Rising population challenge in Edinburgh

Wednesday 7th August 2019

A reduction in delayed discharges from hospital has been highlighted as part of the progress made by Edinburgh’s health and social care services over the past year.

But the arrival of more than 5,000 residents in the city during that time has added to the challenges of meeting rising demand, according to the Edinburgh Integration Joint Board’s (EIJB) annual report published today.

It has highlighted that ‘gradual and prolonged improvements in performance’ across a range of areas have been achieved in Scotland’s capital city.

Despite encountering considerable challenges over the past financial year, Board chair Angus McCann and chief officer Judith Proctor say improvements such as driving down delayed discharge numbers - previously an area of longstanding poor performance – is one example of the progress made in health and social care services in the area.

Since April 2016 the EIJB has had responsibility for much of the adult health and social care services delivered across four localities.

Performance has been measured against six key priorities detailed in the board’s strategic plan – including prevention and early intervention, person-centred care, and efficient resource management.

The arrival of an additional 5,250 residents to Edinburgh since last year – taking the population the EIJB serves to 518,500 – has amplified the challenge of meeting rising demand, particularly in primary care.

Alongside initiatives including the long-term conditions programme and Thrive Edinburgh (focused on mental health and wellbeing), the Edinburgh primary care support team has been developed to change working practices and better enable services to meet demand.

Consisting of multi-disciplinary teams working alongside GPs in primary care, today’s report notes that by the end of 2018-19 roughly a third of this new workforce was in place.

In practice this meant pharmacists had been brought in to supply additional sessions of support in 60 of the city’s 70 GP practices; mental health nurses were working as part of 20 primary care teams to improve support available locally; and 19 primary care teams had link workers operating within them.

These new ways of working meant that around 6,000 additional people were absorbed onto GP lists in 2018-19 with no further individual practices finding themselves unable to continue.

Unlike several NHS boards that have raised concerns about prescription costs in recent months, the report concludes expenditure per person on prescriptions is low compared to other areas in Scotland and the EIJB says it will continue to look for ways ‘to improve the quality of our prescribing’ in the months and years ahead.

Over 78,000 of those living in the area are aged over 65, a figure expected to increase to 89,194 by 2025 and afford services no respite from the pressures of an increasing and ageing population if innovation and reform is not achieved over the same period.

In February of this year, triggered by rising demand, the EIJB gave its backing to an ‘ambitious programme’ intended to quicken the pace of health and care reform in the city, funded with £2m from the £8m of reserves the Edinburgh Health & Social Care Partnership (HSCP) had built up.

Reducing pressure on health and social care systems in the city is a key part of the programme, alongside moves towards more preventative approaches, early intervention and community support.

Today’s annual performance report focuses on many of the same themes, aims and objectives. Success of the transformation programme is still key to delivering services amid ‘ongoing, significant financial pressures’, the report states.

One of the most challenging areas for the city’s HSCP is social care. Annual accounts published in June showed outsourcing social care services in Edinburgh was the ‘single most significant financial challenge’, with externally purchased social care services – including home care – running over budget by more than £6m.

The EIJB’s Judith Proctor and Angus McCann, say some residents are still waiting longer than they should to be assessed and receive the care they need:

‘…but we are steadily improving’, the report states. ‘Fewer people are now delayed in an acute hospital when ready to go home, and those that are delayed, are delayed for a shorter time than previously’.

A need to increase support for unpaid carers in the city is acknowledged - within the summary performance report, only 35% of carers said they felt supported to continue in their caring role.

13.5% of residents are carers (according to the last measure taken in 2011) and increasing support for this group is an area the EIJB says it hopes to address through its upcoming carers’ strategy.