Joint Older People's Inspection

A report on the Joint Older People's Inspection that took place in the Scottish Borders between October 2016 and February 2017 has been published today, Thursday 28 September.

The Partnership welcomes any inspection that helps identify improvements that are needed in our services.

This inspection commenced in October last year, when the Health and Social Care Partnership was very new and at an early stage of development. Clearly progress has continued to be made since the inspection.

There are a number of recommendations in the report which reflect evidence and information the Partnership provided to inspectors and which were areas already being targeted for improvement.

A focus for improvement is strengthening quality assurance processes to ensure that adults who require support and protection are correctly risk assessed and receive this in a timely manner. We have already conducted an independent review and are working across the Partnership to ensure all staff are appropriately supported over our Joint Protocols for Adult Protection.

We have found it difficult to elicit guidance and support from the inspectors in terms of understanding the ratings they have attributed and examples of practice that we can learn from; nonetheless we have already made much progress since the time of the inspection eight months ago. This includes the following:

• We have refocused and expanded the senior management team. Interviews to appoint permanently to the post of Chief Officer Integration took place on 25 and 26 September and we hope to be able to make a formal announcement on this shortly.
• We have streamlined the decision making process and embedded new governance and reporting methodologies.
• The Integration Joint Board has a number of new members and shared sense of purpose.
• Community Led Support Hubs are now up and running in Ettrick, Yarrow, Galashiels and Hawick. These allow a much clearer and single point of access to services for the public.
• A Matching Unit has to date sourced over 170 care packages for people urgently needing a service, virtually eliminating the waiting list in Tweeddale within a week of opening.
• The Partnership's Locality Plan consultation concluded on 16 September, with a report on the results due to be presented to the Integration Joint Board on 23 October.
• Major investment in the Community Equipment Service, Waverley Care Home and new Transitional Care Facility (where people are cared for in an appropriate setting) will be formally opened on 16 October.
• Plans are underway to open a new discharge to assess unit at Tweedbank during November.

We would like to thank the inspectors for identifying and highlighting a number of positive examples where the Partnership is performing well. Key quotes from teh report include:

• "Older people's circumstances and personal outcomes had improved as a result of the services they received in almost all of the 100 health and social care files we read (93%)."
• "91% of those diagnosed with dementia were receiving post-diagnostic support."
• "The approach to assessment, care planning and review all showed an outcome focused approach. Staff involved older people in decisions about their care and treatment."
• "The partnership had a close working relationship with the South East Scotland Cancer Network (SCAN) and had introduced the Transfer of Care After Treatment (TCAT) project which was piloted in four GP practices in Tweeddale. The initial evaluation of this project produced some positive outcomes for those who engaged with the service."
• "The views of carers about access and overall care provided by GPs were positive. Carers told us that their own health needs were being addressed promptly and this was mostly attributed to information held at GP practices and GPs offering appointments at a time to suit them."
• "We met with Encompass which had originally been commissioned by the council to support people with direct payment, but had more recently become a user led charitable organisation ... a number of these older people and their carers ... spoke very positively about the support and service they received."
• "The importance the partnership placed on public engagement and community participation was evident in its service design, policy and strategy development. We identified important strengths in the partnership's approach to consultation and there was a high level of engagement with older people and carers."
• "We saw some positive examples of health and social work staff working well together to deliver effective care, support and treatment. This included joint working out-of-hours between Accident and Emergency staff, the out-of-hours community nursing staff and the social work out-of-hours emergency duty team."
• "The majority of staff in both health and social work services had positive and constructive professional relationships with each other. Most staff said that joint working was supported and encouraged by managers."

Jane Davidson, Chief Executive NHS Borders, said: "We were pleased to hear that, when speaking to older people and their families, inspectors found that they valued the services they received which were usually of a good quality. People felt listened to and supported by staff to make choices about their care and support with their circumstances and personal outcomes improving as a result of the support provided for them, particularly in terms of being able to live where they wanted and stay as well as they could. It was also encouraging to note that services had worked hard to achieve these outcomes which had made a positive difference to people's lives and that people were able to find information and who to contact if they wanted to access services."

Tracey Logan, Chief Executive Scottish Borders Council, added: "Overall, we find it difficult to understand why the excellent work of our staff hasn't been as positively reflected as it might have been with three out of nine areas being graded as weak. However we are pleased that despite this the report graded our impact on the community as 'good'.

"We have recently undergone a Community Learning and Development inspection and our annual audit from Audit Scotland. Early feedback suggests that both of these audits are very positive.

"We shall continue to work with the inspectors to finalise our action plan, which is the consolidation of a range of plans which the Partnership has in place, and assist them as they revisit our services over the next year."