East Lothian Integration Joint Board Annual Performance Report 2023-24

The IJB’s strategic priorities focus on developing services based on what is important to and are needed by individuals in East Lothian.  Services which support people to achieve their personal goals and priorities and support them to be as active and independent as possible.

A recurring feature within this report are examples of how East Lothian Health and Social Care Partnership has worked with third and independent sector colleagues and local community groups to support the health and wellbeing of East Lothian residents, developing new and innovative ways of responding to individual needs.

This report covers a year in which the IJB was presented with very difficult decisions because of the increasingly challenging financial context faced by the public sector across the country.  Towards the latter part of the year, IJB members worked with the HSCP Officers to develop a financial recovery programme, culminating in a set of savings proposals being agreed at the March 2024 meeting of the IJB.  Whilst difficult, the financial recovery actions were identified as necessary to balance the 2023/24 budget and to help ensure longer term sustainability.

Shamin Akhtar Chair of the Integration Joint Board states “We are immensely proud of the progress made during 2023/24.  Numerous initiatives detailed within the report have delivered significant enhancements to continuously improve the health and social care offering to the people of East Lothian, despite financial challenges.  Projected overspends for future years, and ongoing financial uncertainty at a national level, mean the IJB will be faced with further difficult decisions in future years.  However, we remain committed to early and ongoing financial planning to ensure that all our budget decisions are well informed and support the most effective and efficient use of resources.”  

Fiona Wilson Chief Officer and Joint Director of East Lothian Health and Social Care Partnership comments, “The achievements described in the 2023/24 Annual Report have been made possible by the hard work and commitment of our staff who have adapted, innovated, and responded to the numerous and varied challenges that have come their way.  Their dedication to supporting the community and people of East Lothian is the ever-present motivator.   This enables our teams to face the unprecedented financial challenges and uphold our commitment to delivering the best possible care for East Lothian’s communities.

Download the 2023-24 annual report

 

2023-24 Key achievements and performance highlights:

1. Sustainable Service Development:
A crucial strategic priority for the IJB is developing services that are sustainable and proportionate to need.  With a growing and ageing population, the Planning Older People’s Services (POPS) Project has directly connected with East Lothian communities, collecting 2,458 pieces of feedback during its first engagement period August to December 2023, to identify options for future development.  This project is ongoing, and incorporates options appraisal phases and a public consultation period, with final recommendations due in early 2025.

Prominent strides have been taken to meet the demands of Care at Home by establishing a Care at Home Change Board in 2022/23 to lead on the delivery of Care at Home Transformation Programme. Activity during 2023/24 included building on an analysis of data on current and projected care at home costs, supply, and demand to develop a ‘Test of Change’ model for care at home provision to be piloted in 2024/25.

Further data shows the collaboration of integrated services has supported hospital flow admissions.  ELHSCP has a strong performance record in preventing hospital admissions and maintaining low delayed discharge rates. Close collaboration with a range of intermediate care teams – such as Care at Home, the Integrated Care Allocation Team, Hospital at Home Service, daily flow huddles, Intensive Home Treatment Team, Community Mental Health Team and an In-reach Project at Edinburgh Royal Infirmary, have prevented unnecessary admissions.

2. Community Collaboration:
Collaborative efforts with third sector organisations and local community groups have been pivotal. These partnerships have enabled the delivery of innovative and tailored responses to individual needs to enhance the overall health and wellbeing of East Lothian residents.  Three such examples include:

Neighbour Networks, who provide peer support in local communities to help people establish a life in which they are more active and independent, and less reliant on formal support services.  Members of Neighbour Networks are supported to develop skills such as independent travel, cooking, budgeting, employment skills, volunteering, and general life skills.

There are now five Networks in place in Musselburgh, Tranent, Haddington and Dunbar; two of these are ‘Transitions Networks’ for young people with learning disabilities moving from children to adult services.

The Community First Service, which is delivered by the Volunteer Centre East Lothian with funding from ELHSCP.  Community First provides support to people who are struggling with their health and wellbeing, helping them to access community services.  Based on a person-centred approach, the service supports people to explore opportunities available to them, carrying out goal setting exercises which focus on what individuals can do, rather than what they cannot.  There were 326 referrals to the service in 2023/24 and in response to feedback, the service has expanded its audience to support people aged 35+, (previously only available to individuals 50+).

The Musselburgh Meeting Centre opened in April 2023, providing a centre based social club, which offers warm and friendly expert support to people with mild to moderate dementia.  A valuable community resource, Meeting Centres foster a sense of belonging and community, helping people with dementia maintain social connections and reduce feelings of isolation and support people adjust to the psychological, social, and practical changes dementia bring.

3. Prevention and Early Intervention:
Programs focusing on prevention and early intervention, enable ELHSCP to support people to maintain their independence.  While this is a key priority for the IJB, it is a personal objective repeatedly raised by the people of East Lothian.

Smart TEC (Technology Enabled Care) support offered by the East Lothian Rehabilitation Service (ELRS) saw 1,077 referrals into the service during 2023/24, which delivered 3,950 interventions.  The service has also replaced over 55.9% of its analogue stock to digital alarms as part of the national transition to digital communications.

The Falls Prevention and Management Service has grown since its initial introduction in 2022.  Falls are the most common cause of emergency hospital admission, resulting in increased pressure on hospital beds, care packages and rehabilitation service.   Throughout 2023/24 the Falls Prevention Service provided support on a 1 to 1 basis for 289 individuals and delivered group sessions to 84 people in the form of ‘steady on’ falls prevention classes.

The ELRS phoneline offers East Lothian residents direct access to physiotherapy and occupational therapy professions for self-referral, professional referral and to respond to existing patient enquiries. Over 32,300 enquiries were received by the ELRS team during 2023/24.  

A unique service to East Lothian, the Care When It Counts (CWIC) Mental Health team provides accessible help and support to people presenting with a mental health concern.  Made up of a small multi-disciplinary team of mental health nurses and occupational therapists, the service provided 5,400 appointments in 2023/24.  Despite significant increases in demand, patient feedback is incredibly positive, “Without this service, I would not have been able to make changes to my programme as quickly or effectively.  [It] was extremely beneficial … for me, [it was] life changing.”

4. Empowering Individuals:
East Lothian’s IJB has prioritised enabling people to have more choice and control over their care, providing services closer to home.  This is specifically evident within Primary Care Services.  Where services had been centralised in GP practices, there are now more opportunities for patients to ‘go direct’ and seek health advice from primary care practitioners.   The role of the community pharmacist has also expanded to offer services through the Minor Ailments Scheme, Pharmacy First and Pharmacy First Plus.

Further enhancing and provision of services at East Lothian Community Hospital (ELCH) provides local inpatient care, as well as an ever-growing number of outpatient and day service clinics, reflecting the IJB’s strategic objective to provide care closer to home.  The number of outpatients seen in East Lothian has grown from around 30,000 in the last years of Roodlands Hospital (2018/19) to just under 70,000 appoints offered in 2023/24.  In the past year, the capacity of Endoscopy and Day Services units has increased to 30 sessions per week.  Plans are progressing to double the capacity for Dermatology Ultraviolet Phototherapy treatment.  Partnerships with the Haematology Unit at the Edinburgh Cancer Centre has enabled IV therapy to be available within East Lothian.  Residents requiring treatment for anaemia via either blood transfusion or intravenous iron therapy can now access this service in East Lothian.

Within the Adult Social Work team, the ongoing efforts to ‘re-imagine’ the approach to social work services has continued to deliver strong performances throughout 2023/24.  The first point of contact duty system has enabled individuals to be given direct access to information and support, to the extent that there is no longer a waiting list for assessments.  This enabled a much more proactive approach delivering preventative and early intervention approaches, preventing situations from deteriorating or ‘hidden risks’ within waiting lists.

Further development work has gone into recognising and supporting unpaid carers.  Adult, and particularly the Young Carers service, supported a growing number of carers during 2023/24.  It is recognised that there are difficulties in carers accessing regular breaks at a time and place to suit their individual needs. ELHSCP want unpaid carers to take these regular breaks from their caring duties and to reflect this the East Lothian Short Breaks Services Statement has been updated and made easily available across East Lothian.  

An occupational therapy led pathway for adult carers has continued to develop during 2023/24 ensuring that carers gain access to the support they need to maintain their physical, emotional, and mental wellbeing, to achieve a balance between their caring roles and other aspects of their lives.  Testimonials from the Occupational Therapy Carers Pathway can be viewed online at www.eastlothian.gov.uk/support-for-carers.
 

5. Integrated Approaches:
Integrated teams and approaches have been further developed within the organisation to ensure seamless service delivery. Notable efforts include Hospital to Home and Home Services. Integration of the two teams brought immediate benefits in terms of supporting the development of shared care plans and enabling the care of service users to be shared across staff teams. This resulted in a more flexible and efficient use of resources and increased resilience of service provision.

Further testing of integrated services between the Substance Use Service (SUS) and CWIC (Care When It Counts) Service took place during 2023/24. This activity was developed in recognition of the challenges people supported by the Substance Use Services often face in accessing primary care services. The introduction of direct links between professionals in each of the services involved in the trial was shown to help improve access to physical health interventions for patients involved and will continue on a permanent basis. There are plans to roll out this approach to Adult Mental Health Services during 2024/25, again with the aim of supporting people using these services to access primary care.

It is widely understood the impact that housing can have on an individual’s health.  Working closely with East Lothian Council’s Housing Team, the IJB, through its links with Public Health Scotland were able to contribute to the Local Housing Strategy 2024-29, to ensure health was strongly embedded within the plan.  Further partnership is ongoing to help support joint working at a strategic level across Council and HSCP services to ensure respective strategies are aligned.
 

6. Safety and Protection:
Keeping people safe from harm remains a top priority which was reflected in the Adult Support and Protection Inspection, with the service being described as “robust” and “evident the partnership is on a positive improvement journey”.

The MELD (Midlothian and East Lothian Drugs) Contact Service continues to provide information and advice regarding substance use. During 2023/24 there were 1,286 enquiries to the Contact Service (159 during the Out of Hours service). The service has been identified as an excellent example of a single point of entry into Recovery Services and was subsequently submitted as a good practice case study to Public Health Scotland (PHS). In September MELD were asked to give a presentation to Health Improvement Scotland about the achievements of the Contact Service.

In addition, ELHSCP Justice Social Work Services continue to reduce the risk of harm caused by crime within the community.  The roll out of Structured Deferred Sentences, which has strengthened early intervention and prevention approaches, took place throughout 2023/24 and are now available to low and high threshold service users.

The Community Payback Work Team, who develop options for unpaid work for service users have introduced classroom-based sessions to deliver induction, group work, learning opportunities, and inputs from partner organisations (e.g., the Scottish Fire and Rescue Service and CHANGES).

Furthermore, a new Community Justice Outreach Nurse was introduced in 2023/24 to support service users’ health needs including those related to drug and alcohol use, mental health, and minor physical health needs.

  
7. Addressing Health Inequalities:
ELHSCP is committed to addressing health inequalities by continuing to build from the Joint Strategic Needs Assessment that was published in 2023 and using this report as a tool to inform strategic planning activities. 

Integrated Impact Assessments (IIA) are carried out to help consider the potential impacts, positive and negative on people, the environment, and economy when developing policies and service decisions.  The completion of several IIA’s was required in relation to the financial savings proposal presented to the IJB in the March 2024 meeting to set a balanced budget and address the projected financial gap of over £11m. 

Financial Performance and Future Planning:
The annual report concludes with a financial performance review of 2023/24.  The report highlights the financial challenges faced during the year and the steps taken towards a financial recovery program. Despite these difficulties, the IJB managed to balance the 2024/25 budget while planning for long-term sustainability.