Introduction: In 2016 the Scottish Government legislated to integrate the planning and delivery of health and social care to local integration authorities. To encourage innovation in delivery of person-centred integrated care, the Scottish Government commissioned Healthcare Improvement Scotland to support local team co-design, test and evaluate models of Neighbourhood Care teams inspired by the Dutch Buurtzorg model of community nursing.
Description of practice/Change implemented: Local teams were supported to design and implement small self-organising geographically-based teams of nurses and carers. Each team was tailored to their local context and aimed to:
have the person at the centre of holistic care,
support people to make informed choices about their own care,
take a reablement approach, and
make use of formal and informal networks in local communities to support people live well in their community for longer.
The Neighbourhood Care teams served a population within a geographical area and typically supported people with frailty, people at the end of their lives or people who were socially vulnerable.
An evaluation framework has been created to understand the impact of Neighbourhood Care models.
Aim & theory of change: The aim was to develop an evaluation framework that can articulate impact, if any, of Neighbourhood Care models had on delivering holistic integrated care that enabled people to live in their community for longer.
Evaluation is based on a theory of change outline in a logic model. Local sites have been supported to develop process and outcome measures that align to the national logic model. This includes a common set of national measures used by local sites.
The national evaluation explores:
How new models were implemented locally
Experience of frontline staff
Facilitators, barriers or challenges
Evidence of impact on people supported by Neighbourhood care teams, and
Evidence of impact on unplanned admissions and length of stay in hospital.
Highlights: Care Experience Record tool was developed which captured people’s experience of care and referenced evidence against delivery of Scotland’s national set of Health and Social Care Standards.
Transferability: The evaluation framework is transferable to other community-based projects that aims to support people live well in their community and avoid unplanned admissions and time in hospital.
Sustainability: The evaluation framework was designed to be used at key points in time to inform decision making however aspects of the framework could be used for routine performance indicators.
Conclusions: The developed evaluation framework that can articulate impact of Neighbourhood Care models on people who are supported by the model and on staff. However, more time is required to make strong conclusions on impact on unplanned admissions and acute length of stay.
The learning on facilitators and overcoming challenges could be used to inform spread of Neighbourhood Care models and the implementation of other community-based models of care.
Next steps/recommendations: Further research and evidence gathered to inform the business case to demonstrate that earlier intervention of higher-skilled professionals would lead to longer-term savings.