Author:

Abstract

Introduction

This workshop shares insights and explores implementation challenges and solutions when adapting the House of Care framework in three health and care systems: in primary care and community nursing in Scotland; palliative and end of life care in the Isle of Man; and in Litoral Norte region of Sao Paulo, Brazil.

The framework was developed by the Year of Care Partnerships to support people to  identify and set their own goals and self-manage their diabetes. Practitioners were challenged to focus on what matters to people and to draw on non – drug solutions including peer and community supports for wellbeing. By focusing on personal outcomes, clinical outcomes improved. The approach encourages practitioners to embrace a person centred ethos while building their skills in self management, leadership and team working. It strengthens patient and staff health literacy capabilities, and builds knowledge of, and relationships with, local community assets and resources.

The programme has been widely applied as the House of Care in Scotland to promote person centred collaborative care and support planning in Primary Care for people living with long term conditions. A team from the International Centre for Integrated Care has adapted the framework in a small island system and in a LMI economy to engage and empower professionals at the micro-level as well as leaders and managers from meso and macro levels. They are now adapting the framework for community nurses caring for people with frailty.

The relentlessly person centred ethos of the House of Care engages a wide range of disciplines and sectors at the micro level but also resonates with leaders and managers at different levels of care. Listening to patient, carer and family experience, studying care processes and pathways, and exploring the relationships and interactions between professionals from different disciplines and sectors identified common themes, clarified roles and responsibilities, and co-created solutions for better population health and wellbeing.

The House of Care framework is an intuitive model that can be readily adapted to different care settings in both developed and LMI economies. It is an engaging lever for developing collaborative person centred practice and a useful tool to inform and support implementation of integrated care policy.

Format

Welcome – Anne Hendry, IFIC Scotland

Short Presentations

1. Scotland’s House of Care

    Margaret McKeith, Health and Social Care Alliance Scotland 

2. Island Plan for Integrated Palliative and End of life Care

    Anne Mills, Chief Executive, Hospice Isle of Man 

3. House of integrated care in Litoral Norte, Brazil 

    Anne Hendry, Director, IFIC Scotland 

4. Frailty House of Care

   Janette Barrie, University of the West of Scotland 

Discussion

Facilitated by Mandy Andrew, Health and Social Care Alliance Scotland 

Delegates discuss 

What engages and motivates professionals and managers from different disciplines, sectors and levels of the system?

What themes are common to the implementation examples - what are the important differences to consider when adapting the model for different context?

How can the House of Care model help us frame outcome measures for integrated care?