Almost three million hospital bed days lost due to collapse of social care services.
Age UK published the alarming figures on the day the Chancellor announces his Budget.
Findings for the Charity reveal that between just two years (Jan-Dec 2014 and Jan-Dec 2015), there has been a 28.4 per cent increase in the number of hospital days lost due to a lack of social care provision available for people being discharged from hospital[iv]. This increase came in the first year of the Better Care Fund (from April) when it was hoped that pooled funding would reduce delayed discharges.
Cuts to community health and social care services have meant the NHS has wasted bed-days while patients wait for the right care and support in the right place to become available. Looking deeper into the issue, the Charity can reveal there has been a:
- 59.8 per cent increase in bed days lost awaiting a care package at home since 2014 (Jan-Dec 2014: 181,755 days /Jan-Dec 2015: 290,521 bed days lost)[v]
- 13.8 per cent increase in bed days lost awaiting a nursing home placement or availability since 2014 (Jan – Dec 2014: 203,696 days /Jan-Dec 2015: 231,880 days)[vi]
- 9.2 per cent increase in bed days lost awaiting a residential home placement or availability since 2014 (Jan-Dec 2014: 167,685 days /Jan-Dec 2015: 183,114 bed days lost)[vii]
Age UK’s accompanying report: Behind the Headlines, explores the complexities around hospital discharge and looks at the horrible situations often facing older people and their families when it is clear they need follow-up support but none is available. Calls to Age UK’s free Advice Line on delayed discharge have almost doubled in the last three years and some of the callers agreed to share their experiences for the report. The stories reveal what delayed discharge actually means for some older people and what could happen to any older person and their family and friends.
- Ø Terry’s father Richard, 85, is in hospital following a stroke. He is ready for discharge and has been assessed as needing rehabilitative care through two home visits a day. However he was then told that there are no reablement services available in his area. Terry has been told to ‘get his father out of hospital’ and to look for and fund the care himself.
- Ø Liz’s father John has dementia. He has been living at home with his wife Jane, who is his main carer. He has a package of support in place, but his needs have increased recently and Jane feels increasingly unable to manage his behaviour. He was recently hospitalised because of a problem with constipation, but Jane has now been told he will be sent home in the next few days. The hospital social work team does not appear to be involved and there doesn’t seem to have been a review of his care needs. The Community Social Work team have said that if John returns home they will not be able to reassess him for a number of weeks.
- Ø Paul’s wife Mary, 85 years old, is in hospital. She has lost her mobility during her hospital stay. Yesterday the hospital told him Mary was ready for discharge today and she can’t occupy a hospital bed anymore. Nobody has assessed what she will need to help her recover at home, whether she can regain her mobility, or what adaptations are available to help them manage. Paul was able to delay the discharge for a day by getting the Patient Advice and Liaison Service involved but he still wasn’t given any information about her rights, or about how they are going to manage at home.
- Ø Brenda’s friend Lesley was recently in hospital for an operation. In discussions about discharge the social worker enquired about reablement, but the reablement team said this would take two weeks to arrange. Rather than leaving Lesley stuck in hospital, Brenda invited Lesley to stay with her on the understanding that in two weeks’ time she would return to her own home with a reablement package. There were immediate problems in that Lesley needed to take showers morning and evening to prevent her wound from becoming infected but she couldn’t manage this on her own, and no help was offered. And then, to their horror, Brenda and Lesley were informed that reablement services would not be available when the two weeks was up as they didn’t have enough carers.
Age UK argues that a combination of acute shortages of good health and care services to help older people recover, poor co-ordination and sometimes downright buck passing between the NHS and care services, and a lack of information and general confusion about what’s available and who is responsible for paying for care are the main problems behind most delayed discharges of older people from hospital wards.
An NHS bed costs on average £2,121 per week[viii], compared to around £563 for a week in residential care[ix], or £356.58 for home care based on three hours of care a day over the course of one week[x].
Age UK’s Charity Director, Caroline Abrahams, said: “These statistics and our accompanying report describe the slow motion car crash that occurs when you underfund the social care services that allow older people to be safely discharged from hospital – this at a time when demand for such services is constantly rising because our population is ageing.
“Older people, their families and friends, and the overstretched staff in councils and hospitals trying to keep the system going are all victims of the funding decisions that have been made. So too are the hundreds of thousands of people of all ages who have had to wait longer for hospital treatment because of the resulting shortages of available hospital beds for them.
“We show in our report how older people and their families can find themselves trapped in nightmarish situations; under pressure to leave hospital but forced to wait for the care support they need for a full recovery, if indeed this is available at all. Sadly, without it older people may never regain their previous levels of health and fitness. In some cases this means they can no longer live independently, in others that they quickly have to be readmitted to hospital, risking a damaging downward spiral for them all over again.
“This awful situation represents a staggering waste of public funds that also hurts vulnerable older people and their families. It is why we believe the Government should urgently look again at the funding being provided for these kinds of services, acknowledge the need for substantially more investment, and take action to plug the all too obvious funding gaps.”
Responding to the report on, Association of Directors of Adult Social Services President, Ray James, said:
“People deserve to receive the care and support they need in the right place and at the right time. Sometimes that will be in hospital, but when people are well enough to leave, we need to have good care available to get people home safely.
“More people are now living longer, with increasingly complex needs, while adult social care budgets have been cut by £4.6 billion in the last five years. There can be no getting away from the simple truth that the demand for and cost of providing social care significantly exceeds the money being made available by government.
“The Government has promised more money but it is too little and too late. Unless the Government addresses the chronic underfunding of adult social care – and quickly – many services will be at significant risk over the next couple of years, with worrying consequences not only for the NHS, but most of all for older and disabled people, their families and carers. Bringing forward the additional £700,000 per annum funding currently planned for the end of this parliament would go some way to alleviating this immediate pressure.”
[i] “Delayed Transfers of Care Time Series,” NHS England (2015) – https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2015/05/DTOC-England-Timeseries-January-2016-i4R90.xls
[ii] “DTOC – England,” Department for Health (2012) – unpublished data for Age UK
[iii] “Reference costs 2014-15,” Department of Health (2015) – https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/477919/2014-15_Reference_costs_publication.pdf
[iv] “Delayed Transfers of Care Time Series,” NHS England (2015) – https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2015/05/DTOC-England-Timeseries-January-2016-i4R90.xls
[viii] “Reference costs 2014-15,” Department of Health (2015) – https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/477919/2014-15_Reference_costs_publication.pdf
[ix] Laing, W; “Care of Older People, UK Market Report 2014/15,” Laing and Buisson (2015)
[x] Mickelborough, P; “Domiciliary Care, UK Market Report 2013,” Laing and Buisson (2013)