Four in ten people whose discharge from hospital is delayed are awaiting a social care package, according to NHS data.
The figure, revealed today in a government plan to reduce hospital pressures, came as council leaders criticised ministers for a narrative of “blaming” social care for delayed discharges.
About 14,000 hospital beds in England are occupied by a person medically fit for discharge, up by one-third on pre-pandemic levels, said the delivery plan for recovering urgent and emergency care services.
Statistics breaking down how far delays were attributable to social care, NHS or both services stopped being collected in 2020 because of the pandemic. As a result, it is not been possible to accurately identify the causes of the rise, particularly with both services under severe pressures.
Narrative ‘blames social care for delays’
However, in an open letter to health and social care secretary Steve Barclay, published yesterday, council leaders criticised a narrative which “frequently presents social care as being at fault or to blame for all delays to discharge, despite social care having never been the primary reason”.
The plan, published by the Department of Health and Social Care (DHSC) and NHS England today, said that, on average:
- 24% of people delayed in hospital were awaiting home care;
- 16% were awaiting a nursing or residential placement;
- 24% were awaiting intermediate care, a short-term free service, either at home or in a bed-based setting, that is often jointly funded by the NHS and councils.
“We are concerned about the manner in which social care is being portrayed and the level of engagement with local government in national discussions about delayed discharge,” said the letter from the Association of Directors of Adult Social Services (ADASS), Local Government Association (LGA) and council chief executive and senior manager body SOLACE.
The letter follows concerns from social care leaders about the government’s allocation of £200m to the NHS this winter to help reduce delays by block-booking care home placements for up to four weeks. This is in addition to £500m made available for a wider range of services to reduce delays, including home care.
Concerns over inappropriate or unlawful placements
The focus of the £200m on bedded services prompted concerns from social care readers that it risked people ending up inappropriately placed in residential settings, potentially without informed consent, which would be unlawful.
In their letter to Barclay, ADASS, LGA and SOLACE said they were not opposed to the approach, but that conditions needed to be in place to avoid it “leading to people spending longer than necessary in care homes and costing the taxpayer more as a result”.
These included making the quality of care a “fundamental consideration”, with the letter saying that using services rated inadequate or requires improvement by the Care Quality Commission “may not secure the desired outcomes for people and may put further pressure on these providers”.
Call for extra funding across range of services
The letter also set out ADASS, LGA and SOLACE’s priorities for future action to tackle pressures on hospitals including:
- boosting support for unpaid carers to tackle high levels of breakdown;
- increasing care worker pay to tackle serious recruitment and retention problems that saw the number of vacancies rise by 52% in 2021-22;
- investing in voluntary sector provision – such as sitting or home from hospital services – to provide low-level support when people return home;
- funding therapeutic reablement services to help people recover on leaving hospital;
- resourcing NHS primary, community and intermediate care to help resolve crises and prevent hospital admissions.
These were, in part, reflected in today’s NHS England and DHSC plan to reduce future pressures on urgent and emergency care, with a view to getting services ready for next winter.
On adult social care, the plan reiterates the government’s claim that it is making available up to £7.5bn in additional over the next two years. This has been criticised by some in social care on the grounds that £3.2bn was recycled from the delay to the social care charging reforms and is also to be split with children’s services while £1.6bn is reliant on how much authorities can raise through council tax.
The DHSC and NHS England said the extra resource would increase sector capacity, in order to deliver more care packages, and help care providers develop long-term plans to grow their workforce.
Plan to free up social workers
The plan added that it would also allow councils, the NHS and social care providers to “streamline discharge, assessment and placement processes and help to free up greater social worker time and capacity”.
It added: “This will have particular benefit to patients who are likely to require a permanent care home placement or specialist housing placement, including some people with dementia and severe mental health needs.”
On the care workforce, the plan cited a separate £500m pot that was being used to boost skills and wellbeing from 2022-25, and the government’s relaxation of immigration rules to boost international recruitment of staff.
Increasing NHS capacity in community
The plan also included measures to boost the capacity of intermediate care and community health services. Multidisciplinary urgent community response teams, designed to provide care to older people and those with complex needs in an emergency to avoid hospital admissions, would be expanded so that more people can be referred to them next winter.
In addition, the NHS would also increase the capacity of “virtual wards” – through which people can be monitored at home – from 7,000 to over 10,000 beds this autumn.
Trailing the plan yesterday, Barclay said: “Up to 20% of hospital admissions are avoidable with the right care in place. By expanding the care provided in the community, the most vulnerable, frail and elderly patients can be better supported to continue living independently or recover at home.”
ADASS and the LGA were also quoted in the DHSC’s press release on today’s plan, with the directors’ body’s president, Sarah McClinton, saying:“We recognise the importance of expanding and joining up health and care in people’s homes to stop them needing to go into hospital and enabling people to leave hospital safely with therapies and support to recover.
“Key to achieving this will be co-producing plans across health and social care and investment in the workforce in social care and community services and we look forward to engaging with this.”