Planning older peoples' services

[1] Hurdle criteria

The hurdle critia is an assessment checklist containing obstacles and conditions that need to be overcome / met in order to progress to the next stage. Should an option not meet most or all of the criteria, the option will drop out of the appraisal process.

Core Hurdle Criteria 

The core hurdle criteria were developed in collaboration with the Consultation Institute and are informed by the HM Treasury Guidance – The Green Book (2022)

1. Will the option lead to increased wellbeing and improved outcomes for service users in East Lothian?
2. Will the option enhance service and clinical sustainability and is it able to evolve and adapt to meet future need? (e.g. does it meet the health and wellbeing needs of the present population, without compromising those of future generations?)
3. Will the option provide fit for purpose infrastructure that supports East Lothian’s current and future older population?
4. Will the option achieve long term financial viability?

A hurdle criteria is an obstacle or condition that needs to be overcome / met in order to progress to the next stage. Should an option not meet most or all of the criteria, the option will drop out of the appraisal process. After determining the outcome for all options on the long-list, a short list of options will be prepared for further consideration.

The core hurdle criteria should be considered in conjunction with the following objectives and findings.
 

High-Level Project Objectives

All options should align with the high-level project objectives outlined within the
Provisioning Strategy – Community capacity options development project - Terms of reference

• to deliver high quality care and support to East Lothian’s current and future older population, at the right time and in the right place
• ensure services for older people are sustainable and adaptable to the current financial climate, the impact of the COVID-19 pandemic and national policy
• engage with community within East Lothian to ensure co-production of services that will allow for equality of service across our diverse population

Project Performance / SMART objectives

All options should contribute directly or indirectly to one or more of the following objectives:

• Reduce unmet need related to care at home provision:
  • No more than 500 hours of unmet need within care at home provision by March 2024.
  • No more than 20 East Lothian residents within NHS Lothian inpatient beds awaiting a care at home package or care home place by March 2024.
• Reduce number of East Lothian residents presenting at the Royal Infirmary of Edinburgh or in acute settings.

At any point during the project new SMART objectives can be developed and presented to the Project Team for consideration. If the Project Team approves the revised terms of reference, the options development process will be updated to incorporate the new SMART objective(s).

Provision Change Board findings and conclusions

All options should align with and be bounded by the Provision Change Board findings and conclusions:

• Inpatient community hospital beds
  Beds are being managed effectively and there is currently sufficient capacity in the system for the foreseeable future. There is unlikely to be a requirement for additional hospital beds in the medium to long term.
• Care home beds
  Analysis identified that the development of capacity for care home beds in East Lothian is bounded at a maximum of 70 replacement beds and potentially 30 new beds. These figures will be influenced by external provision (private/independent), intermediate care, capital expenditure options (availability) and different models of care.
• Intermediate care
  The intermediate care report highlighted the breadth and depth of those services being provided in East Lothian and the benefit they now provide from previous investment. Intermediate care to be a key priority for further investment.

The following background information is available online:

• Final report of the Community Hospitals and Care Homes Provision Change Board 2021/22
• Planning for an ageing population summer engagement feedback report
• Communications and Engagement Strategy
• Consultation and engagement plan
• Change Board Terms of Reference

Provision Change Board Capacity and Planning Working Group Objectives

The Provision Change Board Capacity and Planning Working Group set the following objectives when undertaking their early options analysis in late 2022. The current Provisioning Strategy Project Team should remain mindful of these when completing their options analysis:

• Reduce reliance on the inpatient hospital bed base.
• Increase or maintain Care Home capacity with integrated provision in place of traditional hospital beds.
• Increase provision and develop new community intermediate care services and models to support people in their own home.
• Align with public sector partners strategic plans (e.g. Lothian Strategic Development Framework, IJB Strategic Plan and Directions).
• Ensure capacity is maximised within constrained capital provision.

Financial Climate and Considerations

All options need to be mindful of the current financial climate and following points in particular:

• The IJB only has delegated revenue budgets within its financial remit while this project must consider buildings and land owned by partner organisations.
• Limited availability of capital funding from partner organisations and timescales associated with any new build, refurbishment or purchase.
• Perceived or actual lack of investment support from partner organisations.
• Some options may impact non-delegated revenue budgets (e.g. facilities).
• Some options can be agreed and progressed by the IJB in isolation whilst others would require discussion and agreement with one or more partner organisations.
• Investment in intermediate care will take time to realise full benefits (reduced revenue impact across the Health and Social Care Partnership; reduction in acute presentations; delayed discharge).
• Reduction in financial settlements.

General Hurdle Criteria

• All options must increase resource efficiency leading to increased wellbeing and improved outcomes for service users in East Lothian.
• All options should be based on evidence based approaches to improving clinical and social care outcomes for service users in East Lothian.
• All options should align with the IJB strategic directions and priorities.
• All options should be deliverable within the competencies of the Integration Joint Board.
• All the engagement work with East Lothian citizens indicates a preference for intermediate care. All options should ensure that provision of intermediate care is the priority. This should mean supporting people in their own homes or a homely environment.
• All options must be deliverable in a difficult environment for recruiting and retaining staff.
• All options should be considered on an East Lothian wide basis whilst also acknowledging ward / area specific provision gaps, particularly those related to area deprivation as described in the Scottish Index of Multiple Deprivation (SIMD) and the 8 data zones within East Lothian that are within the 20% most deprived in Scotland. Equity and ease of access should remain a key consideration at all stages.
• All options should address our Equality Act Duties and Fairer Scotland Duty to reduce inequalities of outcome caused by socioeconomic disadvantage.