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Inspecting Integration of Health and Social Care Services in Scotland
In June of this year, the Care Inspectorate released a report of an inspection they carried out jointly with Healthcare Improvement Scotland. The inspection was a planned initial investigation of how well social care and health care integration was working in one area of Scotland, South Lanarkshire.
These agencies are best placed to assess progress on integration of care services with health care. The Care Inspectorate has a broad remit to regulate and inspect individual registered care services,they also carry our broad scale assessment of how well individual local authorities are providing social care and social work in their particular areas of responsibilities.
Healthcare Improvement Scotland is a scrutiny body which drives participation and improvement in health services across the country. Inspections are carried out and reported on, and the organisation works with a range of other advisory and statutory agencies.
The combined roles of these two agencies gave potential for a uniquely detailed examination of how health and social care are working together.
Scotland decided to bite the bullet of integration several years ago. It was anticipated that it would improve services and reduce the costs, inefficiencies and backlogs which might be caused by lack of joined-up working.
Legislation was passed in 2014 to bring together NHS and local council care services under one partnership arrangement for each area. In total 31 local partnerships have been set up across Scotland and they manage £8 billion of health and social care resources. The stresses and level of change for both parties are clearly enormous, and this inspection provided an early indicator of how well it was working, together with an early assessment of problems that may not have been foreseen.
The report stated the purpose of the inspection was to ‘…evaluate the progress that the South Lanarkshire Partnership was making towards joint working, how that progress was impacting on outcomes for older people who used services and their carers.’
The agencies developed a set of quality indicators to base their assessments of the services inspected. Inspectors from the two main agencies worked together, along with a team that included unpaid carers and health professionals who were seconded for this inspection.
Random samples of case records from service users were perused, with tracking of individual care progress. Focus groups, interviews with individual service users, and meetings with staff and managers were held.
The partnership area was judged to be making good progress in three quality aspects of its functioning, with adequate progress in six other areas. It was judged that most older people were supported at home, reducing the pressure and demand on hospital and care homes. Care at home was felt to be supporting timely discharge from hospital, as well as reducing the pressure on admissions for chronic conditions.
However, the report stated that more needed to be done in the commissioning and provision of intermediate care to assist in the goal of preventive, local care and to enable early hospital discharges when appropriate.
Support for carers, and recognition of their needs, was seen to need improvement. Likewise, there needs to be improvement in services for people with dementia after a diagnosis was carried out.
The report concluded that liaison with the local communities was good in the development and improvement of services. However, the team decided that closer evaluation of community support initiatives is needed.
Uptake of self-directed support, and the maintenance of chronologies and good risk assessment procedures were other areas for improvement.
Overall, the report expresses confidence in the local integrated partnership as it works to its full operational reach. An overall lesson seems to be that commissioning and tailoring of services according to community and individual needs is vitally important for future progress in effective integration of quality services.
The report can be accessed here: Joint inspection of services for older people in South Lanarkshire
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