ResPublica’s latest report, Care after Cure: Creating a fast track pathway from hospitals to homes, argues that delayed transfers of care, and the high costs that go with caring for patients who no longer need specialist acute care, must be resolved to free up much needed hospital capacity.
The NHS, and hospitals in particular, are under increasing strain in terms of both funding and capacity. There has been a sharp increase in A&E targets not being met, and many hospitals are currently at almost full capacity. Acute trusts are projected to record unprecedented financial deficits this year. One of the causes of this increased pressure is the significant number of frail, elderly people unable to be discharged from hospitals to settings that are more appropriate to their needs, resulting in so-called ‘bed blocking’.
Meanwhile, despite welcome attention in the 2015 Comprehensive Spending Review, the social care sector remains in desperate need of further new funding. ResPublica’s previous work on this important area culminated in the publication in November 2015 of The Care Collapse, which revealed the reliance of the health service on the beds residential care provides. If residential care does not receive the financial resources it requires, it will be the NHS – already facing significant pressures – which will feel the effect.
Care After Cure examines how to reduce these pressures on the NHS by making better use of existing residential care facilities, and asks what is needed to allow residential care to step up and take on a more substantial role in the health and social care ecosystem through working more closely with providers of healthcare. The report proposes a ‘Fast Track Discharge Fund’, worth more than £3 billion over the next five years, and funded out of existing NHS budgets, to both pay for residential care beds to accommodate patients with no medical need to be in hospital, and invest in skills, training and facilities within the residential care sector.
We believe that by using funds already due to be spent on patients in hospital experiencing delayed transfers of care to bolster residential care provision and care capacity, we can both improve the precarious financial position of the social care sector and alleviate demand and financial strains on hospitals. We argue that this is an investment – albeit out of existing funds – that policy-makers cannot afford not to make.
Dr Sarah Wollaston MP, Chair of the Health Select Committee, said: This report from ResPublica provides compelling evidence that social care cannot be seen in isolation from the NHS. There is an urgent need to improve access to social care and to address the delayed transfers of care and this can no longer be side-lined by policy makers.”
Baroness Joan Bakewell, a champion for older people, said: “Care homes are vital to our community and most importantly to the people who live in them. I welcome ResPublica’s report that acknowledges the important role that care homes play in our society and proposes important mechanisms for ensuring their sustainable future.
“We value the work good care homes do and this report acknowledges this role and can contribute to securing it for the future. Helping vulnerable people with dementia to live in an environment appropriate for their needs, rather than in an environment not suitable for them, is crucial. Bed-blocking in hospitals causes great grievance to vulnerable elderly people, and this report is a great first step in helping this situation.”
Ian Smith, Chairman of Four Seasons Healthcare, said: “Discharging medically stable patients from hospital to a recovery period of care in a nursing home is a good idea that works in practice. We know because is already happening in our homes, although so far it is on a relatively small scale. We currently have around 375 people who are recuperating in our homes while their longer term care needs are assessed and arrangements made for their ongoing care. It is freeing up hospital beds and saving NHS budgets. We recently launched a 24-7 rapid response assessment and admissions service that helps hospital discharge teams to locate care services in appropriate homes.
Mike Parish, Chief Executive of care provider Care UK, said: “The most critical issue facing our NHS hospitals is inpatient and A&E congestion caused by the unnecessary admission of patients, due principally to limitations in primary care, and difficulties in discharging frail and elderly patients because of the under-funded and under-developed state of social care.
“This causes unnecessary distress and harm to these patients and is immensely costly.
“This can be addressed through more effective partnership and investment in better resourced and technologically enabled forms of primary and social care, and this report makes a strong case for such strategies.”
Justin Bowden, GMB National Officer for the care sector, said: “The crippling costs to the NHS of bed-blocking prove that there is no place for austerity in the funding of social care – to do so is morally indefensible and financially stupid.
“The future of the NHS is intertwined with the fate of social care; as government underfunding sends social care down the pan, so the NHS is dragged with it: bed-blocking rises, we spend money we don’t need to spend keeping people in hospital who shouldn’t be there and, to cap it all, make many of them sicker by doing so.
“Proper investment now in the residential care sector, which is willing and ready to help with the bed-blocking crisis in the NHS, is cheaper in the long run, better for those who should be discharged and frees beds for those who actually need to be in hospital.”
Peter Kyle, the MP for Hove who has campaigned for better care for the elderly, said: “The situation in the residential care home sector is dire at the moment. The 2% precept and the Better Care Fund are supposed to make up the gap in public spending on the social care sector, but there is little confidence that they can – or will – do this. I welcome ResPublica’s practical proposals as an important step in developing funding models for a more sustainable health and social care system.”
Key recommendations of the report include:
Create a Fast Track Discharge Fund, which will pay for out-of-hospital beds and invest in the residential care facilities necessary to care for ‘bed blocking’ hospital patients safely in the community.
Ring-fence, out of the existing NHS budget over the forthcoming five years, the £3.3 billion we project will be spent on inappropriate in-hospital patient care to 2020/21 for the Fast Track Discharge Fund, to enable CCGs to both directly commission residential care beds and train and upgrade clinical care staff and facilities in residential care.
Conduct an independent review into the working of the Better Care Fund, to analyse operations, identify funding flows and recommend improvements.
Emily joined ResPublica in June 2015, and acts as Principal Research Consultant, with a focus on health and public services. She is a specialist in the transformation of public services, including the health, social care and welfare to work sectors....
Duncan joined ResPublica in September 2014. He graduated from Oxford University (Keble College) in July 2014 with a degree in Politics, Philosophy and Economics (PPE), where his studies focused on UK and US domestic politics and central banking. His interests...
Claire Read is a professional writer and editor who has specialised in healthcare throughout her 15 year career. She is a regular contributor to Health Service Journal and DigitalHealth.net (formerly E-Health Insider), with her work also appearing in publications including...