and training. Linked to Modernising Community
       Nursing. Technology such as Call Confirm Live and Digital Pen/Patient Held Record has been
       tested and was developed within organisations with the intention of ensuring joint applicability and
       inter operability. These systems will be rolled out across organisations.

A recent mapping of all Third sector services has evidenced that with a population of 26,500 we have a
relatively strong base on community based care. The Third Sector is already well developed and there is
a comprehensive infrastructure. It is geographically focussed and seeks to respond to the needs of the
local communities in which they operate. The Change Fund has supported Third Sector organisations to
increase their capacity and has provided support to them through training in preparation for joint
Please describe your approach to determining the return on investment of your Change Fund
investments. Please provide summary information on any investments for which you consider clear
evidence is available as to the return on investment that they are delivering
The Change Team are investigating a consistent approach to capturing ROI for all Change Fund projects,
by adapting the use of the eHIT tool that is currently used to evaluate outline business cases to the
eHealth Programmes Board

At present all projects are monitoring outputs against our Project Monitoring and Evaluation Framework,
this was developed taking cognisance of the national measures for adult health and social care which will
form the National Performance Framework The 7 Health and Care Integration Outcomes form the
Change Plan High Level Objectives. Funded projects need to evidence how they will help to meet these

To ensure consistency across partner agencies the Western Isles Change Team provided a standard list
of Outcomes and Outputs linked to these Objectives from which initiatives or projects selected from.
Initiatives/project are monitored on progress against these outputs
All monitoring against this framework will be linked into an outcomes framework which is under

Individual projects will not be able to evidence real difference in isolation. Service pressures can only be
resolved collectively through the integration agenda, pooled budgets and aligned management
Please describe the value of your Change Fund investment in prevention across the entire re-
shaping care pathway. Please explain the rationale that you have used to identify relevant investments, in
particular those that fall within the institutional spectrum

Resource allocation per annum by pathway
            Preventative & Proactive Care &        Effective Care    Hospital & Care       Enablers
             Anticipatory    Support at Home         at Time of         Homes
                 Care                                Transition
 2011/12           £88,203          £260,400              £37,503            £7,085           £139,295
 2012/13          £211,411            £78,445           £105,097            £45,897           £171,150
 2013/14          £238,179          £105,511            £149,313            £94,565           £209,693
 2014/15                tbc                tbc                 tbc               tbc                tbc

Total resource allocation by pathway over the Change Fund to date.
             Preventative & Proactive Care &        Effective    Hospital & Care          Enablers
              Anticipatory     Support at Home Care at Time         Homes
                   Care                           of Transition
 2011-14        £537,793          £444,356         £291,913        £147,547               £520,138

Investment to date has continued to move focus towards anticipatory and preventative care, a number of
our enablers are also in preparation towards preventative care rather than acute hospital provision for
example Dallas, Mental Health Review, Community Equipment, FAST service emergency respite. In
addition investment in equipment which is non recurring has allowed for hospital beds in care homes to
prevent hospital admissions and community beds to avoid hospital or care home admissions.

Workstream allocations for 2013/14 are outlined on the attached spreadsheet detailing allocations, and
support to Carers.

Throughout the Change Team support to carers (Direct and Indirect support) has been above the
minimum of 20% as follows:

 Investment on direct carer support                          £77,250         15%
 Investment on indirect carer support                        £77,453         15%
 Total overall investment on carer support                  £154,703         29%

 Investment on direct carer support                          £97,344         16%
 Investment on indirect carer support                        £67,615         11%
 Total overall investment on carer support                  £164,959         27%

2013/14 -(estimated as allocations not fully completed)
Investment on direct carer support                            £89,544         11%
Investment on indirect carer support                          £80,169         10%
Total overall investment on carer support                    £169,713         21%
Most projects are cross cutting and do not fit solely within one pathway, this is essential within a remote
and rural area, where there is very little single service delivery. Projects which could be deemed to be in
the acute sector were targeted towards service change such as Mental Health Redesign; preventing
delayed discharge and improving service efficiency e.g. aScribe and Patient Transport Pilot; or projects
which link between hospital and care homes to community based services such as our newly established
Dementia Link worker.
Change Fund 2013/14 – Financial Summary

 ITEM                                                                                 £
 2012/13 Change Fund year end spend total                                                      £612,000
 2012/13 Change Fund carryover                                                                 £120,000
 2013/14 Change Fund allocation                                                                £607,000
 2013/14 local resources added to central Change Fund                                          £125,000
 allocation (LA)
 2013/14 local resources added to central Change Fund                                                  0
 allocation (NHS)
 2013/14 other local resources added to central Change Fund                                    £376,324
 allocation (CNES and NHS allocation to Third Sector SLAs)
 Total 2013/14 Change Fund resources                                                          £1,228,824

 Carers                                                              £                      G
                                                              Projected spend     % of total 2013/14
                                                                   in £s          Change       Fund
 Change Fund investment on direct carer support                    £89,544                 11%
 Change Fund investment on indirect carer support                  £80,169                 10%
 Total Change Fund investment on all carer support                £169,713                 21%

The above figure is an estimation as not all Change Fund is allocated, but there is a commitment to ensure
that Change Fund will support carers with a minimum of 20% of Change Fund.

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