We will continue to improve access to information, advice and support to enable people and their carers to lead healthier lifestyles, remain as independent as possible and make an active contribution to their families and communities.
We will develop our capacity to support people at home through new models that provide greater choice and control including timely provision of aids and adaptations and technology to enable care.
We will focus our activity on supporting people to manage their own conditions and to stay healthy and more independent for longer including more open conversations about death, dying, bereavement and expectations for, and consent to, treatment.
We will increase access to services including anticipatory care planning that promote early intervention and recovery and reduce the risk of deterioration in health and wellbeing.
When people become ill and experience difficulties with everyday tasks, we will support them to recover and regain as much independence as possible to remain at home.
We will work with other services and organisations across community planning in Fife, to tackle the factors that determine good health and wellbeing, including education and skills, jobs and economy, transport and housing.
What we intend to do
A range of services will be put in place including:
A Fife directory of services and local community groups to support choice and control for individuals
Extending the Local Area Coordination service to link people with the right service
Befriending services to reduce social isolation
Redesigning pathways to have fewer steps resulting in speedier decision-making and earlier service provision through proactive anticipatory care planning
Systematically identify and treat people who are frail within community settings through a planned screening process, closely linking General Practices with medical consultants, specialist nurses and other professional staff
Increase joint working with Community Planning in Fife and with a range of other services and organisations to tackle the root causes of poor health and wellbeing and inequality in Fife
Impact of what we intend to do (2016-19)
These actions will support and demonstrate progress on:
Reduced reliance on hospital beds and other health and care services
Increased focus on prevention, self-management and shared decision making
Increased capacity in primary and community care
Improved health and wellbeing of the Fife population