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.
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.
Provide a workforce capable of meeting the demands of increased anticipatory care activity within homes or homely settings by addressing the key priorities of the workforce development agenda. These priorities are:
This service was developed in response to the fact that older people can often be unnecessarily admitted to hospital, due to there being a lack of readily available transport to take them home, and the risk that the 4hr A&E target may be breached for them. It was recognised that patients may also be more likely to be admitted especially if they have arrived at A&E later in the day, and there is a lack of family/care support to ensure a safe return home.
In addition to this, a service that would support individuals into their own home, ensuring their safety and comfort, was seen to be beneficial both in terms of direct support to the patient, and potentially picking up on issues which might prevent further deterioration or a potential readmission to hospital.