Strategic priority five: 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.
Our people are our most valuable partners and the past year has proven this more than ever. The pandemic has been tough on everyone, and our people were incredibly committed to supporting the people of Edinburgh through this crisis. Many staff were temporarily redeployed to support our response to covid-19, with our 2020 iMatter pulse survey showing that 78% of respondents had experienced a change either in their job role or the environment they work in during the pandemic. This included staff who were redeployed to support continuing services, for example, staff from day care centres that had to close due to the restrictions worked alongside existing teams to enhance support in our residential units and home care service.
Through our transformation programme, we have been developing our inaugural workforce strategy, to help us ensure that we have a skilled and capable workforce that can deliver our vision of ‘a caring, healthier and safer Edinburgh’. It will set out our vision and priorities for the workforce and a pathway for where we need to be. The strategy focuses on both our own workforce across the City of Edinburgh Council and NHS Lothian as well as the implications for those we work with such as the third and independent sectors, volunteers and the role of carers. At the end of 2020-21 we began engagement with staff on the proposed strategy.
While the pandemic caused some delay in this project, it has also been a catalyst for positive change, expediting changes to how and where we work as well as how we engage, network and communicate.
Once a nurse, always a nurse – A journey back to District Nursing
Sue works within our organisational development team but was asked to return to clinical practice for two months during the pandemic to support our district nursing team. It had been 18 years since Sue worked fully in district nursing, though she had picked up the odd shift to support the team over that time. Sue recently wrote about the experience of returning to the frontline:
“I have to say it was the most valuable and grounding experience, and I feel privileged to have had the opportunity. The extraordinary care, which is provided by community teams 24 hours a day, seven days a week, is truly inspiring. Being alongside caring and compassionate staff at all levels, feeling welcomed, safe and supported, enabled me to transition quickly back into a role I had loved, albeit such a long time since I had held a caseload in the community.
I knew my capabilities and limitations, so with the support of the DN Team Lead and the community nursing team, we agreed what was realistic and achievable in terms of competencies and clinical skills in a two-month period, ensuring patient safety at all times.”
The Market Shaping project within our Transformation Programme will look to transform Edinburgh’s approach to supporting people in their own homes, recognising that choice and control for supported people cannot happen unless there is a sustainable market of providers and services to choose from. It will support the development of a market facilitation strategy and plan taking into consideration our approach to commissioning care at home services, our internal Home Care and Reablement provision, and further development of the One Edinburgh concept. A One Edinburgh Charter will set our expectations and values and ensure that all providers we work with are committed to offering equitable care and support, fair working practices and have common values in line with our own.
In line with the recommendations within the Independent Review of Adult Social Care, we are moving away from the traditional commissioning approach. Alongside work on the One Edinburgh Charter, the project team have been collaborating with providers to co-produce the new over 65s care at home contract. While the covid-19 pandemic meant that collaboration with providers had to pause to allow them to focus on delivering care to existing service users, this work has accelerated from August 2020 onwards. The new contract is expected to be in place by October 2022, with an emphasis on moving away from time and task models of care provision to focus on better outcomes for the people we support.
This project is also supporting the development of a market facilitation strategy and plan to ensure there is a sustainable market of providers and services for supported people to choose from.
Pharmacotherapy is one of the main constituents of the Primary Care Improvement Plan and is expected to invest around £3.5 million each year over the 4-year implementation period (April 2018 – April 2022).
As with many other services, at the beginning of the 2020/21 financial year there was huge disruption to the established pattern of prescribing demand. This was likely linked to changing patterns of patient interaction and demand due to behaviour changes at the start of the pandemic. It is too early at this stage to say whether these changes in behaviour will be sustained. We also saw a strengthening of the role of the community pharmacy during the pandemic, as people stayed local and avoided hospital visits alongside the extension of the Pharmacy First service to allow all patients in Scotland access to treatment for minor ailments at a community pharmacy.
Despite this disruption, we continued to successfully implement many aspects of the Primary Care Improvement Plan linked to pharmacotherapy. New staff continued to be successfully inducted with around 20 new pharmacists and pharmacy technicians deployed and supported. Several new ways of working were explored such as providing pharmacotherapy services remotely and a move towards utilising serial prescribing. This created additional capacity within the system and will be further explored, along with other innovations.
We also met our financial targets with around £2.1 million delivered against an adjusted target of £1.9 million.