Coming Home Implementation: report from the Working Group on Complex Care and Delayed Discharge

Forewords

Our NHS in Scotland provides vital enduring support and healthcare. During the pandemic, we have never been clearer about the benefits of our NHS and the skills and dedication of the people who work within the NHS.

However, no matter how we value it, we also know that a hospital is not a home.

No one should be subjected to unnecessary delayed discharge due to incomplete care arrangements. For every day spent unnecessarily in hospital, that person loses part of their connection with their community, their family, and their friends. Stories like Louis' are unacceptable.

We are not protecting the rights of people with learning disabilities and complex needs if we have to keep people in hospital when they should be living at home or in a homely environment with the right support.

We have a collective responsibility to make this happen.

That is why the Scottish Government has already provided over £20 million of funding in 2021 dedicated to helping Integration Authorities fulfil the vision that out-of-area placements and hospital stays are greatly reduced by 2024.

The experts on the group who have produced this report have set out a way forward. We are very grateful for their work.

This isn't an easy task –reports by the Mental Welfare Commission in 2016 and the Coming Home report in 2018 have highlighted this as a long-standing issue. This additional work and funding recognises that we have to do more.

Success will require a high level of collaborative and partnership working, and of innovative thinking. It requires us to commit to solutions for individuals despite the challenges. It requires us to make best use of the successes that have been achieved for some people and to build on that.

We are fully committed to working together to make this happen.

Kevin Stewart MSP
Minister for Mental Wellbeing and Social Care

On behalf of COSLA and Scottish Local Government I welcome the Report and thank the participants of the Short Life Group and its sub-groups for their work in producing the recommendations contained within it.

We recognise and share the frustration that individuals are delayed in hospitals or accommodated inappropriately out-of-area and are fully committed to ensuring that local community services and accommodation are developed, are available and are sustainable.

It is important to acknowledge that this won't be easy and undoubtedly there will be challenges in different areas of the country in developing new places and attracting and retaining support staff and engaging and maintaining a mix of service providers and in house support services.

The Change Fund to support the development and establishment of those local solutions is welcomed, as is the Reports recognition that we need to see resource transfer from inappropriate settings to ensure local support is sustainable.

The proposals around the development of a Dynamic Support Register, to review, maintain focus and achieve positive outcomes for those currently delayed or at risk of requiring support are welcome, and COSLA look forward to assisting in developing these proposals fully.

We share, with the Scottish Government, the view that success will require a high level of collaboration, partnership working and innovative thinking, and that we all have responsibility to make this happen.

Thank you.

Councillor Stuart Currie
COSLA Spokesperson for Health and Social Care

I believe that people with learning disabilities should be given the right support so that they can live fulfilling lives in the community. This support should always be person centred, supportive, flexible and responsive.

People should only be admitted to assessment and treatment services as an in-patient when there is a clinical need that will benefit from in-patient based intervention.

Behaviours perceived as challenging can describe a range of responses people may display when their needs are not met. Expressions of this behaviour, with no accompanying identified clinical need, are not an appropriate reason to admit people to inpatient assessment and treatment services.

Professor Sir Gregor Smith
Chief Medical Officer, Scottish Government

High-quality care and support that is flexible to meet the needs of the individual is central to our social care values. Every day we work to meet these aspirations for everyone living in Scotland, with human rights central to our approach. We are committed to ensuring a right to family life for everyone. However, when people are inappropriately placed far from their communities, or are delayed in hospital settings, we are not delivering on the high standard of care we set ourselves.

People deserve the services around them to be delivered in a person-centred and enabling way.

Collaborative and innovative working across the sector, which puts people with learning disabilities at the heart of co-design, will be necessary to create and develop solutions for people with the most complex needs so they can be supported into their own home. We must overcome the structural barriers which prevent us currently delivering the best care for each individual, so that people with learning disabilities and complex care needs are effectively supported to live in their home communities.

Iona Colvin
Chief Social Work Advisor, Scottish Government