Making sense of a new care system

LITTLE over a year has passed since the Highlands’ two largest public sector organisations announced an overhaul of how they would organise their care staff.

Meetings in Sutherland, Inverness and Ross-shire have been held to what appears to be limited interest from the public as officials spell out the looming structural changes.

You could hardly blame people for voting with their feet because trying to decipher exactly what Highland Council and NHS Highland have planned is hard, especially when the language on the website is drier than a prolonged drought in the Sahara Desert.

The usual jargon including terms like “joined-up” approaches in a bid to “maximise outcomes” and “person-centred” care services is referred to, but at the centre of the gobbledygook is “the vision” or statement of intent.

It sets out a pledge to improve the quality and reduce the cost of care services through the creation of new and supposedly simpler arrangements.

From 1st April, the council will take over issues relating to children, while NHS Highland staff will assume control of adult community care — people with disabilities, mental health problems and the elderly.

It will see 1200 council employees’ transfer to work under the health board’s auspices, while 250 staff will head in the opposite direction.

The changes will be watched with interest across Scotland because Highland is the first area to be ready to overhaul its care systems.

Health secretary Nicola Sturgeon offered “wholehearted support” in December as she announced the Scottish government’s plans to integrate adult health and social care with a consultation expected in the summer.

But what does it mean for the people in the region who use these services?

The council and NHS Highland claim it will lead to better and quicker decision making, cut bureaucracy and lead to better care plans which involve individuals and families, because one agency will make decisions instead of staff organising care between the two organisations.

However, the pledges have been greeted with a degree of caution by Highland OAPs and children’s groups, while staff are anxious about the speed of change although no jobs are said to be under threat.

As a long serving GP in Lochaber, council leader Dr Michael Foxley worked at the coalface of care.

He admitted the current system can let down the elderly who might not be in the best of health but should not be in hospital.

“When I was a GP if there was a problem with the care package at home and that person arrived [at the surgery] at short notice, quite frequently the only way we could deliver what they needed was by having them hospitalised,” he said.

“Then they were prone to becoming confused and had the risk of hospital infections like C.Diff.

“If it was two o’clock on a Friday afternoon and you phoned the social work manager locally and asked for an urgent consultation for a care package the chances of having a rapid response was usually impossible. Because that person had to be cared for, they would have to be admitted to hospital.”

Care packages can include home carers, health visitors and nurses amongst others.

Dr Foxley said delayed discharges from hospital when an elderly patient was stuck on a hospital ward, not because of their condition but because the care package needed to send them home was not in place, was equally frustrating.

He said having the hospital consultants and nurses, district nurses, GPs, health visitors, care managers and home carers working for the same employer would make the process easier and quicker.

Children across the Highlands with additional needs will also benefit, according to the council leader with one service allowing staff to build up a picture of youngsters who may have unsettled home lives, whether it be parents with drug or alcohol problems, a mother with multiple partners or recent bereavements.

“But the first the council knows about it is when “wee Sandy” maybe turns up at nursery or goes to school at five and his behaviour is odd,” he said.

Dr Foxley said the transfer of NHS staff to the council should help them respond to the child’s needs quicker because there should already be knowledge and an understanding about their domestic situation.

Calum Munro, the policy lead for the Highland Children’s Forum, hoped the system would improve youngsters’ lives.

He said parents of children with additional needs had experience of having to access several different organisations for care and if that process was made easier, the charity would welcome it.

“We hope it will simplify life for the child, their family and their life,” he said.

But the charity would like to see the system reviewed within two years.

However, Dr Ian McNamara, chairman of the Highland Senior Citizens’ Network, wants more “meaningful talks” after a very positive meeting last November.

“But we are now at the stage where we want to know how it’s going to be delivered and three months have now gone when things could have happened,” he added.

Dr McNamara said it had been told transferring the care of elderly people from social work to the NHS would not result in an “immediate explosion” of change but it would be fairly gradual.

The network promotes the interest of elderly people across the region and Dr McNamara said it was a crucial time with many more people living longer.

NHS Highland chairman Garry Coutts acknowledged communication had previously failed between the council and health board which led to people missing out on care.

“We have tried partnership working and there is no lack of commitment but have come to the conclusion that we need to have a single entity, single budgets, single managers,” he explained.

About 650 of the staff are Unison members and Adam Palmer, the area branch secretary, supported the principle of integrated services but not wholesale structural change.

“We are concerned about the timescales of this major change within the Highlands and the details of how this will work for staff and services,” he said.

He said although there will be little or no impact on most staff to start with there will be reorganisation of services.

“There are particular concerns in children’s services about how things will work post-transfer, given that these are for the most part small teams of staff who will be transferred away from other key workers in health, such as consultant paediatricians, midwifery staff, etc.”

Mr Coutts admitted staff were anxious. “But there is also a lot of excitement, they are seeing there is a real opportunity.”

He added the public would see the logic in the changes but predicted it could be up to five years before the system bedded down.