Crisis in care sees families told to step in to fill the gap
●Warning of a ‘major culture change’ needed to tackle pressure on services
One of Scotland’s largest health and social care authorities is set to ask families to “plug the gap” in a bid to relieve pressure in the provision of care for frail and vulnerable people.
The Edinburgh Integration Joint Board (EIJB), which is responsible for care in the city, is set to undergo a “major culture change” that will see the onus placed on patients to look after themselves or receive help from relatives.
The move comes amid a crisis in Edinburgh, where health chiefs allocated a £4.5 million emergency fund last December to tackle the “immediate pressure” caused by the delayed discharge of patients waiting in hospital to be assessed for a care package.
As of March there were 267 delayed discharges against a target of 50, and the number remains “critically high”.
In addition to this, a scathing Care Inspectorate investigation in May last year into the quality of care provision in Edinburgh found that five out of nine factors of care were rated “unsatisfactory” or “weak”. And the EIJB is facing a funding shortfall of £12.4m in 2018-19, assuming savings of £11.1m are made.
Health chiefs are now set to have a “big conversation” with the public about what might be deemed a reasonable contribution from individuals, their relatives, neighbours and local communities to provide elements of social care for themselves.
The EIJB has launched an action plan to get to grips with the service. The plan aims to support all people in Edinburgh who require health and social care, with a shift from focusing primarily on those who are delayed from leaving hospital.
Judith Proctor, chief officer for the Edinburgh Health and Social Care Partnership, said: “The report sets out some of the short, medium and
long-term plans that have been agreed to begin to make a focused impact on outcomes for people.
“It details not just the immediate pressures but the shift in the way we work – that will include culture change and significant investment. The new approach will include a shift towards preventative and early intervention activity that will reduce dependency on acute services and crisis support.
“Health bosses point to a traditional expectation that formal care is provided by public services and that while public spending on health and social care has significantly reduced in recent years, expectations regarding the level and standard of provision have not reduced to the same extent.”
Established in April 2016 as part of the Scottish Government’s flagship reform to integrate health and social services, the Edinburgh Health and Social Care Partnership covers mainly the City of Edinburgh Council adult and social care services and NHS Lothian community health services.
EIJB chairman Ricky Henderson said: “Supporting people to live as independently as possible in their own home and community means we need to think carefully about how our invaluable health and social care services are provided.
“EIJB has, over the last eight months, reviewed its strategic planning approach and this plan sets the future direction of travel and outlines activities that will ensure a sustained focus on improvement in a number of key areas such as reducing the number of people delayed in hospital, preventing unnecessary admissions, and reducing the length of time people are waiting for an assessment in the community.”
He added: “Some of these approaches have been adopted on a trial basis since March and the results are hugely encouraging, with the backlog of assessments reducing steadily month on month.”
However, Conservative health spokesman Miles Briggs said it would “not be right” for the Edinburgh Health and Social Care Partnership to say that they can’t cope with the increased demand, so people should be looked after by their families.
He added: “I fully understand Judith Proctor’s vision of more preventative care and supporting individuals to maintain their independence, but this will not be an easy transition.
“Social care has been under increasing pressure over the last two years and delayed discharge has been steadily increasing in hospitals.
“There will be lots of challenges to face and I would be very interested to know what plans the council have to increase preventative care and allow people to maintain their independence.”
A Scottish Government spokesperson said: “This is a welcome development by the Edinburgh Health and Social Care Partnership and Integration Joint Board as they work to meet the needs of the capital.
“This year the Scottish Government is investing almost half a billion pounds of frontline NHS spending in social care services and integration and in 2018-19 we will provide an additional £66 million to local government in support of social care.
“This will allow local partnerships to work together to make best use of their total resources and ensure people have access to the right care at the right time in the right place.”
“Social care has been under increasing pressure over the last two years and delayed discharge has been steadily increasing in hospitals” MILES BRIGGS