Review of targets and indicators for health and social care in Scotland

Place of care and independent living indicators

109. Concerns about where people are looked after have been expressed in a number of reports. People who are fit for discharge should not have to remain in hospital for want of support at home. The problem of delayed discharge impacts on the unscheduled care pathway and should be seen as part of a system. Similarly, discharge to a care home of a person who was previously independent may be a reflection of the severity of the illness. It may also be a reflection of an elderly person spending too long immobilised in bed.

110. Collecting data on outcomes of people admitted to hospital and comparing lengths of stay might give some insight into where problems with discharge are most common. Reviewing lengths of stay for people with particular conditions might identify different practice or different capacity as causes of long stay in hospital.

111. In terms of support for people with care needs and falls rates, these are reflections of how well the system tries to meet needs and keep people independent. Those people living with disability which makes such support necessary should be involved in shaping the services which are so critical to independent living.

Improve support for people with care needs ( NPF)

Falls rate per 1,000 population in over 65s ( HSCII)

Percentage of adults with intensive needs receiving care at home ( HSCII)

Number of days people spend in hospital when they are ready to be discharged ( HSCII)

Percentage of people admitted from home to hospital during the year, who are discharged to a care home - In development ( HSCII)

Percentage of people who are discharged from hospital within 72 hours of being ready – In Development ( HSCII)

112. Recommendations:

a) Measuring lengths of stay for older people or for specific interventions could point to differences in practice across Scotland. Where such differences are discovered, areas with longer lengths of stay should learn from the better performing systems. Reporting of lengths of stay should be considered as an indicator of effective care protocols.

b) Those responsible for delivering support to elderly and disabled people should carry out a needs assessment in their area. Disabled people report that little effort has been made to assess needs on a population basis. Disabled people should be involved in designing services to meet identified needs.