INSPECTORS have slammed a “lack of leadership” and “poor planning” in a rural health and social care partnership.

A report by the Care Inspectorate into Perth and Kinross Integrated Joint Board (IJB) found there was no system in place to provide senior managers with a “comprehensive picture of how well the partnership was performing” to “capitalise on areas of strength or effectively focus resources and improvement activity where it was needed”.

Inspectors also criticised shortcomings in the IJB’s financial statement, noting it did not include any detail on “how the money spent had contributed to achieving the health and wellbeing outcomes” and contained “no information about budgets or expenditure at locality level”.

Perth and Kinross is facing a projected 33 per cent increase between 2016 and 2026 in the number of people in its population aged over 75. 

As this drives a surge in people living with dementia and other long-term conditions, demand for care services will rise. 

The integration of health and social care through NHS and council partnerships is supposed to reduce the pressure Scotland’s ageing population will place on frontline hospital services, by enabling more people to be supported to live at home. 

The report found the IJB had reduced levels of bed blocking, especially among the over-75s, from a previous historic high. But it added it was “too soon to ascertain if this reduction will be sustainable”. 

On a number of measures, inspectors said the partnership was performing better than average. These included the number of people being re-admitted to hospital within 28 days of discharge – seen as an indicator that patients are being sent home too quickly, possibly to free up a bed.

There had also been a drop in the number of acute patients, such as frail elderly people admitted after a fall, who were occupying beds intended for patients undergoing elective operations. This “had reduced the number of planned surgeries being cancelled”. 

However, the inspectors said weaknesses in some key areas “significantly outweighed the strengths we identified”.

These included shortcomings in the delivery of care at home for adults over 65, too many people spending long periods of time in care homes, and a lack of technology, such as community alarms, to allow people to remain independent at home for longer. 

There had been a “historically challenging relationship” between the IJB and colleagues at NHS Tayside, characterised by “poor communication, trust and information sharing”. 

The report concluded: “In those performance areas where the partnership focuses its attention, such as hospital discharge, a positive impact was evidenced through performance informations. However, overall, there was a lack of leadership and strategic oversight which resulted in poor planning, direction and monitoring of services following the setup of the integration authority.”

The inspectors noted there has been a change of leadership, including Karen Reid, the former chief executive of the Care Inspectorate, who took over as chief executive of Perth and Kinross Council in September 2018. 

NHS Tayside also has a new permanent chief executive, Grant Archibald, who took over in March this year – replacing Lesley McLay, who was ousted in 2018 following an outcry over the use of charity funds for general spending. 

Inspectors said the new leadership team “express commitment to the integration agenda”. 

Peter Macleod, chief executive of the Care Inspectorate, said: “This Partnership has been slow to progress integration of health and social care.”

Robbie Pearson, chief executive of Healthcare Improvement Scotland, 
said: “Key members of the executive and senior management teams had changed. There was an increased commitment to supporting integrated working and the integration agenda from Perth and Kinross Council and NHS Tayside as a result.”

Gordon Paterson, who heads the Perth and Kinross health and social care partnership, said: “The inspection findings reflect the HSCP’s internal 
self-evaluation, which indicated the need to improve on strategic planning and performance reporting and to develop a more integrated organisational structure. 

“The HSCP are committed to achieving the necessary improvements and are already taking significant action on this.

“The report highlights many areas of good practice and recognises the quality of our staff and the excellence of the care we deliver across the people and communities served by the HSCP. 

“There has also been a significant change to our leadership team, with my appointment as the new Chief Officer to lead Perth and Kinross HSCP. New chief executives have also been appointed at partner organisations. The new leadership team are committed to improving the quality of care.”