Strategic priority three: Person-centred care
Being person-centred is about focusing care on the needs of the person rather than the needs of the service and working with people to develop appropriate solutions, instead of making decisions for them. Key to this is working with people using health and social care services as equal partners in planning, developing and monitoring care to make sure it meets their needs and achieves positive outcomes.
We continue to roll out the Three Conversations model as a strategic and cultural framework to working with the people who approach us for support. This approach aims to achieve improved outcomes for people and families, working in a more preventative and personal way. Three Conversations is based on the principle that we should focus on what matters to people, working collaboratively with them as the experts in their own lives. It recognises the power of connecting people to the strengths and assets of community networks, and the necessity to work dynamically with people in crisis. Staff are encouraged to think creatively about how to support people to deliver improved outcomes.
This approach is allowing us to respond to new requests for support very quickly, with the average time to speak to a worker reduced to 2.5 days between December 2020 and February 2021 compared with an average of 37.3 days for those working in the traditional assessment model. As we no longer start with a presumption that paid for support is the only or best response, we are better able to connect people to wider support meaning fewer people require paid for or formal long-term services.
The impact of covid-19 in early 2020 caused a period of uncertainty and slowed progress as we adjusted to pandemic restrictions and staff were redeployed to care homes or other teams to help with the crisis situation. However, the innovation sites rose to the challenge of providing services within the lockdown situation and in 2020-21 we successfully set up a further five new innovation sites and expanded one existing site. Innovation sites have reported that the Three Conversations approach provided an excellent foundation for how they are supporting people through the crisis, and many have utilised digital innovations to remain connected.
We deliver 34 registered adult care services that are subject to inspection by the Care Inspectorate. Due to the impact of the covid-19 pandemic, the Care Inspectorate suspended inspections of all adult care services other than care homes for older adults. The Care Inspectorate developed a new assessment question to meet the duties placed on the Care Inspectorate by the Coronavirus (Scotland) (No. 2) Act and subsequent guidance that they must evaluate infection prevention and control and staffing.
Inspection results are graded on a scale from 1 ‘unsatisfactory’ (urgent remedial action required) to 6 ‘excellent’ (outstanding or sector leading), with the grades 3 and 4 being assessed as ‘adequate’ and ‘good’ respectively.
During 2020/21, 6 covid-focused inspections of our care homes for older adults took place, with grade evaluations summarised below. Our other adult care services were not inspected in 2020/21.
| Service name | Date of inspection | How good is our care and support during the covid-19 pandemic? (range 1-6) | Number of requirements (COVID) | Number of areas for improvement (COVID) |
|---|---|---|---|---|
| Cherry Oak Care Home | 6 October 2020 | 3 | 0 | 3 |
| Ferrylee | 17 February 2021 | 4 | 0 | 0 |
| Jewel House | 28 September 2020 | 4 | 0 | 4 |
| Marionville Court | 13 January 2021 | 3 | 0 | 2 |
| Royston Court | 28 July 2020 | 2 | 3 | 5 |
| Royston Court | 16 December 2020 | 3 | 2 | 0 |
During 2020/21, one non-covid inspection took place in Royston Court. As described in the section below, this care home was the focus of improvement work this year.
| Service Name | Date of Inspection | How well do we support peoples’ wellbeing? | How good is our leadership? | How good is our staff team? | How good is our setting? | How well is care and support planned? |
|---|---|---|---|---|---|---|
| Royston Court | 9 May 20201 | 3 | 3 | Not assessed | Not assessed | 3 |
A Care Home Transformation Group, chaired by our Chief Nurse, was established in June 2020 to oversee a programme of transformation and improvement across care homes.
In 2020/21 improvement work focused on Royston Court Care Home, a 60 bedded purpose-built Local Authority Care Home in North West Edinburgh providing care for frail elderly and people with dementia. This care home had several outstanding requirements and areas of improvement from previous inspections, which the Care Inspectorate condensed into 7 requirements and 7 areas for improvement in September 2020.
Our quality team worked with the care home to implement the Quality Management System approach to improvements. This included understanding the challenges and issues, getting to know the residents and their needs, and reviewing current processes, systems, documentation and reporting. The team also measured quality of care against the health and social care standards to identify areas for improvement. All staff groups were engaged in the plans for improvement and encouraged to develop and act upon change ideas.
An unannounced inspection in December 2020 showed an overall marked improvement across all areas with an indication that improvement is moving in the right direction, with grades expected to be higher at future inspections and if there is evidence of sustained improvement. Since the inspection in December there was another unannounced inspection in March 2021. Across these inspections all seven requirements and 5 of the areas for improvement were met. Further progress has been made around the requirements and areas for improvement and a sustainability plan has been developed to ensure the progress made will be maintained and built on.
During 2020/21, we continued to engage with the Care Inspectorate and Healthcare Improvement Scotland (HIS) (known as the Joint Inspectors) on how we are improving our Older People’s Service following the Older People’s Services Joint Inspection (May 2017) and Progress review (June 2018). The remaining actions on our revised improvement plan, agreed in May 2019, are largely being delivered through our transformation programme. In particular, the Three Conversations, Bed Based Review, Home Based Care, Home First and Workforce Strategy projects outlined in this report will allow us to robustly respond to the recommendations of the Joint Inspection and ensure we continue to provide quality services for older people. A formal response from the Joint Inspectors on our improvement activity is expected in August 2021.