In May, the Parliamentary and Health Service Ombudsman (PHSO) published A report of investigations into unsafe discharge from hospital. It highlighted nine serious cases to demonstrate how best practice is far from what people experienced when leaving hospital.
In a follow-up to this report, the Public Administration and Constitutional Affairs Committee (PACAC) describes the incidence of unsafe discharge from NHS hospitals as ‘unacceptably high’ and the separation between health and social care as ‘political maladministration’.
The Committee makes itself quite clear where it sees the root cause of poor discharge outcomes, ‘A lack of integration between health and social care is preventing seamless discharge processes, coordinated around the patient’s needs. The NHS must support local areas to adopt the best models of integration.’
‘At a structural level, the historic split between health and social care means that interdependent services are being managed and funded separately. We consider this to be political maladministration.’
‘The Government has developed promising plans to tackle this structural disconnect between health and social care, from the Discharge Programme Board to the Better Care Fund and long-term integration policy, but they are far from implemented.’
‘Barriers to the implementation of best practice are prevalent both within hospitals and at the interface between health and social care. We heard that pressures on resources and capacity within hospitals are leading to worrying and unsafe discharge practices. We call upon health and social care leaders to ensure that staff are operating in a culture where person-centred care is the undisputed priority’.
I know that social care providers share huge frustrations around the apparent lack of willingness from health partners to embrace their services as a joint solution to improving outcomes for discharged patients. It seems obvious that separate funding and the pressures on NHS budgets are blinding decision-makers to what is best for those they serve. That leads me to ask, how can this cycle be broken?
The PACAC recommends that:
- The Secretary of State for Health establishes a clear set of objectives for the Discharge Programme Board, together with success measures and timelines, so that its progress can be measured.
- The Government explains what is happening in parts of the country where funding for the Better Care Fund from the New Homes Bonus does not materialise.
- The Government sets out a route map demonstrating how arrangements for long-term, sufficient, sustainable and integrated funding for adult social care will be implemented, by March 2017.
- The Government sets out a clear plan for implementing integrated health and social care plans across the country, as pledged in the 2015 Spending Review.
Whilst these recommendations could, very well, go some way to unravelling this crisis, what is the likelihood of their adoption and implementation?
I’m sure that we, in social care, can be forgiven for thinking, ‘here is another set of recommendations to be ignored’. Report after report make similar observations about how our sector is a crucial component in solving NHS issues, yet little seems to change.
What bewilders me is why we have these important and necessary bodies, when the Government doesn’t appear to act on their recommendations. How can the discharge issue possibly continue to go unaddressed, when the PHSO and the PACAC jointly raise specific concerns and recommend remedial action? If these reports get confined to the filing cabinet like so many before, I question the worth of their existence.
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