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 assets and strengths, and linking with community networks to achieve positive outcomes. Implementation across our assessment and care management teams continues, with new teams such as our dedicated review teams adopting this way of working to support people more quickly, promote early intervention and prevention and ensure people receive proportionate support.
In response to the joint inspections in 2023, we commenced the one assessment project to provide staff with the relevant guidance and tools to deliver consistent, good quality and robust assessments through the implementation of a single assessment template across all teams. Phase one of the roll out plan commenced in February 2024 to provide new or refresh training in Three Conversations to locality staff. A revised recording process was also implemented January 2024 with all teams using the Three Conversations approach to support consistency and good quality recording.
During 2023/24, an average of 78% 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 53% in 2022/23, though some of the increase may be attributable to improvements in the recording process. 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. Moving forward it is critical that we build on our experience of implementation and promote a strong culture of continuous improvement within the HSCP and in this regard we will continue to review the application of this model through the lens of strength-based approaches while engaging with front line practitioners in obtaining their views.
We deliver 35 registered adult care services that are subject to inspection by the Care Inspectorate.
During 2023/24, twenty inspections took place (detailed undernoted), 87% received a grade of ‘Good’ or above. Overall, the inspections found that in Care Homes, people’s health and wellbeing needs were being met, and staff were committed to helping people achieve their best possible outcomes. Improvements in care planning should continue to promote better care for people. In Homecare services, people were supported to get the most out of life and new technology was being introduced to strengthen quality assurance systems and support improved internal communications and care recording.
One service, Royston Court, received grades of weak and adequate and an improvement plan is underway to address the issues raised by the inspectorate.
| Service | Date of inspection | How well do we support people’s wellbeing? | How good is our leadership? | How good is our staff team? | How good is our setting | How well are care and support planned? |
| Be Able South | 01-Mar-23 | 5 | 4 | NA | NA | NA |
| North West Hub Re-Ablement Service | 16-Mar-23 | 5 | NA | NA | NA | NA |
| NE Home Care Service Leith | 19-Apr-23 | 5 | 5 | NA | NA | NA |
| NE Hub – Re-ablement Service | 19-Apr-23 | 5 | 5 | NA | NA | NA |
| North East Home Care Service East | 19-Apr-23 | 5 | 5 | NA | NA | NA |
| South West Home Care Service Pentlands | 03-May-23 | 5 | 5 | 5 | NA | NA |
| North West Home Care Service Cluster 1 | 18-May-23 | 5 | 5 | NA | NA | NA |
| Sheltered Housing Support Service | 29-May-23 | 4 | 3 | 4 | NA | 4 |
| Marionville Court | 13-Jun-23 | 4 | 4 | 4 | 4 | 4 |
| Fords Road Home for Older People | 14-Jun-23 | 5 | 5 | NA | NA | NA |
| Inch View | 28-Jun-23 | 3 | 4 | NA | 2 | NA |
| Jewel House | 06-Jul-23 | 4 | 4 | NA | NA | NA |
| Edinburgh Support Services Community Support | 04-Aug-23 | 4 | 4 | NA | NA | 4 |
| Be Able North | 21-Aug-23 | 5 | 4 | 5 | NA | 5 |
| Clovenstone House | 18-Oct-23 | 5 | 5 | NA | NA | NA |
| Ferrylee | 23-Oct-23 | 5 | 5 | NA | NA | NA |
| North Merchiston | 17-Jan-24 | 4 | 4 | 4 | 4 | 4 |
| Castlegreen | 09-Feb-24 | 5 | 5 | 4 | 4 | 4 |
| Inch View | 26-Feb-24 | NA | NA | NA | 3 | NA |
| Royston Court | 27-Feb-24 | 2 | 2 | 2 | 3 | 3 |
We have undertaken a large-scale project over the last 12 – 18 months within our internally managed care homes introducing new care documentation. Over 450 staff have been trained in the new documentation, we have developed learning resources for staff training and implemented the new care plans. The idea was to standardise the care documentation across council care homes and introduce documentation which is more person centred. We have also developed new feedback questionnaires for relatives and residents including a dementia friendly questionnaire.
We are currently working on another large project, developing and introducing new assurance documentation which we have tested at Ferrylee care home and are now developing and implementing in Royston with the aim to spread to all the council care homes in 2024.
In the last quarter of 2023/24, we have started a cohort of Scottish Improvement Foundation Skills training specifically for care home staff which is planned to run for 6 months. Within the course there is a member of staff from each care home and the senior nurse for care homes. The projects are specific to the care homes and having a cohort specifically for this staff group will help promote shared learning and ideas for improvement across the care homes through this network of improvers.
A Joint Inspection of Adult Support and Protection (ASP) practice in Edinburgh was carried out in the last quarter of 2022 and a full report was published on 14 February 2023. A further inspection of adult social work and social care in Edinburgh was undertaken with the report on this inspection published 21 March 2023. On 13 June 2023 the Edinburgh Integration Joint Board approved a detailed 3 year Improvement plan response to both Inspections.
The year one improvements focused on addressing the root causes of the weaknesses exposed by both inspections by strengthening the fundamental building blocks of good social work and adult protection practice. The plans seek to bring about a culture change in both operational practices and strategic commissioning, all of which are being progressed at pace. However, the length of time that it will take to fully implement all the necessary improvements and embed cultural change cannot be underestimated, especially while managing high levels of demand and an extremely challenging financial climate.
Work in response to the inspections has been taken very seriously. Some of the key achievements in relation to the improvement plan over 2023/24 include:
- New paperwork in relation to Adult Protection Case Conferences agreed and implemented with clear embedded guidance.
- Resources have been transferred from localities to Social Care Direct to improve access for people at the point of contact and ensure people at risk of harm are identified with the right action taken quickly.
- Undertook staff engagement and consultation on a revised, strengthened professional line management structure.
- Introduced new ASP Investigation processes with specific chronologies and risk assessment.
- Social Work student hub continues to operate effectively to support student placement and transition to permanent appointments as appropriate.
- Improved recruitment and retention – By end of June there was a 38% reduction in Social Worker vacancies from April 2023. When including professional Social Workers Occupational Therapists and Community Care Assistants, reduction is 50%.
- Implemented Quality Assurance audit for effective manager oversight and supervision recording.
People living with dementia are more vulnerable and at risk of going missing from a variety of settings including their own home, hospitals, care homes, attending day services and community activities/interests. The Herbert Protocol is a UK nationally recognised tool to support someone with dementia who may be at risk of going missing. Completing a Herbert Protocol form[1] in advance means that if someone subsequently goes missing, it assists Police to conduct the missing person search more effectively and quickly.
The Herbert Protocol was launched in Edinburgh in 2019 as a multi-agency partnership approach, with the primary aim that it becomes well-known towards “business as usual” use. Prior to this launch, few people were aware of the Herbert Protocol. Since then, a programme of activities undertaken across the city to raise awareness and promote the form has been completed. Activities undertaken by members of the multi-agency Herbert Protocol Working Group include:
- 14 features in print and online social media;
- 10 in-person small group workshops;
- 7 information stalls at community festivals and open days;
- 2 conference presentations;
- 500 plus posters and leaflets distributed to community hubs;
- Herbert Protocol briefing poster circulated to all care homes and care at home providers; and
- 38 joint EHSCP and Police Scotland online information sessions attended by 950 staff from NHS, EHSCP, third and independent sector organisations from Edinburgh and across Scotland, with 94% of attendees reporting that their knowledge of Herbert protocol increased after the session.
Police Scotland Edinburgh Division statistics shows that there has been significant increase in use of the form: in 2019, only 5% of the people missing with dementia had completed a Herbert Protocol form but by 2023 this had increased to 28%. In 2023 the average missing time of those with a completed form was 45 minutes compared to 66 minutes for those without. A survey in March 2024 (84 staff and 8 unpaid carers responded) showed that 66% of staff always recommended use of the form with many examples that it is now included in key processes, and 100% of carers would recommend use with 88% indicating the form helps them feel better prepared if the person cared for goes missing.
EHSCP also had a lead role within Police Scotland’s multi-agency national steering group to deliver on national media launch in September 2021 and associated activity. Learning and materials from Edinburgh Implementation were used to support this, including adapting the Edinburgh Herbert Protocol form to one new national form.
It is planned to continue implementation work to early 2026 to ensure Herbert Protocol becomes embedded as part of everyday use.
[1] Herbert Protocol form – https://www.scotland.police.uk/what-s-happening/missing-persons/the-herbert-protocol/