A shock report has found stretched home care services for vulnerable people in the Highlands are not meeting legally required standards, we can reveal.
Investigators discovered staff shortages – made even worse by the coronavirus pandemic – meant there was often no “capacity” to carry out statutory care reviews.
The finding was one of a series which have laid bare the scale of the pressures on a struggling system that offers vital support to about 1,600 people across the north.
After comparing Care at Home services in Inverness, Caithness and Lochaber, the internal NHS Highland probe also showed there was “no standardised paperwork” across the teams, districts or professions.
The “differences of approach” have ultimately been leading to “more paperwork and differing assessment models”.
And the auditors found that demand for one type of care package was not being “appropriately recorded” or “fully understood” by the health board.
‘Deeply concerning’
Conservative MSP Edward Mountain branded the findings “deeply concerning” and vowed to raise them with NHS Highland’s chief executive.
It has emerged health chiefs in the region ordered their auditors to carry out an internal inquiry into the service after becoming “concerned” about a “number of areas of inconsistency in the treatment of individuals”.
Their fears have now been confirmed in the resulting report, which has not been fully published because the health board insists it is an “internal document”.
A series of seven recommendations have been made to try to address the issues in the complex service, which is offered by 19 providers.
Care plans
On the failure to carry out routine care plan reviews, the report said: “Mechanisms are in place to monitor the care plan, review dates and these are flagged up when in they are due and overdue for review.
“However, there is not the capacity to ensure that every single review is happening which is not in line with statutory requirements.
“Covid-19 had further impacted on staffing with redeployment making staff unavailable to carry out reviews.”
The auditors recommended the introduction of a “consistent level of oversight”, with “effective management reporting” on the status of six monthly reviews to ensure they can take place.
They also called for “standardised” paperwork and assessment models across Care at Home teams in the Highland area, as well as “formal metrics for management reporting”.
‘Real pressure’
A spokesman for NHS Highland said the health board commissions audits in order to identify all of the areas of good practice and challenges in specific services.
“This audit provided the board with a clear understanding of the service and made recommendations for improvement,” he said.
“It is evident from this report and from our day-to-day experience that adult social care systems are under real pressure and Care at Home services in particular have been impacted by the pandemic with recruitment and retention of staff an ongoing difficulty.
“We are committed to implementing the recommendations of the internal audit and exploring new approaches to effectively do this.”
Mr Mountain, a Tory MSP for the Highlands and Islands, said he would be raising the findings with local health chiefs.
“I have long-called for home care provision to be enhanced in NHS Highland and this new report underlines again why change needs to happen,” he said.
“Those requiring home care should receive their package as swiftly as possible, but I know from constituents who have contacted me that this isn’t always the case.
“While the pandemic has undoubtedly increased pressures on staffing, there are issues highlighted in this report that have been long-term problems for NHS Highland and which now need to be addressed.
“It is deeply concerning that NHS Highland doesn’t appear to a have a true grasp of the numbers when it comes to demand and capacity levels for home care.”
Rhoda Grant, Scottish Labour MSP for the Highlands and islands, said adult care services, at home and in care homes, were under pressure before the pandemic, but the situation was now much worse.
‘Desperate circumstances’
“Staff need to be very careful not to work with older people if they have Covid and many have left the service due to the desperate circumstances they found themselves in when the pandemic first broke out,” she said.
“Scottish Labour have long been calling for a National Care Service that provides a high standard of care and salaries that recognise the work, knowledge and commitment of care workers who are low paid and often working split shifts.
“We will only recruit into the profession if we value our workforce and recognise that our service users deserve high quality care.”