Prior to this post East Lothian service users who are admitted to any of the Edinburgh Acute hospitals have to be referred to and assessed by the hospital SW if they require an assessment for a possible care home placement. Due to the demand on the hospital SW service, East Lothian service users often had to wait to be allocated and then once the assessment has been completed the SW has to liaise with East Lothian Council regarding vacancies and funding. This in turn could increase the length of stay in an acute bed.
Prior to the establishment of the Duty and Response Team, there was no community rehabilitation team and social care and health elements of support operated independently, albeit collaboratively with one another. This still meant duplication of information sharing and assessment processes for older people requiring the service. The Change Fund enabled the addition of Physiotherapy and Occupational therapy professionals to join the Adult Wellbeing duty and response team to form a multidisciplinary duty, response and rehabilitation team.
Users of the previous traditional home care service received a service that operated in a culture of ‘doing things for’ people that reinforced deficits and increased dependency. This ‘locked in’ resources with people who had the potential to improve their confidence, self esteem and independence while demand for the service was increasing because of the growing numbers of older people. In addition, there were financial pressures on the local authority.
East Dunbartonshire has the highest ratio of older people in Scotland. The percentage of population with dementia in the area is also greater than the national average and is expected to increase even further.
The clinic model contributes to a more efficient use of existing services through enhanced co-ordination of the existing resources of all of the partner organisations. They deliver flexibly and sensitively the type of advice and support that people with dementia have told us they need.
The Western Isles has a changing demographic with a higher population of older people than the Scottish average, this coupled with an ageing workforce and outward migration of young people has brought into focus the need to continue with the modernisation of our acute services and deliver more services closer to communities.
In conducting a review of unscheduled care the National Dashboard summarises NHS Western Isles performance as:
A&E attendances -7% WI v.+ 1% Scotland
A&E admissions : -6% WI v. +10% Scotland
A&E admissions as % of non-routine discharges: 65% WI v. 71% Scotland
Ave. Stay Emergency stay (WIH ) : 5 days less than Q4 2011
Acute beds: down 12% WI v. 2% Scotland
Acute Beds per 1,000 acute discharges: 66 WI v. 44 Scotland
Acute emergency discharges: -2.5% WI v. +2% Scotland
Acute non-emergency discharges: -2.5% WI v. +2.6% Scotland
Beds lost to DDs: 7 WI
In summary for latest period WI has reducing lengths of stay reflecting reduced bed numbers and reduced acute admissions (both emergency and elective) in turn reflecting reduced A&E attendances and onward admissions from A&E. Some of this contrary to Scottish trend (See above list) but remain above average in comparison to Scottish levels for few areas eg. ALoS and Number of beds relative to number of patients.
NHS Western Isles approach is integrating all of our Unscheduled Care activity under a single work stream, taking a whole system approach and working closely with service users, Local Authority partners and Third Sector providers. This work is ongoing.