Crisis and cuts. Two words that are consistently associated with care services.
Care is in crisis now: funding crisis, recruitment crisis, a crisis in delayed discharges from hospital. So it was hardly surprising that when news broke that care homes might close, it was assumed to be a cut to address the funding crisis.
These crises did not appear overnight. Planning and investment has been weak for more than a decade, and the pandemic exposed how threadbare that had become. Good intentions have been by expressed the Scottish Government to implement the Feeley review of care, but that’s still to come.
So that is the backdrop for Edinburgh’s review of bed-based care. It’s part of a bigger picture – with the shared goal to take health and care out of hospital and into communities, helping more people to stay well at home.
No-one would contest the need to look at the future of care services and redesigning, reorganising, recommissioning them across the city to meet the needs of our growing frail population, to be the best we can provide, in the right place at the right time. The aspiration that every change will improve the journey for patients and the outcomes for people is not disputed.
But, as services are redesigned, more consideration is needed on the balance between the private and public sector. Edinburgh has more private care than elsewhere in Scotland – around 70% in hands of private companies.
And private companies, as we all too well know, can walk away when things go wrong. Some run a good quality service; others do not. Some staff are still paid piecemeal per visit, without travelling time. No way to treat some of the most valued staff in our city.
And the council care homes have challenges too. Currently none have nurses as part of the staff team, so if someone has dementia or needs nursing care, the only option is a place in a private home. The city also needs desperately needs ‘intermediate’ care beds – no-one should be stuck in hospital when there is no medical reason for being there. They need somewhere to recuperate, if they can’t go home. Again, the council doesn’t have these beds
In recent years much as been done to allow people to remain in their own homes, with quality of life improving for so many. But for some it has also unintentionally created isolation and loneliness: housebound with only a short, rushed visits from overworked care at home staff. Families are telling me that they want choice, to choose to stay at home or with others, living communally with independence, nursed at home, or in a care home.
Right now choice comes at a price that most cannot afford.
So council care homes, and housing provision needs to expand to be comprehensive, to be able to cater for changing needs as residents grow older and more frail.
That is why I won’t support closing four care homes this week. Instead, I’ll support a process where a clear case is presented, listening and learning from residents, public, staff and unions including public consultation, all to come up with an evidence-based plan to provide the best possible quality care Edinburgh can.
The capital city must be able to provide reliable access to the right care for everyone who needs it, close to their communities, in a safe place when they need it.
Cllr Melanie Main is a member of the Edinburgh Integration Joint Board.