Jsp Appendix 1
Argyll and Bute Council · 17 September 2025
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 17 September 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Argyll & Bute HSCP Joint Integrated Plan Draft Version 0.5
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1 Document control Title Joint Strategic Plan Author Strategic Planning Creation date August 2025 Date of version 07/09/2025 Version history Version Comments V0.1 Draft reviewed by SLT V0.2 Draft Reviewed by SPG V0.3 Draft Reviewed by IJB (Development Session) V0.4 Final draft revie introduction update V0.5 Draft presented to IJB 17 September Edit History Edit Date Comments 3/9/2025 Addition on Fair Work Policy 4/9/2025 Addition on SDS 09/09/25 Introduction update
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2 Contents Foreword .......................................................................................................................................... 4 Introduction ...................................................................................................................................... 5 Plan on a Page ................................................................................................................................. 0 1. Argyll & Bute Health and Social Care Partnership (HSCP) ....................................................... 1 1.1. Our Mission ........................................................................................................................ 1 1.2 Our Vision .......................................................................................................................... 1 1.3 How We Work .................................................................................................................... 1 1.4 Our Services ...................................................................................................................... 2 1.5 Our Locality Planning Areas .............................................................................................. 3 2. Strategic Context ...................................................................................................................... 4 2.1. National Policy Context ...................................................................................................... 4 2.2. Our Population: Joint Strategic Needs Assessment .......................................................... 5 2.3. Local Policies and Plans .................................................................................................... 8 2.4. Finance .............................................................................................................................. 9 3. Our Strategic Priorities and Objectives ................................................................................... 14 3.1. Priority 1: Preventative and Community Based Care ....................................................... 14 3.2. Priority 2: Integrated and Person Centred Care ............................................................... 14 3.3. Priority 3: Financial and System Sustainability ................................................................ 15 3.4. Priority 4: Workforce ........................................................................................................ 15 3.5. Priority 5: Access to Care and Tackling Health Inequalities ............................................. 16 3.6. Priority 6: Digital Transformation ...................................................................................... 16 4. How are we going to get there? .............................................................................................. 18 4.1. Our Values ....................................................................................................................... 18 4.2. Service Quality and Improvement .................................................................................... 18 4.3. Our Approach to Service Planning ................................................................................... 18 4.4. Working with Our Communities, Service Users and Carers ............................................. 19 4.5. Collaboration and Whole System Working ....................................................................... 19 4.6. Service Transformation .................................................................................................... 19 4.7. Intelligence and Data ....................................................................................................... 21 4.8. Performance management .............................................................................................. 21 5. Our strategic commissioning intentions .................................................................................. 22
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3 5.1. Strategic commissioning and market facilitation .............................................................. 22 5.2. Legislation, Policy and Guidance About Service Commissioning .................................... 23 5.3. Challenges ....................................................................................................................... 24 5.4. Engagement with Our Providers ...................................................................................... 25 5.5. Key Market Messages ..................................................................................................... 26
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4 Foreword I am delighted to present Argyll & Bute HSCP’s Joint Strategic Plan (JSP) for 2026 to 2031. The JSP establishes the vision, values and strategic priorities to which we are committed. It provides direction for how health, social work and social care services should be developed in Argyll & Bute, and describes the transformation that will be required to achieve this vision.
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5 Introduction This Joint Strategic Plan is about providing a road map for how we want to deliver our integrated social work, social care and health services over the next 5 years. Scotland’s health and social care system stands at a pivotal moment. As we continue to pursue our vision of integrated, person centred services, we must do so within a landscape that is increasingly constrained and complex. This strategic plan sets out our priorities for delivering high quality, sustainable care in a context shaped by economic difficulty, demographic pressures, public sector policy and reform and tightening public sector finances. In this context, our strategic approach must be both ambitious and pragmatic. We remain committed to the integration of health and social care services, ensuring that individuals experience seamless support across organisational boundaries. Through collaborative working within our Health and Social Care Partnership and our wider partners, we will continue to plan our services in a whole system approach to enable us to improve outcomes and maintain the quality of care in a resource bound environment. We will prioritise person centred care, placing individuals, families, and carers at the heart of service design and delivery. Our focus on prevention and early intervention will help mitigate demand on our hospital services and support people to live independently and well in their communities while supporting those who care for them. We also know that many of our services historically have built high cost into our health and care system at the same time that they have built dependency on our services and reduced people’s capabilities. We will transform service so that they maximise people’s independence in the knowledge that this goes hand in hand with positive outcomes for people. This will mean that we will not provide some aspects of service for which an expectation has previously existed. All of these choices will be challenging but must be focussed on outcomes for people. Given the fiscal constraints, we must make difficult compromises and ensure that every service delivers maximum impact. This means embracing digital transformation, redesigning services for efficiency, and investing in data driven planning to target resources where they are needed most. We will also ensure that our decisions are evidence based and focus on positive outcomes for the population.
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6 We will uphold our commitment to equity and quality, ensuring that services remain accessible and responsive, particularly for those most affected by poverty, isolation, poor health or geography. This means more of our services will be targeted, in preference to universal. At the same time, we will strengthen governance and accountability to monitor progress and inform decisions and keep services safe. Partnership must be at the heart of what we do. As a Health and Social Care Partnership we have a vital role to play in ensuring the people of Argyll and Bute live the lives to which they rightly aspire, but we will never achieve that alone. Working with partners in the statutory sector, the independent sector, charities, voluntary groups and of course carers, we will together tackle the scourges of child poverty, housing, inequality and loneliness. We must do so with the confidence to work differently, and the humility to recognise the limits of the public sector in shaping the full complexity people’s lives. This strategic plan reflects our determination to deliver better lives through better services, even in the face of financial constraint. By aligning our priorities with Scotland’s fiscal realities, we aim to build a resilient, inclusive, and future ready health and social care system.
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Plan on a Page This will be developed for consultation once the draft JSP is signed off for consultation.
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1 1. Argyll & Bute Health and Social Care Partnership (HSCP) 1.1. Our Mission The HSCP provides integrated social care, social work and health services for the population of Argyll & Bute. Our mission is to continue to develop a person centred and whole system partnership approach to planning and delivering our services. We recognise that continuing to deliver on our mission over the next 5 years will be challenging due to increasing demand for our services. We will need to use the resources at our disposal differently and implement wide ranging change so that we can continue to provide effective, safe and person centred services for people in Argyll & Bute. 1.2 Our Vision For our population: The people of Argyll & Bute live healthy, independent lives in resilient communities. Individuals are enabled and supported to thrive and fulfil their potential. We will work with communities to inform service models in line with national policy and best practice. For the HSCP as an organisation: We will transform the way we work in partnership, focus on place and deliver our services within our resource, developing service models to become a modern, flexible integrated, effective and efficient organisation. 1.3 How We Work This is our fourth strategic plan since Argyll & Bute HSCP was created. We follow the body corporate model of integration and our work is overseen by the Integrated Joint Board (IJB). The HSCP is responsible for delivering all the NHS, social care and social work services across the geographic area of Argyll & Bute which have been delegated to the IJB by NHS Highland and Argyll & Bute Council. A separate legal entity, the IJB is responsible for planning and overseeing the delivery of services delegated to it. The IJB allocates an integrated revenue budget for health and social care in accordance with the objectives set out in the Strategic Plan. The Scheme of Integration which is the legal agreement between the NHS and Argyll & Bute Council will be reviewed with community consultation in 2025.
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2 The IJB includes members from NHS Highland, Argyll & Bute Council, as well as representatives of the Third Sector, Independent Sector, staff representatives and public members representing the interests of service users and carers. The governance arrangement for the HSCP and IJB are described in detail the within the Integration Scheme between Argyll & Bute Council and NHS Highland. The IJB and HCSP’s Senior Leadership Team (SLT) set clear direction and organisational strategy which is expressed in the Joint Strategic Plan. 1.4 Our Services Services delegated by Argyll & Bute Council: • All Adult Social Care Services • All Children & Families Social Care Services • All Justice Social Care Services Services delegated by NHS Highland: • Hospital Inpatient Services (scheduled and unscheduled) • Hospital Outpatient Services • Rural General Hospital (Lorn and Islands Hospital) • Community Hospitals • Mental Health Services • Paediatric Services • GP Services • GP Prescribing • NHS Community Services, including community midwifery and paediatrics • General Dental, Opticians and Community Pharmacy • Public Health Improvement Services • Support Services
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3 The HSCP also provides, commissions, or otherwise supports a number of services which it does not have to provide by law. We may have to revise our approach to these non-statutory services over the course of this strategy. 1.5 Our Locality Planning Areas Argyll and Bute HSCP is divided into four locality planning areas which are aligned with Argyll & Bute Council Community Planning Partnership areas. Within three localities, there are further divisions into ‘local areas’ which consist of groupings of natural geographical communities and/or service provision. Planning may sometimes be necessary for smaller areas within a locality. It is important that we continue to ensure that we meet the specific needs of our local communities and we are committed to place based planning. At the same time we have to become smarter about sharing resource between localities and using technology to support cross locality working where it is appropriate. We also need to make sure that there is a good reason for local variation in services and that we offer an equitable and coherent service across the partnership. Our planning localities and local areas are outlined in Table 1. HSCP Locality Planning Area Population Local Area Settlement of 500 and more residents Bute and Cowal (B&C) 20,346 Bute Rothesay, Port Bannatyne Cowal Dunoon, Hunter’s Quay, Innellen, Tighnabruaich Helensburgh and Lomond (H&L) 25,834 Helensburgh, Cardross, Garelochhead, Rosneath, Kilcreggan Mid Argyll, Kintyre and Islay (MAKI) 20,032 Mid Argyll Lochgilphead, Tarbert, Ardrishaig Kintyre Campbeltown Islay and Jura Bowmore, Port Ellen Oban, Lorn, and the isles (OLI) 20,008 Oban and Lorn Oban, Dunbeg Mull, Iona, Coll, Tiree and Colonsay Tobermory Table 1: Argyll & Bute HSCP Locality Planning Areas
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4 2. Strategic Context 2.1. National Policy Context The Population Health Framework 2025– 2035 recognises that health is shaped by far more than healthcare alone. Factors such as income, education, housing, employment, and the environment play a much larger role in determining health outcomes (see Figure 1). As such, this strategy is based on a whole- system, preventative approach that brings together government, public services, communities, and businesses to tackle the root causes of poor health. The framework is built around five key themes: shifting the system toward prevention; addressing the social and economic conditions that influence health; creating healthy, connected places and communities; enabling people to live healthier lives; and ensuring equitable access to high quality health and care services. Ultimately, the framework is a call to action for all sectors to work together in creating a fairer, healthier Scotland, where everyone has the opportunity to thrive. The Health and Social Care Service Renewal Framework (2025–2035) sets out a national vision for a sustainable, equitable, and person centred health and care system in Scotland. The Framework is built around five core principles: 1. Prevention: Emphasising early intervention and reducing the burden of disease. 2. People: Designing care around individuals, empowering self-care and shared decision- making. 3. Community: Shifting from hospital-centric to community-based care models. Figure 1: Determinants of Health adapted from Magnan S. Social Determinants of Health 101 for Health Care: Five Plus Five. NAM Perspectives 2017.
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5 4. Population: Planning services based on population needs rather than administrative boundaries. 5. Digital: Leveraging technology and data to improve access, efficiency, and outcomes. Our plan aligns with these principles and priorities. They inform our transformation programmes, workforce and service planning, commissioning and performance management. 2.2. Our Population: Joint Strategic Needs Assessment A Joint Strategic Needs Assessment (JSNA) was carried out in 2024 with the aim to identify the health and social care needs of the population of Argyll & Bute. There are also profiles available for all four HSCP Locality Planning Areas. The JSNA describes our population in terms of characteristics such as age, where people live, their health outcomes and other life circumstances that can impact people’s health and wellbeing. The aim is to describe current and future needs for social care, social work and health services. Below is a high level summary of key findings. The JSNA pulls together a substantial amount of data and intelligence and will be used by the HSCP and individual services to inform service planning and transformation work. It is also a useful resource for our Third and Independent Sector partners for their service planning. Demographics The population of Argyll & Bute was 85,970 in 2022 (census 2022). It decreased from 88,166 (census 2011) and 91,306 (census 2001).The latest available population projections estimate that the overall population of Argyll & Bute’s localities will continue to decrease between 2018 and 2030. Argyll & Bute is also the council area in Scotland with the highest proportion (27.2 %) of people aged 65 and over in Scotland (census 2022). Local population distribution varies. Cowal and Bute has the highest elderly population, and Helensburgh and Lomond has the most working-age individuals. With a natural aging population, there is an increased need for services supporting individuals with physical long term conditions, multiple health conditions and frailty. People need to be enabled to self-manage their conditions and receive support where appropriate.
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6 A high percentage of Argyll & Bute’s population lives in remote and rural areas and in the most access deprived areas in Scotland. This shapes the need to ensure service accessibility for our residents. Argyll & Bute has 23 inhabited islands, more than any other local authority area in Scotland, including the Wester Isles, Orkney and Shetland. Over 17% of our population live in island communities (14,976). Affordable, reliable and accessible transport is a core need for people in Argyll and Bute considering the remote and rural character of the area. Lack of transport options can present a hurdle for daily life, employment and the access to key services, as well as accessing natural resources. When we plan services, limited mobility especially of younger people needs to be taken into account. Life Expectancy Life expectancy provides a high-level measurement of the health of a population. The 3-year average life expectancy for men at birth in 2019-2021 was 77.8 years in Argyll & Bute. It was significantly higher than the Scottish average (76.6 years). Female life expectance at birth over the same period was 82 years, also significantly higher than the Scottish average (80.8 years). Across the UK and Scotland, life expectancy has tended to increase, but improvement in life expectancy has stalled in the most recently available years. The stalling in both male and female life expectancy at birth points to underlying problems for the population’s health. Austerity politics have been described as a likely important influencing factor. Those living in deprived areas are more affected. The problem is more pronounced in the male than in the female population. Measures to address such health inequalities are needed. This includes measures to address income deprivation, such as income maximisation, debt advice, and signposting to support options. Long Term Conditions Living with long term conditions can significantly impact people’s quality of life. They will also require access to services to treat and manage their condition. In addition, as people age, they are more likely to develop more than one long term condition (LTC). Table 2 highlights that close to 30% of the Table 2: Percentage of population with more than 2 LTC by age group
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7 over 65 population life with more than two long term conditions. Figure 2 illustrates the prevalence of long term conditions in Argyll & Bute compared to the rest of Scotland. The physical LTCs with the highest prevalence in Argyll and Bute were cancer, arthritis, coronary heart disease, asthma and diabetes. These conditions were the most prevalent in Scotland at the same time but the ranking differed. Use of services Argyll & Bute has a higher rate of A&E attendances and unscheduled bed days compared to the Scottish average which indicates a need for better preventive support. Life Circumstances In 2023 the median gross weekly pay for a full-time worker in Argyll & Bute was £657.8, while it was £702.8 on average in Scotland and £682.6 on average in the UK. The pay differed between women and men, with the average gross weekly pay for male full-time workers in Argyll and Bute being £671.9 (Scotland: £727.9, UK: 728.3) and for female full time workers £579.0 (Scotland: £670.8, UK: £629.1) The Scottish Government recognises that the cost of living can be 15% to 30% higher in remote rural parts of Scotland than in urban parts of the UK due to higher transport, food and heating costs in these areas. This can make the rise of the cost of living more acute in these areas. The lower gross median weekly pay for a full-time worker in Argyll and Bute compared to the Scottish and UK average might highlight a risk for the population to be acutely impacted by the rise of the cost of living and highlight the need for support, e.g. advice on income maximisation, debt advice, and signposting to support options. The percentage of children under 16 living in low-income families has been rising in Argyll and Bute since 2014/15, with the exception of a drop in percentage in 2020/21. In 2022/23 the percentage was 19.4% in Argyll and Bute, which equalled 2,430 children. The percentage was lower than the Scottish average of 21.8%. This increase in the percentage of children living in low- Figure 2: Prevalence of Long Term Conditions (LTCs) in Argyll & Bute
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8 income families in Argyll and Bute means there is a growing need to establish and strengthen support for children and young people in poverty from facing additional disadvantages, e.g. through interventions in schools or educational settings. People experiencing poverty, people affected by substance use, and people living in neighbourhoods experiencing deprivation face inequalities that services need to be aware of and try to mitigate. People facing disadvantages like substance use or poverty are at a higher risk of additional disadvantages, such as violence, offending, or homelessness. Addressing and preventing these multiple, severe disadvantages requires integrated support, including cooperation between statutory and non-statutory partners. In June 2023 the Argyll and Bute council was the first local authority in Scotland to declare a housing emergency. To meet the need of affordable housing partners, stakeholders, investors and communities will need to work together. In the process it is important to consider specific housing needs including wheelchair accessible housing that is currently not equally accessible in all housing market areas. 2.3. Local Policies and Plans NHS Highland’s current strategy Together We Care sets out the health board’s vision for delivering outstanding care through strong community partnerships and a committed workforce. Developed through extensive engagement, the strategy focuses on improving health outcomes, creating a supportive work environment, and transforming services through collaboration. It outlines 16 strategic outcomes across the life course, from birth to end-of-life care. Key themes include strengthening foundational systems like governance and finance, and embracing innovation through digital transformation, climate action, and realistic medicine. The strategy also prioritises rural service delivery, workforce wellbeing, and reducing health inequalities. Meaningful transformation in health and social care, however, cannot happen in isolation. People’s health and wellbeing is shaped by more than the services delivered by the HSCP, such as access to good and affordable housing, education, enough income and economic opportunities. We need to take a whole-system approach, where health, social care, housing, education, and other public services work in genuine partnership to improve outcomes for people and communities. Argyll & Bute Council is a key partner and the below plans and strategies are key programmes of work that we need to align with to achieve the best outcomes for the population of Argyll & Bute. • The Local Housing Strategy (LHS)
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9 • The Child Poverty Action Plan • Argyll and Bute Outcomes Improvement Plan 2024-2034 • Argyll and Bute Economic Strategy 2024-2034 Argyll & Bute Council has also prepared a Housing Contribution Statement for the JSP (see Appendix 2). All HSCP service areas will have plans in place for how they intend to develop over the 5 years. These plans translate our priorities and national policy priorities into specific actions for each service area ensuring they are suitable for Argyll & Bute. Recognising the contribution of unpaid carers, we have also published a Carers’ Strategy. In addition, our Living Well Strategy sets out how we support people to live healthy and well lives in Argyll and Bute. The strategy aims to empower people, enable our workforce, and improve access to support. 2.4. Finance Overview The HSCP has considerable resources under its control for the delivery of health and social care services. It is required to operate within the resources available and on a financially sustainable basis. It is essential that financial planning aligns with the Joint Strategic Plan. In respect of finance, the public sector, and health and social care in particular, have had to manage a complex and challenging period. Firstly, a significant investment in services was made, post covid, to re-mobilise services and manage system wide pressures including backlogs of care, increased complexity of demand and rapidly rising waiting lists. This was then followed by a period of very high inflation, unfunded pay pressures and demographic demand pressures. Collectively, these factors meant that the real value of budgets reduced rapidly while demand for care continued to increase. This has meant that the HSCP, and most of the health and social care sector, has not been operating on a sustainable basis in recent years. As a consequence reserves have depleted and financial flexibility and resilience has reduced. There is a clear indication from the Scottish Government that budgets are expected to be under severe pressure throughout the period covered by this strategy, and probably beyond. The challenge facing the HSCP now is establishing how we can reduce spend throughout the period of the plan while at the same time address government strategic priorities associated with investment in community and preventative services.
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10 The HSCP expects that it will need to change care models and curtail some of its activities and services to fit with the resources being made available by the Scottish Government and our partners. How We Allocate Our Resources: 2024/25 Budget The approved budget outlines how we intend to spend the funding allocated to us, this currently totals £398m. Figure 3 summarises the main areas we spend our funding on. Figure 3: A&B HSCP spending distribution The HSCP has projected budget gap in future years for the reasons outlined above. Pressures are expected to continue, particularly the impact of demographic change and inflation. The HSCP will therefore be required to operate on a recovery basis until it returns to a financially stable position where its recurring funding aligns with spend patterns. This will require to be achieved through a mix of: • Service re-design and transformation Children, Families & Justice , … Social Care - Older … Public Health, lead Nurse and Clinical … Social Care - Lifelong Condition… Estates & Facilities (NHS), … Community Acute and Health … Commissioned Services - Other Health … Primary Care & Dental … Prescribi… Managemen t, Planning and … Budget Reserves - Agenda for Change, …
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11 • Efficiency improvement • Service reductions Table 3 summarises the projected budget gaps: Revenue Budget Summary 2026-27 £m 2027-28 £m 2028-29 £m Opening Recurring deficit 8.9 8.9 8.9 NHS Cost & Demand Pressures 11.1 22.4 34.0 Social Work Cost & Demand Pressures 6.8 12.9 18.8 Allowance for unachieved savings 3.0 1.0 0 Estimated funding uplifts (11.6) (23.2) (35.1) Budget Gap 18.2 22.0 26.6 Table 3: Projected Budget Gap 2026/27 to 2028/29 The gap between our expected expenditure, if we try to continue to operate as we do at present, and the resources we expect to be available to us is estimated at £18m in 2026/27 and then it continues to increase through to 2028/29. Our financial and service planning must align to the resources we expect to have available, this is going to be particularly challenging in light of the demographic change outlined in this document and continuing patterns of increasing health and social care spending over the past 8 years with a forecast through to 2028/29 (see Figure 4).
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12 Figure 4: Health and Social Care Spend 2017/18 to 2028/29 actual and projections Figure 5: Gap between HSCP resources and spend 2026/27 to 2028/29 This increasing pattern of spend illustrates how challenging it will be to deliver savings at the scale required as we look ahead. Error! Reference source not found. illustrates the projected funding gap over the next three years. 0 100 200 300 400 500 17/18 18/19 19/20 20/21 21/22 22/23 23/24 24/25 25/26 26/27 27/28 28/29 Health & Social Care Spend - Actual and Forecast £m Social Care £m NHS £m 370 380 390 400 410 420 430 440 450 460 26/27 27/28 28/29 Spend v Resourcing £m Spend £m Resourcing £m
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13 The financial plan is therefore to set a balanced budget in agreement with Argyll & Bute Council and NHS Highland. This will require service change and reductions and potentially additional financial support. The financial plan will therefore have to align with a process of service change aimed at reducing costs. Savings targets at this scale will require changes to service delivery and reductions in the scope and scale of the services the HSCP can continue to provide going forward. Engagement with partners and with the wider community will be critical throughout the process as care systems are re-modelled both locally and nationally. There are significant risks relating to finance and financial sustainability and these will require to be balanced with risks associated with the delivery of government policy and legislation and the safety of services delivered to the communities we serve. Key risks associated with financial planning include: • Delivery of new and existing plans to change services and make savings • Continuing high inflation and increasing demand • High levels of macroeconomic uncertainty and public service funding pressures • Sustainability of key partners and commissioned service providers • Increasing costs associated with new legislative duties The financial risks and pressures outlined will require to be managed throughout the period of the plan and service planning will need to take into account available resourcing, plans will be continually updated as the political and economic context develops.
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14 3. Our Strategic Priorities and Objectives 3.1. Priority 1: Preventative and Community Based Care Preventative and community based care is about shifting the focus of health and social care away from crisis intervention and towards early support and prevention. Many health challenges can be avoided or mitigated through timely, community level interventions that address the root causes of poor health, such as social isolation, poverty, and housing insecurity. We will work to strengthen local services and embedding care within communities, making it easier for people to access the right support at the right time. We will promote multidisciplinary working, where professionals from health, social care, and the third sector collaborate to deliver holistic care tailored to individual needs. By investing in preventative measures, like support or self management, anticipatory care planning, community wellbeing initiatives, and support for carers, we aim to reduce pressure on acute services and improve long term outcomes. Objectives: • Develop initiatives and scale early intervention programmes • Develop community and multidisciplinary teams • Develop primary care and support development of third and independent sector capacity 3.2. Priority 2: Integrated and Person Centred Care Many, if not all, of our services have evolved organically and over time, often without an evidence base. How we deliver our services has not always kept pace with patient need and other developments such technological change. There is also a long way to go in terms of delivering truly integrated and person centred services. We will need to innovate and develop more effective and person centred delivery models ensuring that we provide high quality and truly integrated services, which embed the Getting it Right for Everyone (GIRFE) principles. This includes the redesign of our unscheduled and planned care pathways. Objectives • Ensure we have robust governance in place to support quality and safety
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15 • Develop modern innovative care models that deliver effective, flexible and responsive care which will meet the need our communities • Collaborate with our communities to build resilience and acknowledging our role in addressing the climate challenge • Implement flow and discharge redesign (such as Hospital at Home) • Use real-time data for flow and demand management • Ensure we have accessible planned care pathways 3.3. Priority 3: Financial and System Sustainability To ensure the long term sustainability of our services we have to change how we allocate resources and deliver services. We will need to find ways to disinvest in some activities to invest elsewhere; moving away from reactive, hospital based care towards preventative, community based approaches that better reflect the needs of our population. This shift is not just about cost saving, but about delivering better outcomes and equity. Financial sustainability requires us to shift towards value based investment, where service planning decisions are guided by the impact on people’s health and wellbeing. Objectives • Ensure the financial sustainability of the HSCP • Plan for sustainable delivery sites and estate • Embed a value based approach to service planning and commissioning • Redefine our partnerships and partnership working in line with NHS and wider public sector reform supporting to drive the development of shared services and efficiencies • Shift resource toward prevention and early intervention 3.4. Priority 4: Workforce Our workforce is our most important resource and one of our greatest strategic risks in the short and long term. Staff will be valued, supported, and empowered to lead and deliver services but also to actively participate in service improvement and transformation. Objectives • Carry out workforce skills gap analysis to inform workforce planning • Create local talent pipelines • Invest in leadership, wellbeing, and Continuous Professional Development
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16 • Support the development and delivery of staff roles to address the specific needs of remote, rural and island communities • Support workforce development in the independent and third sector 3.5. Priority 5: Access to Care and Tackling Health Inequalities A commitment to fairness and equality is at the core of the IJBs purpose, strategy and vision. The HSCP provides a wide range of essential and critical services to the most vulnerable in society. Most health and social care services are aimed at all social groups despite differences in need. They are often disproportionately used by people whose needs are lower. People and communities with the greatest health and social care needs often experience poorer access to support. Given our geography, we need to ensure that services are accessible for all our residents, including our island communities and those who live in remote mainland locations. Objectives • Develop modern innovative care models that support equality of access to health care, social work and social care • Target services for marginalised populations • Carry out Health Inequality Impact Assessments (HIIAs) for all our change projects • Engage communities in service planning and review 3.6. Priority 6: Digital Transformation Digital tools and technologies are key enablers to support the transformation of the health and social care system in Argyll & Bute. Digital technologies can: • Empower people to self-manage their health though digital tools • Improve access and equity, through the expansion of remote consultations, telehealth, and digital therapies, such as online Cognitive Behavioural Therap. • Promote secure data sharing across services to improve coordination of care • Support population health planning through better use of analytics and Artificial Intelligence • Support the Workforce by providing staff with modern digital tools to reduce administrative burden • Enable mobile working and real-time access to patient information • Drive innovation through enabling co-design
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17 We need to support digital inclusion to ensure everyone can access and benefit from digital services. Objectives • Scale Technology Enabled Care and digital tools to support community and hospital at home delivery • Promote digital inclusion • Enhance data integration and cybersecurity
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18 4. How are we going to get there? 4.1. Our Values Compassion, Integrity, Excellence, Leadership and Continuous Learning, are the key values of the HSCP. We will need to apply these values as we work with our staff and our partners to develop our services and the partnership. 4.2. Service Quality and Improvement We will create a culture of continuous improvement to ensure our services deliver safe care and support. We will work with our staff and partner organisations to promote effective leadership across the HSCP to create the right conditions to ensure service quality and continuous improvement and to ensure that quality is everyone’s priority. This will be supported by the introduction and of a HSCP-wide Quality Management System. 4.3. Our Approach to Service Planning In developing a strategic plan, it is easy to think that how we deliver services is a straightforward choice: either provide services very locally or concentrate them in a smaller number of locations. In practice, services are planned and delivered along a spectrum that ranges from very local service delivery to some services that are delivered in only a small number places in Scotland (or in fact the UK). Where a particular service 'lands' along that spectrum depends on a number of things such as: • How many people need it or will need it in future • How many staff we need and their level of training • Equipment and accommodation that is needed • Geography • The overall funding available We welcome the Scottish Government's policy directions that health and social care services need to change and that we need to provide more community based services. This approach is more applicable to some services (social work or physiotherapy) than others (planned operations, specialist mental health treatments, some residential placements). To ensure that all our services are sustainable in the long term, we will have to change how we deliver some services over the
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19 course of this plan to make the best use of the resources we have. This may change how and where you access some of our services. 4.4. Working with Our Communities, Service Users and Carers Services should be designed around people, not systems or institutions and we seek to embed co- producing services with individuals, carers, and communities into our service planning and delivery to ensure they reflect real needs and preferences. We will work with our Locality Planning Groups and Community Planning Partnerships (CPPs) to work collaboratively with local populations. Our Engagement Strategy ensures that consultation and engagement is embedded in our way of working and bespoke engagement is carried out before policy changes are agreed. 4.5. Collaboration and Whole System Working Partnership and true whole system working will be central to improving our services. Key partners we will work with to plan and deliver our services include: • Voluntary Sector organisations and service providers • Independent sector service providers • Argyll & Bute Third Sector Interface • Colleagues from Argyll & Bute Council (education, transport, economic development and housing) • NHS Highland We will also work collaboratively across our boundaries, with other HSCPs and health boards, such as the Scottish Ambulance Service, NHS Greater Glasgow & Clyde, and the West of Scotland Planning Region and where appropriate the North Scotland Planning Region. We will ensure that the needs of our population are considered and build into regionally and nationally driven service re-design and commissioning decisions by ensuring strong representation West of Scotland Planning Group and other relevant regional and national groups. 4.6. Service Transformation Our Transformation Board will oversee our service transformation programmes and projects. It will agree priority programmes for each year and ensure the HSCP understands the progress that is being made and that the caused for delays are addressed. The IJB will have oversight of the Transformation Board, which is a decision and action focussed body. It will report monthly to the HSCP SLT and quarterly the IJB’s Finance and Policy
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20 Committee. We will work with our partners (Council, NHS Highland, Third Sector and providers) to scope joint projects and programmes. We will need to take a phased approach. Our immediate areas of focus are: • Financial sustainability • Delivery of core services • Risk management • Ensuring quality of care • Health and safety • Safe consolidation of service delivery and available workforce • Improving management practice • Community dialogue • Evidence based change • Development of transformation proposals that are well-scoped and time limited • Fostering a culture that is open to change Our priority areas for transformation in the medium term are: • Whole System processes • Care at home redesign • Review of care homes • Primary Care modernisation • Population Health: prevention and reduction of health inequalities Our long term priorities for transformation in partnership with Argyll & Bute Council, NHS Highland, our providers and the third sector are: • Infrastructure • Digital Modernisation • Development of sustainable service models • Sustainable secondary care pathway • Housing and amenities • Sustainable population and workforce • Improving the how we commission services • Workforce learning and development • Our environment
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21 4.7. Intelligence and Data We will make decisions based on evidence and data. All our service areas will have access to management information and will use this data to refine their operating models and to inform continuous improvement. We will also work with our external providers to improve the quality of the performance information that they provide us about the services that we commission from them. We will ensure that this information is used consistently to inform our service planning, commissioning and contracting. 4.8. Performance management The HSCP will continue to report performance in a holistic way through our Integrated Performance Management Framework (IPMF). We will review the IPMF to ensure that it effectively helps us to consciously monitor our performance and to drive our transformation projects. All service areas will have their own operational plans that will translate the HSPC’s strategic priorities into specific actions and a programme of work that will be monitored by Heads of Service and their senior managers.
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22 5. Our strategic commissioning intentions Many of our services are not directly delivered by the HSCP. In fact, we work with a wide range of third sector and commercial providers to source appropriate social care services for our population in Argyll & Bute. There are also services which are purchased from outwith the HSCP area, these are called out-of-area placements. We also support some providers through grants, which are payments to voluntary organisations to support activities which would otherwise not be viable. It is important to note that a large part of the unscheduled and scheduled care activity for a variety of specialist secondary care services is accessed in or provided by NHS Greater Glasgow & Clyde (GG&C), along with some more specialist community services for the population of Argyll & Bute. Our geography means that there are very few patient pathways link to NHS Highland secondary care services and we work with NHS GG&C and number of other NHS boards, to source both person-facing and back-room services though service level agreements. All HSCPs are asked to develop market facilitation plans or statements to support the development of sustainable social care markets for their area and to ensure that current and potential providers are equipped to deliver effective services that meet the needs of local populations. The main aim of this section is to give clarity for current or potential service providers our approach to commissioning social care services within Argyll & Bute and how we aim to support a functioning social care market through our commissioning and procurement arrangements. 5.1. Strategic commissioning and market facilitation A key mechanism though which we work with other organisations to provide services on our behalf is called commissioning. Strategic commissioning involves assessing and forecasting needs, linking investment to agreed outcomes, considering options, planning the nature, range and quality of future services and working in partnership to put these in place. Market facilitation entails commissioners working closely with providers, supported people, carers and their internal colleagues (procurement, legal and financial) to encourage the flourishing of a sustainable, effective range of providers and types of support in an area.
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23 5.2. Legislation, Policy and Guidance About Service Commissioning Public Bodies (Joint Working) (Scotland) Act 2014 The act places a duty on IJBs to produce market facilitation plans and to involve a range of service providers, service users, representative bodies, and professionals in the commissioning process. Care Reform (Scotland) Bill If passed, this legislation will have implications on the delivery and commissioning of community health and social care services commissioned by A&B HSCP. Proposed changes include: • Specific procurement routes/arrangements for third sector organisations • Potential for ministers to amend the light touch threshold for procurement • Rights to breaks for carers • Independent advocacy and advice for service users ad public • Provisions for improved information sharing and information sharing standards • Introduction of Anne’s Law to give formal recognition to some family and friends and their role providing care, support and companionship. • Creation of a National Care Advisory Board to support the creation of a national Support & Improvement Framework for local services, including delegated children’s and justice social work services. Self-Directed Support (SDS) Act 2013 SDS aims to deliver choice and control to individuals receiving care. Our approach to commissioning services will be aligned with the principles and values of SDS as set out by the Scottish Government. We will make use of the flexibility afforded by the Procurement Reform (Scotland) Act 2014, to ensure that our contracts and procurement processes have the flexibility to enable SDS. Health and Care (Staffing) (Scotland) Act 2019 We must ensure that our commissioning activities comply with our duties under the Act when planning or commissioning social care services.
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24 Best Value The Local Government in Scotland Act 2003 sets out a statutory framework for Best Value for local authorities and in 2020 the Scottish Government published revised statutory guidance on best value within which Public Bodies should work. Public bodies have must be able to demonstrate a focus on continuous improvement in performance around the themes of: • Vision and Leadership • Effective Partnerships • Governance and Accountability • Use of Resources • Performance Management • Equality • Sustainability Anchor Organisations and Ethical Commissioning Argyll & Bute Council and NHS Highland are anchor institutions. In other words they are large organisations which have significant presence in their local community. By sourcing and procuring services locally, with organisations that work ethically and sustainably, the HSCP can help bring wealth to Argyll & Bute. Health and Social Care Renewal and Population Health Frameworks As outlined in section 2 the frameworks lay out ambitious objectives in terms of achieving a shift towards prevention and also in regard to better access to services in the community. This means that some activity that is currently delivered in hospital sites will, over time, move to community settings. However, there will always be a requirement for very complex treatments, and these must be delivered from a limited number of modern hospital sites that have the required equipment, infrastructure, and workforce. Health boards and HSCPs are also asked to shift their approach service planning and commissioning towards population based approaches and away from planning services around a specific boundary. 5.3. Challenges Budget Pressures
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25 As highlighted throughout the plan, demand for health and social care services is outstripping available funding and rising costs continue to put pressure on the HSCP and our providers. Workforce Recruitment and retention of skilled staff is an issue for the HSCP and our providers. This is exacerbated by competition from other sectors and the ongoing impact of changes to immigration rules and regulations. Service Gaps and Market Failure Our geography and relatively small population base means that it is difficult to attract providers to fill specific service gaps. This is illustrated by the fact that the HSCP provides a higher proportion of social care services in house in our more remote localities compared to our localities that are located closer to the central belt. 5.4. Engagement with Our Providers To support the development of this plan, we shared a consultation survey with all our social care providers and held engagement events. Feedback was sought on the priority areas for our commissioning priorities [This is planned work as part of our engagement strategy].
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26 5.5. Key Market Messages Commissioning should align with strategic objectives and, as such we have grouped our key market messages in accordance with our JSP strategic priorities. Priority 1: Preventative and Community Based Care We will seek to invest in and commission services that reduce demand on acute care and support independence. The JSNA highlights that Argyll & Bute communities do not come in one size. The needs of residents in Helensburgh may differ from those of Oban or our Island communities. Moreover what works in one location may not work in another. We will work with local communities and providers to ensure that services a responsive to local need and take account of the local context. We will work with our local communities and localities to ensure they have an active role in local planning and commissioning of health and social care services. We will work with public health to ensure that grant funding is aligned to both national and local priorities and is robust in the monitoring of outcomes. Priority 2: Integrated and Person Centred Care Care should be designed around people, not systems or services. We will prioritise personal outcomes over service outputs. Our commissioned services should ensure that individuals are active participants in their care planning and delivery. We will align to strategies which have personal outcomes at their centre. We will work with providers to embed the GIRFE (Getting it Right for Everyone) and GIRFEC (Getting it Right for Every Child) approach to support holistic, coordinated care. Priority 3: Financial and System Sustainability Over the next five years the HSCP will take action to bring spending back into alignment with the available funding. This will have an impact our commissioned services and providers. We will ensure all care packages are reviewed on a regular basis to ensure that they still meet individuals’ needs. We will also seek to redesign our services and we will work with our providers to innovate and co- produce new service models that support system sustainability through:
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27 • promoting independence and self-management • reducing unnecessary variation • reducing unnecessary demand and interventions (i.e. admission to hospital, when there is a more appropriate service) We will take an outcome based approach to commissioning. We want all our services to be clearly linked to outcomes and evaluated against them. We will work with providers to clearly demonstrate the benefits they deliver for individuals and evidence the wider social impact they have in communities. We will continue to work with our providers to support evidence gathering of national, local and individual outcomes. Priority 4: Workforce Commissioning must consider the skills and capacity needed to deliver integrated, person-centred care in Argyll & Bute. We will ensure that our commissioning supports the workforce of our provider organisations. We will maximise opportunities for joint and collaborative training. We will continue to encourage and support Fair Work through our contracts in line with advice and guidance from the Scottish Government. We will consider how the design of our commissioned services can impact on the delivery of Fair Work principles. We will work towards the signing of The Ethical Care Charter, recognising that safety, quality and dignity of care is directly linked to employment terms and conditions. Priority 5 – Accessing care and Tackling Health Inequality We will ensure that all our commissioning decisions will be assessed for their impact on communities across Argyll & Bute. We will refer to the Fairer Scotland Duty, the Islands (Scotland) Act and Equalities & Islands Impact Assessment to protect the most vulnerable to ensure that we are inclusive to all areas and to those with protected characteristics. We take our role as an Anchor Organisation and our role as our role in supporting Community Wealth Building seriously. We will commission social care services locally wherever possible. We will ask our providers to highlight their contribution to their local communities too through community benefits. Priority 6 – Digital Transformation
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28 Many of our provider organisations have adopted and embraced technology (such as scheduling systems). We want to work with providers to trial and roll out new systems such as remote welfare checks, medication prompts and other digital solutions. We will also need to improve how we oversee and manage commissioning within the HSCP. Governance and Oversight We will set a up a Commissioning Oversight Group, which will report to the Whole System Planning Group, Strategic Planning Group and SLT to provide oversight and ensure we take a coordinated whole system approach to service commissioning. We will develop a standardised process for the allocation of temporary grant funding aligned with strategic priorities, particularly prevention and early intervention and which will be overseen by the Commissioning Oversight Group. The Commissioning Oversight Group will agree a matrix to prioritise services which are likely to benefit most from focussed review and redesign. Strategic Provider Engagement We will engage with the third sector and providers on how we can best support: • Sharing of best practice, learning and innovation and new ways of working between providers. • Potential partnership working between providers. Business Processes We will create a central commissioning function to support individual teams with their commissioning projects. We will also implement consistent process for contract monitoring and service reviews and audit ourselves against it. All commissioned services will have a clear and up- to-date service specifications in place, which reflect current guidelines and best practice. Service specifications will include activity, quality and performance metrics, which are regularly reviewed. Service specifications are regularly updated. Commissioning of Individual Social Care Packages We will have a consistent process for assessment and reviews of individual packages of care. We will review and update internal policies and processes and our scheme of delegation for the
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29 approval of individual care packages. We will assess people who are out of area and work with providers on how we can relocate people if that is possible and meets their needs.