There were almost five times as many delayed hospital discharges in South Ayrshire than in East Ayrshire according to recent health board figures.
While the focus has been on delayed discharges role in Ayrshire hospitals being close to capacity, the gap in performance between the three authorities in the NHS Ayrshire and Arran boundaries is striking.
Delayed discharges occur when patients who are medically fit to leave hospital cannot - due to insufficient care or accommodation.
This often means that other patients are unable to get treatment until beds are freed up.
Last week, Labour MSP Colin Smyth revealed that the 'bed blocking' had cost NHS Ayrshire and Arran £12,777,210, with a total of 46,044 bed days 'lost' in 2021/22.
The Health and Social Care Partnerships associated with each authority are responsible for addressing issues that lead to delayed discharges, with NHS Ayrshire and Arran Health Board figures revealing that South Ayrshire is responsible for the vast majority of delays.
In September 2022, a total of 5,975 bed days were lost across NHS Ayrshire and Arran. South Ayrshire was responsible for 3,408 (57 per cent) of these. North Ayrshire lost 1,834 (30 per cent) days while East Ayrshire lost 733 (13 per cent).
The disparity becomes even more apparent when it comes to the number of patients having to be kept in hospital for more than two weeks.
East Ayrshire stands out as having had no patients delayed for more than two weeks, bar one month in 2018.
In comparison, South Ayrshire accounted for around three quarters of the delayed discharges in Ayrshire in September 2022, with North Ayrshire making up the remaining 25 per cent.
Total delayed discharges for September 2022 stood at 191, with 111 in South Ayrshire, 53 in North Ayrshire and 27 in East Ayrshire.
While the issues facing health and social care are undoubtedly complex, the main reason for the disparity is not, according to South Ayrshire Health and Social Care Partnership (SAHSCP).
For them, the issue comes down to available social care falling by 40 per cent over the 18 months, the reliance on the private sector and, ultimately, the number of care workers.
Billy McClean, head of community health and care services told the Local Democracy Reporting Service: "We have experienced real challenges in staffing, particularly within our care at home services over the last eighteen months.
"This has led to a reduction in the amount of care available by approximately 40 per cent, this reduction means that there is not enough care available for the number of people who need it and has resulted in a high number of people waiting for care packages both in hospital and in the community."
He said that there was no difference in policy between SAHSCP and those in East and North Ayrshire and that they regularly share best practice.
Instead the number of days being lost appears to correlate strongly with the proportion of care commissioned with the private sector and those available in-house.
Mr McClean explained: "The main difference between South, North and East Ayrshire is that South Ayrshire have a high proportion of commissioned care (traditionally 80 per cent) with North Ayrshire having 40 per cent commissioned care and East Ayrshire only 20 per cent with the remainder being delivered by in house council care."
This was actually a boon for the area early on in the pandemic as it gave South Ayrshire greater flexibility to increase the amount of care delivered than those relying on in house care.
Mr McClean said: "Commissioned care hours rose from approximately 10,000 hours to 12,000 hours per week (20 per cent increase) and enabled us to reduce the number of people who were delayed to fewer than 20 in April 2021.
"As the pandemic and system pressures have dragged on, commissioned services have really struggled to recruit and retain staff even more so than our in house services, which have also struggled.
"A number of care providers have either handed back hours, pulled out of the market or have been unable to deliver the quality expected and services have been taken in house.
"As a result the number of commissioned hours have fallen to 6,700 hours per week (a fall of 45 per cent from our peak) and this has been the main contributor to our very significant and relatively rapid rise in delayed transfers of care.
He added that South Ayrshire also had a older population with greater dependency on the system.
"We understand the impact that these delays have on the people waiting, their families and the wider health and care system and we are working hard with our partners to do everything possible to recruit more staff and use the care we have as efficiently as possible."
The efforts to tackle the issue include:
- A new team to review those awaiting care
- 10 additional beds in an SAC home
- Support from other parts of the council's workforce
- A dedicated post to improve recruitment
- A new fast track training course in partnership with Ayrshire College which includes 12 hours paid employment and guarantee of interview.
Mr McClean continued: "We have begun to see more people applying for and joining our Care at Home teams, however we still require more people to consider a career in care.
"We will be running recruitment events throughout South Ayrshire over the coming months, information on current job vacancies can also be found out our website."
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