Adult social care support and community health: draft Scottish learning and improvement framework

5. Draft Scottish Learning and Improvement Framework

The aim of the framework is to provide an overarching common direction for improvement activity across the adult social care support and community health system. It seeks to support the focus of improvement activity around the agreed priority themes and signpost data, evidence and information to support local change initiatives. Once operationalised it will provided professionals and organisations with a clear way of recording and understanding the impact of the changes they are testing in order to inform their approaches.

Taking an improvement approach will change the intention of much of the data collected from a performance reporting and scrutiny to data capture at all levels in the system, which prioritises system intelligence to inform decisions and helps better understand the collective impact of the improvement activity.

The term ‘improvement’ is used broadly to refer to ‘any measurable, positive change to an outcome from an established baseline’.

The framework will interface with service level improvement frameworks. This will aid integration of the system and support a flexible approach to delivery (at a service or local level) for the improvement activity deemed most appropriate to deliver positive change to an outcome. This could include:

• Advances in technology, medicine and psychosocial interventions;
• Developing the knowledge and skills of those working in social care support and community health services;
• Redesigning systems, services, and processes, so they enable staff to reliably carry out tasks to the highest quality;
• Developing the knowledge and skills of the general population to better manage their own health and wellbeing.

The SLIF will also support the system to demonstrate its contribution to three overarching policy drivers: the National Performance Framework, the PANEL Principles and the Health and Social Care Standards: my support, my life.

Human rights based approach and PANEL principles

The Scottish Government are committed to embedding human rights across its policy making, decision-making and delivery.

Taking a human rights based approach (HRBA) is about making sure that people's rights are put at the very centre of policies and practices. The HRBA is a framework for ensuring that both human rights principles and standards are integrated into policy, planning, service delivery, and evaluation. It emphasises empowering individuals and communities, particularly those who are marginalised, to claim their rights and participate in decisions that affect their lives and increasing the ability and accountability of duty bearers to uphold rights. Applying the approach ensures that public services and policies are designed and delivered in ways that respect, protect, and fulfil human rights. It shifts the focus from charity or needs-based models to one where individuals are recognised as rights-holders and institutions as duty-bearers. Done correctly, a human rights based approach ensures that intersectionality and people whose rights are most at risk are central to the process.

The PANEL principles are central to this approach and provide a practical guide for implementation. By embedding participation, accountability, non-discrimination, empowerment, and legality into everyday practice, the HRBA promotes fairness, dignity, and justice for all.

The SLIF has embedded the PANEL principles through its design and development, and will continue to ensure these principles are delivered throughout its implementation. Annex 2 includes a PANEL analysis which provides a description of how the SLIF delivers a rights-based approach and areas for future consideration.

Figure 2 gives the overview of the links to policy drivers. The detail of the thread between the draft framework and these policy drivers is provided in Annexe 2.

National Performance Framework – this is the overarching policy driver, at a national level.

The Health and Social Care Standards and a Human Rights Based approach, based on the PANEL principles, sit beneath and feed into meeting outcomes relevant to health and social care services within National Performance Framework.

Two key outcomes within the SLIF feed into and support the Health and Social Care Standards, a Human Rights Bases approach and the National Outcomes. These are relevant to people and the workforce and they are: ‘People, including Unpaid Carers are enabled to live a good life as independently as possible in a place of their choosing’ and, ‘The adult social care support and community health workforce is thriving’.

Who is the framework for?

The framework is intended to support all professionals and organisations working in adult social care support, social work and community health to capture intelligence around their improvement activities, and to inform decisions in a way that drives improvements for people.

The framework aims to provide consistency and clarity to support intelligence around what is working well across the sector, and why. It will focus activity around agreed priority themes, while supporting local flexibility on approaches to how service improvement happens.

The SLIF will not cut across professional responsibilities and accountabilities. While individual services and settings may have their own improvement focus, the SLIF will provide a link between activity across the system. This will help to demonstrate collaborative impact and reduce duplication.

The framework will be a live document which will be regularly reviewed. This is to ensure new evidence and intelligence generated from its data collection and monitoring function is used to ensure the framework remains focused on the priorities for future improvements.

Priority themes

The SLIF sets out five cross-sectoral agreed priority themes for improvement, which are:

• Ensuring person-led practice^[1] is embedded as the way care is provided;
• Supporting the workforce;
• Supporting people who provide unpaid care;
• Creating integrated systems and processes of care, which enable rights-based delivery;
• Embedding ethical strategic planning and commissioning.

Each of these priority themes are equally important and interdependent. Action to improve one priority theme will have an impact on others, therefore, considering interdependencies is fundamental to the success of the framework.

Work within each of these themes will be tracked by a set of common outcomes, which have been agreed as part of the framework’s development. Figure 3 on the following page sets out an overview.

Scottish Learning and Improvement Framework

Two key outcomes within the framework are 1.  People, including Unpaid Carers are enabled to live a good life as independently as possible in a place of their choosing and, 2. ‘The adult social care support and community health workforce is thriving’

Contributory outcomes that support these key outcomes include:

• People are connected and supported through their local communities
• People have an active role in maintaining their health and wellbeing
• People experience coordinated care and support delivered by a workforce working effectively across the system
• Workforce work in a system and culture that supports high quality, safe, human rights based care as standard
• The adult social care support and community health system is continually improving and making best use of resources
• Planners and commissioners work in ways that further equalities and human rights

 This is supported by two framework pillars:

• Meaningful measurement at every level of the system, from individual to national
• Embedding effective approaches to the management of quality at every level of the system, creating conditions and enabling continuous learning and improvement

Priority themes within the SLIF are:

• Ensuring person led practice is embedded as the way care is provided
• Supporting the workforce
• Supporting people who provide unpaid care
• Embedding ethical strategic planning and commissioning
• Creating integrated systems and processes of care which enable rights based delivery

Framework Pillars

To maximise impact, during the co-production of the framework it became clear that, alongside the framework, the conditions needed to be created to support an improvement approach.

As a result, the framework has two core pillars to support improvement:

1. Creating meaningful measurement at all levels of the system, from individual to national;

2. Embedding effective approaches to the management of quality at every level of the system, creating conditions and enabling continuous learning and improvement.

Meaningful measurement at each level of the system

Moving from the primary use of data for performance management and scrutiny, to an improvement approach, is a fundamental pillar of the framework.

The framework will support an improvement approach to data which is structured on what is important at each level of the system, to inform learning and effective development.

To support this process, a set of principles for meaningful measurement have been developed. This creates clarity to review indicators and measures supporting the framework at the national, regional and service level.

Meaningful Measurement Principles

Across all levels of the system meaningful measurement:

1. Is clear, consistent and well defined;

2. Avoids duplication and unnecessary measures;

3. Is meaningful at the different levels of the system.

At the national level meaningful measurement:

4. Is clear in its purpose;

5. Leads to meaningful insight and intelligence.

At the regional or organisational level meaningful measurement:

6. Is flexible and responsive to local need;

7. Is co-designed with people using and providing services (including providers and the workforce).

At the individual level meaningful measurement:

8. Is useful to people and promotes ownership;

9. Data requests facilitate ease of input.

In order to track impact, a range of measures reflecting the breadth of issues that can affect people’s outcomes will be identified. This avoids, as far as possible, a situation where any single measure generates unintended actions in the system by becoming the single focus of activity for health and social care services. The identification and further development of measures and indicators will be developed in collaboration with a range of internal and external stakeholders, including GIRFE.

Embedding effective approaches to the management of quality at every level of the system, creating conditions and enabling continuous learning and improvement

To embed an improvement approach in the system, creating the conditions for quality and improvement are essential. This goes beyond capturing data and intelligence and recognises the importance of leadership, skills and capacity, and embedding a supportive and respectful culture.

The following have been agreed as key drivers to creating the conditions for quality and improvement:

• Clarity at every level of the health and social care system on what a quality management approach is and why it matters;
• Increase the capacity and capability for improvement based on what matters to people;
• Identify and embed effective mechanisms for evaluating and spreading improvement;
• Enable cultures of collaboration, continuous learning, improvement and innovation.

These drivers will form a core part of the testing phase to operationalise the framework and will require action at a local and national level.