Care home discharge plan risks inappropriate placements and neglects causes of crisis – sector

Council and provider heads criticise failure to invest in community services to prevent hospital admissions and 'disappointing' casting of social care as servant of NHS following £200m announcement

Home care worker speaking to older person

Government plans for the NHS to discharge people from hospitals to care homes risk inappropriate placements and neglect the root causes of the acute pressures on the health service.

That was the warning from social care leaders today after the government announced £200m for integrated care boards (ICBs) to ‘block book’ residential beds with a view to discharging 2,500 people from hospital.

This is designed to reduce from almost 13,000 the number of people on hospital wards who are medically fit for discharge in order to release pressures across the NHS, particularly on its beleaguered accident and emergency system.

The money is on top of £500m already earmarked for ICBs and councils to clear hospital beds, part of which was allocated last month and which the Department of Health and Social Care (DHSC) said would be well spent on home care, in order to reduce delayed discharges.

Risk of inappropriate placements

However, the Association of Directors of Adult Social Services (ADASS) raised concerns about the focus on discharging people to care homes in the latest fund.

“The best place for most people leaving hospital is their own home – with the appropriate support in the community that they need to recover,” said ADASS president Sarah McClinton and chief executive Sheila Norris.

“Use of the funding should be guided by the ‘home first’ principle, rather than the default being that people are discharged into care homes. Otherwise we run the risk of people being inappropriately placed and then remaining in residential provision indefinitely. Legally, and morally, it is right that they have a choice about where they live.”

ADASS was also among a host of social care bodies to criticise the failure to invest in home and community care that they argued were at the root of why many people were ending up in hospital.

“People are deteriorating in the community and falling into crisis because of lack of community support,” said McClinton and Norris. “We must recognise that long-term, sustainable investment is needed in primary and community based care and support and for family carers.”

‘A decade of consistent underfunding’

For the Local Government Association, community wellbeing board chairman David Fothergill issued a similar message.

“A decade of consistent underfunding of social care and underinvestment in community health services has led us into this crisis and it will not be fixed through tacked-on funding that fails to address any of the root causes of this situation,” he said.

Homecare Association chief executive Jane Townson highlighted that the 13,000 people waiting to be discharged from hospital was a small fraction of the approximately 500,000 awaiting a social care assessment or service, according to ADASS data.

“We need to fix the problem at both ends,” she said. “Most people want to be discharged from hospital back home. Buying up care home beds is a necessary sticking plaster for this winter but does not address underlying causes, so people will continue to be left waiting for care at home.”

Providers ‘unable to recruit and retain staff’

She said that home care providers could not provide the capacity needed to meet demand as they were unable to recruit and retain staff, with vacancy rates of 14.1% as of October 2022.

Townson added: “We call on the government to invest substantially more in home care to maintain and develop the workforce, innovate, improve quality of life, extend healthy life expectancy, take pressure off the NHS, reduce costs, and enable economic recovery.”

Under today’s plan, the NHS would be able to fund care home placements of up to four weeks for discharged people over the next three months.

In a statement to Parliament today, health and social care secretary Steve Barclay said he had asked NHS England to ensure that people discharged to care homes received “wrap-around care…so that it is the shortest-possible stay on their journey home and into domiciliary care”.

Care homes ‘can and do make a difference’

For the National Care Forum, chief executive Vic Rayner said this was “a situation where care homes can and do make a real difference, enabling people to leave the acute system, gain support and rehabilitation, and then continue their journey home”.

“This is already happening in many parts of the country, and the additional funding will make this happen at pace,” she added.

However, she stressed that care homes must be funded to “pay their staff a wage that reflects their expertise and skill in enabling people to build back confidence, health and resilience to enable them to return home, or to continue a fulfilling life within a care setting”.

She also echoed other sector leaders in highlighting the need to invest in prevention and warned against there being a “cliff edge” in support when this funding ends in March 2023, by urging the DHSC to plan for March 2024.

“There may not be enough money, but make a plan, provide some certainty to enable organisations to take on new staff, to invest in new facilities and to develop their in-house rehabilitative resources,” she added.

“Without this long term vision, all of this money will be swallowed into short term fixes such as over reliance on agency staff, or the prioritisation of hospital patients over those with urgent needs in the community.”

‘Disappointing’ narrative on social care

Fothergill, of the LGA, meanwhile, criticised the “disappointing” narrative that social care’s role was “solely to ease pressure on the NHS” and that it was “failing to do its job”.

“Until the government presents social care as an essential service in its own right – valued equally highly as the NHS – we will continue to lurch from one sticking plaster to the next,” he said.

Both the LGA and ADASS also raised concerns about the impact of the NHS purchasing placements alongside councils in local care markets.

For ADASS, McClinton and Norris said the government’s plans would “see the NHS competing with some councils in local care markets”, while Fothergill warned: “The NHS should also agree the purchase of such beds and how the wrap around support will be provided with local councils so that there is a consistent approach to the local care market.”

Care provider representative body Care England, meanwhile, raised concerns about a lack of consultation with social care bodies over the plans.

Policy ‘imposed without proper consultation’

“It is the right policy to discharge people from the hospital when they are medically fit, but yet again, the government has sought to impose this on the care sector without proper consultation,” said chief executive Martin Green. “This policy will fail unless it is driven by a national approach with a proper NHS tariff and specification. If the government leave it to localism, it will fail”

“But there has been little consultation with the social care sector on how this can be achieved. Yet again, the Government has talked to the NHS and pretty much nobody else, and this is why their policies never work.”

Though the funding expires in March, the government has hailed the level of funding it is providing for adult social care from 2023-25, which it said was worth £7.5bn, as “historic”.

This encompasses an extra £2.7bn in grant funding, and the recycling of £3.2bn from delaying the planned “Dilnot” reforms to social care charging for use on core adults’ or children’s services over the two years. Authorities would also have access to an additional £1.6bn should take full advantage of the opportunity to increase council tax by up to 3% and the adult social care council tax precept by 2% in each of the two years.

Were all of this funding to go to adult social care, councils would be able to fund the equivalent of 100,000 additional care packages in each of the two years, ministers have argued.

However, this is conditional on councils raising council tax by the maximum amount and allocating all of the Dilnot funding to adults’ – as opposed to children’s – services.

Fothergill also indicated that the funding was insufficient.

“We have consistently said that £13 billion is needed for social care so that its many pressures can be addressed and councils can deliver on all of their statutory duties,” he said. “This is the level of investment needed to ensure people of all ages can live an equal life and reduce the need for hospital treatment in the first place.”


2 Responses to Care home discharge plan risks inappropriate placements and neglects causes of crisis – sector

  1. Chris Sterry January 10, 2023 at 5:21 pm #

    All of this is so true, for this Government and really all the preceeding Government don’t have a clue and are not only not prepared to listen, they give the impression that they don’t really wish to.

    They have no understanding of the problems and to some extent don’t even recognise there are problems, for to slove problems, firstly it has to be recognised there are problems and then have the wish to solve them, which this Government appears to have little wish to do so on a sustainable basis.

    Sticking plasters are only for the short-terms and even for the short-term the sticking plaster has to be of the right size. Yes, the money going in seems large, but nowhere near how much is needed for even short-term, let alone full sustainability and the sticking plaster has to be applied to the right areas.

    What is being done is so much similar to the Nightingale Hospitals created during COVID, yes good to do, but so ineffective if staffing is not available.

    Social care needs so much, sufficient staffing resources, trained to the correct extent and being paid for being the skilled experts they are and not the dire amount currently paid but also increased travel expenses, much better working conditions, working Bank Holidays recognised and paid accordingly to mention just a few.

    So many more good care workers are required as the shortages far exceed those in the NHS and without them, no matter how much insufficent funding is given by the Government any successes will not be achieved.

    The NHS needs social care and social care needs the NHS so they have to work together, be allowed to work together, but without a listening Government all are doomed to failure, which is then a major failure for the whole of the UK.

    Whether the UK can afford the required funding, it has to for if it does not then the crisises will continue until it is far too late, which is very near, if not here already.

  2. Anon January 13, 2023 at 9:07 pm #

    Covid care home dump Mark 2. So many unlawfully and forcibly moved then kept against their will in March 2020. Legal cases against LAs who failed to undertake best interest assessments. Legal cases against care homes for the impact of the same. Hope many and their families will refuse to comply. Hope care homes have learnt from Covid dumping . Including that the NHS doesn’t give a damn about the care sector. Some will be threatened with forcible discharge home if they refuse to go but will take potentially dying at home unattended over going in to a care home they fear will never leave. Every older and disabled person’s nightmare.