Priority 5: Making best use of capacity across the system
It is important to ensure that capacity within the system is utilised in a balanced and progressive way to deliver the best outcomes for the people of Edinburgh. We continue to work with our partners in the third and independent sectors to ensure that the services we offer can meet increasing needs and demands within the continuing challenging financial climate.
During 2022/23, a Recruitment and Retention Oversight Group was set up to support initiatives to address health and social care recruitment challenges. This is supported by regular performance monitoring around recruitment and retention. We also increased our resources to support hiring managers with recruitment processes in the social work area to ensure onboarding could take place efficiently and effectively.
We engaged with Capital City Partnership (CCP) to support our recruitment activity across the city, with outreach activity and community-focused engagement being undertaken to identify and generate interest in joining the partnership. The main drive is at entry level for social care services and since November 2022 local and targeted recruitment fairs have taken place monthly. Referrals (registered to the programme) now total 437. A total of 56 interviews have taken place with more in the pipeline and 32 job offers have been made. CCP also secured support of Community Renewal for additional staff support, established a short Health and Social Care training course programme using CCP Vocational Training Framework (VTF) funding and have established strong links to Department of Work and Pensions (DWP) and MyJobScotland.
Further work around recruitment, workforce planning and training and development, including for leadership, is planned as part of our response to the recent inspections of Adult Support and Protection and Adult Social Care and Social Work.
Working Together is Edinburgh Partnership’s workforce strategy for a caring, healthier and safer Edinburgh. This ambitious strategy has been developed to ensure we have a skilled and capable workforce for today and tomorrow that can deliver on our strategic priorities and meet the health and social care needs of the citizens of Edinburgh.
The strategy highlights 4 key broad priority areas of focus, these being: Health and Wellbeing; Culture & Identity; Capacity and Transformation; and Leadership & Development. A Workforce Steering Group comprising senior executives and lead Trade Union and Partnership representatives was formed to begin leading on the implementation of our strategy. Key areas identified so far include: Supervision & Support; Workforce Plan; and Visible Leadership.
Progress has been challenging due to a number of factors including winter and system pressures, and ongoing resource and capacity issues. As a result, we are reviewing our structural and governance arrangements as part of a reset for this important and necessary work. We are also working on an update to our workforce plan which is due for submission to the Scottish Government in October 2023.
‘One Edinburgh’ is part of our Home-Based Care and Support project within the Innovation and Sustainability Portfolio and is our collaborative approach to the delivery of internal and external home-based support. It aims to deliver a vision of preventative approaches and support solutions that enable more people to remain independent at home, or in a homely setting, for as long as possible.
There are three pillars to the One Edinburgh care at home programme.
Total Mobile – We began to implement our new mobile workforce scheduling solution for our internal Home Care and Reablement provision. An enabler for our internal redesign, we anticipate completion by the end of 2023. Almost 600 devices are now deployed to the Homecare and Reablement team who are also benefiting from access to email, Microsoft Teams, public transport apps for route planning, and the Thrive app for vital access to learning and development training.
Internal Re-Design – We have progressed with the redesign, planning and modelling of our internal homecare services to shift from long term care support services to a focus on prevention and reablement, though some long-term care at home will still be delivered internally. This will support our approaches to prevention and early intervention, supporting individuals to live independently for longer.
We established a citywide care at home operational leadership group at the start of 2022 which has oversight, monitors activity and capacity levels, ensures maximised use of capacity, and drives forward performance improvements in relation to this. The team meets daily, making quick evidence-led decisions and taking actions around the internal and external care at home capacity across Edinburgh. The aim was to centralise discussions and planning approaches about care at home support across the city, with specific focus on reducing hospital delays and community unmet need; reducing the time that individuals wait for support to be arranged; and maximising the commissioning of capacity available through the external market.
Significant improvements have been delivered through this group with a reduction from January 2022 to March 2023 of 83% in the number of people delayed in hospital waiting for a package of care and an average reduction of 84% in the number of days people wait for care at home support arrangements to be put in place. For the same period in the community, there has been a reduction of 72% in people waiting for care at home support arrangements, and an average reduction of 36% in the number of days waiting for these arrangements to be put in place.
One Edinburgh Care at Home Commissioning – While the internal re-design analysis and modelling was undertaken, framework commissioning was largely on hold during 2022/23. However, the ongoing activity with care at home providers to continue the shift towards new collaborative working continued. With clarity about what our proposed internal care at home provision will be, there was further analysis and modelling undertaken late in 2022/23 to define what will need to be commissioned from the external care at home market.
The application of the Primary Care Improvement Plan (PCIP) and Transformation and Stability (T&S) funds in Edinburgh enjoyed another constructive year in 2022/23. These funds are now almost all recurringly committed to supporting the equivalent of approximately 300 additional full time primary care staff across the city. Our latest evaluation indicates that these staff make a workload contribution equivalent to almost 600 additional medical sessions each week, helping offset the continuing impact of Covid-related pressure and the ongoing population increase. The feedback from patients treated by these new professionals is overwhelmingly positive, as the experience of these staff working in Primary Care.
Pharmacotherapy accounts for 38% of the PCIP funding. The workforce combines primary care workload augmentation with cost and quality-related activity. As a result of the ongoing attention of GPs to high quality and cost-effective prescribing, now facilitated at practice level by the pharmacotherapy team, Edinburgh has lower expenditure per head of population than any other area of Scotland. The number of pharmacy technician staff has grown and these staff are increasingly able to provide multi-practice support for relatively routine processing of medicine-related activity. All pharmacotherapy activity is carefully monitored to ensure that quality and safety are enhanced as part of this work.
Fifty-five of our 70 medical practices are currently accessing the Community Treatment and Care Centres (CTAC) services, and there are plans for further expansion in 2023. CTACs take a proportion of several time-consuming procedures, such as complex wound dressings and ear irrigation, away from medical practices, thus allowing Practice Nurses to provide more ‘long-term condition’ management and care. Our vaccination team has removed almost all routine vaccination from medical practices, with approximately 300,000 vaccinations delivered during 2022. While some patients will now need to travel further than their local surgery to receive some elements of primary care treatment, this will allow medical practices to concentrate on the services they are best placed to provide.
We have invested in both Primary Care Mental Health Nurses and physiotherapists embedded in practice teams. This allows many more patients to be treated locally and quickly rather than referred to another specialised service team. In addition, our Community Link Worker service now covers approximately half of City practices, offering both direct support and advice to patients about relevant community resources available both locally and across Edinburgh.
An important part of the primary care transformation process is the ongoing development of the primary care premises required to support our growing population. In 2023, we were able to offer new accommodation for two of our medical practice teams and helped almost 20 others with improvements to their premises which enabled more patients to be absorbed. We also renewed the ‘Edinburgh Primary Care Population and Premises Report’ to ensure we adjusted our plans to the additional requirements of the City of Edinburgh Council’s ‘City Plan 2030’. This year, we had a large number of people from the Ukraine who followed on from new citizens coming to Scotland from Afghanistan the previous year. One of our medical practices took the lead in ensuring people living on the ship in Leith and in two city hotels had the support they needed, whilst others were welcomed into local practices when they were able to secure local accommodation.
Whilst much progress was made in 2022, the pressure of population increase, the aftershocks of Covid and the ‘cost of living crisis’ has meant that Primary Care remains under considerable pressure.