IJB Strategic Plan Development 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.

On this page:

• Why is this a strategic objective for the IJB?
• What do we need to prioritise to deliver this strategic priority?
  • 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.
   

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).