Making decisions together

Image shows a 7-stage timeline. Aug to Sept 23 gathering interested people. Oct to Nov 23 creating a long list of ideas. Dec 23 to Jan 24 Assessing ideas against criteria. Feb to April 24 Investigate and model short-listed options.  May to Aug 24 Appraise short-list options against desirability, feasibility, viability. Sep to Dec 24 public consultation on proposed recommendations.  Jan 24 / Feb 25 present final recommendations to IJB.  Timeline may be subject to change.

 

Discussing, considering and proposing options

graphic image depicting a 5 stage decision process, idea, analyse, options, feedback, decision

 

From our previous research we know that many older people want to stay in their own homes for as long as possible. To help make this happen, we need to continue developing the services that are in place to support people in older age. 

By engaging with our citizens and communities, we want to draw on your experience of health and social care to inform how high-quality and sustainable services can be developed. 

  • what has worked well in the past?
  • where can we improve our services to enable people to stay at home for longer? 
  • what ideas or suggestions do you have that could make this happen? 


Gathering ideas 

We need to come up with options that are:

  • realistic
  • achievable within a timescale not exceeding 10 years

The most useful options are those that will help to co-design:

  • services offered to people within their own home or local area
  • services delivered within dedicated care home facilities
  • services provided in East Lothian hospitals, where someone needs to be admitted for treatment
  • services that focus on early intervention and prevention
     

Considering and analysing the options

Top Tip:  If you haven't already done so, please read our background information documentation here.

The engagement process will run from August 2023 to December 2024.

This will be made up of serveral different stages.

  • August to September 2023 :  Gathering interested people
    We will gather interest from a wide range of stakeholder and community groups to contribute ideas and suggestions as part of this engagement project.
     
  • October to November 2024 : Creating a long list of ideas and suggestions
    We will collate ideas and suggestions from stakeholder groups, an online survey, engagement events and workshops to create a ‘long list of ideas, options and suggestions’.
     
  • December 2023 to January 2024 : Assessing ideas against criteria to create a short-list
    We will assess every suggestion against pre-set ‘hurdle criteria’.[1] Hurdle criteria are conditions that need to be met for an option to progress to create a short-list of options.  This will be done in collaboration with an Independent Community Panel, who will act as a critical friend. 
     
  • Febuary to April 2024 : Investigate and model short-listed options
    We will investigate, model and test the shortlist of options. This will include looking at costs, timescales and demand.
     
  • May to August 2024 : Appraise short-listed options against desirability, feasibility, viability
    The Project Team and Stakeholder Group will then work on a shortlist. They will assess each option for desirability, viability and feasibility. They will be using an assessment framework to help them assess each option in a fair and consistent way. The options will be scored and weighted, to develop a refined options list.
     
  • September to November 2024 : Public Consultation
    There will be a twelve-week public consultation on the proposed finalised options.
     
  • January to February 2025 : Present final recommendations from engagement and consultations to the IJB
    A final report will be go before the East Lothian Integration Joint Board (IJB). They will discuss all the findings of the engagement and consultation process. They will then make a decision and direct ELHSCP on which options to take forward.
 

[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:


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.