Scotland's care watchdog has issued a damning report after an inspection of health and social work services for older people in Edinburgh found that delivery of key processes was 'unsatisfactory'.
There were also four areas that the Care Inspectorate and Healthcare Improvement Scotland described as weak.
Crucially, inspectors said the ways in which adults at risk of harm were protected needed to improve significantly.
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.
They 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.”
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.”
Overall, the report makes 17 recommendations for improvement including ensuring all unpaid carers' needs are identified, assessed and met.
Health Secretary Shona Robison said: “This is clearly a disappointing report that raises a number of important concerns about the provision of social care in Edinburgh. It is now essential that the Edinburgh Health and Social Care Partnership addresses these issues as a matter of urgency, and I note that they have already started to implement the report’s recommendations.
“The partnership has sought to assure me that they have a comprehensive plan in place to address these issues. However, I will be seeking further confirmation in the coming weeks and months that progress is being made.
“As the report itself highlights, many of the changes introduced under health and social care integration were at a very early stage at the time of this inspection. The partnership was in a period of transition and significant changes have happened in the meantime.
“The integration of health and social care is one of the most significant reforms since the establishment of the NHS. It is about ensuring that those who use services get the right care and support whatever their needs, at any point in their care journey.
“By bringing together NHS and social care services we will ensure people get the right care and support for their individual needs, and that staff across health and social care are equipped to work together to make full use of their shared skills and resources.
“We have taken action to protect and grow our health and social care services. In the current year there will be almost half a billion pounds of additional investment in social care and integration.”
Officially established in April 2016 the Edinburgh Health and Social Care Partnership covers mainly the City of Edinburgh Council adult and social care services and NHS Lothian (NHSL) community health services. At the time of the inspection, the partnership was about to reorganise its services through four localities. This change helps align services with 12 community planning neighbourhood partnerships which involve local communities to identify local needs and priorities.
The joint inspection involved meeting over 90 older people and carers and around 600 staff from health and social work services, the third sector and the independent sector.
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.”