Delays in discharging people from hospital due to problems arranging social care support rose sharply this summer, NHS figures show.
Between April and September patients spent 261,324 extra days in hospital due to social care issues – an increase of 33% on the same period last year.
Around 30% of all delayed discharge days are now due to social care. Last year the figure was around 25%. Hold-ups sorting out home care packages are the most common reason, accounting for more than a third of cases.
Delays where both social care and health services were responsible rose 23% – from 52,406 days last summer to 64,617 this year. Delays attributed solely to the NHS rose 0.29% – from 526,998 to 528,552.
James Thompson, an analyst at the King’s Fund, told Community Care that after years where increases in NHS-related delays generally outstripped rises in social care delays, the trend was shifting.
He said: “Although the overall number of delayed discharges is rising, social care is increasing at a faster rate. The figures suggest issues with the capacity of home care and residential care services. When it’s time to discharge someone it appears there are fewer options.”
More complex needs
Grainne Siggins, urgent care lead at the Association of Directors of Adult Social Services (Adass), said pressures that traditionally spiked during winter were increasingly being felt all year round.
She said: “There are signs more people are being admitted to hospital with multiple needs and long-term conditions and the support they need on discharge is more complex. They often need calls four times a day and double handed care.”
Securing those care packages can be particularly hard when social services are only informed about decisions to discharge a patient at short notice, said Siggins. Some councils are also struggling to recruit enough home care workers to meet demand, despite offering “significant” hourly rates to providers, she added.
Siggins said Adass is working with NHS providers on ways to minimise delays. Revised guidance has been issued and work is underway to promote earlier discharge planning and increased use of reablement and intermediate care: “We need joint planning and to work on this proactively together. These are all system delays and often make things very difficult for individuals who could leave hospital.”
Commissioning criticism
Colin Angel, policy and campaigns director at the UK Homecare Association, said the shortage of care workers to meet the pressures, particularly over winter, was due to “consistently poor” commissioning by local authorities and NHS commissioners.
He said: “To plan successfully, councils and clinical commissioning groups need to include home care providers from across the local market in their forward planning and contract terms need to be agreed between commissioners and providers that will enable effective recruitment.
“Just expecting providers to deliver over winter on existing purchasing arrangements is simply not going to work.”
Councillor Izzi Seccombe, the Local Government Association’s community wellbeing spokesman, said: “Health and social care leaders widely recognise that a properly funded social care system is essential to alleviate the pressures on the NHS.
“We urgently need adequate funding for social care from the government in the spending review to make sure that local areas can deal with winter pressures – or we risk leaving our most vulnerable to suffer unnecessarily in hospital in the coming months.”
A Department of Health spokesperson said the government was increasing funding for the NHS, adding: “This will tackle the underlying challenges to join up care for patients, improve access through seven day services and do more to prevent illness in the first place.”
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This is a very one sided headline… Firstly, it’s the NHS that register the reason for DTOC’s, with approximately 50% of the alleged social care delays actually being health delays and patients not actually being fit for discharge (or because of ‘family choice’ whereby rightly so, people should have the right to choose where their relative should live – a human right, not a social care ‘delay’); secondly, when you look at these statistics in the full context and notice that in some areas length of stay in hospital has actually halved, you realise that the emphasis has shifted to care needs that would have been met in hospital, now needing to be met in the community (by social care services). Length of stay in hospital hasn’t halved simply because the population has started healing twice as fast, it’s because the care needs have moved into the community – the right thing of course, people being better at home rather than in hospital, but the funding hasn’t followed these needs and still social care gets the bashing for the failures in acute hospital discharge targets. Perhaps it would be better to sort out the failures in primary care, so as less people are admitted to hospital in the first place, therefore easing the demands on discharge rates?
Quickly? Were you in Brussels protesting in March 2004 when the European Union prcruoement directive that imposed any willing provider on us was agreed? I think the proposal to insist on qualified providers in the NHS will be an improvement, and I think Clinical Commissioning Groups with their patient focus and duty to engage local people in decision-making will be a breath of fresh air.Many of the best non-NHS providers are charities and Community Interest Companies that re-invest in healthcare in the same way that NHS Foundation Trusts do. Some are public companies that draw capital investment into the NHS from pension funds and from abroad. Private profit-making companies are rare in healthcare, and local people are going to get the final say on whether to use them.
Oh dear, does this mean the NHS is getting better at blaming Social Services for its woes? Are they really succeeding in convincing people that the continuing reduction in the number of hospital beds (12,265 fewer beds in the last 5 years alone) has nothing to do with it? We will of course believe that the NHS is not systemmatically cost shunting and illegally shifting responsibility when we see the Continuing Healthcare figures increase in proportion to the cut beds!!
Totally agree with this. There will always be enopeticxs (e.g. clearing hospital beds during a declared state of emergency), but I’ve worked with care homes and extra care housing sites where it’s not out of the question for people to arrive unannounced from hospital at 2:00am. Sometimes they don’t even have the right medication with them. Hospital discharge is a critically important transition point and poor facilitation strips people of their dignity, abuses the goodwill of care and support staff, causes distress for families and can lead to deterioration in health states and financially costly hospital readmissions.
The headline is indeed a bit scewed but that is hardly surprising in a source aimed at a social care readership. The actual figues show that about 62% of delayed days are down to the NHS (waiting for medicines, tests or consultants to do ward rounds etc) while 31% are down to social care reasons and 7% are attributable to both.
Statictically, the pure NHS number is the largest but that still leaves a large degree of responsibility with social care organisations. The SC number has increased over the period from 26 to 31%. NHS delays tend to be quite short eg while waiting for drugs or a ward round but a smaller number of SC delay episodes can lead to a very much increased number of days lost while waiting for either funding or an available place.
This is a “whole system” problem that is not helped by blame-shifting or defensiveness. It is not good for the tax-payer overall or for the individuals concerned and their families to have people stuck in hospitlals past the point where there is a medical need for them to be there.
I am appalled at the thuohgt of private profit making companies coming in and undermining the NHS. As a tax payer my opinion has not been sought. Private companies will mean less patient care, less staff training, less research and generally less caring system. What happens when a client chooses their provider, then is dissatisfied with the service of equipment? Can they just switch provider? What happens to the equipment? Lots of unanswered questions. How did this happen so quickly with very little local consultation. Very disgusted.I expect a prompt reply as you are all so efficient with the shiny website and pushing AQP through so swiftly.
The issue here is not blame shifting or defensiveness but political manipulation. The politicians and civil servants pressurize the poor staff trying to keep services running with a series of statistical manipulations and associated press releases. NHS England bed numbers have been reduced by 4,000 in the last year, and over a 180 day period there is an increase of 87,000 bed days in the delays. That actually represents a pretty substantial saving for the Whitehall mandarins who have a net profit of 4,000 x 180 days – 87,000 = 633,000 bed days. Oh, and just for accuracy – the figures show that average length of NHS delays continues to be greater than the average for LA delay.
Agree with all of the above, especially the need for the whole system review and that needs to include home care providers. I have worked in both hospital social work and home care supporting people discharged from hospital and the solution needs to to liaise with all of these and the manner services are commissioned too. No good having 7 day NHS, social services if home care can’t rota or have funding to ensure they can build in the necessary resources to respond at rhevdropvof a hat. Hope many contracts involved that degree of on call cover????
The point raised in the first comment regarding ‘family delays’ is equally poignant. The definition of medically fit which can be called at the click of a finget- complex and life changing decisions can not and there needs to be an acceptance of that. I like the idea of bed based enablement to give people time but have equally experienced such arrangements done on the cheap- staff who have no idea that theyre even an enablement service whose role is to promote confidence and help people trying to get home! Such services can work in my view but need proper investment and experienced care workers who are appropriately rewarded for their skills and experience to support our older people in their recovery.
I also strongly agree that pantiets should not be discharged later than 6pm. I have recently experienced two attempts by our local hospital (where I work) to discharge my elderly father; the second failure being due to an adminstration error and argument between transport department and the ward. He went from supposedly being discharged and transported home at 4.00pm to being lugged back to the ward and put to the bottom of the evening transport list arriving at home at 8.30pm. He is 92yrs old. Less than 36 hours later he was readmitted with chest pain, shortness of breath and hospital acquired pnemonia. That was 3 weeks ago he is still in the hospital!. The rush to get the elderly out is appalling and it doesn’t seem to matter what time of day or night and how much distress is caused to both them and their relative/carers.
After all is said and done…all the calculations are gathered and the percentage of blame is portioned out to either the NHS, Community Care or Families…has anybody stopped to understand what is really occurring here? We all have problems, mainly down to funding, being understaffed because of budget cuts in all areas, proportioning blame will not cure the ill! Social Care and the NHS are supposed to be working in partnership.. the Government like to take the spot light away from themselves by commissioning surveys and letting others take the responsibility whilst everybody else tries the blame culture!
The opportunity might be taken to sthetgrnen the requirement to plan for discharge of hospital patients [peferably using the term ‘transfer of care’] by specifying other than in wholly exceptional circumstances, no patient is to be discharged from hospital at a time of day that results in arrival at the destination later than 1800 hours. There may well be good reasons for discharging patients in the evening, but such discharges should be the exception, and should only be arranged with the knowledge and consent of the patient/carer/relative and the receiving place, eg care home, where appropriate.The legislation at present makes no such restriction, whiohc has meant that some patients are discharged not only later than 6pm but also later than 11pm. Imposing a much earlier deadline than 11pm would ensure the overnight’ discharges are elimnated and help to prevent evening’ transfers as well.