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Community Care Outcomes Framework

Policy Title: Community Care Outcomes Framework

Department: DIRECTOR-GENERAL HEALTH and Chief Executive NHS Scotland

Group: PRIMARY and COMMUNITY CARE DIRECTORATE

Division: Partnership Improvement and Outcomes Division

Branch: Joint Future Unit 

Aims of the Policy
What is the purpose of the policy (or the changes made to the policy)? The purpose of the Community Care Outcomes Framework is to improve joint delivery of community care services and, as a result, provide better outcomes for people who use those services and their carers. It includes a number of measures:
•% of community care service users feeling safe.
•% of users and carers satisfied with their involvement in the design of care package.
•% of users satisfied with opportunities for social interaction.
•No. of patients waiting in short stay settings, or for more than 6 weeks elsewhere for discharge to appropriate setting.
•No. of people waiting longer than target for assessment, per 000 population.
•No. of people waiting longer than target time for service, per 000 population.
•% of carers who feel supported and capable to continue in their role as a carer.
•% of user assessments completed to national standard.
•% of carers’ assessments completed to national standard.
•% of care plans reviewed within agreed timescale.
•No. of emergency bed days in acute specialties for people 65+, per 100,000 pop.
•No. of people 65+ admitted as an emergency twice or more to acute specialties, per 100, 000 pop.
•Percentage of people 65+ admitted twice or more as an emergency who have not had an assessment.
•Shift in balance of care from institutional to ‘home based’ care.
•% of people 65+ with intensive needs receiving care at home.
•% of people 65+ receiving personal care at home.

The Framework allows local authority/NHS partnerships to understand their performance locally at a strategic level in improving outcomes for people who use community care services or support, and their carers. It also allows partnerships to share this information with other partnerships in Scotland and mutually compare performance directly on the basis of consistent, clear information.
Who is affected by the policy or who is intended to benefit from the proposed policy and how? The intention is that people who use community care services and their carers will benefit as the objective of the Community Care Outcomes Framework is to improve community care services. Through use of the Framework local authorities and their NHS partners are requested to jointly demonstrate continuous improvement in the delivery of community care services.
How has the policy been, or will be put into practice, and who is or will be responsible for delivering it? The Guidance on Single Outcomes Agreement (October 2008) refers specifically to the Community Care Outcomes Framework as one of the frameworks which local partnerships(Local authority/NHS) may consider helpful in supporting their Single Outcomes Agreements. So far 30 of the 32 partnerships have indicated that they intend to begin to use the Community Care Outcomes Framework in whole or in part during 2009/10.
How does the policy fit into the Scottish Executive's wider or related policy initiatives? The Community Care Outcome Framework fits with the Government's Healthier strategic objective ‘to help people to sustain and improve their health, especially in disadvantaged communities, ensuring better, local and faster access to health care.’
It also fits with the national outcome ‘ Our public services are high quality, continually improving, efficient and responsive to local people's needs’
Have the resources for the policy been allocated? No
What's known about the diverse needs of the target audience?
Is there information on Age? Yes
Age - Evidence The Scottish Government’s statistical publications show that in April 2008 68,759 people in Scotland were receiving 651,104 hours of home care services. Of that figure 10,444 were aged 65 -74; 23,277 were 75 – 84; and 21,617 were 85+. The proportion of people aged 65 and over receiving intensive home care (10+ hours a week) as a percentage of all older people receiving long term care has increased from 25.6% in 2003 to 31.6% in 2008, reflecting the priority on shifting the balance of care. 8655 people aged 65+ received 10 - 14 hours of home care;3688 received 15 - 19 hours of home care; and 2989 received 20+ hours of home care.

There were also 31,274 people aged 65+ in Care Homes. Of that figure 3583 were aged 65 -74: 11,728 were aged 75 - 84; and 15,963 were 85+.

There were 1747 people over 65 receiving long term care in hospital. Of that figure 409 were aged 65-74; 748 were 75 - 84; and 590 were 85+.

The percentage of people aged 65 or over who were admitted as an emergency inpatient more than once was 4.9 % in 2008.
Age - Consultation In 2004/05 six roadshows were held and a number of consultative events and meetings were arranged as well as a written consultation to inform the development of the Joint Services Framework – Better Outcomes for Older People published in 2005. Included in that were people who used services and carers who helped to identify areas where local authorities and the NHS could work together to improve services through joint working including:
•An active and healthy life
•Independence at Home
•Enhanced Care
•Services for carers
•Services for older people with additional needs
•Services for People with dementia.

Although partnerships were asked to evaluate the improvement in outcomes for older people this proved difficult to measure without a national framework. This led to the development of the Community Care Outcomes Framework. The Framework includes 16 measures which were developed at stakeholder events in November 2006 and March 2007 as a wider open consultation (written and web based). A number of organisations representing older people were included in identifying the outcomes which partnerships should measure and there was further opportunity to contribute following a presentation at the Scottish Pensioners Forum in March 2007.
Is there information on Disability? Yes
Disability - Evidence The Scottish Government’s statistical publications show that in April 2008 68,759 people in Scotland were receiving 651,104 hours of home care services. Of that 3,754 people had dementia; 3,285 had mental health problems; 3,705 had learning disabilities; and 53,091 had physical disabilities.

Of those with learning disabilities 10% were 65-74; 4% were 75 -84 and 2% were 85+.

Of those with physical disabilities 11% were 65-74; 16% were 75 -84 and 39 % were 85+.

Statistics for the Adults with Learning Disabilities Implementation of ‘Same as You?’ show that in 2007 there were 22,875 adults with learning disabilities. Of these 2,062 were 65+.
Disability - Consultation In 2004/05 six roadshows were held and a number of consultative events and meetings were arranged as well as a written consultation to inform the development of the Joint Services Framework – Better Outcomes for Older People published in 2005. Included in that were people who used services and carers who helped to identify areas where local authorities and the NHS could work together to improve services through joint working including:
• Services for older people with additional needs
• Services for People with dementia.

Although partnerships were asked to evaluate the improvement in outcomes for older people this proved difficult to measure without a national framework. This led to the development of the Community Care Outcomes Framework. The Framework includes 16 measures which were developed at stakeholder events in November 2006 and March 2007 as a wider open consultation (written and web based). A number of organisations included in identifying the outcomes which partnerships should measure.
Is there information on Faith/Religious Belief? No
Faith/Religious Belief - Evidence  
Faith/Religious Belief - Consultation  
Is there information on Gender? Yes
Gender - Evidence The Scottish Government’s statistical publications show that in April 2008 68,759 people in Scotland were receiving 651,104 hours of home care services. Of that figure 22,007 were male and 46,752 were female.

Statistics for the Adults with Learning Disabilities Implementation of ‘Same as You?’ show that in 2007 there were 22,875 adults with learning disabilities. Of these 2,062 were 65+. Of that figure 1,004 were male and 1,058 were female.

Also 70% of older people in care homes were female and 30% male.
 
Gender - Consultation In 2004/05 six roadshows were held and a number of consultative events and meetings were arranged as well as a written consultation to inform the development of the Joint Services Framework – Better Outcomes for Older People published in 2005. Included in that were people who used services and carers who helped to identify areas where local authorities and the NHS could work together to improve services through joint working. No information was sought on the basis of gender.

Although partnerships were asked to evaluate the improvement in outcomes for older people this proved difficult to measure without a national framework. This led to the development of the Community Care Outcomes Framework. The Framework includes 16 measures which were developed at stakeholder events in November 2006 and March 2007 as a wider open consultation (written and web based). A number of organisations included in identifying the outcomes which partnerships should measure although no information was sought on the basis of gender.








 
Is there information on Lesbian, Gay, Bisexual and Transgender (LGBT)? No
LGBT - Consultation  
LGBT - Evidence  
Is there information on Race? Yes
Race - Evidence 0.5% of Care Home residents are from minority ethnic backgrounds. No other evidence on community care services is held by race.
Race = Consultation In 2004/05 six roadshows were held and a number of consultative events and meetings were arranged as well as a written consultation to inform the development of the Joint Services Framework – Better Outcomes for Older People published in 2005. In particular consultation meetings were arranged with service users and carers in the Dixon Centre in Glasgow, the multi-ethnic carers group in Edinburgh South/Central, Ethnic Minority Carers in Aberdeen, the Wing Hong Chinese Elderly Centre. The following organisations were also particularly involved:
- Minority Ethnic Carers of Older People (MECOPP)
- MinorIty Ethnic Learning Disability Initiative (MELDI)
- Edinburgh Chinese Elderly Support Association (ECESA).
- Minority Ethnic Health Inclusion Project (MEHIP).

Although partnerships were asked to evaluate the improvement in outcomes for older people this proved difficult to measure without a national framework. This led to the development of the Community Care Outcomes Framework includes 16 measures which were developed at stakeholder events in November 2006 and March 2007 as a wider open consultation (written and web based). A number of organisations included in identifying the outcomes which partnerships should measure although no comments were received from any minority ethnic groups.
Is there enough information to help understand the needs and/or experiences of the target audience regarding:
Age? Yes
If not, what other information is needed? See step 2 for information.

The objective of the Community Care Outcomes Framework is to ensure that local authorities and NHS Boards jointly demonstrate continuous improvement in the delivery of community care services. Age should not be a factor in whether or not a person receives an appropriate community care service.
 
Disability? Yes
If not, what other information is needed? See step 2 for information.

The objective of the Community Care Outcomes Framework is to ensure that local authorities and NHS Boards jointly demonstrate continuous improvement in the delivery of community care services. Disability should not be a factor in whether or not a person receives an appropriate community care service.
 
On Faith/Religious Belief Yes
If not, what other information is needed? Although no information is available on the basis of religion and belief the objective of the Community Care Outcomes Framework is to ensure that local authorities and NHS Boards jointly demonstrate continuous improvement in the delivery of community care services. Religion and belief should not be a factor in whether or not a person receives an appropriate community care service.
Gender? Yes
If not, what other information is needed? See step 2 for information.

The objective of the Community Care Outcomes Framework is to ensure that local authorities and NHS Boards jointly demonstrate continuous improvement in the delivery of community care services. Gender should not be a factor in whether or not a person receives an appropriate community care service.
On Lesbian, Gay, Bisexual and Transgender? Yes
If not, what other information is needed? Although no information is available on the basis of sexual orientation the objective of the Community Care Outcomes Framework is to ensure that local authorities and NHS Boards jointly demonstrate continuous improvement in the delivery of community care services. Sexual orientation should not be a factor in whether or not a person receives an appropriate community care service.
Race? Yes
If not, what other information is needed? See step 2 for information.

The objective of the Community Care Outcomes Framework is to ensure that local authorities and NHS Boards jointly demonstrate continuous improvement in the delivery of community care services. Race should not be a factor in whether or not a person receives an appropriate community care service.
.
What does the information given say about how this policy might impact positively or negatively on the different groups within the target audience?
On Age Positive impact – The Community Care Outcomes Framework requires local authorities and NHS Boards to jointly demonstrate continuous improvement in the delivery of community care services regardless of age.
On Disability Positive impact – The Community Care Outcomes Framework requires local authorities and NHS Boards to jointly demonstrate continuous improvement in the delivery of community care services for all client groups.
On Faith/Religious Belief  
On Gender Positive impact – The Community Care Outcomes Framework requires local authorities and NHS Boards to jointly demonstrate continuous improvement in the delivery of community care services regardless of gender.
On Lesbian, Gay, Bisexual and Transgender  
On Race Positive impact – The Community Care Outcomes Framework requires local authorities and NHS Boards to jointly demonstrate continuous improvement in the delivery of community care services regardless of race.
Will there be any changes to the policy?
On Age No
On Disability No
On Faith No
On Gender No
On Lesbian, Gay, Bisexual and Transgender No
On Race No
Comments  
Does the policy provide the opportunity to promote equality of opportunity or good relations by altering the policy or working with others?
On Age? Yes
Age - Comments The objective of the Community Care Outcomes Framework is a tool for local authorities and their NHS partners to demonstrate better outcomes for all people aged 65+ who use community care services and their carers.
On Disability? Yes
Disability - Comments The objective of the Community Care Outcomes Framework is a tool for local authorities and their NHS partners to demonstrate better outcomes for all people aged 65+ who use community care services and their carers.
On Faith? Yes
Faith - Comments The objective of the Community Care Outcomes Framework is a tool for local authorities and their NHS partners to demonstrate better outcomes for all people aged 65+ who use community care services and their carers.
On Gender? Yes
Gender - Comments The objective of the Community Care Outcomes Framework is a tool for local authorities and their NHS partners to demonstrate better outcomes for all people aged 65+ who use community care services and their carers.
On Lesbian, Gay, Bisexual and Transgender (LGBT)? Yes
LGBT - Comments The objective of the Community Care Outcomes Framework is a tool for local authorities and their NHS partners to demonstrate better outcomes for all people aged 65+ who use community care services and their carers.
On Race? Yes
Race - Comments The objective of the Community Care Outcomes Framework is a tool for local authorities and their NHS partners to demonstrate better outcomes for all people aged 65+ who use community care services and their carers.
Level of relevance to the policy, based on the work that has been done
Age High
Disability Medium
Faith Medium
Gender Medium
Lesbian, Gay, Bisexual and Transgender Medium
Race Medium
Does a further assessment need to be done?
On Age? No
On Disability? No
On Faith? No
On Gender? No
On Lesbian, Gay, Bisexual and Transgender? No
On Race? No
Comments if a further assessment is needed?  
Comments if no further assessment is needed? The overall objective of the Community Care Outcomes Framework is to demonstrate better outcomes for all adults aged 65+ regardless of age, disability, gender, sexual orientation, race or religion and belief. If there is any further review of the policy it would then be advisable to carry out a further assesment to ensure that this objective is being achieved.
How will this policy/function be monitored and evaluated to ensure there are acceptable outcomes for all?
Comments Success will be assessed in terms of the achievement of better outcomes for people who use community care services and their carers. This will be monitored by the joint local authority/NHS partnerships using the Community Care Outcomes Framework to evaluate their progress. For those partnerships who use the Framework it will allow Scottish Government to see progress. Scottish Government will also monitor progress of some of the outcomes through the NHS HEAT targets on multiple emergency admissions, balance of care and delayed discharge. Some partnerships may also demonstrate progress through their Single Outcome Agreements.