Inspection of services for older people helps Edinburgh Health and Social Care Partnership plan for the future

A joint inspection of health and social work services for older people in Edinburgh has been published today (Tuesday 16 May).

The Care Inspectorate and Healthcare Improvement Scotland report highlights findings from the extensive inspection carried out last year between October and December.

Work is already well underway by the Edinburgh Health and Social Care Partnership to put the recommendations in place from the report. This report will assist the new senior management team in determining priority actions to strengthen health and social work support for older people living in Edinburgh. A comprehensive action plan has been developed and implemented to tackle the issues raised.

Whilst the report highlights several areas of concern, inspectors acknowledge the Edinburgh Health and Social Care Partnership was at a crucial time of transition during the inspection process and the final report focuses on the practice as it was in October, not where it is following transformation.

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.

The report is critical of practice, performance and the delivery of key processes at the time of the inspections. These areas needed significant improvement.

Some of the 17 recommendations from the inspection 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

The report also highlighted 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. 

The report states that the Edinburgh Health and Social Care Partnership has a shared vision for services for older people and had embarked on an ambitious exercise to transform the culture and the way in which services in the city are provided with recognition that this would take some time to deliver. 

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.”

Notes to editors:

The report recognises that at the time of the inspection the Edinburgh Health and Social Care Partnership was at a crucial time of transition:

"We acknowledge that at the time of inspection the partnership was in a period of significant transformation.   A recently established integrated senior management team was in place.  The partnership was about to reorganise its services based on locality hubs and cluster. 

"Leaders of health and social work services collectively understood the need for change in the strategic delivery of older people’s services and had identified many of the future challenges in delivering integrated services for older people."

 The following quotes are examples of good practice taken from the report:

“The partnership was acting to improve the quality of care in care home settings.  Local enhanced GP services for care homes meant more proactive engagement in areas such as anticipatory care planning. Care home liaison nursing services were viewed very positively by care home providers.”  

“Good examples included services delivered by Voice of Carers Across Lothian, the carers’ support team, the integrated carers’ team and Stepping Out, a city-wide service offering respite weekends away. “

 "The Milan day centre provided a dedicated service for black and minority ethnic older people and the quality of this particular service was good.”

“The hospital at home service was co-located with a day hospital service at Liberton Hospital. This positive initiative enabled access to diagnostic services to follow up older people on the same day if required, for around 30 referrals a month, and opportunities to assess service users quickly and prevent admission to hospital.”  

 “Prospect Bank ward, part of Findlay House NHS facility for people assessed as needing hospital-based continuing care, had been selected as a dementia demonstrator site as part of a national initiative. As one of four sites across Scotland, the aim was to improve the older person’s experience and satisfaction levels.”

“The Be Able day service for older people aged over 65 years the service helped to:

• improve their mobility both indoors and outdoors

• regain or increase their confidence and motivation to manage everyday tasks

• take part in social activities again

• keep them as independent as possible for as long as possible.

courses ran for around 14 weeks where trained staff offered:

• exercise programmes to improve strength, balance and stamina

• memory programmes to help stimulate, improve and maintain memory

• help to reduce the risk of falls.”

"A patient experience anticipatory care planning team (PACT) was being piloted at the Royal Infirmary of Edinburgh and the Western General Hospital. Their approach demonstrated an outcomes-focused and patient-centred approach, enabling better case identification and proactive intervention as well as a focus on the efficient use of NHS resources. An independent evaluation showed reductions in unplanned hospital admissions for frail elderly patients and for patients with multiple morbidities which had led to a reduction in the use of acute hospital beds.”

"Some positive work was being carried out by local pharmacy services, including participating in reviews of medicine management and polypharmacy reviews11, particularly in care homes. Other areas where pharmacy was helpfully involved included the long-term conditions programme, falls prevention and carer support to help link carers with primary care.”


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