Welcome: Planning Older People’s Services Public Engagement and Consultation

Introduction

East Lothian Health and Social Care Partnership (ELHSCP) is committed to ensuring that key stakeholders and the local community have an opportunity to engage and actively contribute to the planning and development of older people’s services.

East Lothian’s population is changing, and people are living longer. We know many older people want to stay at home for as long as possible, and more emphasis is needed on services which support timely discharge from hospitals or can prevent unplanned hospital admissions. These services are known as Intermediate Care.

To make this possible, the development of high quality, sustainable services are required. But we do not want to develop these services alone. We want the people of East Lothian to be part of the conversation.

As part of our Planning Older People’s Services (POPS) project, ELHSCP wants to identify, design, and develop services together with the people of East Lothian; so together, we can identify solutions that will benefit each of the county’s communities for generations to come.

While this project has focused on older people’s services, it is important to recognise and acknowledge that health and social care services that support people’s independence can be required at any stage in life. The priorities identified following the engagement stages of this project reflect this. The priorities and opportunities they present, are relevant across the life span.

Project objectives

To be successful, this project’s aim is to identify options and solutions that are realistic and achievable and will deliver high quality care and support to East Lothian’s current and future older population, within a timescale not exceeding 10 years.

Our priorities:

• 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 communities within East Lothian to ensure co-production of services that will allow for equality of service across our diverse population.

Project timeline

At the outset, a project timeline was established identifying the key progression milestones this engagement project would go through.

How did we get here?

Gathering interested people

The Planning Older People’s Services Project (POPS) commenced its initial round of community engagement events in August 2023 , which included a variety of engagement opportunities including online and paper surveys; face-to-face and virtual engagement sessions, held with communities, staff, the third and independent sectors; and individual interviews to gather as many views as possible.

At these sessions, ELHSCP shared its 2022 ‘Planning for an ageing population’ engagement findings , focussing on the facts that almost everyone would like to remain living independently at home for as long as possible and that Intermediate Care was seen to be a priority for future investment and expansion.

Attendees were then provided with additional background information as part of the POPS project’s Case for Change , specifically:

• Population projections suggest the number of people aged over 65 living in East Lothian will increase dramatically (32%) over the next 10 years.
• Any ideas or suggestions put forward to deliver, expand and/or improve health and social care services must take account of and try to mitigate the impact of deprivation on some communities in East Lothian.
• East Lothian is currently dealing with a long-term staffing and recruitment crisis, which is both a local and national concern.
• Financial budgets are very stretched and are likely to continue to be so in the next 5-10 years.
• There were additional issues to consider including access to community venues, issues with public transport and the arrival of the National Care Service.

Having set the scene, ELHSCP asked people to put forward ideas, suggestions, and feedback on what we could do to:

• Increase the provision of intermediate care,
• Address the challenges with supply and demand for care at home services,
• Help more people to die in the place of their choosing,
• Address issues of equitable access to services,
• Build sustainable health and social care services.

Collecting feedback

The first round of engagement sessions invited people to share their views and ideas about the future of older people’s services.

Between August and December 2023, ELHSCP hosted over 44 events, 36 of which were in person, the remaining either virtual or hybrid. These events allowed ELHSCP to directly engage with 702 people. A further 141 took part in our online survey and 11 in printed questionnaires.

In total 2,458 individual pieces of feedback on how to improve or deliver older people’s services in East Lothian were collected.

Information was also gathered from the feedback and responses obtained from the IJB Strategic Plan Health, Housing and Place Engagement (April – July 2022) (1,060 participants), the Dementia Strategy and the Planning for and Ageing Population engagement in 2022.

The 2,458 pieces of feedback were categorised into 49 separate themes, which were further condensed into the 19 recurring key themes below.

Creating a long list of options

The 2,458 pieces of feedback received from the first round of engagement incorporated 314 actionable suggestions for developing older people’s services.

These were then consolidated into 105 long-list options. These 105 options were then assessed against 4 pre-set hurdle criteria, by the overarching Project Team and the Independent Community Panel.

Assessing ideas against set criteria

This activity involved each ‘long-list’ option being assessed against 4 conditions that needed to be overcome or met to progress to the next stage .

For ease several of the intermediate care and palliative care suggestions were amalgamated together under the same suggestion heading, resulting in the survey outlining 82 options for consideration.

Hurdle criteria questions

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?

This hurdle criteria exercise was undertaken in two parts:

Stage 1: members of the ELHSCP Project Team and a group of community representatives which were formed to create an Independent Community Panel, assessed each of the 82 options individually via an online survey.

Using a predetermined scoring mechanism, the results were as follows:

• 26 of the options automatically passed to the short-list stage.
• 12 options automatically dropped out, as they were unable to meet the supermajority conditions.
• 44 remaining options were put to the vote during a face-to-face exercise.

Stage 2: These 44 options were discussed by the Project Team and Independent Community Panel, and a consensus was agreed as to determine which options should go on the short-list.

Short list of options

Following the hurdle criteria assessment, a total of 61 options were placed on the short-list.

These were categorised under the following 17 theme headings.

Investigate and model short-listed options

The 61 short-listed options were allocated to a Senior Officer / Manager within the Health and Social Care Partnership for further scoping and development.

Of the 61 options that passed the hurdle criteria exercise, at the outset:

• 22 options were categorised as either action already underway or business as usual,
• 39 options were chosen to go through to the modelling and development exercise.

Officers were asked to consider strategic priorities, financial implications, timescales, staffing and workforce, procurement and commissioning, market conditions and demand, relevant data, anticipated benefits, outcomes and service impacts, strengths, weaknesses, opportunities, threats, risks and any related ongoing workstreams.

Following the modelling and development exercise , it was agreed:

• 16 options were recommended to proceed to the options appraisal.
• 40 options were regarded as action already underway / business as usual.
• 5 options were withdrawn from further consideration at this point.

Options appraisal exercise

The options appraisal exercise was undertaken by representatives of the project team and independent community panel during a half-day face to face exercise on Tuesday 30th July 2024 .

The Project Team and Independent Community Panel collaborated and agreed a set of criteria and weighting in advance of the exercise, that each of the 16 options would be assessed against.

The criteria focused on three themes:

• Desirability (35% weighting)

  • Does the option promote our strategic and project objectives
  • Does the option help to improve clinical and social care outcomes for older people?
  • What is the level of support for the option from the community and key stakeholders?

• Feasibility (35% weighting):

  • Can the option be implemented in a timely fashion and within the context of the current financial climate?
  • Does the option allow partner organisations / Integration Joint Board to discharge statutory functions?
  • Does the option expose partner organisations / Integration Joint Board to risk of challenge?

• Viability (30% weighting):

  • Does the option represent value for money? Taking into consideration the current financial climate, improving outcomes, improving service delivery and invest to save.
  • Does the option improve integrated working, reduce duplication, and allow efficiencies to be realised?
  • Is the option viable and sustainable from a workforce perspective?

Each of the attendees carried out their assessment privately to reflect their own experiences, position, organisation, and community. This ensured that the exercise represented as broad a range of stakeholder opinions as possible, and we are confident that it provides a result that is both balanced and representative.

Their individual responses were collated and analysed using the weighting and scoring outlined above.

At the outset of this engagement process, it was proposed that the appraisal exercise would identify a maximum of five options to progress to public engagement and consultation .

Following the options appraisal process, the following achieved the highest weighted scores:

The table below details the 16 options in ranked order following the appraisal exercise. The top seven have been used to develop the above four priorities. The full report from this exercise is available in the link below .

The Planning Older People’s Services project is now in its final engagement stage, presenting the project findings and priorities over a 12-week public engagement and consultation period between Monday 16th September and Sunday 8th December 2024.  

Planning Older People’s Services Public Engagement and Consultation

Only by engaging with stakeholders can East Lothian Health and Social Care Partnership (ELHSCP) develop services for older people, which reflect local needs and aspirations.

In conducting this project of engagement and consultation work, ELHSCP have complied with the national standards for community engagement as outlined by the Scottish Government.

This public engagement and consultation aims to gather stakeholder’s opinions on the findings and priorities of the Planning Older People’s Services project to date. The feedback gathered will be incorporated into the final report, which is due to be presented to the East Lothian Integration Joint Board in February 2025.

How to get involved

We have created a dedicated website ELHSCP POPS Website which provides full details of the engagement process to date. We will continue to share regular updates to this website and our social media pages. We will work closely with local media, including local radio and press organisations.

You can get involved by:

Attending a pop-up event We will be hosting a series of in-person pop-up events, within each of the major towns in East Lothian. You are welcome to come along and share your feedback in person. We will also have paper copies of our project findings and feedback form.

Send an e-mail You can share your feedback via email: engagement-hscp@eastlothian.gov.uk

Through social media You can engage with us through social media: Facebook: @elhscp X: @elhscp

You have until Sunday 8th December 2024 to tell us what you think.

Who we want to talk with and listen to

We really appreciate you taking the time to provide us with your feedback. We are consulting with a wide range of people, who have an interest in or may be directly affected by the delivery of older people’s services in the future. This includes people currently making use of our services, their family members and/or carers, health and social care staff, community groups, third sector organisations, providers, partner organisations and the public who live and work in East Lothian and may require access to older people’s services in the future.

What we want to know

We need sustainable solutions to plan and deliver older people’s people services over the next 10 years across East Lothian.

While doing so, we must take into consideration:

• population projections, (an increase of over 32% in people aged over 65),
• we take account and try to mitigate the impact of deprivation on some communities,
• the level of deprivation within some communities,
• the current social care recruitment crisis, and
• an ever-challenging financial position resulting in limited budget resources.

Our engagement activities, assessment, modelling, analysis, scoring and weighting exercises has identified the following four priorities that should be considered by the East Lothian Integration Board when developing its Older People’s Service strategy.

Further information and context on each of the four priorities is available below:

Identified priorities

Priority 1: Palliative and end of life care

Option 11 and 14: Review palliative and end of life care throughout East Lothian including development of an end-of-life care sheet.

Palliative care is defined by the World Health Organisation as an approach that improves the quality of life of patients (adults and children) and their families who are facing problems associated with life-limiting illness, usually progressive. It prevents and relieves suffering through the early identification, correct assessment and treatment of pain and other problems whether physical, psychosocial, or spiritual.

Palliative and end of life care affects us all at some point. More than half a million people are expected to die each year, and many live with a life expectancy of less than a year at any one time. This is set to increase with a growing older population, so more people are expected to die at an older age.

Within East Lothian there is already a huge amount of work being carried out to support people at home, or within the local authority area. ELHSCP’s chief nurse is leading a partnership project to improve joint working and collaboration within palliative care. This initiative, which involves third sector support organisations, aims to shape the strategic direction and develop future services.

Many people feel uncomfortable talking about their wishes for the end of their life. Not talking about it denies the person the opportunity to fully participate in discussions and decisions about their current and future care.

This priority indicates a request to review and enhance the options available within palliative care, so people can plan and consider their preferences for their end-of-life care and treatment.

Priority 2: Polypharmacy reviews

(Option 95): Introduce polypharmacy reviews that are not exclusive to care home settings.

As people age, they become more vulnerable to having multiple health or medical conditions. They can often be complex in nature or classified as chronic conditions. To treat these conditions, older people are often given a number of different medications. This is known as polypharmacy, “many medications”.

Polypharmacy reviews are undertaken to ensure that patients taking multiple medications are doing so for the right reasons, to ensure safety and effectiveness. They are a proactive intervention measure with the aim of preventing harm from medicines, hospital admissions, and mortality from complex medicines regimes.

Currently the East Lothian Pharmacotherapy team undertake polypharmacy reviews for care home residents in collaboration with the Care Home Team and General Practitioners. General Practitioners can also undertake polypharmacy reviews but are limited by capacity.

This priority indicates an opportunity for a more coordinated approach to polypharmacy reviews undertaken in East Lothian. An ‘invest to save’ approach could see an increase in polypharmacy reviews aiming to reduce potential harm from medicines in older patients, improving quality of life, reducing medicines burden for patients, reducing avoidable hospital admissions, and ensuring medicines are used cost effectively across East Lothian.

Priority 3: Intermediate Care

(Options 77, 79 and 80) Invest in existing intermediate care services, including step-down, and development of new intermediate care approaches.

Intermediate care services are provided to patients, usually older people, either leaving hospital or when they are at risk in the community in order to help maintain their independence and reduce the likelihood of unnecessary admissions to hospital.

Evidence shows that well-designed intermediate care can improve people’s outcomes and levels of satisfaction, reduce admissions to hospital and long-term social care services, and reduce delayed discharges from hospital.

A report presented to the East Lothian IJB in February 2023 highlighted the breadth and depth of intermediate care services being provided throughout East Lothian and the benefits now being realised due to earlier investment.

Examples of ongoing intermediate care development work include:

• The Care at Home Change Board, which aims to review the current delivery of care at home services and identify alternative methods of organising, scheduling, and resourcing services to meet the increasing needs of the East Lothian’s ageing population.
• Implementation of the dementia strategy,
• Enhancing the use of technology within the East Lothian Rehabilitation Service.

Recommendation 3 of the final report encouraged the Integration Joint Board (IJB) to focus on extending Intermediate Care resources, develop new and more intermediate care provision and noted that it should be a key priority for further investment.

This priority provides an opportunity to remain committed to developing intermediate care services to facilitate care closer to home and ensure that East Lothian’s population can remain within their own communities for as long as possible. Provision of efficient and effective intermediate care is also vital to alleviate pressure on hospital and care home beds.

Priority 4: Technology

(Option 85) Explore better use of technology and associated services to allow people to remain within their own homes for longer.

The potential benefits and opportunities that technology offers in the context of health and social care could be limitless but are ultimately bound by affordability, lack of infrastructure, data protection, skill gaps and negative perceptions / attitudes. Within East Lothian the assessment and use of consumer technology and telecare solutions is core practice across many care pathways. Our rehabilitation service will always consider technology solutions where possible, in preference to formal care. Ongoing challenges do exist in relation to integration of core social care and health information systems, and this translates into a wider national issue. While our rehabilitation service uses technology extensively, there are likely wider technological applications that could be used throughout East Lothian’s health and social care teams, and this will be a focus of our recently established Digital Change Board.

A local example of good practice is the Wellwynd Hub in Tranent where a range of technology is on display for people to see and try including medication reminders, GPS devices and lighting options as well as examples of how smart speakers and smart screens may be able to assist someone with daily living. It is recognised that when technology is embedded seamlessly into care and support it can be transformative, improving people’s quality of life ensuring information is readily available to help staff provide the right care in the right place at the right time.

This priority identifies an opportunity for enhancing the use of technology and increasing digital choice in order to support the development of efficient and sustainable services for older people, that are agile and responsive to the changing needs of the East Lothian population.

Equalities and health impacts

We recognise that we must be fair, and consistent across East Lothian. Changing the way in which older people’s services are delivered will affect everyone living in the East Lothian area regardless of age, sex, disability (physical, mental health or learning disabilities), race, religion and belief, sexual orientation, gender reassignment, marriage or civil partnership, or pregnancy and maternity status.

We must ensure that our proposals take into consideration people who are vulnerable, especially older adults, and their carers. We have undertaken an exercise called an Integrated Impact Assessment (IIA). This includes an overview of the potential positive and negative impacts any changes may have on people, and how we can mitigate against these issues to address our equality duties.

The Planning for an Ageing Population (2022) IIA is available to view on our website at .

An interim Integrated Impact Assessment has been conducted for the POPS project, which can be viewed online at . This will be updated once this project concludes depending on the outcome of the IJB’s decisions.

Protected Characteristics Some people with a protected characteristic may be more disadvantaged or face more difficulties when trying to access health care services.

The Equality Act 2010 protects people from being treated worse than other people because of their age, gender reassignment, disability, race, marriage and civil partnership, sex, pregnancy and maternity, religion and belief (including no religious belief), sexual orientation.

Our questions to you:

We have three questions that we would like to ask you as part of this engagement and consultation activity.

1. What are your comments on each of the identified priorities which came out of the Planning Older People’s Services project?

• a. Palliative and end of life care Review of palliative and end of life care throughout East Lothian including development of an end-of-life care sheet (option 11 and 14).

• b. Polypharmacy reviews Introduction of polypharmacy reviews that are not exclusive to care home settings (option 95).

• c. Intermediate Care Investment in existing intermediate care services, including step-down, and development of new intermediate care approaches (option 77, 79 and 80).

• d. Use of technology Explore better use of technology and associated services to allow people to remain within their own homes for longer (option 85).

• e. General comments Do you have any general comments regarding the identified priorities you would like to add at this time?

2. What feedback would you like to share regarding the Planning Older People’s Services engagement process?

3. Are there ways in which we can better engage with our communities regarding health and social care in future?

How will your feedback be used?

Your feedback, whether provided at a pop-up engagement event, via the online survey, by email or interaction on social media will be gathered and analysed. This feedback, along with the analysis undertaken during the engagement stages of the project will be complied together to prepare a final report.

The report will form the basis of a recommendation for planning older people’s services, which will be presented to the East Lothian Integration Joint Board for final consideration in February 2025.

Get in touch

Should you have any questions regarding the planned engagement and consultation activities, the opportunities in which you can interact with us, or queries about the project to date, please contact us via email: engagement-elhscp@eastlothian.gov.uk

We also recommend that you review the information on our dedicated website: ELHSCP POPS Website

The deadline to tell us what you think is Sunday 8th December 2024.

Thank you!