Priority 6: Right care, right place, right time
As part of making sure people receive the right care in the right place at the right time, we want to ensure people are supported to live as independently as possible. We are committed to ensuring people are supported at home and within their communities whenever possible and are admitted to and stay in hospital only when clinically necessary. Central to our thinking is working towards the provision of care tailored to the individual, in a place which best provides this care and as close as possible to when it is required.
In a year where the effects of the covid pandemic and cost of living crisis were still to the fore, impact on carers is still being felt and reinforced through the Carer Survey. There continues to be valued support for carers through the contracted provision through our voluntary sector partners, and our internal supports.
The refreshed Edinburgh Joint Carer Strategy for 2023-26 was published in July 2023, and continues the focus across the six key priorities and embrace the five themes identified through the National Carer Strategy. This is the result of collaboration and wide engagement with carers, supported people and other key stakeholders.
Work on refining the documentation for wider implementation of Adult Carer Support Plans (ASCPs), and associated training was completed in July 2023 for contracted voluntary sector partners, who are now able to undertake conversations to complete the plans, which support an outcome-focused approach for carers.
An outcomes-based reporting framework OutNav, was further progressed by all carer providers with its application tested in March 2024. This will complement the quantitative data reported upon against the Strategy and provide valuable insight into the difference that our work in Edinburgh is making to the lives of unpaid carers.
Work has progressed through on the Carer Landscape-Edinburgh Action Research (CLEAR), which was designed to capture wider carer supports and contribution to the Carer Strategy beyond the commissioned services.
We have continued to work with NHS Lothian to embed the Discharge without Delay (DwD) programme. Phase one was particularly successful at the Western General Hospital (WGH) with DwD wards showing a 50% reduction in bed occupancy by patients in delay. This work will be presented at the NHS Scotland Event June 2024 to highlight the positive collaboration between the partnership and NHS. All Edinburgh HSCP intermediate care facility (ICF) wards have been operating Planned Date of Discharge (PDD) since March 2023. This has continued to evidence improvement in length of stay resulting in a greater number of patients accessing our ICF.
During the financial year, the focus of the DwD programme has moved to Early Supported Discharge (ESD). This initiative went live in December 2023 with the aim to reduce hospital occupancy through increasing the numbers of patients discharged within 0-72 hours of admission within the front door. Early data indicates 137 patients identified in the first 3 days of admission as having potential for ESD with a total of 148 new services organised. The team continues to monitor patients who are unable to be discharged within 0-72 hours and ensures opportunities for earlier discharge are explored.
Our Discharge to Assess service (D2A) continues to be well utilised pathway with 3,300 referrals received in the 2023/24, which represents an increase of over 800 referrals on 2022/23. Our Hospital to Home (H2H) team is actively involved in prevention of admission for patients in crisis or at end of life. The team also continues to support bridging of care packages to enable people to return home at the earliest opportunity. This service has supported 316 patients from 1st April 2023 to 31st March 2024 with bed days saved per patient ranging from 1-14 days.
A single point of access via the Flow Navigation Centre continues to embed and provide a professional response to requests from healthcare professionals for people who require urgent therapy and/or urgent social care interventions. The establishment of an emergency department frailty team has resulted in increased referrals to Hospital at Home (H@H) services. Weekend admissions to Edinburgh H@H increased from 17 in November 2023 to an average of 36 per month up to end of March 2024, an average increase of 113% from baseline. Edinburgh Community Respiratory Team supported 11,943 clinical contacts during 2023/24 with activity continuing to focus on prevention on admission for people living with Chronic Obstructive Pulmonary Disease.
ATEC 24 offers a range of preventative and enabling supports to citizens of Edinburgh, which includes Community Alarms; Telecare; Sheltered Housing Support Service; the Assistive Living Team; Children and Families Occupational Therapy Service; and a Community Equipment Loan Service to Edinburgh, East and Midlothian communities. The Community Equipment Loan Service (CELS) provides specialist daily living equipment on loan to those with an assessed need, determined by a health or social care professional.
For the past year, the call handling function of our Telecare Service has been temporarily provided by London Borough of Newham Council while we upgrade our Alarm Receiving Centre (ARC) to a digital cloud-based platform in order to continue to deliver our services after the analogue network is switched off in 2025. We have worked collaboratively with the Digital Office and others to onboard the National Shared ARC, and are the first Partnership to do so, with the transition complete and all calls returned to our team in Edinburgh in May 2024. The new ARC will offer greater flexibility in call handling to support quality customer experience and service improvements. In this coming year, we will be working to replace the remaining analogue devices in customers’ homes to digitally capable technologies to minimise the risk to citizens from the analogue switchover.
The Assistive Living Team (ALT) was formed to support early intervention with citizens who present with less complex needs through the provision of equipment, telecare and community-based support. This past year we have recruited two technology practitioners to promote the use of telecare and digital solutions to enable people to live well, at home, for longer.
The Community Equipment Loan Service continues to deliver essential equipment to people through East and Midlothian and Edinburgh Communities. During 2023/24, while there have been some additional challenges with increased demand and changed parking restrictions, we have made significant improvements in our delivery operations by moving to a digital process, and in this coming year we plan to consolidate that as well as increase our recycling and refurbishment programme to deliver improved efficiencies.
In Sheltered Housing, we have introduced three Step Down facilities to support people to be discharged from hospital in circumstances where they cannot immediately return to their current accommodation. This has provided people with improved quality of life, for example, allowing people to return to work, which they would not have been able to do from hospital.
The innovation and sustainability review of our Learning Disabilities services continued through 2023/24, with five of the thirteen proposals identified as priorities for additional development. Strategic developments have seen increased focus on savings and efficiencies, due to an ongoing significant gap in the budget for 2024/25. From our existing programme, some elements will be implemented under business as usual, whilst remaining elements have been built into a wider new programme ‘Working-age pathways’.
Working-age pathways includes people with life-long conditions of any age who have a condition which limits their ability to live independently (except those who have a main diagnosis of a functional mental illness). This programme will focus on place-based care, accommodation with support, and support at home for people needing the most intensive services.