Bed-blocking not our fault, say councils

Social care leaders have rebuffed claims this week that bed-blocking is on the rise because of councils’ failure to provide sufficient social care services.

Half of doctors surveyed by online network thought the problem of delayed discharges from hospitals was worse now than a year ago, while 200 (40%) said it had not improved, in a poll for The Guardian. Doctors blamed the unavailability of social care services, due to council cuts, for trapping older people in hospital.

The number of monthly delayed discharges from acute hospitals in England rose to 2,575 in December 2010 from 2,305 in November, however this is below the figure for September of 2,952.

Social care leaders rejected the idea that councils were to blame for the latest increase, saying that some delays were the fault of the NHS and that the cold weather and outbreak of ‘flu had stretched capacity across the whole health and social care system.

“Funding is under pressure, however people get stuck in hospital for all sorts of reasons; many of them are nothing to do with social care,” said Richard Humphries, senior fellow in social care at the King’s Fund. “It’s important that social care isn’t used as a scapegoat or whipping boy and we mustn’t get into the blame game. It’s important to see health and social care are working together.”

“Councils are under extreme pressures but delays sometimes are due to market capacity and the need to move people [from hospital] humanely,” said Sarah Pickup, honorary secretary of the Association of Directors of Adult Social Services.

Adass and the Local Government Association said “significant progress had been made on reducing delayed transfers” over recent years.

However, Ruth Cartwright, a former hospital social work manager and now joint manager for England at the British Association of Social Workers, said some councils were at fault over delayed discharges.

“Some local authorities have not worked as they should have done with health to facilitate timely discharge [by providing] care in the home coming from health and social care personnel for an interim period.” But she added that a lack of resources were a key problem: “Basically you have a combination of not enough hospital beds, especially in areas where there are disproportionate numbers of older people, and shortages of resources in local authorities.”

She warned the situation would deteriorate due to impending council spending cuts off the back of the government’s comprehensive spending review.

The survey was published a day after the government announced £162m in funding for the rest of 2010-11 to help people leave hospital more quickly through increased funding for home care, reablement services and short-term residential care places. The money will be given to PCTs to pass to councils to spend, according to local agreements.

Pickup said the extra money would help in areas such as improving rapid response capacity but councils could only buy-in services that were available in the social care market.

The funding will be followed by further funding worth about £1bn a year for reablement and post-discharge support from 2011-15.

Cartwright warned that this would be insufficient to relieve pressures given the broader cuts to councils.

However, Professor Ian Philp, the former national clinical director for older people at the Department of Health, said he was hopeful that the money would help tackle delayed discharges and prevent unnecessary hospital admissions, in tandem with a new policy to fine hospitals if patients are readmitted within 30 days of discharge.

Under the Community Care (Delayed Discharges) Act 2003, councils can be fined by hospitals if they are responsible for a delayed discharge because of a failure to provide social care. However, in many areas, fines have not been imposed or have been offset against council contributions to jointly funded intermediate care services.

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