Services for older people in Edinburgh require ‘substantial improvements’

Substantial improvements are required in some health and social work services for older people in Edinburgh, following a joint inspection of services in the city carried out by the Care Inspectorate and Healthcare Improvement Scotland.

The report, published today, assessed how well health and social work services provided by the Edinburgh Health and Social Care Partnership delivered personal outcomes for older people and their carers. It identified some areas of good practice but also areas where improvements must be made.

Inspectors looked at how services work together to deliver services to older people, and how far they enable people to be independent, safe, as healthy as possible and have a good sense of wellbeing.

Across nine quality indicators four were found to be ‘adequate’, four were ‘weak’ and one was ‘unsatisfactory’. Inspectors said the way services supported people was “very complicated” which “staff and older people struggled to understand and navigate.”

Performance against some important national indicators, like how quickly people ready to leave hospital can do so, was poor, although new teams had been introduced to assess people’s needs and support them better.

Inspectors found that when people received services, they were generally of good quality and made a positive difference but too many older people and carers were unable to get help until their needs became critical.

Although inspectors found ambitious plans in place to improve the experience for older people, they noted that there was “substantial work to do to improve access to services. It was not uncommon for older people to wait for lengthy periods before getting the support they needed.”

They added: “There were weaknesses in the ways older people had their needs assessed and in the way their care was planned.”

Crucially, inspectors said the ways in which adults at risk of harm were protected needed to improve significantly. The report is critical of practice, performance and the delivery of key processes and makes 17 recommendations for improvement. These include:

• Further develop and implement approaches to early intervention and prevention services to support older people to remain in their own homes and help avoid hospital admissions
• Ensuring all unpaid carers’ needs are identified, assessed and met 
• People with dementia receive a timely diagnosis and diagnostic support for them and their carers is available 
• Work with the local community and other stakeholders to develop the market for care at home which includes risk assessment and contingency plans
• Improved communication with staff
• Making sure older people get timely needs assessments and service provision and timely reviews of their care and support
• Ensuring self-directed support is used to promote greater choice and control for older people

Karen Reid, chief executive of the Care Inspectorate said: “This report lays out clearly what is working well and what needs to improve. “Where older people and carers did receive services, these were generally of good quality and made a difference. However, older people are not getting the right support at the right time, delivered by the right people.

“We know new strategies are being put in place to help people leave hospital more quickly, but the partnership needs to support older people much earlier on, preventing them having to go into hospital wherever possible.

“The leadership team must plan and deliver services in an integrated way, ensuring people’s needs are understood early and met well. This will require a real focus on innovation. Leaders needed to be more visible and keep staff engaged and motivated through an ambitious change process.”

The report does highlight some areas of strength and good practice, for example:

• Staff are highly committed to better joint working and the possibilities afforded by the integration of NHS and Council Health and Social Care Services 
• A number of promising initiatives delivering positive outcomes in different parts of the city such as the hospital at home service and Be Able day service 
• Early indicators that the new team of service managers are working effectively together to shape services
• A range of community based multi-agency services had been put in place with the aim of support older people at home, avoiding unnecessary hospital admission and supporting hospital discharge planning.

Rob McCulloch-Graham, Chief Officer, Edinburgh Health and Social Care Partnership, said: “We accept the contents of the report, but also acknowledge the inspection was carried out just prior to the partnership completely reorganising its services based on four localities across Edinburgh. Many of the concerns highlighted within the report had been previously identified by the Partnership and work was already being progressed to address through the Partnership.

“Ensuring older people receive the care they need, both in hospital and at home, continues to be a top priority for us which is why we have already taken significant steps to make improvements in these areas.

“After the preliminary inspection results, we established an improvement team which has already produced positive results, almost halving the number of people waiting for care within their homes and reducing hospital waiting times by around 20%.

“This report pulls no punches and there are clear lessons to be learned – however, the inspection was carried out before we implemented a long-term reorganisation of care and we were pleased to note that staff remain positive and committed to the important work they are doing.”

You can download the report here: http://cinsp.in/2qS0Lkc