A senior manager at East Lothian Health and Social Care Partnership (HSCP) has warned of a ‘crisis’ facing care at home services, with at least two providers at risk of collapse.

The interim Planning and Performance Manager at East Lothian, Laura Kerr, told the Integration Joint Board that the ‘current, severe pressure’ is leaving much needed care undelivered.

In her report to the board’s most recent meeting, Ms Kerr says the problems are so severe that NHS Lothian is having to move people medically fit for discharge into care homes, while they wait for support to be organised.

But, she warned not all those assessed as requiring care in the community will receive it due to capacity issues.

There are 12 care providers in East Lothian, at least two of which are in danger of folding.

The report states: "The quality of care by the independent and third sector is closely monitored and on the whole to a high standard.

"However, the number of providers competing with each other for care staff and care packages has meant the efficiency of which care at home can be delivered is compromised."

The Scottish government is reforming social care, including through the creation of a National Care Service. The blueprint for the changes, the Feeley review, called for a system of “ethical” commissioning but ministers have faced criticism for effectively watering down some of these proposals.

Price-based competitive tendering was causing an ‘ongoing detrimental impact on sustainability of providers, quality of support and choice for individuals,’ third sector representative body the Coalition of Care & Support Providers said in its response to the proposals.

More than 1,200 people receive care at home in East Lothian, adding up to 20,569 hours of support each week.

However, the report shows by last month external providers – which deliver 92% of the region’s service – have decreased their provision by nearly 1000 hours a week since 2019.

Ms Kerr recommends the IJB look at options to increase in-house provision, which could reduce risk, while creating further capacity in the community and improving hospital discharge times.

Changes to how eligibility criteria are applied is also being considered, but the IJB will need to assess risks of this approach before such a policy change.

Recurring funding of £62m has been announced nationally to increase capacity in care at home community services as part of the government’s NHS support measures.

Though this may help fulfil unmet need and deal with current surge in demand, Ms Kerr says ‘there are no quick fixes’ to the problems facing the service.

In December the Health and Care Secretary said that funding should not be a barrier to reducing delayed discharge and enhancing social care capacity.

In Stirling all support provided to people in their homes is being reviewed due to 'significant' staff shortages.

A survey of third sector care providers in November found more than half had had to reduce the amount of support they provided amidst staffing issues, which was described by a sector leader as potentially “catastrophic” for those in need of care.

Read more: "Underfunded" IJB to review all care packages; Insight: Social care seen as “lapdog” of NHS; Budget: Major increase in social care spending

 

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