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Chapter 8: Capacity planning
Capacity planning is the first part of the commissioning process. It tells us what services exist and deals with future demand. It is an essential part of whole systems planning.
Capacity planning needs to be rooted in the realities set out in this Report - providing services that are labour intensive for a growing population of older people, when the labour is smaller and in a highly competitive labour market.
Early in our deliberations we came to the conclusion that we could not determine the range and capacity of services at local level. That depended on many things, notably:
- the pattern of existing services in the area - the Audit Scotland reports referred to earlier point out the complexity of local systems, and how they vary between local authorities in one health board area; and
- the population in the area, and that expected over the next 20 years (some areas are popular retirement areas; others had high growth as new towns in the 1960s and 1970s, with consequent large numbers of baby boomers retiring in 20 or so years' time etc).
All these factors mean that every area is unique, and that capacity planning must be done locally. But this must not be too local - because of the interaction of people and services, there needs to be a wide framework. In this context we believe that means health board level.
We were interested to note that although Lothian Health Board was doing capacity planning across its area, in practice there were different capacity plans for each local authority. So while there needs to be an over-arching view at health board level, there will usually need to be separate capacity plans for each local authority within the health board area.
We have set out a framework of the way we believe health care and community care should be provided to meet the needs of older people in the years ahead. We note that older people also need housing, leisure and recreation, and lifelong learning services.
Traditionally the model of care has been something like this:
- NHS continuing care for the most complex packages of care.
- care home environment - for a mixture of needs.
- sheltered housing - for people who need support but who don't need to be admitted to a care home.
The main thrust of our report is that services need to be much more flexible in future, and we have set out ways in which we believe this can be achieved. These need to be built into capacity planning at local level.
A capacity plan should set out:
- needs already known
- demographic changes
- current capacity - services, staffing and spend
- what is happening already
- the anticipated need for different kinds of services and types of accommodation in future, and particularly the increase or decrease in provision required compared with current provision to meet needs in 10 years time.
and for the future should take account of:
- the model of care to be used
- housing requirements - housing with care, sheltered housing, extra care housing etc - to meet people's needs (not forgetting special needs)
- transport, leisure and community learning facilities and provision
- the workforce
- finance - any capacity plan has to highlight revenue and capital requirements
- monitoring and evaluation - performance managing outcomes and the quality of care. Is what is done, and the model of care used, cost effective and value for money?
The capacity plan should also:
- set out the creativity needed to provide services in future - lifting eyes above the horizon to consider new ways of working, and of providing integrated services
- identify risks, e.g. on staffing (what happens if the required staff are unable to be recruited?)
- extend to the wider agenda and include, for example, the private sector, housing and hospices.
Capacity planning means a need to re-design services - e.g. reviewing what district nursing services do, considering if home helps can be re-trained as personal care workers doing a wider range of tasks. Could someone else provide that particular bit of the service? If so, what training is involved? What would district nursing services now do, to use their training and capabilities to best effect?
Capacity planning can be a powerful tool to implement the kind of service change we envisage in this report, linking into the changes that will result from the establishment of Community Health Partnerships and implementation of Building a Health Service Fit for the Future.
We do not know the state of capacity planning across Scotland. While we were meeting we were aware that some areas - e.g. Lothian - were quite advanced with new capacity plans. We believe that:
- every NHS board and local authority should have forward looking capacity plans that cover a significant period ahead (such as 10 years)
- where they do not already have such plans, a forward looking capacity plan should be prepared as a matter of urgency. This should be tied in to planning to implement Building a Health Service Fit for the Future and the Executive's response Delivering for Health since these, as already noted, have a considerable knock-on effect for community care and housing.
Annex D is a simple diagram that illustrates a process for reviewing the model of care and capacity. This is based on experience that these are the main elements that need to be worked through on an integrated basis, led by local authorities, with partners from health and representatives from the voluntary and independent sectors.
There may be a need to strengthen and support the skills required for effective capacity planning. The Joint Implementation Team at the Scottish Executive stands ready to provide advice and assistance if asked.
Once capacity planning has been completed, the service design and commissioning processes can begin. This is dealt with elsewhere, notably in Better Outcomes for Older People, and we do not repeat the ground here other than to reiterate the need for a whole systems approach. It also links clearly to the whole systems approach taken by the Joint Performance Information and Assessment Framework (Indicators JPIAF 10 and 11).
In taking forward capacity planning, a number of major building blocks were set in place in 2005:
- Better Outcomes for Older People: Framework for Joint Services
- Building a Health Service Fit for the Future
- Delivering for Health, the Executive's response to the above Report which makes it clear it is accepted as the basis for future planning
- the factors set out in this report relating to the future provision of services; and
- the Registrar General for Scotland's latest population projections.
Together these now provide a developed national framework in relation to population, and the nature and level of services. They must be the basis on which NHS boards and local authorities undertake capacity planning.
Capacity planning leads to commissioning. This involves working in partnership (involving users/ carers and the independent sector), making best use of resources (and joint resources), managing the market, effective contracting arrangements, and ongoing review and evaluation of services. This ensures that capacity planning is carried through.
Commissioning of services for older people is dealt with in depth in the Better Outcomes for Older People report. It should be noted that further work on joint planning and joint resourcing is being done by the Joint Resourcing Group as part of the Joint Future work.
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