West Lothian

Template for SOA case studies 2010

Name of CPP: West Lothian

Name of case study: Zero Bed Blocking

Brief outline of case study:

Measures put in place to ensure that patients are discharged from hospital as soon as possible and no delay is incurred in moving them to rehabilitation.


This case study demonstrates good practice or progress in addressing the following issues.

Economic recovery




Children's early years


Health inequalities


Other key local issues


A shift to prevention and early intervention




Better use of resources (budgets, staff, buildings, equipment, etc.)


Improved business processes (service planning, staff engagement, performance management, etc.)


Partnership working


Localisation of the SOA / local Community Planning


Community engagement and feedback


Engagement of the voluntary sector


Engagement of the business sector


Improved performance attributable to the SOA approach


More cost effective performance attributable to the SOA approach


Contact details of lead officer:

Charles Swan
Group Manager
Assessment and Care Management
Social Work Services
St Johns Hospital
West Lothian
01506 524088



Name of case study: Zero Bed Blocking

SOA outcome/s and National Outcome/s supported by the case study:

Outcome 6 – We live longer healthier lives

Partners involved in case study:

West Lothian Council
NHS Lothian
West Lothian Community Health and Care Partnership
Range of private sector care providers

Description of activity:

West Lothian have successfully instigated a range of measures to ensure that performance in relation to delayed discharge is outstanding. Since 2008 West Lothian CHCP has consistently achieved a zero delay.

The range of measures put in place to achieve this are outlined below.

Moving On Policy

Whilst it is recognised that many people who are considered fit for discharge are able to return home with or without support, there are a proportion who due to their ongoing needs may require to be supported elsewhere, the most common alternative being a care home or supported accommodation. It is appreciated that moving into any care facility does constitute a major change in someone’s life and hence one that requires careful consideration if it is to be successful.

Guidance is offered to each individual who requires such care at every stage of the process, in addition our ‘Moving On’ Policy seeks to afford the individual concerned real choice with the individual and their family being invited to identify at least three different care facilities which they consider to be acceptable.

Once ready to be discharged from hospital, if a vacancy is identified within one of the facilities that is one of the preferred options, they will be moved there directly. However in the event that the individual is ready to be discharged and none of their preferred options has a vacancy they may be transferred into our Interim Care Unit (Craigmair) until a suitable vacancy arises.
This temporary placement is mutually beneficial as it prevents the blockage of a hospital bed whilst allowing the individual to be appropriately supported whilst awaiting a placement of their choice.


Craigmair is the interim (short stay) facility. This facility, where admissions are jointly managed by health and social work staff, provides interim care for those aged 65 plus who are assessed as requiring a care home in the longer term but whose placement of choice is not yet available. The interim care unit is an excellent early example of a partnership arrangement where the use of shared services can deliver efficiencies. Having identified a need not only for an interim care unit but an alternative site for a continuing care ward, both were built on the same site and share utilities including kitchen and ancillary staff.

Service Matching Unit

The Service Matching Unit has played a significant part in contributing to the prevention of delayed discharge at a number of levels. The service matching unit commissions the services identified during the assessment process, reducing bureaucracy for highly skilled care management staff and offering improved/streamlined information to providers who deliver the service. Additionally the Service Matching Unit ensures that service providers systematically deliver services for hospital discharge as a first priority. This model has since been replicated in other authorities.

Re-enablement and Hospital Discharge Team

West Lothian Council was one of the first authorities in the UK to develop a highly successful Early Discharge and Re-enablement service. This service not only facilitates early discharge through effective partnership working but has developed a delivery model which promotes independence which reduces health inequalities and reduces the need for ongoing care services.

Commissioning for Better Outcomes

West Lothian has a proud history of commissioning with key partners to ensure that services are responsive to need and available at the times identified by service users. SOA’s have enabled West Lothian to commission for the outcomes they wish to achieve, in this case of living longer, healthier lives, rather than just bed space to ensure that there is no delayed discharge.

The range of choice available in terms of care at home compared to that in other authorities was the subject of comment in the SWIA inspection of 2007. This included innovative approaches such as the use and development of SMART technology as well as choice and reliability in terms of personal care services.

The partnership arrangement with local care home providers is particularly effective insofar as a well established agreement in relation to ‘holding beds’, where appropriate ensures that the ‘Policy on Choice’ is supported by a fair and transparent approach to the allocation of vacancies where they become available.

Other Relevant Provision

All of the above ways of working seek to ensure the avoidance of delayed discharge. There are of course a number of other services which contribute to this target. For example, the provision of a home safety service, meal service, shopping service and laundry service.

Evidence of impact / progress:

Since 2008 West Lothian CHCP has consistently returned zero delayed discharges.

The interim care unit at Craigmair has had a positive impact as it ensures that people receive the appropriate care without being place in a long-term care home that is not of their choosing.

West Lothian now have a well developed care-home network with everyone working closer together, enabling better communication and delivery of services.

What added value has the SOA approach brought to the delivery of these benefits?

The SOA approach highlighted delayed discharge as a priority for West Lothian given an increasing older population. It has allowed West Lothian to raise the profile across a range of partners.

The SOA approach allowed West Lothian to highlight that this was not just a national target, but was a key issue locally which has a knock on effect across a whole range of services, not limited to Social Work and the NHS.

The SOA approach was also the enabler for West Lothian to commission for outcomes, an approach which is now being applied in other areas. This approach ensures that it is the desired outcomes which are achieved, rather than targets, which contribute to leading longer healthier lives.

Good practice and lessons learned:

Work together with the customer to get the best outcome for all, as you can ensure that you are delivering what the customer really needs.

Plan services in partnership, this ensures that all the required elements can be delivered cohesively.

Commissioning for outcomes has now been adopted by the Tobacco, Alcohol and Drug Partnership as a way of working. It will also be implemented in the new way of working with and supporting the Voluntary sector.

Last Reviewed: 01/06/2011