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All across Scotland, the 31 Integration Joint Boards have been meeting to begin their official work in running social care in Scotland.   This is a major shift in policy that has been given an easy ride so far.  The NHS is one of our national treasures and bring social care together with health can surely only be a good thing.   But as our article on Page 2 suggests, the NHS may not always guarantee good care.Learning Disability is the elephant in the room

The minutes of all Joint Boards are available online for anyone to have a look at.  We analysed the agendas and papers for 62 meetings of 31 Integrated Joint Boards to see what they talked about. 

There is no mention of Learning Disability Services in these  meetings between March and June of 2016.  Often the poor relation of  social
work, we worry about a lack of priority for people with learning disabilities.   We did spot one reference inside the papers of the Glasgow Board which promised a further review of Learning Disability Services for the year 2017-18 as part of another “efficiency drive.”

The importance of tackling the  “Delayed Discharges” of older people. Is clear.  Some explain that the Scottish Government has provided a strong financial incentive if targets are reached to reduce delays of more than 2 weeks.  Most IJBs discuss delayed discharges at every meeting. Some had 4 agenda items dealing with this.  

Delayed Discharges are about people who no longer need hospital care but can’t leave hospital for various reasons.  This is an expensive cost to health boards.  A former Cabinet Secretary for Health said “The average cost of keeping someone for a week in an acute hospital across Scotland is £4600 a week.  While on average, to keep and treat someone in a home setting is £300 a week.”

Actions by the IJbs to tackle Delayed Discharges are varied – Clacks and Stirling are proposing the building of a new Intermediate Care complex for 116 people as part of a “Care Village”.  East Renfrewshire is proposing to sell off their only “In house” residential care home and buy (cheaper?) care from the independent sector. Edinburgh is increasing its uptake of Care At Home while reducing its Complex Care Respite Services at the Astley Ainslie. Renfrewshire will use Technology Enabled Care and Staff Tracking systems to get more out of the “In House” Care At Home Team.

The East Dunbartonshire Board approved a Delayed Discharge care package for a patient with Guillain-Barre syndrome.  Since some Boards had not discussed clinical or professional care at all, it was unusual to see one Board resolve an individual case.  KS had been stuck in hospital for less than 6 months and while he continued to need special help with breathing, he no longer required hospital care.  Because KS has the capacity to explain what he wants, he was allowed to reject  a nursing home option and opt for a support service in his own home.  The package has been agreed at a cost of £6,655 per week (annual cost of £346,107). 

Its great to see really innovative community care packages being developed.  But from this brief survey of Integrated Joint Boards, we are worried that the “delayed discharges” of older people and their medical needs are going to be the priority and that once again Learning Disability service are  being left behind.