East Lothian Council
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Integrating health and social care in East Lothian

Why do we need to change?

We need to be better at preventing ill health. We want the population of East Lothian to become a healthier community through prevention of ill health and the promotion of health and wellbeing. Around 20% of adults still smoke in East Lothian, which is below the Scottish average of 25.0%. Alcohol deaths are below the Scottish average and the proportion of the population hospitalised because of alcohol or drugs is also significantly lower than the Scottish average. 

However, we also know that there are increasing numbers of people of all ages with long-term conditions such as heart disease, lung disease and diabetes.  In East Lothian, we have higher rates of high blood pressure, asthma, cancer, strokes and dementia than the Scottish average.

We need to care for more people close to home

There is good evidence that it is better to care for people as close to home as possible.  Inpatient hospital care will always be important but it is only really appropriate for people with acute medical needs.  There are many benefits associated with delivering care in people’s homes or communities and we think that providing choice about where people are cared for is vital. The ‘care closer to home’ approach is about:

  • defining the role of hospitals in meeting the needs of the population
  • providing community alternatives which improve care and experience.

We need to be able to meet the increasing demand for health and social care services

In 2012, there were 100,850 people living in East Lothian, and our population is expected to grow by 12% between now and 2025. This increase is not necessarily spread evenly across all age groups.  The percentage of the total population of East Lothian who are of working age is lower than the Scottish average. The percentage of young people (0–15 years) and older people (65 years and over) is higher than the national average.  Over 18% of our population are aged 65 and over.

Many older people enjoy good health and continue to make a significant contribution to society as carers, learners, workers and volunteers. ELHSCP has a key role in enabling people to live as full and healthy a life as possible as well as caring for the most vulnerable.

We need to develop a new model of care which fully meets the needs of all people and our services need to reform and modernise in order to meet this growing demand.

We need to tackle health inequalities in our population

Inequalities in health outcomes between the most affluent and disadvantaged members of society are longstanding, deep-seated and have proved difficult to change. Across East Lothian, people living in the poorest neighbourhoods die four years earlier on average than people living in the richest neighbourhoods and they spend more of their lives in ill health.  This is due to a complex mix of social, economic, cultural and political reasons. As a health and social care partnership, we need to actively work with colleagues in housing, education and a range of other sectors in order to address such inequalities as a priority.

We want to make sure that our hospital services are sustainable, good quality and used appropriately
The gap between demand for services and current provision is widening.  We know we cannot continue to provide services as they currently are.  Historically in East Lothian there has been an over-reliance on hospital services.  Over recent years, more of our older people in East Lothian have been admitted to our hospitals than from other areas in Lothian.

We need to make best use of resources available

East Lothian Health and Social Care Partnership will ensure that we know:

  • what joint resources we have
  • how we use them
  • how we can achieve the greatest efficiency and productivity.

With our combined resources, we should be able to provide a better service in time.  Pressure from demand and changing population means that we will have to change the way we work.  The challenge is to work out how to use our joint resource to achieve the maximum benefits.

We need to make sense of where services are best delivered

We currently have access to three large acute hospitals in Lothian and three local hospitals and community hospital facilities in East Lothian.  There are also residential and nursing homes for older people and a number of day centres and health centres.   So, our strategic plan  will look at how we can make best use of these. We should develop new service models that can deliver more care throughout our communities.

Workforce

Integration of health and social care will affect both staff working for the NHS and East Lothian Council. It will also have an impact on independent organisations. The majority of social care services, for example, are delivered by the independent sector and integration of services is as important for them as it is for wider public services such as housing and leisure.

We also have to recognise the roles of independent contractors, such as GPs, community pharmacists, dentists, optometrists and the voluntary sector. They support and deliver health and social care for our population and we need to ensure that they are actively involved in all of our planning and development.

Money

East Lothian HSCP spends 59% of its health and social care budget on institutional care, which is more than the Scottish average (56%).   There will always be a need for hospitals and care homes, particularly as people get older, but we need to make sure that specialist services are used appropriately to meet people’s needs.  We need to focus on how we can provide more community-based services that will support people to be cared for in their own homes or communities.

East Lothian Council, John Muir House Brewery Park Haddington East Lothian EH41 3HA.