Care package chaos

More revelations of the often chaotic state of services for older
people have emerged as legislation to impose fines on local
authorities deemed responsible for bed-blocking passes through
parliament. The fines, under which hospitals will be “reimbursed”
by councils for the cost of delayed discharges, are expected to
come into effect in April when the odds will still be heavily
stacked against social services departments. And, in addition to
genuine delayed discharges, there is mounting evidence that GPs are
getting their patients into hospital beds purely to secure an
adequate care package for them when they return to the
community.

Funding earmarked to alleviate the crisis is unlikely to have the
desired impact when, only last year, it cost the NHS £720m in
one quarter alone. To rub salt into the wound, many councils that
pinned their hopes on the 6 per cent annual increase in social
services spending announced in the budget are now finding that they
will get much less. Adjustments to the funding formula mean that,
while some departments will get as much as 8 per cent, others –
predominantly those in the south – will get as little as 3.5 per
cent. The changes reflect population changes and deprivation
indices, but this will be small consolation to the many departments
that are already heavily overspent on their budgets. By last April
overspends were running at £200m in total and there is every
indication that the chorus of calls on departments’ resources will
grow louder still, not least from services for older people.

For one thing, there is a gathering storm over the level of care
home fees, with the Coalition for Care threatening to advise its
members that they should not accept residents unless fee levels are
“commensurate with the amount of care given”. In practice, this
would mean a hike in fee levels of up to 30 per cent. Then there is
the target of a 30 per cent increase in intermediate care provision
by 2005-6. Not only does this have significant cost implications in
its own right, but in the meantime the scarcity of care packages
designed to prevent admission to hospital in the first place is
likely to continue. For some councils, the figures will simply
never add up.