Priority 3: 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.
The Three Conversations approach focuses on what matters to a person and on working collaboratively with them as experts in their own lives, with staff considering a person’s strengths and community networks to achieve positive outcomes. Implementation across our social care services began in 2019, with 23 innovation sites currently adopting this way of working to support people more quickly and promote early intervention and prevention. This year, Astley Ainslie, Longstone Digital Tech Team and SCD Response Team became live innovation sites and started using the Three Conversations approach.
The contract with Partners 4 Change ended July 2022, and the roll-out of the approach has been supported internally since then. However, the rollout programme has been affected by current system-wide pressures and capacity, including the temporary withdrawal of programme and project management support, so the rollout has been refocused on the continued implementation to the four Locality Teams.
During 2022/23, 53% of new people who contacted us within the teams using the Three Conversations approach benefitted from personalised short-term support, such as building community connections and providing equipment, advice or information, rather than formal long-term care services being required or increased. This figure was 35% last year. The number of people without formal long/term care services requiring repeat support remains low, and when required has been due to unforeseen changes to their circumstances.
We deliver 34 registered adult care services that are subject to inspection by the Care Inspectorate. Following a reduction in inspection frequency due to the Covid-19 pandemic, 2022/23 saw the resumption of inspections across all sectors in the Partnership.
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, 4 and 5 being assessed as ‘adequate’, ‘good’ and ‘very good’ respectively.
During 2022/23, nine inspections took place. No requirements or areas for improvement were made and all services inspected in 2022/23 were rated ‘good’ or above. The grade evaluations can be summarised as follows:
| Service Name | Date of inspection | How well do we support people’s wellbeing? | How well are care and support planned? | How good is our staff team? | How good is our leadership? |
| Fords Road Home for Older People | 09/06/2022 | 5 | N/A | N/A | 4 |
| Clovenstone House | 05/10/2022 | 4 | 5 | N/A | 5 |
| Castle Crags – Care at Home / Housing Support | 21/11/2022 | 5 | N/A | N/A | 5 |
| Castle Crags – Care at Home / Housing Support Group 2 | 27/01/2023 | 5 | 5 | 5 | 4 |
| Positive Steps | 06/12/2022 | 6 | 5 | 5 | 5 |
| SE Home Care Service Cluster 2 | 07/12/2022 | 5 | N/A | N/A | 5 |
| South West Home Care Service Canal | 20/12/2022 | 5 | N/A | N/A | 5 |
| SW Hub –
Re-ablement Service |
30/01/2023 | 5 | N/A | N/A | 5 |
| Support Works | 09/02/2023 | 5 | N/A | N/A | 5 |
| Be Able South | 01/03/2023 | 5 | N/A | N/A | 4 |
A particular focus over the past 12 months has been working with the team at Royston Court Care Home to maintain the standards achieved as a result of the improvement work in 2021/22. This includes quarterly checks to ensure that improvements made are embedded and sustained. The home continues to make good progress with their improvement work which will hopefully be recognised and validated in their annual inspection from the Care Inspectorate.
As a result of the Care Inspectorate identifying an area for improvement, we have been working on the standardisation of person-centred care plan documentation. This work has progressed well and the aim is to move all residents across to the new care plan documentation by the end of August 2023. This will improve outcomes for residents and allow staff to deliver and evaluate the best possible standards of care.
We also offered Scottish Improvement Foundation Skills training to staff across the Partnership as part of the plan to increase Quality Improvement Capacity and Capability. To support improvement in the care homes and increase staff understanding of Quality Improvement methodology, two spaces were allocated to care home staff on each cohort. This will allow us to build a team of improvers within the care homes to identify and drive improvement.
- Partnership working across health and Police Scotland is making an invaluable contribution to identifying adults at risk of harm and working well with partners to improve their safety and wellbeing
- The third and independent sectors in Edinburgh continue to be a real asset in the health and social care integration landscape, with providers being highlighted as giving ‘vital support’ to adults at risk of harm
- The way we are conducting large scale investigations has been positively recognised
- Our strategic leadership throughout COVID-19 has been recognised in ensuring business continuity during the pandemic
However, the report also raised some challenges and areas for us to continue to work on to improve the quality of our Adult Support and Protection activity:
- Like many other HSCPs who have already been inspected in this area, the quality of chronologies and risk assessments in Edinburgh have been highlighted as needing improvement
- The quality of adult protection case conferences has also been cited as an area requiring improvement
- Our wider vacancy challenges, particularly within our social work teams, have also been noted
- Quality assurance activity, capacity assessments and consistency of support and protection for all people when required were also highlighted as areas requiring improvement.
An improvement plan focusing on these areas for improvement has been created and will be overseen by the Edinburgh Adult Protection Committee, which includes senior staff from the Council, NHS Lothian, Police Scotland, the voluntary sector and partner agencies. Regular updates will be circulated on the plan and progress made.
Inspection of Adult Social Work and Social Care Services
A second Care Inspectorate report was published in March, following a request from the Minister for Mental Wellbeing and Social Care that they undertake an inspection of council services delegated to EHSCP. The report highlighted the indirect consequences of broader system pressures, with recruitment issues being a major factor. Alongside that, there remains a need to address our partnership structures and governance, our pace of delivery and to invest in our shared systems and processes.
Key areas identified for improvement focused on:
- The design, structure, implementation and oversight of key processes, including the assessment of people’s needs and their case management
- Approaches to early intervention and prevention, which were uncoordinated and inconsistent
- Self-directed support (SDS), which had not been implemented effectively
- Insufficient support for unpaid carers
- Staff being under considerable pressure and sometimes overwhelmed, though the report also noted most staff experienced and valued positive, responsive and person-centred support from their immediate line manager
- Strategic leadership and management oversight of key processes, meeting legislative requirements, policies, procedures and guidance and to ensure sufficient capacity and capability to deliver safe and effective services for vulnerable people
- Embedding approaches to self-evaluation for improvement and quality assurance were not well-embedded
- Social Work governance with strategic decisions being well informed by a social work perspective
A joint improvement plan with the Adult Support and Protection inspection has been developed in response to the report. This incorporated some of our current developments that align to needs identified in this report. This includes the recent appointment of a Principal Social Work Officer which will strengthen our leadership and support of social work. The plan also sets out our improvement activity under six priorities:
- A focus on early intervention, prevention and demand management
- Reducing waiting lists and improving access to services
- Best use of resources to meet demand and an improved structure
- Getting basic and key processes right
- Workforce – improving recruitment, retention and governance
- Better governance, including professional supervision, manager oversight and quality assurance.
A strategic Inspection Oversight Group has been established to support the improvement work. This group will oversee and approve inspection improvement plans, ensuring actions are focused on outcomes and are SMART. This group will also provide regular updates for staff and stakeholders as we progress, and report into our governance structures and committees.
Case Study 3: Minority Ethnic Health Inclusion service (MEHIS)
| Zoda is a 48-year-old African single parent with three children under 12 years who moved to Edinburgh to escape domestic abuse. She speaks several African languages and Spanish but struggled to read her medical appointment letters in English. Zoda was referred to MEHIS by her GP as she had potentially serious medical conditions and was missing her medical appointments. The African Link worker visited Zoda at home.
The African Link worker supported Zoda to understand the health system in Scotland, understand her medical conditions, provided self-management advice and advocated for her at GP and hospital appointments. Unfortunately, Zoda’s health deteriorated and after an in-hospital stay she lost her only job on a zero-hour contract. The Link worker continued supporting Zoda with the professionals (physiotherapists, occupational therapists, pharmacists) involved in her care and she was linked to: · English classes · Food banks / Pantries · Family, physical and other social activities · Informal, trusted African support groups (who provided invaluable care / assistance to Zoda and children during her hospital stay) · Housing and benefits advice |
| Personal Outcomes: |
| Zoda’s mental health has improved and she commented,
“I am so glad the GP connected me to someone like me who can understand my situation.” “I was alone with my children, now we have an African family.” |