Health Secretary Thérèse Coffey has announced a £500 Million fund to help patients leave hospital this coming winter. Across the country, thousands of elderly patients who are medically fit wait days and sometimes weeks to be discharged from hospital. The hold-up is usually a failure to organise the next stage of their care.
The issue is with the adult social care sector which is in crisis due to a severe shortage of staff, with a recent Guardian report identifying over 165,000 vacancies. Meanwhile the BBC found the care staff crisis has left over half a million people, both in the community and in hospital waiting to be assessed.
In a press release, Coffey stated: “The Adult Social Care Discharge Fund will help speed up the safe discharge of patients from hospital this winter to free up beds as well as helping to retain and recruit more care workers. With 13,000 patients in beds who should be receiving care in the community, the aim of the fund is to improve the flow in emergency departments and help reduce ambulance delays.”
How the plan will work
The details of the government proposals are set out in “Our Plan for Patients”. The policy paper indicates that this funding “will support discharge from hospital into the community and bolster the social care workforce, to free up beds for patients who need them.”
The fund spread across 152 local authorities responsible for adult social care will amount to a little over £3 million each. The aim is for the cash to be used flexibly by the local care systems to bolster staff recruitment. It should help smooth the pathway for people who leave hospital when they are ready, with the right care and support in place. The government plans to hold the local NHS and local authorities to account for implementation.
The current Hospital Discharge and Community Support guidance expects the NHS Bodies and Local Authorities to adopt a discharge processes that meets needs of the local population. This includes support for family and unpaid carers. Patients should not be discharged to ‘step-down’ care simply to free up beds. It also states that people don’t have the right to remain in a hospital bed if they don’t need acute care.
So, in order to be discharged, there are two main elements, a place for the patient to go, and someone to assess or provide their care. In both cases, East Anglia is found wanting.
East Anglia care homes in crisis
East Anglia Bylines, through its ‘Spotlight’ team, has already reported on the fact that care homes and home care across the region are in crisis. It found 1 in 5 care homes were either deemed to be ‘In Need of Improvement’, Inadequate’ or ‘Had not been inspected’. It also found that 1 in 3 home care providers were found to not meet the criteria to be classified as ‘Good’ or ‘Outstanding’ with the vast majority ‘not having been inspected yet’ by the Care Quality Commission (CQC).
There have been numerous examples reported across East Anglia in recent months where homes and care providers have been found to fall short of the expectations. Osbourne Court care home in Hertfordshire, staff had so little time, they used wet wipes to clean one resident and only showered and washed their hair once a week. Ashley Care was deemed ‘Inadequate’ due to the lack of time staff had with each client in their home. The main cause was down to not enough staff to cover all the clients on their books.
The Levelling Up, Housing and Communities (LUHC) Committee was told earlier this year that competition for staff from the leisure and hospitality sector has led to a lack of recruitment. NHS Leaders called for a National Minimum Wage for Social Care to prevent an exodus. Figures for 2020-21 show the average hourly wage of an independent care worker is £9.01 while for a barista, according to Indeed, is £9.91.
Health Foundation: $500m is far too little
It is unknown if the government’s £500 million pledge is a new cash injection, or a redistribution of the requested £500m cut in NHS funding sought by the government earlier this year. But it barely dents the over £7 billion a year the Health Foundation reported would be needed to stabilise and improve adult social care in England.
If the government is serious about alleviating the hospital bed bottleneck, then it will first need to spend over ten times its current pledge to reverse the adult social care crisis. As any competent first aider knows, trying to fix a broken leg with an elastoplast doesn’t work.