Health & Social Care

It’s Scottish Government policy that health & social care services are integrated. This makes absolute sense given the close connections between health services managed by the NHS and social care services managed by the local authorities.

The model in Argyll & Bute is a legally consituted body called the Integrated Joint Board for Health & Social Care (IJB). The IJB is responsible overall with the NHS and Argyll & Bute Council being partners and with each continuing to employ NHS and social work staff respectively.

In June this year the IJB agreed on a programme of cuts totalling some £8.5m. I’ll just cite a small number of these affecting the Bute & Cowal area to demonstrate the impact:

• Review a number of high cost care at home pacakges to save £200k
• Review and remove some sleepover support services to save £150k
• Close existing dementia day service and fund befriending service to save £10k
• Close Struan Lodge as a care home and turn it into a community support hub to save £175k
• Redesign how homecare services are provided to save £375k
• Re-design community hospitals to save £2.25m

The problem, apart from the obvious, is that there was no consultation at all about any of these. Any consultation will only be about what happens after these decisions are implemented. There has been a lot of anger and criticism directed at the IJB since it became clear what they planned to do and how they intended going about it.

To take one example, Struan Lodge, there has been no consideration given to what the demand is, either now or in the future. The closure decision has been taken on a zero evidence basis; the only basis appears to be financial. Here is what I wrote to the chief executive of the IJB, Christina West, on 12 August:

Since I was copied into this I think it’s reasonable that I make a point here Christina.

It was the total lack of consultation prior to the decision that is the issue, not how you intend to consult from now on having made the decision.

Not only was there a lack of consultation, the decisions on Thomson Court and Struan Lodge were based on absolutely no evidence of demand. Closure of Struan Lodge today would leave no spare bed capacity at all for Dunoon and Cowal. In 25 years the numbers over 75 will double across Argyll & Bute but I don’t know what the position will be in Cowal, do you Christina?

Pasted below is what I said on 28 July to the locality planning group when I was unable to attend the first group meeting.

Regards

I have not, as yet, seen any evidence that supports the proposal to close the care beds at Struan Lodge. Let me be clear about what I would need to see before I could support any such decision:

• A long term, ie 25 year minimum, projection on the numbers of elderly people in Cowal.
• Within this, I’d need to see a breakdown of the numbers in various elderly age groups based on best projections of increasing life expectancy.
• The next key part of the information needed would be projections of the elderly who would need care of some type, split by care type. Having a larger percentage of the elderly cared for at home is accepted but with the growth in the numbers of elderly people, this could still mean an increase in the absolute number of care beds that are needed.
• All of the above needs considered against current and projected future capacity.

As of today, there are 10 bed vacancies in Cowal. I got this from the papers for next week’s area committee. I am told that one of the care homes with 8 of these vacancies can’t actually fill them due to either finance or staffing issues. Even if that information is incorrect, closing Struan today would fill current spare capacity.

3 years ago, when the ill-conceived proposal to close Struan first surfaced, we were told there were 38 bed vacancies. We have a maximum of 10 today so demand has increased in 3 years; what will happen over the next 25+ years?

The empirical evidence to support the closure of care beds needs to be both long term and as sound as it can be before any decisions are taken. It’s far harder to create new capacity than it is to shrink it.

I have not had a reply to the above as of today, 23 August. I wonder why.