Informal engagement with local providers has highlighted an opportunity to support training and development needs, in particular development of leadership and management skills for 9 care home managers and also 3 managers of extra care housing through the My Home Life programme.
The principles behind Reshaping Care emphasise the need for effective partnership working across all sectors involved in supporting older people. The independent sector is a major provider of health and social care services across Scotland. The appointment of a Development Officer was intended to achieve the following aims:
Ensure the sector were fully informed, engaged with, and represented in relation to the Reshaping Care agenda.
Identify and encourage relevant workforce development opportunities for the sector which will support the principles of continuous change and improvement.
Promote key Reshaping Care themes amongst the sector and their role in contributing towards these e.g. falls prevention, infection control, end of life care, dementia, medications, anticipatory and preventative care
The number of people in the UK aged over 65 is growing and is forecast to reach 16.1 million by 2035. The burden of disease associated with aging will increase as will the demands on health services including end-of-life and palliative care. The National Confidential Enquiry into Patient Outcome and Death in 2008 found that rather than advanced care planning and palliation taking place, some patients were subjected to excessively active interventions in their last months of life.
The pilot study aimed to ascertain whether using primary and secondary care data to identify patients at risk of hospital admission and agreeing and implementing an Anticipatory Care Plan in this population could help to reduce hospital admission rates. Anticipatory care planning allows patients to express their wishes for care prior to a sudden deterioration in their health.
The negotiation of each organisation’s contribution to making the pathway work. Developing a pathway that is easy to access and offers the fallen person timely assistance. Promoting and embedding the pathway across all organisations.
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).