Model of Change


The change process will need to be driven through leadership across our health and social care system.

We have been trying to shift away from the traditional acute-focused care, which was the

norm during the second half of the 20th Century, to a system which is much more responsive to supporting people with long-term conditions live independently in the community.


20th Century   21st Century
Centrally planned

Locally planned
Input driven

Outcomes driven
Organisational focus

Partnership focus
Geared towards acute conditions

Geared towards long-term conditions

Embedded in communities
Lead professional dependent

Integrated teams
Episodic care

Continuous care
Disjointed care

Holistic care
Reactive care

Preventative care
User as passive recipient

User as active participant
Self-care infrequent

Self-care encouraged and facilitated
Carers undervalued

Carers supported as partners
Low tech

High tech
Disaggregated patient information

Aggregated patient information


Leadership within the Partnership

The ongoing development of a strong partnership focus by the leadership of NHS Western Isles, the Comhairle, and the third and independent sectors is clearly a crucial component in the delivery of our proposed reforms. To that extent, we are committed to ensuring that:

  • The work of the IJB dovetails with the strategic priorities of the two parent bodies and the Community Plan;
  • The management of the integrated service reports to a joint Corporate Management Team, co-chaired by the Chief Executives of the Comhairle and NHS Western Isles;
  • The Chief Officer is supported by a strong team of senior managers and lead professionals who will be responsible for the delivery of the strategic plan;
  • We develop a strategic relationship with the third and independent sectors which recognises their contribution as equal partners;
  • We work with all of the communities of the Western Isles to transform our service offer and our approach to delivering care and support;
  • Our leadership involves decentralising power, responsibility, resources and accountability to localities;

Change Funds

In order to make the transition to the new model of care, the Scottish Government has provided partnerships with additional funding over a number of years. We used the Older Peoples Change Fund to support a range of new projects, some of which delivered a lasting impact and hence have been continued with mainstream NHS/Comhairle funding.

The Scottish Government has given each partnership access to an Integrated Care Fund. Our share of that pot locally is £640,000 per annum. The first year of that resource has already been committed to expanding the number of long-term care beds we have on the islands in order to reduce the number of older people living in hospital. So we will see the expansion of the Bethesda care home so that we can provide nine respite beds, which will allow the other care homes to dedicate their capacity to long-term care.The Scottish Government has also identified a delayed discharge fund, which is designed to support system change to reduce the number of people waiting in hospital (£200k per annum locally).

While we will mainstream the Integrated Care Fund resource by 2018/19 to support the cost of additional community care beds, during 2016/17 and 17/18, the resource will be used to support initial double running costs associated with the reform of mental health services and the implementation of intensive reablement and intermediate care. The delayed discharge fund will be used to support the ongoing costs of a highly responsive community equipment store, which is a pre-requisite of an effective reablement service.

Clinical and Care Governance

The Integration Joint Board is accountable for ensuring that appropriate clinical and care governance arrangements are in place. To enable it to do so, we will put in place structures and processes to support clinical and care governance and to provide assurance on the quality of health and social care we deliver. This includes:

  • An Integrated Clinical and Care Governance Group will be established to provide assurance that the care we deliver is safe and appropriate
  • The Chief Social Work Officer will continue to report directly to the Council on professional social work matters
  • The medical, dental, nursing and AHP leads within the integrated service structure will report directly to the Medical Director and Nurse Director on professional matters

In addition, we will develop clear links to our Area Clinical Forum; Managed Clinical Networks; Adult and Child Protection Committees and other appropriate professional groups.

Delivering the Change

Our success will also be dependent on creating the conditions for professionals to use their experience and judgement to maximum effect in improving outcomes for service users. This will be focused on improving the coordination of care across different professional roles; the effectiveness of communication within and across disciplines; and the empowerment of professionals to make effective evidence-based decisions.

The reforms which we are proposing are intended to move us towards that operational environment, where multi-disciplinary teams are the norm and where interventions are built around the needs of the individual.

Physical Environment

Housing, adaptations, aids, design changes, and assistive technology to maintain the independence of the person and support family carers

Multi-disciplinary teams

Locality teams that bring together GPs, social care, community nursing, social work, AHPs, and mental health practitioners to ensure that care is responsive and well-coordinated

Community Support

The informal capacity that exists within a locality area to support socialisation, transport, physical activity, educational opportunities, which will improve mental and physical health and well-being

Specialist Care

The highly specialised health and social care input which is required periodically to improve health outcomes, often delivered within specialist secondary care facilities

Delivering the change diagram

Community Engagement

One of the major innovations of the health and social care integration agenda is to put a renewed focus on the importance of community leadership and community development. This is about more than just the empowerment of Locality Planning Groups, important as that may be: it is also about building on community assets and infrastructure to ensure that local people are able to live purposeful lives.

This will mean that people are socially connected, to friends and family; are able to pursue the every-day activities that support people’s interests and ambitions.

This is often provided by community initiatives which are supported by multiple funding partners and it is important that we continue to support community ventures even when resources are tight.

There is emerging evidence of the value of a ‘place-based system of care’, which involves organisations collaborating to improve health and care services for a geographically-defined population, managing the common resources available to them. This is often based on strong community engagement relationships, which drives the reform process within localities.

This is a model that we would like to explore in the Western Isles.

Shifting Our Resources

One of the over-arching goals of the strategic plan is to shift resources from building-based services like hospitals and care homes to community based settings, where people are supported in their own homes. While the detailed work will be taken forward within the context of the individual reforms set out in this plan, we would expect to see the amount we invest in residential care fall slightly as we introduce an extra care housing model. Similarly, we anticipate that as we shift away from long-stay psychiatric hospital care towards community based care and diagnosis, and as we make inroads into delayed discharge, we will see our overall investment in hospital reduce, with a corresponding increase in primary and social care.This is shown in outline terms in the graph below:

The consequence of this shift will not just be our budgetary provision changing over time but also how we deploy our staff – our most valuable asset.

We will work with our staff teams to support the transition towards community based care, including consideration of any training and support arrangements that have to be put in place.

In order to deliver against this wider objective, we will also take forward key workforce policies designed to attract, retain and support people to deliver high quality health and social care.