Is Government’s hospital discharge plan a long-term prospect?
Discharge delays
According to NHS England, an average of 13,440 patients a day remained in hospital in December 2022 despite no longer meeting the criteria to stay. This is 30% more than the daily average for December 2021 (9,150). Government suggests around 24% of patients with delayed discharges are waiting for home care, 16% are awaiting a care home place and 24% are waiting for intermediate care.
Discharge funding
Government’s policy paper ‘Our plan for patients’, published in September 2022, pledged £500m ‘to support discharge from hospital into the community and bolster the social care workforce, to free up beds for patients who need them’. £300m will be given to integrated care boards (ICBs) to improve bed capacity, £200m will go to local authorities and the funding will be pooled into the £500m Better Care Fund.
About the funding to block-book care home beds, Health and Social Care Secretary, Steve Barclay, said it will facilitate 2,500 people to be discharged from hospitals. This is on top of the 1,000-1,200 delayed discharge cases targeted through the Better Care Fund.
Sector scepticism
In response to Government’s Better Care Fund, The Nuffield Trust argued that it is merely the latest attempt in a long line of insufficient short-term fixes, concluding that ‘the Government’s down payment may prove to be just too small a deposit to prevent this fragile system from crumbling completely.’ Concerning the funding to block-book care home beds, the Health Foundation raised concerns about whether a residential setting would be the most appropriate place for the majority of people being discharged from hospital to further recover, citing the Government’s own guidance that less than 5% of people discharged from hospital will need ‘24-hour bedded care’.
Furthermore, the British Geriatrics Society has suggested that ‘decisions that solve rather than shift problems’ need to be made before the sector can accept that long-term solutions have been proposed. Moral concerns have also been raised by the Association of Directors of Adult Social Services (ADASS) who highlight the ‘risk of people being inappropriately placed and then remaining in residential provision indefinitely’.
In a joint letter to the Health and Social Care Secretary in January 2023, ADASS, the Local Government Association and Solace, stressed that ‘certain conditions need to be in place in order to avoid the approach leading to people spending longer than necessary in care homes and costing the taxpayer more as a result’.
More to come
In the 2022 Autumn Statement, Government committed to investing an additional £1bn of funding in England in 2023-24, increasing to £1.7bn in 2024-25 to get people out of hospital on time and into social care. £600m in 2023-24 and £1bn in 2024-25 will be allocated through the Better Care Fund aforementioned. The remaining £400m in 2023-24 and £680m in 2024-25 will be allocated to local authorities through a ringfenced adult social care grant which will also help to support discharge.
Social care has been chronically underfunded for over a decade and, as delayed hospital discharges become a greater issue for the health service, it is important to recognise that stopping people from turning up at the front door of hospitals is just as important as supporting people to leave safely, well and in a timely manner.
The Local Government Association, the Association of Directors of Adult Social Services (ADASS) and Solace (the representative body for senior strategic managers working in the public sector) recently jointly wrote to the Secretary of State for Health, Rt Hon Steve Barclay MP, asking the Government to urgently engage with councils and care sector partners, including people with lived experience, to address the current delays in discharging people from hospitals.
Much of the recent narrative on social care suggests it exists solely to ease pressure on the NHS and is failing to do its job. Many people draw on social care to support them to live independent and fulfilling lives and the continual focus on supporting the NHS, important though it is, devalues the huge contribution care and support makes in its own right to people and communities.
Until the Government understands and presents social care as an essential service in its own right – valued as equally highly as the NHS – we will continue to go from one sticking plaster to the next.
Current pressures can only be addressed by collaborative working in every area between councils, the NHS and wider health and care providers and a range of measures across systems.
We have consistently said that £13bn is needed for social care, so that its many pressures can be addressed, and councils can deliver on all of their statutory duties. This is the level of investment needed to ensure people of all ages can live an equal life and reduce the need for hospital treatment in the first place. Social care will never truly thrive if we continue to fail to address any of the root causes of this situation.
Piecemeal funding is no substitute for a strategic approach to the pressure on hospital beds, which requires a much broader range of actions to prevent admission, streamline discharge for those who do not need ongoing health or social care and focus on capacity to support recovery.
Cllr David Baines, Leader of St Helens Borough Council, Local Government Association
@LGAcomms
It is important, in the context of the question, to acknowledge that this is not the first hospital discharge plan the social care sector has seen.
Every year the sector is faced with a dilemma of delayed hospital discharges as the winter months approach: the attention then turns to the ability of the social care sector to ease mounting pressures on the NHS. By and large, social care has always worked hard to create solutions and provide support when called upon to do so.
The difference this time is that a pot of money has been made available by the Government, which is time limited, to support the discharge process. Colleagues in the NHS have worked, through a Taskforce, to consider solutions in collaboration with local authorities and, for the first time, care providers have been around the table too.
However, group thinking remains very much NHS focused: with strong interventions which providers were able to influence, stressing the need for a wraparound service to support social care teams, as they deliver care to individuals admitted who need ongoing clinical interventions to enable the best possible outcomes
for them.
The funding released by the Government is a short-term fix and on its own it will not create sustainable solutions for the future; however, as a blueprint for future investment to alleviate pressures on the NHS, it stands a chance. Success for the model can only be achieved if there is real investment in the social care sector simultaneously; without that, it’s likely to be another failed initiative from the Government.
To create a sustainable hospital discharge plan that is truly fit for the future, there is an urgent need to establish a social care system which can not only cater for the complexities of the individuals being cared for but is also funded accordingly.
We cannot keep feeding the NHS and starve social care, because by doing so we are continuing to do what we always do while expecting a different outcome. The people we care for deserve much better than this and the Government has a duty to deliver a solution.
Nadra Ahmed CBE, Executive Chairman, National Care Association
@NationalCareAsc