To improve entire patient pathways in the areas of Medicine of the Elderly, orthopaedic rehabilitation, stroke services and management of acute patients with dementia and delirium. Specifically to use lean methodology to:
Improve flow to ensure that patients get timely access to the appropriate services
Reduce lengths of stay for older people
Improve health and social care interfaces
Support the rebalancing of care towards care in the community
Improve the management of patients in acute settings with dementia and delirium.
 (Care Homes not in scope for the programme. MoE encompassed community & social care services (except Stroke, GORU & Dementia).
Investment in the implementation and ongoing development of a web-based IT system to support the effective provision of the Equipu Community equipment Partnership across 6 local authorities and NHSGGC.
The service was established in 1998 by Lochalsh and Skye Houisng Association to provide a ‘traditional’ small repairs service to disabled people and the elderly. Through collaboration with the Highland Council and NHS Highland it has since set up and operated Joint Equipment Stores in Portree and Broadford to collect, deliver and manage all equipment owned by Social Work Services and NHS Highland. The service also now includes telecare and occupational therapy support, and runs a demonstration/assessment room within Portree hospital as a training facility for the use and benefits of devices.
All these complementary services are aimed to support people to remain in their own homes and to shift the balance of care from hospital into homely settings. They illustrate the key contribution that locally based housing associations can make to the reshaping care agenda, working in partnership with health and social care.
To provide high quality information in the form of DVDs for people with dementia and their carers.
One important aspect to the support of people with dementia and their carers is the availability of high quality information. Scotland’s National Dementia Strategy (2010) and the ‘Standards of Care for Dementia in Scotland’ (2011) highlight the importance of information in improving understanding of the benefits of early diagnosis and support through all stages of the dementia journey.
An integrated housing and social care plan across local authority, health, third and independent sector providers was implemented to promote service improvement and cost efficiencies whilst improving outcomes for individuals and their carers. Specifically:
To provide services designed to promote independence and wellbeing through flexible and integrated onsite personal care and housing support teams within sheltered and very sheltered housing.
To address recruitment difficulties
To reduce in-house service costs, maximise capacity, reduce duplication and reduce travel time.
To reduce the number of admissions to hospital and facilitate a speedy return home following an illness/crisis.