While the Government announced progress on A&E waiting times yesterday, and claimed better performance on delayed discharges, while down, delayed discharges remain higher than two years ago.
Why is the problem of 'bed-blocking' so hard to overcome? A recent Care Commission report on the care of elderly people provides a timely snapshot of the progress being made in Glasgow, to improve care and integrate health and social services.
Despite praising services, inspectors nevertheless made ten recommendations for improvement. The 'could do better' verdict was partly based on factors outwith the control of health and social service chiefs in the city. So-called 'Glasgow challenges' include the sheer scale of service delivery, high levels of deprivation and higher levels of ill-health among older people than Scotland in general.
Loading article content
Glasgow City Council and NHS Greater Glasgow and Clyde, together known as the Glasgow Partnership, are advised to sustain their efforts to meet delayed discharge targets. But the inspectorate also wanted more done to mitigate the damaging effect on older people. The longer such patients spend waiting for a care home place, or a community care assessment, the less likely they are to return home.
While the partnership has met a key Government target on delayed discharges once, in April 2011, at that point the target was to have no delays over six weeks in length. The current target, of no delays over four weeks, has never been met in the Glasgow Partnership area.
Another area where the Inspectorate wants to see improvement is in cutting the number of emergency hospital admissions to . Here again, Glasgow Partnership's performance is below par, but the report says having five large general hospitals with A&E facilities may be making them more likely to be used.
So what is working? Inspectors praised a pharmacy-based scheme to review the medicines elderly patients are on, on the basis that a significant proportion of hospital admissions are related to medication. Half-way house care homes have helped cut admissions, and re-ablement schemes to get those who do end up in hospital back to their own homes have all been successful.
Framed in terms of the number of care hours saved (between 37% and 51%, the report says), reablement might be seen as a way of cutting community care costs. But the recipients are full of praise for the service, as are staff, the Care Inspectorate found.
Less so the support for carers. The amount of respite on offer to carers has apparently fallen dramatically. Many were suffering as a result, they said. Meanwhile charges for care services were causing some older people to pay for fewer services, putting more pressure on carers.
There are areas in which organisation can be better. Joint working seems to be falling down in terms of a push to ensure plans are in place for emergencies - the plans are there, but not shared effectively.
But money and cuts, inevitably, are a key factor. Some occupational therapists told inspectors the budget for equipment had run out until the next financial year. This is just one of considerable financial pressures the report says both council and health board are facing.
Many health and care partnerships across Scotland face similar challenges. While progress is being made, services still need to improve. But there may be a limit to how much improvement can be achieved without considerably more money.