Sarah Mitchell Programme Director for the Active and Independent Living Improvement Programme and Susan Kelso AHP Lead for Early Intervention (Scottish Government) spoke to Iriss.fm about the programme and the LifeCurve Survey.
The Active and Independent Living Improvement Programme (AILIP) was officially launched on April 26th by Shona Robison MSP, Cabinet Secretary for Health and Sport. The vision for Scotland as outlined in the Health and Social care Delivery Plan is to have a Scotland with high quality services that have a focus on prevention, early intervention and supported self management.
The AILIP will be a key contributor to delivering that vision.
Sarah Mitchell, programme director for the Active and Independent Living Improvement Programme, and Susan Kelso, AHP Lead for Early Intervention with Scottish Government, spoke to Iriss.fm about the programme and the current Life Curve survey, which they would like AHP's to complete. The Active and Independent Living Improvement Programme, or AILIP, was officially launched on April 26th by Shona Robison, MSP Cabinet Secretary for Health and Sport. The vision for Scotland, as outlined in the Health and Social Care delivery plan, is to have a Scotland with high quality services that have a focus on prevention, early intervention and supported self-management. The AILIP programme will be a key contribution to delivering that vision. Sarah and Susan tell us more.
SM The programme is about the AHP's contribution, the Allied Health Professions, I should say, contribution to the whole health and social care agenda. So, we have out national health and social care delivery plan, which was launched last December, and we are really looking at how the AHP's can contribute to that by keeping people healthy, active and independent and supporting their whole personal outcomes. So, it's really one of the key drives or one of the key deliveries of that whole policy agenda. The focus is about delivering improvements and about how people are supported to manage their wellbeing, live active and independent lives and become, or remain, economically active and participate in their local communities. So, we have been working for a long time now, we had our own nation delivery plan between 2012 and 2015, and then building on that the Minister for Public Health, in May 2015, said we could progress that and have this Active and Independent Living Improvement Programme with the focus of prevention and early intervention. We've had various work streams ongoing through our muscular skeletal programme, out anticipatory care programme, working with children, young people and dementia. Following a whole raft of consultation with people who use services and our key stakeholders who we work with across health and social care, we asked them 3 powerful questions about what it meant for them to be healthy, active and independent and what should the Allied Health Professions do to support them and help them maintain their independence and live independently within their communities. From that consultation we identified, what we call now, 6 ambitions. So, it's about improving access to our services, about increasing the awareness of what it is that AHP's can do, it's about partnership working across multi-agencies and across sectors, about developing research and innovation and using technology to improve access but also to support that whole agenda around independent living, having a workforce that is fit for purpose, in effect, so currently looking at where we are intervening, and that's some of the work that Susan is going to be talking about, with our life curve, but it's about supporting the workforce in terms of doing the right thing in the right place and at the right time, and looking where we are currently intervening and then looking at our research approaches to develop that further. We are the only professions that work across both health and social care so we have a mainly OT workforce that work specifically and predominantly in social care and social work services. SO, we have got our muscular skeletal programme, that was kind of our flagship programme which really started back in 2007, that was a long time ago, when we said we should utilise NHS24 as a gateway to looking at referrals to manage the demand of the services coming through. Now we have got self-referral or direct access for all our muscular skeletal services in Scotland, so people don't have to go via a GP to get into the services, they can phone directly into the NHS24 and be triaged into the service, if necessary, or into the most appropriate service, but also given good self-management advice. We are building on that now with looking at web-based interfaces so people can actually just go onto their iPad or their phone and go through a whole series of questions and be directed into the most appropriate service. So, that's kind of building on the whole technology. Our fourth programme, we have done a lot of work now again, our programme called Up and About and we are now looking at working with the ambulance service to identify what are the most appropriate pathways for older people, generally, who have fallen at home who aren't injured but the usual route is to just convey them into hospital, but we have identified that actually that is not the most appropriate way to manage and support these individuals so we are doing a lot of work about what's the best, appropriate intervention. So, to keep them at home but to be supported with the appropriate community support, we are looking at working with the ambulance service to reduce that conveyance, that's one of their targets, but it's more than that, it's more about making sure that the person has the right and most appropriate care and ongoing support. Without Nation Force programme, we are also launching our taking the balance challenge, so this is about identifying people who are potentially at risk of falling and giving them a challenge to do a single leg stance challenge to improve their balance. We are doing a campaign so hopefully we will get that out as widely as possible to ensure that people can do this and•
F When is that kicking off?
SM So it's really kicked off, it's an ongoing process. We are working with Age Scotland, we are working with the Care Inspectorate and we are working with Scottish Care, so we are trying to just get that message out as widely as possible and it's part of our bigger preventative ongoing work around, what can we do to get people more active? Again, that forms part of the life curve, so we thought, what can we do to get people doing more activity at any age? So, intergenerational, what should you do, as a child, to be more active? What should you do, as a person of working age and how do we support people who are well elderly but also our frail elderly, to do more activity, to get moving more. So, it's called Move and Improve and that will build on some of our work that we have done once we've done the life curve survey. One of the other big pieces of work, which is a newer programmed, is around supporting people who have got a long term condition and are struggling to get into work and we know that there is very good evidence for good work and good health and there is work ongoing in Scotland around a single gateway, to ensure that people who are struggling with work or are falling out of work because of a, maybe a muscular skeletal condition, or a mental health condition, how can we support people to get back into work in a supportive way in terms of their rehabilitation needs, and so we are developing an education framework so that AHP's know what it is that they should do to support people if, who come into their services, who need support to get back into work as soon as possible, if that's the right thing. Whether that's paid or unpaid work, but to support them because we know that meaningful activity is one of the key things in terms of the whole social interaction for people, but also developing what we call the fit note, the AHP fit note, so that the Allied Health Professions can support and sign people back into work as opposed to, again, going back through the whole channels, through the GP services. So, that's another element of our work.
F Do you see any challenges along the way with these pieces of work or...?
SM I think the key challenge is that AHP shouldn't think that they are doing this in isolation, so we are part of a bigger multi-disciplinary, multi-agency team, and it's not one single intervention, it's very complex in effect, but it's about how we work with partners to achieve the best outcome for the person, and getting buy in from other policies or other work streams to identify that actually, if we put the person at the centre of this, the right thing is what we should be doing, and utilising and looking at all the community assets that are around about to support that person to live, you know, an active and independent life.
SK I think that is one of the challenges that frontline practitioners will find because personal outcomes, person centred approaches, they are imbedded across health and social care services, whatever sector or whatever service that you are in, and I think generally people who work in those sectors totally buy into that approach. It's the right thing to do, it's why they came into this area of work in the first place, but I think often they are constrained by the structures, the processes that are put in place, the very real challenges they face in terms of resources and budgets and time and the increasing demands on the services. So, I think one of the challenges is for them to stay connected to their own values about why they got into the work and how frontline managers, senior managers, educators, the higher education institutes, how can they all work together to support embedding this approach so that it happens in the face to face interaction with somebody, it happens in supervision, it happens in team meetings, it happens in strategic meetings, it's just threaded through. So, I think that, for me, is one of the big challenges that I hear people at every level in sectors grappling with. It's part of the whole cultural shift that everybody is talking about, really, in terms of moving from service led approaches to personal outcome approaches, which is a process and a journey that we have been on for quite a long time, but it seem to be gathering pace now when we look at the health and social care delivery plan and we look at all the other major pieces of legislation that are impacting services right now.
SM And I suppose it's embedding the work that we are doing within the integrated joint boards, so they have all their strategic commissioning plans and their strategic plans and it's about identifying what the contribution is that the AHP's can support in that work. So we have got the 9 health and wellbeing outcomes, and it's how we can support because a lot of those wellbeing outcomes are really right for what we are trying to achieve, so it's about making that message wider so that people identify that actually AHP is a part of that whole solution in driving this agenda forward.
SK So, as part of our AILIP programme we are conducting what is an ambitious piece of work, really. So, AHP's probably make up round about a third of the workforce across health and social care, mostly in health, there are about 600 staff who work in social work, social care settings, thereabouts. So, we are asking all of those practitioners, where they work in adult services, to do this life curve survey with 2 people, and that's over a 2-week period, so we are right in the middle of that now, we started on 10th May and we are concluding on 26th May, so that's next week, so people have had just over 2 weeks to think about 2 people who are typical for their service users and to take this life curve survey with them. Now, the survey itself, where does it come from? So, we've been working with professor Gore, who is in Newcastle university, and I guess he wears 2 hats, he is professor of Ageing and Vitality in Newcastle and he also is MD of a company that is interested in using technology to help people age well. So, we have been working with professor Gore who, with his academic hat on, has developed a model of ageing which he calls Compressed Functional Decline, that's a bit of a mouthful, so he is calling it the life curve. Essentially what that describes is the kind of typical journey that we are all on as we begin to age. There has been lots of literature, lots of research looking at activities of daily living, which are often markers for independence, markers for ageing, markers for how we would want to support people and what level of support people would need. So, there is research that has been around for 20, 30 years and within that, but it's not been picked out, it's very clear that there is a set order to which we lose these everyday activities of living as we age. That's quite interesting to think about, so if we know there is a set order and we get to plot people on their life curve, if you like, by finding out those activities that people aren't able to do and how long have they not been able to do these activities for, and that gives them a mark about where they are on their ageing journey, which means it's interesting for them and their family, but it's also interesting for service providers because if we know where they are then we kind of know where they are going next and it also means that we have an idea about the kind of intervention that we might want to be doing with somebody. So, for example, the activities of daily living are really a proxy, if you like, for the physical impediments that somebody experiences as they get older, and I am talking about age because we start to age around about the age of 42, that's about when we could start to age, but of course it's really easy to measure age but it doesn't actually predict anything and it doesn't help us understand how people age because we all know people who are in their mid-50s who look very different from people who are in their mid-80s. we have got lots of very active and fit people in their mid-80s these days. We tend to hear a lot about people in that age group who are more frail and, obviously, depending on where you live, so we are in Glasgow today, in certain areas of Glasgow, because of the life chances that people haven't had and the social economic background that people are living in, then that clearly impacts on their ageing journey as well. The life curve itself is looking at these 15 markers, these activities of daily living, so the first thing that we identify that you are not able to do by yourself is not being able to cut your own toenails and the last thing that we identify that you are not able to do by yourself is to eat and drink. So, round about the middle of that is being able to have a full wash, so either being able to get in and out of a shower, get in and out of a bath, or have a full strip wash if you like, and that's quite interesting to know because if you think about eligibility criteria for social care services, often that's not seen as a priority. So, if we don't identify that as a priority, then people are already half way down their ageing journey and they have lost functional ability before we even get to see them. So that's quite an interesting thought. So, the move and improve campaign and piece of work that Sarah was talking about, is trying to address the market that is about walking 400 yards, and that's about the 3rd or 4th activity that people struggle with on the life curve and you typically will see that people rapidly will drop off on their function ability after they can no longer walk 400 yards. So, physical activity, I mean there is so much research now about physical activity being good for a mental health and physical health and our cognitive functioning for staving off dementia and other cognitive difficulties. So, our More and Improve Campaign is aimed to try and identify people who are at that point in their life curve and to try and change their trajectory to try and look at what they could do, what we could do to support them, to become more active and to regain that ability to walk 400 yards.
So, the survey itself is quite unique, it's never been done before. It's a partnership approach, we are working with Strathclyde University, the professor of Rehab Engineering, that's professor Phil Rowe, Newcastle University, and we are working with ISD and we are working with the Scottish health economists and the government. The reason we are doing that is that we are collecting each person who takes part in the survey, we are collecting the CHI number, the unique NHS personal number, and that will allow us to gain access to the information that ISD hold about them in terms of the use of health and social care services that they have used over the last 5 or 6 years. Now, we know that most of that will be health, there isn't a lot of, it's the source data, it was previously called (... unclear), so we know that there isn't a lot of social care data in there, there will mainly be health but, nevertheless, it's going to be a great source of data not just for us within our programme, but actually right across the other programmes and other sections within Scottish government. So, if you think about self-directed support, you think about care at home, you know, you think about justice services, you think about any service actually understanding people on their ageing journey and their use of services and the cost of that. The health and social care delivery plan talks about prevention, one of the main thrusts, I mean Allied Health Professionals, there are 12 different individual professions in that group and we either do things, we either help to diagnose difficulties, like some of our radiographers, or we provide therapeutic intervention or we do rehabilitation and enablement, and so when you think about that being our contribution and what we are trying to do is to support people with an enabling approach, then the life curve survey is going to be able to plot where all those staff are across Scotland and if we are intervening quite far down on somebodies life curve journey then we are missing our opportunity and the whole of health and social care is missing an opportunity at using the skills that we have got to the best of our ability.
We are really interested in a study that was done in Canada in 2014 that looked at people on the 400 yards' marker on the life curve and they gave half of that group general public health information about keeping active and keeping healthy and then the other group they gave very targeted, individualised help and support to and, perhaps not unsurprisingly, that latter group could walk the 400 yards 2 and a half years longer. So, for us within our programme, within AILIP, and what we do following getting all the life curve data back, it really is about keeping that personal outcome approach completely focused within the preventative ways of working that we develop from the data, because it's about working very closely with the person who is living with the health and social care difficulty, or where they are on the life curve, and it's making sure that what we do is very much based on the things that are important to them and what motivates them, what matters to them in their life, who matters to them in their life. So, if we don't have those conversations while we are talking about keeping active and healthy, then we are not actually going to get anywhere with people, I don't think.
SM Can I just add one thing? And building on that is with the other message, and it's the message to the chief officers and the chief executives and policy makers, what is the cost associated with very cheap really interventions around keeping people active and independent, versus allowing them, in effect, to slip down that life curve? So, what is the cost of keeping someone able to walk 2 and a half years longer, versus going further down onto that life curve and the health and social care costs associated with that? So, the conversations that this data will enable us to have with the people who are in charge of the money, the money men, we'll have different conversations and that will, I think, a whole cultural change as well.
SK Well, we will have the data ready to talk about and share, I imagine by early August, early September, Late August, early September, and so from that we will be able to plot, across the country, where people are, what services they are seeing, what type of services they are seeing and what the total cost of the health and social care usage is. We have also made the opportunity to talk about some additional questions as well, because obviously, there are some major areas of concern that Scottish government is trying to address so we are asking people about their emotional wellbeing, because Scottish government want to knit together that disconnect, currently, around mental health services and physical health services. We are asking people about their caring responsibilities, we are asking people if they work or have other meaningful activity, we are asking people about their housing circumstances and whether that meets their needs or not. So, we are trying to capture, there is only about 6 other questions, and people so far have said the survey is really quick, it only takes a couple of minutes for the person to administer. We have also made it available where people aren't able to consent to share their personal health number, so if they have a power of attorney or a welfare guardianship in place, then their guardian or power of attorney can sign on their behalf, so it means we are not missing out on a number of people say, for example, with a learning disability, who use our services who wouldn't have capacity to give consent themselves. So, it's very exciting, it's very unique and, I guess, what it will tell us, it's a baseline data really and it will just tell us where we are and it will tell us the cost of what that is to intervene in a particular point in their life curve journey.
F Is it going to be a report that's produced?
F It's going to be a printer report?
SK Yes, we will, we would want to, I think, find different ways to make the information available, because people will use information in different ways and will access information in different ways. So, yes, we will have the information for the whole of Scotland but we will then be able to give each local area back their own information and I would certainly be committed to trying to think about how we present that information in different formats to be useful to people.
SM I think one of the strengths will be about how the AHP's then look, locally, at the data that comes back and then can look at how they transform their services to ensure that we have a focus on prevention and early intervention. It might not be that they are doing that, but it actually will ensure much better partnership working across agencies because we will identify how we can work differently in the future. So, it can have some quite, very good and accurate data about predictive modelling, so what could services look like if we did this and let's maybe test it out, in a safe environment to do that.
SK Yes and I think, clearly, one of the whole focus around some of our work around prevention and that, kind of, fit with personal outcomes, we really need to be able to work in partnership, that's one of our ambitions within the whole AILIP programme and it's really key. So, partnership is not just about making sure that we work in multi-disciplinary teams, it's not just about making sure that we work across sectors, I think probably one of the things the life curve will really highlight to us is where we need to share our knowledge and skills more broadly with universal services. So, we've got example is of that already within the Falls programme, where we have worked with leisure service staff who now run classes around strength and balance and condition specific programmes, for people with long term conditions. So, I think there is much more of that we can do, because we are not going to create, nobody is going to get any more staff or any more resources so it's about how we do that more cleverly and think a bit more creatively about how we share what we have to offer. The partnership is also much more about, how do we harness people's own experience, their own expertise? How do we support them to build their capacity and their resilience to be able to live well and to live active and healthy lives, how do we actually do that? How do we work with them to identify some of the barriers that they face? That might be their own barriers within their own circumstances, it might be within their communities, and so how do we work with communities to be able to remove some of the barriers that are stopping people from living the way that they want to live? I think some of the life curve data will really help us identify that.
SM We are trail blazing this, but actually probably all, most of health and social care services are at that end far down in the life curve so it's actually, how can we all support people to live health, active and independent lives and it's actually everyone's business. So, the AHP's are doing it but what we are trying to say is, this is not an AHP thing, this is about everyone's business. We are just, I suppose, we are leading the way in taking this whole agenda forward because, you know, many of the policies are talking about prevention and early intervention, but it's actually the how and we are leading the way in how are we going to do this? As much as we all talk about prevention and early intervention and supporting people to live in a homely environment, all of the direction, you know, a lot of the services and everything are still based in the far end and the acute and what we are doing now is actually, how can we support people much better to live in their communities? And we are doing that, so we are the vehicle driver to take that forward, I think.
SK And, as I say, in terms of social care, whilst the Allied Health Professionals, mainly the occupational therapists in social care, make a huge contribution towards self-directed support and, in particular, care at home, the re-ablements approach that is used there, I think we have an untapped potential and we are not making the best, most creative use of the range of skills and knowledge that not just occupational therapists, but that other Allied Health Professionals can make to support people with really creative solutions to how they receive their social care.
F So you are still looking to contributions to this survey as well?
F Do you want to speak a bit about that?
SK Yes, so essentially the number of AHP's were, it's quite a large group across Scotland so this is quite an ambitious programme and we have been talking to staff since the beginning of January, so we've done a number of awareness sessions, either over a WebEx session or in person. We've got identified communication leads across the country, we've got a community of practice on the knowledge network and all the data is on the community, it's in the public arena, so member of the public, you don't have to have any special password or anything to log on, members of the public can go and have a look at it. There are videos from professor Gore, who speaks about his work which just gives a bit of background and context. So, we have got another week and a day and we really want all Allied Health Professionals out there, those that are registered and those that are unregistered, so support staff and any students, anybody that is working with adults, we really want them to take part in this. It's a huge, fantastic, exciting piece of work and it is their opportunity to contribute to this. So, we really want them to take part and make sure they have got all the information they need, make sure they find out where their survey booklets are, identify the 2 people they want to do this with and find out how they get it returned to Strathclyde University, who are going to do all the data entry for us.
SM We should say, also that Scottish Care, they just launched their Bring Home Care Pack last week and at that conference, Donald McAskill who is the Chief Executive, talked about the life curve and how they have a huge number of staff, a massive workforce who work with the Care at Home Group and they are going to look at undertaking the life curve survey with those staff as well to ensure that part of the work that we want to, the collaborations that we want to do is work with Scottish Care to do some training with the Care at Home staff, so they start using enabling approaches with the clients and people that they see and they are going to do the survey, after we've done our survey, so they get all the learning and they will do the survey too, so we will have a rich amount of data.