Care Home Management

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Scotland calls for better clinical oversight and improved communication in care home discharge

By freelance social care writer Eleanore Robinson

Hospital discharges to care homes in Scotland can benefit from better clinical oversight and intra-organisational communication, according to a new Care Inspectorate report.

The Scottish watchdog said in the Triennial review of initial case reviews and significant case reviews for adults (2019-2022): Learning from reviews document, published last month (January), that poorly planned hospital discharges were a “significant feature” in some cases. 

Identified themes included poor communication, delays in the assessment of capacity, and not ensuring appropriate resources were in place to meet the adult’s needs on discharge. The report added that a contributing factor for some adults was that their stay in hospital was during the Covid-19 pandemic.

“This required consideration and improvement across health and social care”, it said.

Communication shortfalls
The social care regulator for Scotland identified a need to improve responses where health and social care staff raised multiple concerns to their line managers that did not progress to an adult protection action.

It continued: “For a significant few (17 per cent) the adult was residing in a care home when the harm occurred.

“These adults had an assessed care plan. The support provided had not mitigated the risks and often there were missed opportunities to protect the adult.”

Overall, care homes featured in 28 recommendations from reviews, the report found.

Many of these said that health and social care partnerships should improve their clinical oversight arrangements.

They should also strengthen communication and pathways between community nursing services and care homes, Care Inspectorate said. 

Strengthened communications
To avoid vague or complicated recommendations, a standard approach using shared language and understanding would build greater consistency, opportunities to benchmark and improve shared learning opportunities, according to the report.

It cites the example of a focused recommendation following a case review in Aberdeenshire.

The directive instructed that there should be a protocol in place that ensures that no patient who is subject to adult support and protection procedures is discharged without a full multi-disciplinary and multiagency meeting to consider the potential risks and any control measures required to reduce such risks to an acceptable level.

“For the avoidance of doubt, such meetings must include community health and social care representatives,” it added.

More positively, the Care Inspectorate said its adult support and protection joint inspection work has shown that care homes make a high number of adult support and protection concern referrals to health and social care partnerships.

“We also saw that the Covid-19 pandemic had strengthened multi-agency care home assurance activity”, it added. “These factors should encourage stronger practice in this area over time.” 

The report concludes that coordinated leadership is required at a national level to implement, support and govern review activity and improvement work.

It argues that a national approach to learning should help to improve practice in adult support and protection and outcomes for adults at risk of harm.

This includes establishing a national, coordinated approach to address the issues with hospital discharge, as well as other issues identified in the report such as neglect and self-neglect.

In addition, there should be a rethink of training and support for good practice, supported by a pool of “well-trained and skilled reviewers” to support more consistent application of methodology and approach.

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