Angus Integration Joint Board (IJB) is developing a new Strategic Commissioning Plan (Plan) for 2023-2026. This plan will set out the vision of Angus IJB and our ambitions for the adult health and social care services which are delegated by Angus Council and NHS Tayside to Angus Heath and Social Care Partnership (HSCP).
The resource challenges that we face, both in terms of finances and workforce, are bigger than they have ever been. This means that the IJB will have some difficult decisions to make in the years ahead. We ask that people continue to engage with us, understand why changes need to happen and help us make the best decisions for our local communities.
The Plan is aligned to the nine National Health and Wellbeing Care Outcomes and describes the key themes we will focus on to address the increasing health inequalities in Angus and ensure we deliver high quality community health and social care in the most efficient and effective ways so that adults are supported to stay well and maintain their independence.
The Plan is required to take into account the current and future health and wellbeing needs of the population of Angus. The population of Angus is 116,000 and this expected to slightly decrease over the next ten years (2018 – 2028). However, we expect there will be fewer people aged 65 and under which reduces the number of working aged adults. We also expect the number of people aged 75 years and over will increase by 30%. This has implications for service provision as evidence indicates that the older people become they tend to have more long-term health problems. We know we need to do more to prevent avoidable admissions to hospital.
It is widely accepted that deprivation is linked to poorer health outcomes. 7.7% of people in Angus live in areas of greatest deprivation in Scotland. People in Angus have a higher life expectancy than Scotland. Life expectancy in Angus has not grown over the period of the last strategic plan. There continues to be a real gap between life expectancy for those living in the most deprived areas of Angus where men can live approximately nine years less and women three years less than those living in the least deprived areas of Angus. The proportion of life spent in good health varies, with men experiencing 81% of their life in good health (2% higher than the Scottish average) compared to women who spend 74% of their life in good health (2% less than the Scottish average).
Individuals, families and communities are at the heart of this Plan. We continue to have a firm commitment to the principles of reducing inequalities, promoting opportunities and eliminating discrimination in line with the Equality Act and with Human Rights legislation.
It is important to acknowledge that the landscape in which we have developed this plan is markedly different compared to our previous plans. We can no longer assume that there will be any significant additional funding to support the delivery of health and social care. This means that the resource challenges that we face, both in terms of finances and workforce, are bigger than they have ever been. It also means that services we currently provide as a Health and Social Care Partnership we may no longer be able to do.
The Plan was created through engagement with staff, our partners, service users and the public. We have developed a ‘plan on a page’ which outlines our vision, values, strategic priorities, our commitments and some important areas that will enable us to achieve our priorities over the next three years.
Angus Strategic Commissioning Plan on a Page
Feedback suggests that it is acceptable to ask people to do what they can to make a difference. We have developed a series of joint commitments based on the fact that we will do what we can to support people with an assessed need but we ask that people do what they can to help themselves, their families and neighbourhoods to improve and/or maintain their health and wellbeing.
We continue to develop the Angus Care Model which is shifting the balance of care from the traditional setting of hospitals to supporting people to live in a homely setting for as long as possible.
We were asked to redesign our Angus Care Model image to show the range of services that are available and where they are provided across Angus.
We asked you to review the priorities detailed in our previous Plan. You told us they were unclear and needed to be simplified. We have listened to your feedback and refreshed our priorities. (More details of our commitments to these priorities can be found on the ‘plan on a page’.)
Our priorities are:
- Prevention and Proactive Care: This is about promoting ways to keep people healthy; building stronger and more resilient communities; acting early to anticipate needs.
- Care Closer to Home: This is about providing care closer to home whenever possible; working with partners to provide the right care in the right place at the right time; supporting carers to sustain their caring role and enable them to have a fulfilling life alongside caring.
- Mental Health & Wellbeing and Substance Use and Recovery: This is about delivering the ambitions of the Angus Living Life Well Plan which aims to meet the mental health and wellbeing needs of the adult Angus population. We also want to support people to recover and manage their condition and provide consistent delivery of safe, accessible, high quality drug treatment across Angus.
- Equity of Access and Public Protection: This is about removing barriers to accessing services and addressing inequalities; reducing homelessness; keeping vulnerable people safe.
More about what we are going to do
We are developing a Delivery Plan which details the actions we plan to take over the next three years to deliver on the priorities within this Plan to make sure we can deliver high quality community health and social care in the most efficient and effective ways so that adults are supported to stay well and maintain their independence.
For each of the priorities identified, we have described where we aim to be by 2026 and the actions required to achieve this. Progress on our Strategic Commissioning Plan will be monitored on an ongoing basis using the agreed National Health and Social Care Integration core indicators.
More about what we will do:
Priority 1. Prevention and Proactive Care.
Where we want to be by 2026:
- People are better informed about what they can do to help themselves maintain and improve their health and wellbeing.
- Increased availability of evidence-based exercise programmes to support people to maintain and improve their health and wellbeing.
- Reduce the variation in the way medicines are prescribed, undertaking medication reviews and increasing awareness and availability of evidence-based alternatives to a prescription.
- People in Angus are more aware of how they can reduce their risk of falls.
- Increased use of anticipatory care planning so people are more informed about the support, care and treatment available for their mental and physical health, which supports making choices about planning for the future.
Some examples of what we will do:
- Work with partners to enable and support individuals and communities to take ownership of their health and wellbeing
e.g. improving the quality and access to information and activities that promote a healthy lifestyle.
- Explore and introduce evidence-based alternatives to a medicines first approach e.g. Nature Prescribing.
- Offer condition specific exercise classes across Angus e.g. falls prevention, stroke rehabilitation, pulmonary rehabilitation.
- Continue to review and support the self-management of long-term conditions and promote digital solutions.
- Promote digital solutions to support independence e.g. Independent Living Angus Platform and LifeCurve.
- Provide targeted support for quality improvements in prescribing.
- Increase community involvement through existing networks and look to build new ones.
- Increased focus on planning for the future so potential issues will be identified before they become a crisis.
- Ensure young people who require services as adults receive the support to meet their needs.
Priority 2. Care Closer to Home.
Where we want to be by 2026
- Have an equitable and sustainable model of care home and care at home provision which best meets people’s needs and is available with their locality.
- Reduce unnecessary variation in community care provided across Angus localities including access to care provided at home rather than in hospital.
- Increase the number of carers who feel supported to continue in their caring role.
Some examples of what we will do:
- Explore a variety of options to meet unmet need in care at home provision.
- Continue to build the community stroke rehabilitation pathway.
- Develop an Angus-wide model of nursing which best meets the needs of those who reside in an Angus care home.
- Refresh the Angus Palliative and End of Life Care Plan 2019-2023.
- Revise care provision models to ensure that the care and treatment people need is delivered by the most appropriate person with the knowledge and skills required.
- Introduce an electronic patient record for community nursing and allied health professionals to enable mobile access to a person’s clinical information.
- Continue to develop and implement the Angus Primary Care Improvement Plan and the Angus Primary Care Premises Strategy.
- Continue to develop and implement the Physical Disability and Learning Disability improvement plans.
- Undertake a strategic review of the GP Out of Hours service to ensure the sustainability and provision of accessible services.
- Review the delivery model for community meals.
- Review the delivery model for community alarm.
- Review how people who need help to take their medications at home receive support from the most appropriate person.
- Ensure people’s homes meet their needs especially in relation to adaptations and use of telecare.
- Explore and improve the delivery of health and social care closer to home preventing the need for acute admission to hospital.
- Develop a framework for decision making and eligibility criteria for complex care packages.
- Refresh the Angus Carers Strategy and deliver on the priority areas to improve visibility, empowerment, life-balance, influencing and equity of Carers in Angus.
Priority 3. Mental Health and Wellbeing and Substance Use Recovery.
Where we want to be by 2026
- Recruit and develop mental health specialist multidisciplinary teams to provide mental health care in communities rather than in hospitals.
- Implementation of all 10 Medication Assisted Treatment (MAT) national standards.
- Introduce community mental health hubs in all four Angus localities.
- Physical health and medication monitoring requirements for all those with a mental health disorder will be met across Angus.
During 2022 we engaged widely and produced the Angus Living Life Well Plan which contains a number of actions that we are currently working on:
- Good mental health for all – Helping people to know what to do to keep themselves mentally well.
- Primary and Community Mental Health – Getting help from GP practices and local community support networks quickly so that people can get back to feeling well.
- Specialist Adult Mental Health – Improvements in access and delivery of specialist mental health services for adults
- Older People’s Mental Health – Improvement plan for specialist mental health services for people over the age of 65 years.
- Leadership and Culture.
Some examples of what we will do:
- Continue to develop specialist mental health multi-disciplinary teams providing mental health care in communities rather than in hospitals, developing new roles for staff and pathways of care in the community.
- Improve access to high quality suicide prevention training.
- Improve social support, prevention and self-management opportunities for people with mental distress.
- Continue to develop multi-disciplinary teams providing substance use services in communities. Developing new roles for staff and integrated pathways of care to holistically meet care and treatment needs. In a timely manner.
- Further develop pathways of care to ensure people at high risk of drug related harm are proactively identified and offered support.
- Work with Health Improvement Scotland and local partners to develop and deliver pathways of care that ensure people with co-occurring mental health difficulties can receive mental health care.
Priority 4. Equity of access to high quality health and social care.
Where do we want to be by 2026?
- Increase the number of staff who have completed the Angus Core Roles and Responsibilities in adult protection training.
- Continue to reduce homelessness.
Some examples of what we will do:
- Improve urgent and unscheduled care pathways so that people access the right care at the right time in the right place.
- Ensure staff understand the levels of inequality in Angus to enable improved decision making that makes a positive contribution to reducing health inequalities.
- Improve access to advocacy services so all adults, carers and care experienced children and young people have timely access to advocacy services.
- Work with Angus Council to expand housing options so more people can live independently in their own homes.
- Develop new models of support for people at risk of homelessness.
- Continue to deliver the national Ending Homelessness Together strategy and Angus Rapid Rehousing Transition Plan in collaboration with housing partners and other stakeholders.
- Continue with the implementation of the homelessness service review to prevent and address homelessness.
- Progress quality assurance and improvement work in adult protection across all services to protect adults who may be at risk of harm.
How to be involved in shaping this Plan
We would like to hear your views on our vision, priorities and the range of actions we are proposing over the next three years.
** The survey has now closed. Thank you to everyone who shared their views and provided feedback.