£500m shake-up of health and social services

PATIENTS have been promised a “seamless” service under a radical shake-up of health and social care in the Lothians.

The ageing population has left the city needing an extra 5000 hours of home care every year. Picture: comp
The ageing population has left the city needing an extra 5000 hours of home care every year. Picture: comp

The £500 million master-plan, drawn up by the city council and NHS chiefs, will look to tackle issues such as bed blocking and home care shortages.

It is hoped the new system – which will see NHS Lothian pool its community care resources with the region’s four councils from April – will stop patients being shunted between health and social care providers.

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The move has been sparked by the Scottish Government, which wants to reduce the amount of time people spend in hospital, benefiting the elderly and those with long-term health conditions and disabilities.

And it comes as NHS Lothian faces a £70m shortfall in its budget while the city council has to make cuts of £67m by 2017.

Soaring demand on services caused by an ageing population has left the Capital needing an additional 5000 hours of home care every year, putting additional strain on already-stretched hospitals.

While crippling levels of bed blocking – where a patient cannot leave hospital because there is no care in place – have left hospitals at breaking point.

With the number of over-75s – the biggest users of NHS services – set to increase by more than 25 per cent in the next decade, many claim an overhaul in care is necessary to tackle the ever-increasing demands of older people, many with multiple conditions and complex needs, such as dementia.

Experts say the challenge facing health bosses is to build a properly integrated system before the combined costs of the ageing population lead to irresolvable issues and a vast increase in the price of providing care.

Jean Turner, a former GP, MSP and executive director of the Scotland Patients Association, said integration would also help to cut through “red tape” faced by many patients switching between organisations.

She said: “What causes delays for a lot of people is the fact the NHS and local authority work together from different budgets – so when 
someone’s coming out of hospital, it’s out of the NHS budget and into the local authority.

“This should avoid organisations saying it shouldn’t come out of their budgets and causing bed-blocking hold-ups. But I still think if it’s a finite budget, decisions will have to be made and many challenges will continue. It may be a while before it’s seamless but you have to start somewhere.”

Draft plans are now at the public consultation stage before a final version is sent to the Scottish Government at the end of March.

Ricky Henderson, health and social care leader at the city council, said he was confident the revised format would lead to an improved service.

Councillor Henderson said: “It should allow people who work in the health service or health and social care to work together in a more seamless way and lead to people not feeling like they get passed from pillar to post.

“The big agenda is to tackle health inequalities. It is still the case in Edinburgh that if you are born in some parts of the city, one of the poorer areas, your life expectancy is less than if you are from one of the more prosperous.

“There’s no secret in terms of the budget challenges for both NHS Lothian and health and social care within local authorities but I am confident that, by further integrating our 
services, it will lead to an improved and more targeted service for everyone who needs it.”

The Wester Hailes Healthy Living Centre and joint leasing of the former Pentland Hill to provide a step-down facility for patients trapped in hospital, are examples of the organisations working jointly.

Three £27m partnership centres in Edinburgh and West Lothian are also in the pipeline, which will provide an array of health services under one roof.

But Labour MSP Sarah Boyack said the arrangements alone would not be enough to tackle the “huge pressures” being placed on social care across the Lothians.

She said: “A joined-up approach is an important first step to addressing our care needs but action is urgently needed to invest in capacity.”

Professor Alex McMahon, director of strategic planning for NHS Lothian, said: “This new approach will build on the integrated work and good relationships which already exist between health and social care colleagues and services.”


By Ranald Mair Chief executive of Scottish Care

We support the move towards closer integration and think that having joined-up planning between the health service and local authorities is important.

It makes sense if you look at the Edinburgh challenges in terms of people being stuck in hospital, sometimes waiting for care home places, sometimes for care at home packages.

We need a joined-up approach to planning how much social care we need to balance out the health care we are trying to provide so that people have access to the right care, in the right setting at the right time. Simply having integration doesn’t automatically solve the problem but it gives the opportunity to look at putting the resources that are needed in the right places.

From the Scottish Care perspective, Edinburgh is a difficult area for social care providers to operate because the cost base is higher. It costs more to run services here than in other parts of Scotland, so there needs to be greater investment.

Recruiting staff to work the social care setting is harder in Edinburgh because people have other opportunities in the retail sector or hospitality industry, so if we’re going to attract people we need to pay them appropriately, we need to be successful in the local employment market so again, we need a joined-up approach to the planning of the workforce we’re going to need going forward. The likelihood is, that given the demographics, we’re going to need more care of all sorts in the future and from the public’s point of view, it needs to be reliable.

There is a series of challenges in Edinburgh and integration isn’t a magic wand to ensure everything is sorted but it gives us a better base from which to start.

The elephant in the room is that this is going to cost more money for social care. We might ultimately make some savings in hospital care but not immediately.