Joint inspection of services for older people in the Scottish Borders

Health and social care services in the Scottish Borders are delivering some positive outcomes for some older people in the area, but there are also some key weaknesses in the delivery of some important services.

That is the view of inspectors following a joint inspection of services for older people across the Scottish Borders Health and Social Care Partnership which includes the Scottish Borders Council and NHS Borders.

The inspection was carried out between October 2016 and February 2017 by the Care Inspectorate and Healthcare Improvement Scotland.

Inspectors looked at how well health and social work services for older people across the partnership worked together to deliver good outcomes for older people and their carers.

Inspectors noted that there were key strengths in the quality of services provided to older people and that these delivered good outcomes when people accessed them.

But inspectors also said there were lengthy waits for people to have their needs assessed, and people often had to wait for services to be provided even after their needs had been assessed.

Across the nine key indicators of performance, inspectors found one to be ‘good’, five to be ‘adequate’ and three to be ‘weak,’ including ‘delivery of key processes’; ‘strategic planning and plans to improve services’; and, ‘leadership and direction.’

Inspectors found that despite some positive early work in respect of health and social care integration, the partnership’s vision had not been communicated effectively to all stakeholders. Restructuring had created uncertainty across some areas, particularly mental health services for older adults. More visible leadership and effective communication regarding the wider vision and reasons for change was needed to keep staff motivated and engaged throughout this period of transition.

Inspectors also found significant weaknesses in how people’s needs were assessed. The partnership needed to work closely with the Adult Protection Committee to strengthen practice in protecting adults at risk of harm.

Karen Reid, chief executive of the Care Inspectorate said: “Our inspection lays out clearly areas of strength but also improvements which must be made quickly, so that local services protect vulnerable older people, deliver high quality care and meet their needs well.

“We expect to see people who experience care much more closely involved in designing changes to the health and social care services they will use, with clear pathways for accessing care and eligibility criteria that are consistently and appropriately applied.

“Waiting times for getting support must be minimised. This requires greater focus on early intervention, coupled with services working together to help older people live in their own homes for longer and avoid being admitted to hospital where that is not necessary.

“We recognise that there have been some recent senior personnel changes, but our inspectors identified the need for strengthened leadership of change and better workforce planning at all levels. That must involve the voluntary and independent sectors, so the right people with the right skills to support older people are in the right place at the right time.”

“We expect to see progress accelerate and require the partnership to develop a detailed action plan which will improve the experience of people across the Borders.”

Robbie Pearson, Chief Executive of Healthcare Improvement Scotland, said: “Prioritised action will be required across services to ensure that older people and their carers are protected and their needs met and their wellbeing improved.

“We will be discussing with the partnership how it intends to make the necessary improvements and what support will be required. We will require an action plan detailing how the partnership will take the necessary actions.

“Our organisation has also carried out a separate inspection for the nutritional care of older people at Borders General Hospital following on from this joint inspection. This report has also been published today.”

The report has identified 13 areas for improvement. The Care Inspectorate and Healthcare Improvement Scotland will monitor improvement and will return to the partnership to review progress no later than 12 months following publication of this report.

The report is available here: