Weaknesses in Islands' care service

Services for older people in the Western Isles are performing well in some aspects, but crucial areas for improvement have also been identified by inspectors.

That is the conclusion of a joint inspection by the Care Inspectorate and Healthcare Improvement Scotland which looked at how well the health and social work services partnership between NHS Western Isles and Comhairle nan Eilean Siar delivered good personal outcomes for older people who access services and their cares.

The inspection was carried out in April and June 2015 and a report of the inspection has now been published.

Across nine key indicators of performance, inspectors rated one as ‘good’ and five as ‘adequate’. Three indicators were evaluated as weak: ‘key performance outcomes’, ‘planning and improving services,’ and ‘leadership and direction.’

In total, the report contains twelve recommendations for improvement.

The report of the inspection noted there were “important weaknesses in the key performance outcomes being achieved for older people.”

Inspectors said too many older people were subject to delayed discharge from hospital and were having to wait too long for care at home support or a care home placement.

There had been very limited development of reablement and intermediate care services, which can support older people experience positive outcomes.

The Western Isles Partnership needed to ensure that older people with dementia were able to benefit from a timely diagnosis and were able to receive post-diagnostic support.

Support to carers needed to be enhanced to help them continue in their caring role, inspectors added.

However inspectors also said there was a well-developed network of condition-specific services and responses in place from which older people were able to benefit.

Front line health and social work staff were well motivated and worked well together, but inspectors recognised that the Western Isles Partnership faced a number of staff recruitment and retention challenges and were working to try and overcome these.

There was a strong sense of community spirit and the partnership needed to do more to harness this.

The Partnership has some important plans in place to redesign and improve services and it needs to press ahead with these, inspectors said, in order to support older people at risk of unnecessary hospital admission or waiting to be discharged from hospital.

The report identified the need for improvement in partnership working, especially between NHS Western Isles and the Comhairle and in aspects of senior leadership and especially as the Partnership moves towards health and social care integration.

Karen Reid, chief executive of the Care Inspectorate, said: “This report has highlighted important weaknesses in services provided for older people across the Western Isles, and we have clearly laid out our recommendations as to how these should be addressed.

“In particular, effective and consistent leadership is needed to ensure that services deliver better outcomes for older people who access them, and for their families and carers.

“We require significant improvement to ensure high-quality care is provided to older people in a way which reflects their needs and promotes their rights.

“The Care Inspectorate will now work with Healthcare Improvement Scotland and the Scottish Government’s Chief Social Work Adviser to directly support improvement in the partnership.”

Robbie Pearson, Acting Chief Executive of Healthcare Improvement Scotland, said: “In this joint inspection we found that most of the older people and carers that we met were generally happy with the services provided to them in the Western Isles.

“They felt that the services contributed to better outcomes in respect of their health and wellbeing. We also saw good examples of older people being supported to remain in their own homes.

“However, we found a number of important weaknesses that need to be addressed. A significant proportion of older people were subject to delayed discharges from hospital – this issue was raised in a previous inspection for the care of older people by Healthcare Improvement Scotland.

“We are confident that the recommendations set out in this report will result in significant improvements in the care that older people receive.”

The Care Inspectorate and Healthcare Improvement Scotland have now asked the partnership to publish an action plan detailing how it intends to make the improvements identified as necessary by this inspection.