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Highland Community Care Partnership Com-pàirteachas Cùram Coimhearsnachd na Gàidhealtachd

NHS Highland. The Highland Council, Comhaire na G&agraveidhealtachd
 

Personal Plan

The Personal Plan is a NHS Highland & Highland Council Partnership initiative currently being developed in two phases to replace the Highland Single Shared Assessment (SSA).  A new care pathway is currently being trialled in the Lochaber area.

Phase one:

A single access solution that will facilitate and support adults in need of social care and ensure a single point of entry and contact, a timely first response, quicker access and decision making for level 1 & 2 access requests, resources and interventions.

The partnership response will be to anticipate and support people to remain healthy, active and independent or access intensive or specialist services where required.

Phase two:

The personal plan will be a professional assessment tool to ensure easier access to assessment and resources through a single point of entry for all levels of service.

The Personal Plan is designed to capture minimum or comprehensive details depending on the adult’s circumstances to ensure an appropriate, timely and proportionate response from services.

The Personal Plan will be an integrated seamless assessment toward the progress and outcomes achieved for each adult in Highland.

Click on the links below for further information:

 

Development of the Plan

The Partnership Pathway (access response and decision making process) and development of the personal plan (assessment tool) has been enhanced through a range of policy initiatives, progressed at a National level, since 2006.

These include:

  • action to enhance support for carers, and to the development of a revised Carers Strategy;
  • publication of the on-line Commissioning Effective Services for Older People Workbook to assist local partnerships estimate future need and demand for services;
  • action following Lord Sutherland’s Independent Review of Free Personal and Nursing Care (2008), to improve the clarity and consistency of access to care services for older people;
  • progress of the Shifting the Balance of Care agenda to move resources and activity from hospital and residential settings into the community, including the identification of 8 high impact changes;
  • publication of the Long-Term Conditions Toolkit (HDL (2007)10) and local Action Plans;
  • publication of Living and Dying Well (October 2008), the national action plan for palliative and end of life care;
  • publication of the Delivery Framework for Adult Rehabilitation in Scotland and Falls Prevention Guidance (HDL (2007)13);
  • publication of revised guidance on NHS Continuing Healthcare (CEL 6(2008));
  • confirmation of dementia as a national priority and progress of a range of programmes to improve support for people with dementia and their carers;
  • publication of National Guidance on Self Directed Support (CCD7/2007);
  • publication of Equally Well (June 2008) and the Equally Well Implementation Plan (December 2008) on reducing health inequalities;
  • the Review of Older People’s Housing (2005-2008) and follow-up action to improve sheltered housing options and enable older people to remain at home;
  • further roll-out of the Telecare Programme; & Telehealth developments
  • consultation on revised guidance on Equipment and Adaptations;
  • establishment of the Care Information Scotland national community care information service for older people from early 2009;
  • continuing progress with the Changing Lives agenda to build capacity and a confident, competent care workforce; and
  • Development of the Community Care Outcomes Framework.
  • Reference Scottish Government, February 2009
  • Better Together (Long Term conditions) NHS Scotland

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Contents

The Personal Plan will be designed to capture details about:

  • the Adult
  • the Adult’s relationships, family, friends and community
  • the Adult’s environment

The plan will aim to achieve the Outcomes important for all adults with social care issues and needs, such as:

  • Improved health and emotional well-being
  • Improved quality of life
  • Making a positive contribution
  • Informed Choice and control
  • Freedom from discrimination
  • Economic well-being
  • Personal dignity
  • Unpaid carers support & quality of life improved

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Legislation

The development of the personal plan is underpinned by existing community care legislation

Under section 12A of the Social Work (Scotland) Act 1968, local authorities have a duty to assess any adult (i.e. person over 18) who they believe may need community care services.

Further Related Adult legislation

The welfare legislation detailed is not an exhaustive list, and is not an interpretation of the law: the partnership where necessary would check the relevant statute directly.

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Policies, Procedures and Guidance informing the personal plan in Highland

The personal plan will promote an equality impact assessment on age, religion belief, and sexual orientation.
 

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