Health and social care strategy for older people: consultation - easy read

Health and Social Care Plan for Older People Tell us what you think : Easy Read

What is this consultation for?

There are a lot more people aged 65 or older in Scotland and this number is getting bigger.

Old age offers many new choices and chances.

It can also bring things that are not so good.

Many older people:

• have very bad health conditions
• take more medication
• go to more health appointments
• stay in hospital more
• have poorer health than younger people
• have delays getting discharged from hospital

Older people were one of the groups affected the most by Covid-19.

We must make sure all older people in Scotland have health and social care services to support them.

Many older people's health and social care services need to change so they are what older people need.

In March 2021 the Scottish Government published a plan called a 'Statement of Intent'.

This is how we will develop a new health and social care plan for older people.

Why Your Views Matter

This consultation is one of the ways we are asking people what they think about the new health and social care plan.

We want to hear what many different people think.

At the end of 2021 we spoke online to a lot of older people from organisations and groups that support them.

The information from the online events helped us decide what questions to ask in this consultation paper.

What will the new plan link with?

The new plan must link with actions and recommendations from:

• the Independent Review of Adult Social Care
• the National Care Service consultation
• A Fairer Scotland for Older People

What have people told us so far?

People said the most important things were:

Prevention

Staying physically and mentally active can:

• reduce our risks of dementia
• help us meet new people and keep in touch with others
• help prevent falls.

Person Centred Care

Older people must be at the centre of decisions about care and treatment.

They must be able to communicate what matters most to them and staff must listen and act on it.

Home First Approach

Home First services make sure people receive care and treatment in their homes and local communities as much as possible.

Care at Home and Hospital at Home are examples of this type of service.

Integrated Health and Social Care.

Integrated means linked and working together.

We have integrated health and social care in Scotland but it is not the same in every area.

Dignity and Respect at End of Life.

We need to talk about death and dying in an open and honest way and support ways for people to have these conversations.

We must continue to support families through their bereavement, recognising that people grieve in different ways.

Tell us what you think

There are 55 questions in the whole consultation

There is space after each question so you can type your answer.

The space will grow as you type.

You do not have to answer every question.

There is space at the end for you to add more information if you want to.

Save your document and email it to:

olderpeopleshealthstrategy@gov.scot

Send it to us by 17 June.

What you tell us will help us to decide what will be in the Health and Social Care Strategy for Older People which will be published later in 2022.

The consultation is split into 4 parts based on the main themes from what people told us:

Part 1: Place and Wellbeing
Part 2: Preventative and Proactive Care
Part 3: Integrated Planned Care
Part 4: Integrated Unscheduled Care

Part 1: Place and Wellbeing

Wellbeing means feeling comfortable, healthy and happy.

Where we are born, grow, age, live and work makes a difference to our health.

In this section we want you to think about the different organisations that support older people and how they work together to provide the care and support needed in their local community.

What You Told Us

There are some excellent examples of support being provided by voluntary organisations in Scotland.

The support they give is very important to an older person's wellbeing and helps them to stay connected to other people.

Question 1

Do you have examples of communities, voluntary and public sector organisations working together to improve older people's health and wellbeing and reduce any health inequalities which they experience?

Write your answer here:

You told us:

Many people depended on voluntary services during the Covid pandemic.

Many voluntary services are only funded for a short time.

Voluntary organisations, NHS and social care services do not share information well.

Older people have to give the same information to different services which takes too long.

Health and social care services are not the same across Scotland.

Health staff said it is important for them to know their local area and what services people need.

This is very important in areas of deprivation and poverty.

A deprived area is one where people have more difficulties in different parts of their life.

Poverty meansnot having enough money to buy basic things like food or housing.

These areas can have very different needs:

• older people who are isolated

An isolated person does not have much contact with people.

• older people who are frail
• people with very bad health conditions that have lasted a long time

Isolated older people are more likely to contact the Scottish Ambulance Service in a time of need or crisis.

Question 2

Think about your physical health. What kind of advice and support would help you make decisions about your health, care and treatment?

Write your answer here:

Question 3.

What kind of people or organisations would you like to help you with this?

Write your answer here:

Question 4.

Think about your wellbeing - what kind of support and activities would help you to stay connected to people in your community?

Write your answer here:

Question 5.

How could local organisations and places like community groups libraries, museums, art galleries or leisure centres help you with this?

Write your answer here:

Mental Health and Wellbeing

Older people are more likely to experience things that make their mental health worse, such as poverty, isolation, loneliness and poor physical health.

The coronavirus pandemic has made these things worse.

Many older people were shielding or were at high risk from coronavirus and this also affected their mental health.

Question 6

If you were worried about your mental health what health or care service would you ask for advice and support?

Write your answer here:

Question 7

Has the coronavirus pandemic made it more difficult for you to get mental health services if you needed them?

Yes ☐ No ☐

If you answered 'yes' please tell us more:

Question 8.

What could we do to make it easier for you to get mental health services if you needed them?

Write your answer here:

Question 9.

Is there anything else you would like to add about mental health services for older people?

Write your answer here:

Housing

A person's home makes a big difference to our health and wellbeing especially as we get older.

We must make sure our homes support older people to live independently at home for as long as possible.

Question 10

Tell us about the housing you live in just now.

Write your answer here:

Question 11

What kind of housing, adaptations or equipment for your housing would support you to live independently at home for as long as you want?

Write your answer here:

Question 12.

Who would you like to be able to give you the housing and adaptations you need?

Write your answer here:

Question 13

Is there anything else you would like to add about Place and Wellbeing for older people?

Write your answer here:

Part 2: Preventative and Proactive Care

Preventative means trying to stop something before it happens.

Proactive means preparing for something happening in the future.

These services:

• will support people to stay well and prevent them becoming ill.
• will support people to avoid a crisis – when things are very difficult or dangerous
• will group round individuals and families to support them.

The approach has been used for a long time in children's services through Getting it Right for Every Child.

What You Told Us

Most people see prevention as being able to use services and activities in the community.

They are not always described as health and social care services but are a very important part of people's physical and mental wellbeing.

These include:

• places where people meet and are a reason to go out like libraries and cafes
• accessible toilets and benches or seating
• transport, including community transport
• saving money including help with the cost of keeping your house warm.

Being able to get to places and services and being able to afford them is a big issue.

Some services are closed in the day.

Some services shut down in the pandemic and have not started up again.

Groups that are used more by older people are very important as places to meet and get information from workers and volunteers they know and trust.

This is even more important for:

• people who do not use English as their first language
• people with no internet access
• people who find it hard to remember or follow complicated information.

People told us they wanted:

• up to date information so they knew when groups and services started up again
• advice on how to keep safe from coronavirus
• reasonable rents for places like Community Centres – some prices are so high people cannot afford to use them at all
• easy ways to get funding for these activities.

Many funds support activities for children and young people.

Funding arrangements during COVID were more practical and helpful.

• to make sure things that work well keep going and are not lost

Question 14

Think about health and social care services for older people in Scotland.

What has worked well in the past?

Write your answer here:

Question 15

What is working well just now?

Write your answer here:

Question 16

How do you think services could be made better?

Write your answer here:

Question 17

What would make it easier to have access to leisure facilities or any other kind of physical activity?

Write your answer here:

People told us they wanted:

• information about keeping yourself and your house safe, such as tips on preventing falls and small changes to homes such as grab rails.
• the Care and Repair service. It is not available in many areas.
• information about food and nutrition.

Nutrition means eating well to stay healthy.

• access to podiatry services to look after your feet

The Scottish Government have guidance on personal footcare

Anticipatory Care Plans

Anticipatory Care Planning is a way of thinking ahead about care.

People are supported to discuss how they would like to be treated and cared for if their health changes or gets worse.

Anticipatory Care Plans:

• are a way of noting what is important to the person about their health and care
• information about what type of treatment or care would or would not be acceptable to them.

These can be shared in advance with the people and services who may be able to help.

Question 18

How much do you know about Anticipatory Care Plans?

Write your answer here:

Question 19

How do you feel about having an Anticipatory Care Plan yourself?

Write your answer here:

Question 20

What do you think about this Anticipatory Care Planning type of care?

Write your answer here:

Question 21

If you would have an Anticipatory Care Plan, who would you like to discuss it with?

Write your answer here:

Question 22

When is a good time to have discussions about Anticipatory Care Planning with older people?

Write your answer here:

Minority Ethnic Communities

Minority ethnic communities experience some of the poorest health outcomes.

We want to speak with minority ethnic communities during this consultation so we can learn more about this and decide how to make this better.

Question 23

Is there anything else you want to tell us about preventative and proactive care for older people?

Write your answer here:

Part 3: Integrated Planned Care

Integrated means different services working together.

Planned care is care and treatment that is arranged in advance with health and care staff.

It includes planned care like:

• operations
• social care at home
• check-ups by your doctor for things like blood pressure

Social Care

Many of the issues on social care we heard about were about staffing.

You told us:

• staff need more training and support
• they should be respected for the work they do
• many people thought social care had got better in the last 10 years
• there are still problems with poor quality care

This makes people worried about getting care.

• sometimes staff have not turned up

COVID restrictions and staff vacancies have made this worse

• you want care providers who know the area
• you want to have choices in who provides social care
• people want care providers who are from the same equality group as them

For example someone from a black or minority ethnic group would like a carer who shares or understands their background.

The main changes people said would make care at home better are:

• workers telling you if they are running late, which people understand will happen
• to have the same service always provide the care – people like smaller local providers or teams within bigger providers

It also makes people feel safer - other people in the area will know if the care is not good.

• having a friend or relative with you when you want that

It should be the person you choose and not just one person named as your carer.

• carers must remember it is your home first, not their workplace, and treat you and your home with respect

Question 24

Tell us about any social care or other help with everyday living that you or a family member get in your own home?

Write your answer here:

Question 25

What was your experience of these services?

Write your answer here:

Question 26

What are your experiences of health and social care services working together?

Write your answer here:

Question 27

What could be done to make health and social care services work better together?

Write your answer here:

The Scottish Government is working on a plan to make big changes to the healthcare that people living in care homes receive.

Planned Health Care and Reviews

You told us about a regular general health check for older people is provided by a range of health staff.

It gives people a chance to have their medication reviewed and talk about how to look after their health.

It could be used to target frail older people or older people with who have very bad health problems.

Question 28

Do you live with a long-term physical or mental health condition or illness?

Yes ☐ No ☐

Write your answer here:

Question 29

If you answered 'yes', how do you feel about the way your health is looked after and checked?Write your answer here:

Question 30

If you answered 'no', can you get regular health checks?

Write your answer here:

Question 31

Where would you like your health checks to be and who would you like to provide them?

Write your answer here:

Question 32

What support would you need to help you look after your own health?

Write your answer here:

Other ways of getting in touch with health staff.

You told us:

• it was difficult to get face to face appointments during the COVID pandemic with only phone calls or online services available in some areas
• phone calls were fine for short questions or advice but not for serious or long calls
• some NHS Boards had campaigns to tell people about different services, and who to contact when

The Scottish Government published 'Right Care Right Place' guidance about where to go for urgent care, health advice and support.

Question 33

Tell us about your experience of any health care appointments you have had in the last 2 years.

Write your answer here:

Question 34

Which healthcare services did you use?

Write your answer here:

Question 35

What type of appointments did you have?

For example face to face, phone or video?

Write your answer here:

Question 36

What support would make it easier?

Write your answer here:

Question 37

What would make it easier for you to know who to contact when you need advice or support for a health issue?

Write your answer here:

You told us the most important change would be to patient transport:

• getting times of transport and times of things like clinics to match up
• making sure staff know how the appointments system works
• taking account of why some people need someone with them at their appointment – for example a person with dementia
• having a Freephone number

Question 38

What is working well just now to support planned health care and treatment?

Write your answer here:

Question 39

What could be better?

Write your answer here:

Question 40

Is there anything else you would like to add?

Write your answer here:

Palliative and End of life

Palliative care is good care for people whose health is getting very much worse and their life is coming to an end.

You told us:

• it was important to talk about end of life care with health staff and with family and friends even though this could be difficult
• people did this in a series of small conversations in a casual way like on a walk, having a chat in the garden or around something in a TV programme they were watching together
• people also talked about what they did not want to happen to them as they came to the end of their life
• people want to know:
  • there would be services to manage their pain
  • family or friends would not be left to care for them with no advice or support
• many people who got palliative care support had experienced delays in getting the care started.

This was usually because someone in the NHS did not understand how to make the referral.

• people thought palliative care was an excellent service for the person and their family
• health and social care staff should be more confident to have end-of-life conversations

The Scottish Government will produce a new palliative and end of life care plan in 2022.

Question 41

When you or a family member are near the end of your life, what care and support would you want?

Write your answer here:

Question 42

When thinking about palliative and end of life care in Scotland, what is working well?

Write your answer here:

Question 43

What could be better?

Write your answer here:

Question 44

Is there anything else you would like to add?

Write your answer here:

Question 45

What would support you to talk with family or medical staff about how you would like to be cared for at the end of your life?

Write your answer here:

Question 46

Who would you prefer to have these conversations with?

Write your answer here:

Question 47

Is there anything else you would like to add about integrated planned care for older people?

Write your answer here:

Part 4: Integrated Unscheduled Care

Integrated means different services working together.

Unscheduled care is care and treatment which cannot be planned in advance.

It includes emergency GP appointments or A&E treatment.

You told us you wanted:

• services that help people avoid being admitted to hospital where possible and making sure they can be treated at home or closer to home
• services that make sure people stay in hospital for as little time as needed and do not have to go back to hospital
• services that plan for patients:
  • to be discharged from hospital without delay
  • to move their care so they can be treated at home or in the community
  • and help people get back to living independently with support from local teams.

Post-operative

Post operative is the time after surgery.

Post operative support is different in all parts of Scotland.

Older people need extra support after surgery.

It could be with things like dressings or just a general chat on how they are feeling.

Question 48

What is working well just now to support older people who need urgent or emergency care?

Write your answer here:

Question 49

What could be better?

Write your answer here:

Question 50

Is there anything else you would like to add?

Write your answer here:

Question 51

What support do older people need after surgery?

Write your answer here:

Many people told us good things about the Hospital at Home service.

Hospital at Home provides hospital level care in a person's own home.

This service stops you having to go into hospital for treatment.

Older people said it helped to stop worries about going to a hospital appointment.

Question 52

Do you have any experience of Hospital at Home?

Write your answer here:

Question 53

What do you think about Hospital at Home?

Write your answer here:

Question 54

If you have no experience of Hospital at Home, do you think this is a service you would use if you needed it and would it work well for you?

Write your answer here:

Question 55

Is there anything else you would like to add about integrated unscheduled care for older people?

Write your answer here:

Please use this space to tell us about any other areas you feel should be included in the new health and social care plan for older people.