Fife-wide review of care home packages as people waiting for months for help

Fife Health and Social Care Partnership (HSCP) - the joint NHS/council venture created to better conjoin complimentary healthcare services - says the audit will ensure people are always receiving the right care amid plummeting workforce numbers.

Fiona McKay, from the HSCP, told a meeting of its management board on Friday, said that a recent "big spike" in demand for home care had not been "useful".

"There is significant work going on and the level of questions and a review programme has started," she said.

"Everyone who has a care at home package is being reviewed. That will also make sure people are getting the right care at the right time in the right place - particularly rural areas."

As reported by the Local Democracy Reporting Service last week, hundreds of Fifers are waiting an average of 77 days to be assigned a home care package following a hospital discharge.

The excessive delays are contributing to an increase in bed blocking in Fife's hospitals. Care bosses say a lack of staff in the private sector is to blame - with carers lured to Fife Council, NHS Fife or even other sectors such as hospitality by the promise of better wages and more favourable working conditions.

HSCPs across Scotland commission private companies to provide care alongside in-house council social care. In Fife, the annual private agency bill for home care amounts to £44 million a year.

The most recent set of contracts was agreed in 2018 and extended an extra two years until 2022 due to the coronavirus pandemic - netting private and third-sector care firms a total of £178.3m of public funds for care services that, at present, they cannot supply.

Critics of the independent care sector say it will never be able to compete with public sector employers and private firms in other sectors until it pays staff better.

But Paul Dundas, independent sector lead at industry representative body Scottish Care, says the solution to the recruitment crisis is "not purely financial".

He said: "There is considerable work going on. We have met with providers in the independent sector who have concerns about their current capacity and creating space to meet demand.

"There are considerable vacancies across external providers just now but they are very engaged and are very motivated to work with the health and social care partnership to address the concerns.

"It's not purely a financial solution. What has come back recently from external is a need to be supported around workforce planning and how we might empower local employers to respond to demand from the Fife population.

"It's important to listen to employers themselves."

Lynne Garvey, head of community care services at Fife HSCP, says "blue sky thinking" is needed to address the "sticking point" of care at home recruitment.

She added: "It's about what we can do collectively to try to expedite some actions to make sure there is significant difference on the ground.

"Whether that's encouraging people to apply for external provider positions, we're taking significant steps to address this issue as it's huge and we need to take action."

HSCP bosses have agreed a set of targets to reduce the impact of the problems within home care, including an aim to reduce bed blocking by 10%.

But Dr Chris McKenna, NHS Fife's medical director and an active A&E doctor, says Covid-19 has exacerbated health problems among older people who have stayed away from hospitals during the pandemic, squeezing healthcare services to breaking point.

He said: "We haven't been helped by multiple lockdowns leading to an acceleration of frailty.

"Isolation has not been good for that demographic, which we're already very aware of, but it is compounded [by Covid]. It feels like it's moved up a notch and that is putting a burden on multiple services: social care, acute services.

"Add in to that the unmet demand for medical needs that people perhaps discounted, and we're seeing older people presenting often already with more serious or more advanced conditions.

"I get to sit here and talk about this because I see it myself with my own eyes at the Victoria Hospital when I'm doing my other job. It's absolutely putting pressures on all of our system.

"What we need to do as an [HSCP] is support the team to come up with the plan that helps to solve this. We will need to find a solution to this because reducing delays nearly 10% is not going to allow a functional system.

"We have to find ways to support people to find help at the right time for the right person and usually that means at home, but we're struggling with that for all the reasons articulated."

Cllr Rosemary Liewald, chair of the HSCP board, remains under no illusion about the challenge of the task at hand.

She concluded: "There is work going on across the piece - but it is a huge, huge, vast amount of work and it will come back [to be discussed again]."

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