Agenda item

6.1 The winter system pressures update was provided to the Board as the Board had oversight of all delegated services, and it was important that Board members were aware of the recent pressures across health and social care, and that they were considered in terms of: the impact on our communities and health and wellbeing outcomes; the impact on the levels of risk and the strategic risk register; and the impacts in terms of the annual plan for 2023-24 in line with the new Strategic Framework.

6.2 Dr Rachel Mollart provided an insight into a typical working day of a GP and then provided some observations on the update.

6.3 Mrs Fiona Sandford commented that whilst she recognised the difficulties in supporting GPs with their clinical workload she was keen to explore what could be done to support GPs with the admin tasks they were required to undertake. 6.4 Mrs Karen Hamilton highlighted the need for hard data from primary care to be able to formulate some lobbying of the Scottish Government.

6.5 Dr Mollart commented that the new GMS contract was trying to release some of the administration pressures on GPs but that was not materialising given the Scottish Government had pulled the funding of the contract. She advised that data was collected nationally and the reports released were very high level with the lowest aggregate being at Health Board level and not at GP Practice level. She advised that the GP community had undertaken adhoc surveys which showed that pressures continued to be on the increase.

6.6 Mrs Susie Flower commented that it was a similar position in community services particularly within District Nursing due to vacancies and sickness absence with some locality areas moving to the provision of priority care for patients only. She advised that there continued to be an increased need for diabetic patients and the data showed an increase in contacts with patients to District Nursing of 340-370 with no additional workforce provision. Treatment rooms were closed and evening services were stretched leading to impacts on other services.

6.7 Mrs Jen Holland commented that social care was under constant day to day pressure with vacancies and staff undertaking back to back shifts to keep services operating. There was a significant loss of staff due to people retiring and people leaving for jobs in other sectors as care sector wages were equal to the living wage. A number of beds had been closed for a significant period of time due to an inability to maintain staffing levels to keep the beds open as well as compliance with Care Inspectorate regulations. A RAG status had been introduced within home care with care being provided to those deemed as Red. Some 60% of the provision of home care was through external providers but that had reduced to 40%. There was a focus on moving people on from hospital and some were waiting in the community for care home places or care at home and there needs were not being met. She drew the attention of the Board to the build up of pressures across all interfaces across the whole system.

6.8 Mrs Lynn Gallacher commented that there was also an impact from the winter pressures on the third sector. There was an unprecedented volume of referrals and staff were working above and beyond their normal working hours to support families and unpaid carers. Relationships for carers were breaking down and the main issue was resource in terms of care and it was interesting that it was across the whole system and heavily impacted on unpaid carers.

6.9 Dr Mollart commented that unpaid carers did a remarkable job and were frustrated that they could not help out when family members could be cared for at home from a medical point of view.

6.10 Dr Lynn McCallum commented that from a secondary care perspective, it remained under immense pressure and it was challenging to support the elective care programme. She spoke of the work of the Kaizen programme and the progress that it had made and the difficulties in sustaining that given the increased winter pressures across the whole system of secondary care, primary care and social care. She advised that secondary care was seeing a significant decline in peoples functions which were leading to a need for higher levels of social care. Work was underway on clinical decision making and a real focus was on values based medicine.

6.11 The Chair commented that she recognised the ability to progress things was constricted at present, but she urged the Board to appreciate that it had been given an opportunity to hear honestly from a number of key sectors and as a single audience that had responsibility to look across the whole system, on behalf of the Board, she recorded the Boards’ appreciation for what was happening and what people and their teams were delivering on the ground to support patients and the local population with their health and care needs.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the update.