The government announcement of an extra £200 million to move patients fit to discharge from NHS beds to care homes, and other settings, has received a mixed reception – NHS leaders say they need the money as soon as possible to begin freeing up beds and are concerned there will be delays, in contrast social care leaders warn that the pressure to discharge patients fast has already led to inappropriate placements and the scheme is just another “sticking plaster” that doesn’t address the long-term problems.
There are an estimated 13,000 people in NHS hospitals that are fit to discharge and the scheme, announced by Health and Social Care secretary Steve Barclay, aims to free-up around 2,500 beds by funding “maximum stays of up to four weeks per patient” in care homes or other settings. The scheme runs for just three months to the end of March 2023.
The scheme is similar to the national discharge scheme begun in 2020 as the NHS needed beds for Covid patients, which led to thousands of patients moving out into care homes. Funding for this scheme ended in April 2022.
This £200m is in addition to the £500m adult social care discharge fund (ASCDF), announced in September 2022. However, Barclay claims that the extra £200m means the NHS will be able to “immediately buy up beds in the community.”
NHS leaders fear, however, that the distribution of the money will be as slow as the £500m ASCDF; it took many weeks to distribute the first £200m of the ASCDF, and the final £300m is only now being distributed to organisations .
One national NHS leader told HSJ: “If this announcement is to be anything more than politically-driven theatre and have an impact before the start of spring, then the money needs to be in place in the next week to 10 days.”
In contrast, The British Geriatrics Association (BGA), the Association of Directors of Adult Social Services (ADASS), the Local Government Alliance (LGA), and charities that work with the elderly, fear that the rapid discharge of people from hospital means they could end up in care homes or hotels which are totally unsuitable for their needs. The BGA noted:
“In order for this to have the intended impact, care homes must be able to provide the necessary rehabilitation to help older people recover. This requires expert input from nurses, therapists and medical staff. If this expertise is not in place to aid recovery, then older people’s health will continue to decline and hospital readmission becomes more likely.”
The ADASS is also concerned about the focus on care homes, when if the right care package is in place, home is the best place. Chief executive Sheila Norris noted:
“Use of the funding should be guided by the ‘home first’ principle, rather than the default being that people are discharged into care homes. Otherwise we run the risk of people being inappropriately placed and then remaining in residential provision indefinitely. Legally, and morally, it is right that they have a choice about where they live.”
Hospitals in Devon, Cornwall and Dorset are already discharging patients into hotels. With beds booked in hotels in Plymouth and Bournemouth for what are described as “medically fit guests” with social care needs.
Louise Jackson, health and care manager for Age UK, told the BBC that care hotels were “unlikely to be appropriate settings” and added that “this is another sticking plaster, whereas what we need is sustained core investment.”
This constant reliance on short-term funding schemes, means that nothing has been done to tackle the root problems of why so many people are ending up in hospital. David Fothergill, chairman of the LGA community wellbeing board told CommunityCare:
“A decade of consistent underfunding of social care and underinvestment in community health services has led us into this crisis and it will not be fixed through tacked-on funding that fails to address any of the root causes of this situation.”
Fothergill added:
“Until the government presents social care as an essential service in its own right – valued equally highly as the NHS – we will continue to lurch from one sticking plaster to the next”.
Jane Townson, Chief executive of the Homecare Association, the membership body for home care providers, highlighted that the 13,000 people waiting to be discharged from hospital was a small fraction of the approximately 500,000 awaiting a social care assessment or service, according to ADASS data.
“We need to fix the problem at both ends,” she said, “buying up care home beds is a necessary sticking plaster for this winter but does not address underlying causes, so people will continue to be left waiting for care at home.”
It is clear that these short-term funding schemes also do not address one of the major issues in social care, the workforce crisis.
Home care providers can not provide the capacity needed to meet demand, according to Townson, as they were unable to recruit and retain staff, with vacancy rates of 14.1% as of October 2022. Overall, there were 165,000 vacancies in social care, up 52% over the previous year. With the median hourly rate of a care worker listed as just £9.50 and with an HCA with two years experience getting only £11.30, it is clear that pay is an issue. Supermarkets and other retail outlets pay more.
Without a plan for long-term funding increases, however, neither homecare companies nor care homes can invest in new staff or increase pay rates. Martin Green of Care England, which represents the largest private care home providers, has said it wants the government to pay them £1,500 a week per person, citing the need to pay care workers more and hire rehabilitation specialists. The current rate of pay is described by Green as “inadequate”.
More than anything, however, the industry would like a long-term plan, as the chief executive of the National Care Forum Vic Rayner told Community Care:
“There may not be enough money, but make a plan, provide some certainty to enable organisations to take on new staff, to invest in new facilities and to develop their in-house rehabilitative resources. Without this long term vision, all of this money will be swallowed into short term fixes such as over reliance on agency staff, or the prioritisation of hospital patients over those with urgent needs in the community.”
And as the BGA notes what happens after the three months of funding ends, it will be the same problems just in a few weeks time:
“There is a risk that discharging older people to care homes will simply move the problem down the line and we will be in the same crisis situation in two to three weeks as older people come to the end of the funding period and have ongoing health and social care needs.”
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