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CHAPTER TWENTY: MODELS OF CARE

Four key milestones for models of care were given in this section of the Action Framework along with 3 actions.

20.1 MILESTONES

Consultees were asked whether they agreed or disagreed with each of the 4 key milestones and invited to comment on any or all of them.

Managed Clinical Networks

As tables 20.1 and 20.2 show, a large majority of those responding to the questions on the two milestones for MCNs expressed agreement.

In addition to those MCNs listed in the Action Framework, 7 consultees identified other MCNs, or components of MCNs, which they felt were appropriate, although one NHS Board felt that there were too many MCNs for District General Hospital level.

Seven consultees felt that existing MCNs or other networks should be examined and some of these consultees commented that best practice should be examined and built upon.

"There is a need to identify / map out services that are presently delivered through a network, identify what works well and build on that success".
NHS Board

Table 20.1
54: A prioritised Strategy for children's services MCNs agreed by 2006

Base: All those responding in each category

Five consultees commented on the need for a wider range of models to be considered including care and service delivery networks. Four consultees expressed concerns over timescales, with 1 NHS Board commenting specifically that timescales were not realistic .

Table 20.2
55: Delivery of the MCNs identified within the Strategy by 2008

Base: All those responding in each category

Care pathways for the 10 commonest conditions resulting in attendance at A&E and admission to hospital by 2008

Again, the majority of those responding agreed with this key milestone, however 8 consultees requested clarification on the 10 commonest conditions. An NHS Board pointed out that "there is no action identified for this point. Who will do this, where and at what level?" Two consultees asked "What about Primary Care referrals?" while 2 requested clarification on the inclusion of mental health conditions or learning difficulties. The question of whether these would be the same 10 conditions referred to in the section on emergency care was raised by 2 consultees.

At the workshop session one group felt that using only 10 conditions was too restrictive and that this should be more. They suggested 25 but in fact felt this should apply to all specific types of illness, and that these should have "an element of hospital and community care".

Table 20.3
56: Care pathways in place for the 10 commonest conditions resulting in attendance at A/E and admission to hospital by 2008

Base: All those responding in each category

Joint appointment of staff

Table 20.4 shows that a majority agreed at this question with very a small number disagreeing.

Table 20.4
57: Evidence of the joint appointment of staff to services operating as a single service for Scotland by 2007

Base: All those responding in each category

Funding sources were mentioned by 3 consultees including an NHS Clinical Group who commented on their own experience and added "for these posts to flourish there must be a route for secure fiscal arrangements".

Concerns over successful implementation were raised by 2 consultees with a Royal College commenting that they "may be difficult to implement since the administration of local and regional jurisdictions are not clear".

Two consultees commented on the need for national guidelines or standards and for these to be based on research or good practice.

At the workshops, one group suggested that for all services that are suitable for cross Board working there should be, in addition to joint appointments, joint funding and planning with "consistent communication and outcomes".

20.2 ACTIONS

Seventeen consultees took the opportunity to comment on the 3 actions given in relation to models of care with 5 of these giving general positive comments on the actions listed.

Two consultees saw a need to link progress measures with outcomes and one Royal College and one Local Authority felt that there should be a "Multi-disciplinary approach to children and young people's health".

The diversity of services across Scotland was highlighted by 2 consultees who stressed that this must be taken into account. Other comments, mentioned by one consultee each, included:

• the need for provision of advocacy;
• the need for reference to the role of local authorities;
• the need for input from AHPs;
• the importance of good communication;
• the importance of readily available clinical information;
• guidance on cross-Board appointments;
• concern over planning mechanisms and timescales;
• that care should, as mush as possible, be delivered locally.

Examples of Models of Care (suggested by workshop participants)

• Models for in-patient services including pre-admission services, admission, discharge and follow-up care;
• Out-patient models of care;
• Discharge planning models of care;
• Day care/day care essentially surgical and anaesthetic procedural based;
• Rapid response care;
• Short stay assessment;
• Models of care that can be provided in the locality;
• Models of transitional care from adolescent to adult care;
• Integrated Care encompassing health, social services, education, others in terms of single joint assessment, provision and review, ie Getting it Right for Every Child;
• Integrated Care Pathways;
• Models for respite care;
• Models for home ventilation;
• Models of communication.

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