At the moment, there are two main issues for us, the first of which is capacity downstream in care homes. Year on year, there has been an increase in the number of care home placements that we are funding. Obviously, we have a good relationship with all the providers in South Ayrshire, and we work hand in glove with them to manage capacity and demand as best we can, but the homes are, by and large, full. It had certainly been our strategic ambition to try to manage down the number of people ending up in care homes, and in certain circumstances, if we are able to intervene more quickly, we can prevent deterioration. After all, there is good evidence to suggest that if older people stay in hospital any longer than 72 hours or so, the risk of their ending up in a care home is higher.
To some extent, our ability to achieve the ambition of speeding up people’s discharge has been a consequence of our inability to provide home care timeously. As I said in response to an earlier question, we are seeking to increase our home care capacity and to manage it more effectively. For example, we have introduced a reablement service. We were asked earlier about learning between partnerships, and I think that there has been good learning across Scotland on this issue. Instead of people being helped with bathing, going to the toilet or whatever, reablement is a way of supporting them early in their time in home care with a view to helping them to do those things for themselves and, as a result, to need less from the service. However, we have introduced reablement only recently, and we still need to see its full effects.
In this respect, there are two issues for us: using our home care capacity more effectively and adding to total home care capacity. In thinking strategically with regard to our commissioning plans, we need a better understanding of the data on the local population, particularly that in South Ayrshire, where the demographic characteristics are quite unusual. I think we are beginning to establish that there is relatively high deprivation, but there are also relatively high numbers of older people as well as a much smaller group of people of working age. As a result, the dependency ratio in South Ayrshire is very high.
As we begin to reflect on what we do with the entire system, I should point out that delayed discharge is simply a symptom of the system not working in the way that we want it to. What we want to do as we look at commissioning is to understand what the future demands are likely to be and manage our service in that way.