Edinburgh's care crisis: Scottish Government team says care hours for older people should be reduced
A Scottish Government team was sent into the Edinburgh Health and Social Care Partnership (HSCP) in July to help tackle a range of problems, including delayed discharges and unmet need for care across the city.
Now its initial report to ministers highlights an estimated demand for around 7,500 hours which is not being met and says the team is concerned that the backlog means the partnership’s statutory duty to carry out an assessment in reasonable time is being “compromised”.
The report – which is due to be discussed in private today by the Edinburgh Integration Joint Board (EIJB), which oversees social care in the Capital – includes a graph showing that the number of home care hours for people of all ages in Edinburgh was more than twice as much as the next nearest local authority. And it says even focusing on data for the over-65s, Edinburgh still provides an average of around 14 hours a week per person compared with a national average of around 10 hours.
It says: “There are strong indications of over-prescribing of packages of care, which in turn reduces the capacity available.” And it recommends an HSCP elsewhere in Scotland should undertake a sample review of care packages in Edinburgh to see how they compare.
The report adds that a review of care-at-home packages has already released eight per cent of capacity and says the team would encourage “the continuation of this work with increased resource and with alignment to the recommendation above regarding potential over-prescription of care package size”.
The report notes that there have been many previous attempts to address the problem, dating back to before the partnership was formed, and that similar issues and proposed solutions came up repeatedly. It says: “This reinforces a perception of deeply ingrained cultural issues and some change inertia.”
And it suggests too much assessment of need takes place in hospitals and led by occupational therapists with little involvement from social workers. “There is a concern that this can lead to an overly cautious approach and over-prescribing of care.”
Des Loughney, of Edinburgh Trades Union Council, criticised the move to cut care hours. “They say Edinburgh has an average of 14 hours of care per week and in the rest of Scotland it’s 10 hours per week, so their logic is you cut the hours in Edinburgh. That’s not how you deal with real people having real care needs. You don’t say 'You’re getting more than the Scottish average so we're going to cut it'. And they’re not consulting staff or carers or relatives or anyone.”
Mr Loughney, who is due to make a deputation to the EIJB meeting, also pointed to another report which talks about plans for a triage team. He said: “Social work will do an assessment with relatives and carers and the client and come up with a package of hours. That package will not now be implemented, it will be referred to a triage team and they will decide whether the hours are appropriate.”
The Scottish Government team says Edinburgh HSCP has one of the lowest proportions of in-house staff of any partnership in Scotland. And it recommends new recruitment approaches to take on at least an additional 60 care-at-home workers by the end of December 2022.
Mr Loughney said there was no detail on how that would happen. “There is no admission that these are skilled workers they're looking for and that they should be treated appropriately. The system is in crisis, but we say you resolve it by improving the terms and conditions so you can recruit and retain staff.”
The report does, however, say pay rates in Edinburgh for social workers, mental health officers and occupational therapists are among the lowest in Scotland and says given the cost of living in the Capital, this can only make it harder for the council to recruit such staff. And it recommends improved salaries and conditions for social workers.
On delayed discharges – where patients are medically ready to leave hospital but either a care home place or a home care package is not available – the report says Edinburgh performs poorly compared to other partnerships. The situation improved as a result of actions taken during the pandemic, but it has now “largely returned to how it has been historically with over 200-250 beds occupied daily with patients experiencing delayed discharge”.
The report says around one-third of delayed discharges are due to lack of a home care package and around two-thirds due to a lack of appropriate care home beds. The team floats the idea of “step-down facilities”, where patients could go between hospital and going home or to a care home, noting that such places were available in the Capital some years ago but were decommissioned.
A spokesperson for the Edinburgh HSCP said: “The pressures on health and social care are a continuing national picture. It remains an unprecedented context and time. Yet despite this, enormous efforts are being made daily in an effort to provide and meet growing care and support needs.
“Overcoming challenges long term is a whole system effort in both Edinburgh and right across Scotland. It’s commonplace for HSCPs to work with colleagues across Government, NHS, third and private sectors, and where possible seek assistance, guidance and support, so that together we provide good, reliable, and quality services for those in our care. Edinburgh HSCP has been reporting on the current challenges it has faced in terms of the reduction in workforce and the increase in demand for its services and has recently benefited from some additional support and insight from colleagues working alongside the Scottish Government.”