Good Practices Overview | Basque Country | Czech Republic | Norrbotten | Puglia | Scotland
Reshaping Care for Older People – RCOP
Summary of the good practice:
From 2011- 2015 a national improvement programme and £300 million Change Fund has enabled more older people to live well at home or in the community through preventative, anticipatory and coordinated care and support, intermediate care at times of transition, and technology to empower greater choice and control. A cross sector improvement network supported testing new approaches, spreading Good Practice, understanding variation and joint commissioning and resourcing to improve outcomes. Each local partnership’s Change Plan described how health, social care, housing, Third sector and independent sector partners would work together to test and spread interventions across the four pillars of the RCOP pathway.
Examples of the interventions and approaches include:
- empowering older people and their carers to remain active, independent and connected with families, friends and social networks
- building community capacity for preventative supports
- applying a national risk prediction tool to target high resource users
- scaling up anticipatory care planning
- polypharmacy reviews
- community rehabilitation and reablement
- proactive, coordinated and integrated care management
- frailty pathways for community CGA
- Hospital at Home and intermediate care
Success factors offer transferable learning for other systems:
- adaptive and collaborative leadership;
- coproduction and social innovation with citizens;
- innovative use of ICT;
- use of funding and contracts as a catalyst for change;
- use of data and quality improvement approaches to support spread;
- joint commissioning and resourcing for sustainable change;
- joint governance and outcomes framework;
Challenge addressed by the good practice
- The increasing demand on health and social care associated with ageing and multimorbidity.
- The need for a stronger focus on personal outcomes as well as system outcomes
- The desire to shift the balance of care to care and support at home
- The need to empower and enable greater choice and control for people who use services and their carers.
Key innovative elements of the good practice
- Development of a local Change Plan for older people with strategic commissioning of health and social care budgets in each local partnership
- Local change and improvement support and a series of national learning events
- Systematic spread of anticipatory care interventions and intermediate care
- Use of funding to lever growth in community and Third sector capacity to help people stay well and connected
- Use of matched local and innovation and European funding to increase adoption of telecare.
Full Scirocco information on the good practice
SciroccoGP-Scotland-5-RCOP-Reshaping-Care-for-Older-People.pdf [PDF]
Publications and reports on the good practice
Contact point: Anne Hendry: anne.hendry@lanarkshire.scot.nhs.uk