Development of IJB Strategic Plan 2025-2030

We will transform, or significantly change, how services are planned and delivered to ensure that population needs can be met as effectively as possible within the resources available, whilst continuing to prioritise delivery of the outcomes that matter to individuals.

Delivery priorities

• 1.1 Continuing to shift the balance of care from hospital to community settings
• 1.2 Delivering services that are ‘outcome focused’ – planned around individual’s needs and reflecting what is important to them
• 1.3 Developing a Primary Care Strategy reflecting current and projected demand and identifying key priorities for development and investment
• 1.4 Developing Community Mental Health Services to support the shift of mental health provision from acute to community settings
• 1.5 Working with third sector partners to deliver new and innovative services, including through collaborative and coproduction approaches
• 1.6 Developing the use of digital technology to enhance and transform services
• 1.7 Developing services to meet the projected demand for palliative and end of life care, including in people’s homes and community settings
• 1.8 Working with partners in the Lothian Health and Social Care System to deliver shared priorities and identify opportunities for collaboration
   

Why is this a strategic objective for the IJB?

The need for health and social care services in East Lothian will continue to grow over the lifetime of the Strategic Plan. 

• East Lothian’s population has increased significantly in recent years and continued growth is projected.
• Population growth will result in a continued rise in pressure on public services, including health and social care services.
• For East Lothian, the largest growth is in the older population (65+), with an even higher percentage growth in the over 75s age group.  
• People typically need more support from health and social care services as they age, so growth in the older population is particularly significant for the IJB when developing its Strategic Plan.   
   

Meeting this growing need within the resources available will be increasingly challenging, meaning that we need to make significant changes to how we plan and deliver services:

• In common with IJBs across Scotland, East Lothian has faced increasing financial pressure in recent years, and this is set to become even more challenging.
• Financial recovery measures have already been implemented and difficult decisions made.
• Significant changes are now needed in relation to how we plan and deliver health and social care services to need growing demand within available resources. 
• In some cases, further transformational change will be required.
• The challenge is how we continue to improve outcomes for individuals whilst reducing costs.
• Taking a whole system approach, working collaboratively with our partners, will be essential in delivering the change needed. This includes partnership working at an East Lothian level, as well as with Lothian partners within the Lothian Health and Care System.

We need to engage with the public and other stakeholders to ensure that services continue to meet need effectively and that changes do not cause unfair disadvantage

• The level of service change needed will require further difficult decisions to be made and a shift in culture and expectations.
• Changes will potentially be unpalatable, and this adds to the challenge.
• Engagement with communities and other stakeholders will be important as new approaches are developed.
• We need to ensure that we assess the impact of any changes, including the impact on people with protected characteristics and on those more vulnerable as a result of social, economic, or other life circumstances. 

This objective reflects the Scottish Government strategic direction

• The Scottish Government has identified 4 key area of work related to achieving its vision of ‘a Scotland where people live longer, healthier, and more fulfilling lives’ – these include providing health and care that is ‘high quality, effective, sustainable and good value’, whilst ensuring provision is ‘responsive, respects individual needs, and delivers outcomes that matter to people’ (Scotland’s Population Health Framework 2025-2035)

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What do we need to prioritise to deliver this strategic objective?  

Focusing on the strategic delivery priorities below will help us to achieve this strategic objective. Further details, including timescales and targets, will be included in Annual Delivery Plans developed for each year of the Strategic Plan. In addition, there are a number of strategies / programmes already in place, or under development, that will provide direction (these are highlighted in bold italics below).

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1.1 Continuing to shift the balance of care from hospital to community settings.

Shifting the balance of care from hospital to community settings has been a key strategic objective for the IJB since its introduction.

Significant progress has been made in developing ‘Intermediate Care Services’ that provide support to people at home as opposed to hospital inpatient provision. These services deliver better outcomes for individuals; reduce pressure on hospital beds; and make more efficient use of resources. ‘Intermediate Care Services’ in East Lothian include Care at Home; Hospital to Home; Discharge to Assess; Day Services; the Emergency Care Service; and the Falls Service. Also key are the range of commissioned services delivered by third sector partners, including, for example, Day Centres for older people and Community First. 

Activity to support the Lothian wide Unscheduled Care Programme and ongoing development of the ‘Home First’ model in East Lothian will help further progress the shift in the balance of care from hospital to community. The challenge will be to continue to move service provision in this direction and to ensure that this is reflected in the allocation of budgets. 

The reallocation of financial and other resources will be required to support this ongoing shift from hospital to community. This will include the review of set-aside and hosted services arrangements and associated budgets.     

Specific activity required over the lifetime of the Strategic Plan will include:

• Ongoing participation in the pan Lothian Unscheduled Care Performance Improvement Programme, supporting a whole system approach to reducing pressure on acute services and bed based care.
• Continued development of the East Lothian ‘Home First’ model approach and the Single Point of Contact.
• Ongoing investment in and development of Intermediate Care Services, including delivery of the recommendations from the Planning for Older People Services programme report. 
• Delivery of the priorities identified in the Care at Home Strategy – to include improving the allocation of care at home and removing care at home as the default option for care.
• Working with partners to move to an integrated budget for the IJB to help progress flexible use and reallocation of resources from acute to community (reflecting shifts in service provision). This will include working with NHS Lothian colleagues and the wider Lothian Health and Care System to review the use of set-aside budgets.  

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1.2  Delivering services that are ‘outcome focused’ – planned around individual’s needs and reflecting what is important to them.

Developing services that are ‘outcome focused’ means that services are planned around individual need and what is important to the person receiving the service. Outcome focussed approaches help to ensure that services are appropriate and proportionate, promoting independence and, where appropriate, reducing reliance on formal services.    

This principle already underpins much of HSCP service delivery and commissioning of services, and will continue to underpin service development, including in relation to the transformation agenda.  

Revisiting and improving our approach to the implementation of Self Directed Support (SDS) in East Lothian will be a key area of focus going forward [1]. The overall aim of this work will be to support and enable people to achieve the outcomes that are important to them to lead full and meaningful lives.

Given the growing pressure on formal health and social care services, we need to help facilitate the use of alternative support to help people achieve their outcomes where appropriate (for example, through services delivered by third sector and community partners).

Specific activity required over the lifetime of the Strategic Plan will include:

• Ongoing development of strengths / asset-based assessments by Adult Social Work teams.  
• Redevelopment of the East Lothian Self-Directed Support (SDS) Plan to guide improvement work in relation to the use of SDS in East Lothian. This will be driven by an SDS Delivery Group, with oversight by the Intermediate and Social Care Programme Board.
• Continuing to take an outcome focused approach to health and social care commissioning (as outlined in the East Lothian HSCP Commissioning Strategy).

References:

[1] Self-Directed Support (SDS) gives people choice and control over how their social care is planned and delivered. The Social Care SDS (Scotland) Act 2023 defines values and principles in relation to SDS.

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1.3 Developing a Primary Care Strategy reflecting current and projected demand and identifying key priorities for development and investment  

For the vast majority of people, their main contact with healthcare services will be through primary care, with dentist and GP appointments accounting for the highest proportion of contacts.

In East Lothian, primary care services include those provided by GPs, dentists, opticians, and pharmacy, along with a range of services managed and delivered directly by the Health and Social Care Partnership (HSCP).[1]

Given what we know regarding the anticipated increase in demand across all services, future pressure on primary care is clearly an area of concern. Activity is needed to look at current and projected demand to inform the strategic planning and delivery of primary care services that are able to meet future population needs. Supporting General Practice sustainability and resilience must be a key priority within this, alongside the ongoing development of HSCP managed primary care services.    

Specific activity required over the lifetime of the Strategic Plan will include:

• Development of a Primary Care Strategy covering all primary care services, based on analysis of current and projected demand and identifying key priorities for development and investment.
• Establishment of a Delivery Group to deliver the Primary Care Strategy, with oversight from the Primary Care Programme Board.
• Ongoing participation in work to deliver HSCP priorities within the Pan Lothian Primary Care Programme as part of the Lothian Strategic Development Framework.  

References:

[1] Often referred to as ‘Primary Care Improvement Plan’ or ‘PCIP’ services. 

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1.4 Developing Community Mental Health Services to support the shift of mental health provision from acute to community settings.

Shifting the balance of care from acute to community settings is also a priority in relation to mental health service provision. Operationally, HSCP services continue to deliver activity to prevent unnecessary hospital admission; reduce the length of stay and preventing delayed discharge for patients in mental health inpatient settings. However, ongoing service development and resource allocation will be required to ensure there is sufficient capacity within community mental health services to continue to support this shift, as well as to meet any increase in demand resulting from demographic or other factors.

Specific activity required over the lifetime of the Strategic Plan will include:

• Development of a Community Mental Health Strategy to support the planning and delivery of community mental health services to meet current and projected demand and to support the ongoing shift of provision from acute to community settings. 
• Working with partners and potentially neighbouring IJBs to develop supported housing options for people in the community as an alternative to or following hospital admission.
• Ongoing participation in Pan Lothian Improvement Programmes as part of the Lothian Strategic Development Framework (including programmes relating to Adult Mental Health Discharge Without Delay; Older People Mental Health Discharge Without Delay; and Redesign of Mental Health Unscheduled Care Improvement Programmes). 
• Participation in Lothian Adult Neurodiversity Pathways Group to develop whole system patient pathway discussions.

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1.5 Working with third sector partners to deliver new and innovative services, including through collaborative and coproduction approaches.

Third sector organisations in East Lothian have a strong track record of delivering new and innovative service models and are well placed to work with communities to deliver collaborative and coproduction approaches.  Development of third sector provision also makes a valuable contribution in terms of promoting community cohesion and resilience, reducing social isolation, and supporting inclusion.  

We will continue to strengthen our relationship with our third sector partners, including through exploring further opportunities to work with the sector to develop new and innovative approaches to service delivery.

Specific activity required over the lifetime of the Strategic Plan will include:

• Working with the third sector to coproduce a ‘Compact’ setting out the principles underpinning the relationship between the sector and the IJB and recognising the sector’s key role.          
• Implementing the East Lothian HSCP Commissioning Strategy and Market Facilitation Statement, updating these as required to ensure that they fully reflect the IJB’s commitment to the third sector. 

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1.6 Developing the use of digital technology to enhance and transform services.

The use of digital technology offers significant opportunities to enhance and transform how we deliver health and social care in East Lothian. Digital options can help make better use of available resources, as well as supporting self-management and playing a role in prevention and early intervention.

This includes the use of digital technology in people’s homes, but also by health and social care services in a range of other settings. Technology can include things like alarms, monitoring devices, and telecare equipment, but also the development of online / digital options for accessing services and online resources providing information and advice.

Digital technology is already used by a number of HSCP services, most notably by the East Lothian Rehabilitation Service (ELRS), including, for example, in relation to the Technology Enabled Care (TEC) Service. We now need to explore and develop opportunities to expand the use of technology across all of our service areas.

Specific activity required over the lifetime of the Strategic Plan will include:

• Development of an East Lothian HSCP Digital Innovation Strategy to identify, develop, and deliver opportunities to use digital solutions to support the delivery of health and social care (with oversight by the Digital and Data Programme Board). 
• Ongoing work to increase the proportion of appointments and other patient / service user contacts taking place remotely with the use of digital technology. 
• Ensuring that any developments under this priority consider the risk of ‘digital exclusion’ and take steps to mitigate against this risk, including through retaining non digital options if needed. 

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1.7 Developing services to meet the projected demand for palliative and end of life care, including in people’s homes and community settings.

National projections indicate that the number of people requiring palliative and end of life care will increase significantly as the population ages. We need to ensure that we have services in place to respond to this growth in need, particularly in terms of providing palliative and end of life care and support to people at home or in community settings.

The Planning for Older People’s Services (POPS) project’s Final Report recommended that palliative and end of life care should remain a key strategic priority in the revised IJB Strategic Plan and that a Palliative and End of Life Care Strategy / Delivery Group be formed within the IJB Programme Board structure.

Specific activity required over the lifetime of the Strategic Plan will include:

• Development and delivery of an East Lothian Palliative and End of Life Care Strategy, including reflecting the recommendations in the Planning for Older People’s Services (POPS) project’s final report . This work will be led by a Delivery Group with oversight by the Intermediate and Social Care Programme Board.

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1.8  Working with partners in the Lothian Health and Social Care System to deliver shared priorities and identify opportunities for collaboration.

East Lothian IJB, along with the three other Lothian IJBs and NHS Lothian form the Lothian Health and Care System (LHCS). The Lothian Strategic Development Framework (LSDF) sets out LHCS priorities for the next five years up to 2027-28.

Specific activity required over the lifetime of the Strategic Plan will include:

• Continuing to work with Lothian Health and Care System (LHCS) partners through a range of forums to deliver the Lothian Strategic Development Framework (LSDF) and other shared priorities.
• Exploring further opportunities for collaborative working with other Lothian IJBs to deliver efficiencies and develop service provision.
• Taking forward discussion with LHCS partners to review current arrangements for set-aside and hosted services (including with regard to budget arrangements) and to look at opportunities for efficiencies and potential budget reconfiguration.  

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