The Scottish Government is facing renewed calls to drop their plans for a centralised National Care Service after figures obtained through Freedom of Information (FOI) requests by the Scottish Conservatives showed the “shocking” extent of waiting times for care assessments to be undertaken.
One social care user in Edinburgh waited a total of 1,775 days – almost five years – before receiving a care package, statistics dating back to 2017 have shown. In Argyll and Bute, a patient waited 1,071 days – nearly three years – to get a suitable package in 2021.
The figures have been published as a leading medic renewed calls for Scottish families to step in to care for their elderly relatives to ease the burden on hospitals.
Professor Andrew Elder, president of the Royal College of Physicians Edinburgh (RCPE), said the key to alleviating the crisis in primary care was to focus on freeing up beds.
A crisis in social care recruitment and staff retention has left many elderly patients, who are otherwise healthy enough to be cared for in the community, stranded in hospital beds as they await a suitable care plan for discharge, contributing to spiralling accident-and-emergency waiting times.
Figures released under FOI show patients in Fife waited more than 1,000 days for a care package three years running from 2019, while the longest ongoing waiting time in Borders and Dumfries and Galloway was 685 days and 595 days respectively. One patient waiting waited 928 days for a care assessment in Moray before it was carried out last year.
Only five of Scotland’s 32 local authorities – Aberdeen City, Angus, Comhairle nan Eilean Siar, East Dunbartonshire and West Lothian – did not respond with waiting time figures for care packages.
Scottish Conservative shadow social care minister Craig Hoy said: “It is utterly shameful that patients are waiting years for appropriate care packages to be put in place or even to be assessed for the care support they require.
“These overwhelming failures should finally make the SNP Government do the right thing and drop their illogical and reckless plans to centralise care provision through their National Care Service. That will only take further resources away from local care providers, who understand patients’ needs and are best placed to deliver them.”
The figures have been released after the latest waiting time figures for A&E departments showed a record 1,925 Scots spent half a day or more there in the week leading up to Christmas Day.
Prof Elder said: “The fundamental problem that we've got is that we have people who need to be in hospital, but we can’t get them in, and people who don't need to be in hospital, but we can’t get them out.
“Really, the key to unlocking the problems at the front door of our hospitals actually lies at the back door. And that is in helping frailer, older people who cannot return home without support to get home more quickly.
“There is no doubt that there is no improvement across Scotland overall, in the ability of hospitals to swiftly discharge patients with complex care needs back to the community. If we could solve that, we could improve upon delayed discharge, and that would greatly ease the problems I'm describing at the front of the hospital.”
One short-term solution, according to Prof Elder, could be to ask Scottish families to care for their loved ones following a hospital stay, until a more permanent care package can be arranged.
He said: “I think that in the short term, we have to maximise the use of all possible capacity in social care venues – so care homes and community hospitals, and interim facilities – to enable us to get patients out of the acute hospitals, where acute care can be delivered, where they may wait for a package of care to get them home.
“We have to ensure that every single one of those resources is utilised.
“A huge amount of informal care of older people is already delivered by friends and family. There's a huge contribution there, but I think that we could be asking some families to pick up care for a short period to bridge discharges home, until formal packages of care are available.”
Prof Elder said members and fellows of the RCPE were “concerned”, “saddened” and “angry” about the state of the NHS.
“This is my 40th winter in the National Health Service and this is the worst we [the RCPE] has ever seen,” he said. “This is the most difficult period that we've ever seen in our collective experience of the National Health Service, and it's manifesting in all the ways that your readers will already know about, it's manifesting in ambulances not being able to offload patients into acute receiving units or emergency departments or hospitals.
“Then we'll get into the hospital, there's two things. Mainly they have to wait longer than is ideal to be seen and assessed. And they're seen, and they wait, in areas that are sub-optimal, because there isn't the capacity to care for them and assess them and treat them in the usual emergency department or acute medical units.
“Then beyond that, those that have to be admitted are being admitted sometimes to wards that are not purpose built and are not the specialty that they require.”
On Friday, First Minister Nicola Sturgeon chaired a meeting of the Scottish Government resilience committee to discuss the ongoing pressures on the health and social care system. Speaking after the meeting, Ms Sturgeon said: “It is clear that health and social care is currently experiencing a period of intense and indeed unprecedented pressure.”
She added: “I am clear that the Scottish Government must and will do everything it can to support our health and care service throughout the next few weeks. We remain in daily contact with health boards and there is already a huge amount of work being done, but we will leave no stone unturned to explore and implement any additional measures that could be taken to help alleviate pressures.”The impact of the winter crisis is being keenly felt by medics, said Prof Elder, who are powerless to help.
“I think there's a fundamental issue of dignity for people being seen and assessed in areas that are not designed for clinical care,” he said.
Health secretary Humza Yousaf said: “Being at home or in a community setting is in the best interests of anyone who no longer has any clinical need to be in hospital. We work closely with health and social care partnerships to reduce delays in getting people to the most suitable place, ensuring people are cared for in the right setting and beds are there for those who need them.
“In common with health services across the UK and globally, NHS Scotland is working under significant pressure and the pandemic continues to affect services. Social care has been hit by a triple whammy of Brexit, which has impacted staffing, the pandemic and high energy and inflation costs, all putting significant pressure on the sector.
“Investment this year to help address delays, includes £124 million to enhance care at home, £200 million to increase the hourly rate of pay to £10.50, £20 million to support interim care arrangements and £40 million to enhance multi-disciplinary teams."