Chapter 3: Coordination and Management
Several issues emerged in relation to the coordination and management of services. This mirrored the quantitative analysis which positioned coordination and management as the area where survey respondents were least content in relation to social care (Scottish Government, 2016b). The comments highlight the importance of partnership working between agencies, with clear communication across organisations as well as with service users. Responses focused on discharge planning and the need for agencies to work collaboratively at crucial points in people's care trajectories.
The coordination and management of services was a prominent theme within the comments. Only 75 per cent of people responding to HACE reported that the services they received were well coordinated, which is a decrease of four percentage points from the 2013/14 survey (Scottish Government, 2016b). The integration of health and social care addresses some of the issues highlighted in this section, although its potential benefits are not reflected within these comments due to the stage of integration implementation when people were responding to HACE 2015/16.
This section outlines the main factors mentioned in relation to coordination and management, including:
- Care management
- Inter-agency working and communication
- Discharge planning
Participants highlighted frustrations with having to take on care management roles. The comments demonstrate the need for coordinated services in order to alleviate the burden involved in organising and managing support. This is particularly pertinent during times of adversity when individuals may be struggling to cope. The following quote is typical of comments in relation to this issue.
"Currently caring for parent with dementia. There is no joined up services, you are just constantly referred to different services and given leaflets to read. You have to do all the groundwork yourself, which is very time consuming and difficult when you are dealing with someone who is losing their memory."
Inter-agency working and communication
Inter-agency working affects access, delivery, and coordination and management. The way organisations communicate with each other, as well as with individuals and families, is an important area of social care experience. Positive comments focused on effective communication and timely partnership working between agencies.
"30 mins out of hospital the equipment I needed was delivered and installed promptly. I have a new found respect for physiotherapists and the job they do."
"Doctor organised early intervention team to come to my house to help in the care for my mum, who was released from hospital and came to live with me because she was unable to live on her own. Got excellent support from doctor and community nurses."
In contrast, negative responses, like the one below, provided examples of fragmented care and expressed concerns about communication structures.
"Lack of communication between services provided. Totally disjointed. One did not seem to know what the other was [doing], this led to time wasting and much unnecessary duplication e.g. filling in the same answers to the same questions time after time."
Discharge planning was a central focus within coordination and management. The responses provided examples of people being in hospital for longer than required due to a lack of alternative support. There were also examples of people being discharged from hospital without the support they required being in place.
"Social services had a two to three week delay in providing any help with post-operative care. I was bed blocking at hospital but district nurses agreed to come every other day and family help allowed me home (partner ill at time). Bed blocking a major hospital for lack of simple after care at home is economic madness."
"When discharged from hospital it was assumed as a younger person I wouldn't need help or support but that family would provide. No offer of support for [activities of daily living] offered other than commode."
"After my stroke which hospitalised me for months, I required my bathroom converted to a wet room, the provision of a ramp for wheelchair access and the installation of a stair lift. Although I needed all these as soon as I was discharged and brought home, it took many months before this happened. I seriously struggled in the intervening period and was greatly distressed and inconvenienced. The time interval was far too long!"