Health and social care: winter preparedness plan 2023-2024

Priority Eight. Prioritise care for the people in our communities who need it most.

Some people are more vulnerable to the pressures and challenges brought about by winter, the colder weather, and Covid-19. We recognise the issue of poorly heated homes as a driver of poor health and almost £3bn has been allocated during the ongoing cost of living crisis to tackle poverty and protect people as far as possible. This includes £350 million this year for heat, energy efficiency and fuel poverty mitigations.

Anticipatory, or Future, Care Planning aims to support people to think and plan for changes in their health and care that might happen when they are living with a serious illness, have a longer-term condition or disability that could get worse, or are getting older and frailer, focusing on what matters to them.

There are a number of actions that can be taken within existing legislation and process to address pressures within health and social care services to ensure that adults with incapacity (AWI) can be discharged from hospital when medically fit and cared for in a setting more appropriate for their needs. Delays in the court system are often cited as a cause of unnecessary delay with the AWI guardianship process. The Scottish Courts and Tribunals Service (SCTS) has confirmed that there is currently no backlog in civil law cases, and that any cases relating to guardianships for AWI can be actively prioritised. This is particularly the case where input from the courts could help to facilitate moves that are of benefit to the patient. SCTS has highlighted that applying for interim guardianship orders where appropriate will enable cases to be expedited more quickly.

How we will jointly deliver this priority:

• Relaunch the Warmer Homes Scotland scheme from October with more funding and more help for households at risk of fuel poverty to receive a climate-friendly heating system, insulation and increased energy efficiency.
• Direct people to the Scottish Government’s Cost Of Living website which has a range of resources including how to get in touch with your local council for help with energy and bills, and has specific advice for older people or those who are disabled.
• Continue to scope options for increasing creation and review of Anticipatory Care Plans (including renaming as Future Care Plans) focusing on specific population groups.
• Provide the Covid-19 booster for those at higher risk, as per the JCVI statement of August 2023, and explore access for older and frailer groups to receive their flu and Covid-19 vaccines in their home in partnership with local agencies and the independent sector.
• Continue to encourage close working with our valued partners in the independent sector, and with unpaid carers, to enable continued support for older and frailer people who may need practical help to keep them safe and well.
• Where necessary, local systems will prioritise social care and support services for those who need it most and are considered to be at a critical or substantial risk level.
• Continue to work together with Partnerships, Boards, and people with lived experience to reduce inappropriate out-of-area residential placements and inappropriate hospital stays for people with learning disabilities and complex care needs.
• Encourage the use of local authority applications for guardianship of Adults With Incapacity where appropriate (as opposed to private applications) and apply for interim guardianship orders where appropriate to expedite cases. We have updated the national best practice guidance for Adults With Incapacity, noting that it is and average of 91 bed days for a private guardianship application. The guidance draws on experiences of statutory partners and aims to set out for local systems models of good practice to support a reduction in delayed discharges where adults lack capacity
• Provide support to allow the timely discharge of Adults With Incapacity, including:

• Targeted guidance for practitioners, using good practice examples, as referenced.
• Proposals for reform of legal aid practice.
• Ongoing training at basic, intermediate, and advanced levels for practitioners delivered on a joint basis with NES, MWC and the Law Society.
• Targeted meetings with HSCPs with higher numbers of AWI delayed discharges to offer assistance and understand the local challenges to help inform any necessary national response.

• Increase public awareness and uptake of Power of Attorney, to ensure people continue to have their wishes and voice heard and to help enable people to be discharged from hospital as quickly as possible to the best setting for their ongoing care.
• Support the continued roll out of the Healthcare Framework for Care Homes that provide proactive and preventative multidisciplinary care to vulnerable individuals.