David Wood: Why joined-up thinking is vital over social care

TOO many patients are unable to be discharged from hospital in a timely manner because of delays in putting their social care packages in place.

These delays waste precious NHS resources and put patients at greater risk of contracting a hospital-acquired infection, which will in turn lengthen their hospital stay.

The Government needs to ensure funding for social care is sufficiently in place, that there is greater connectivity between the NHS and social care providers and, crucially, that funding is protected so patients can always be discharged as soon as they are medically fit.

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Social care budgets need to be considered alongside NHS budgets because cuts to the social care will ultimately have a negative effect on the NHS. 

Social care services – provided by local authorities – are usually provided in a person’s home or residential setting. They cover everything from getting a person out of bed, washing and dressing, to round-the-clock care in a nursing home.

These services provide essential support for people, which allows them to remain living, fulfilled healthy lives for longer and keep them out of hospital. Social care also provides support for people to rehabilitate and recuperate after a hospital stay.

Of course social care, unlike the NHS, is not free at the point of delivery. Some people over the age of 65 will get help with the costs, but others have to pay the full cost of the care.

Indeed last year only 650,000 people received help with social care from their council, out of 1.8 million requests. This is one reason why Chancellor George Osborne paved the way in last week’s Autumn Statement for town halls to raise council tax bills by up to two per cent – provided the extra income is spent on adult social care.

Delayed discharges, also known as bed blocking, is a term used for patients who are medically fit to be discharged but are unable to be. Across England, several thousand patients are still occupying medical beds even though they are medically fit.

However, they haven’t been discharged because of problems accessing social care services. According to figures compiled by the NHS in England, the numbers of delayed discharges have increased by over a quarter since 2013. Indeed, just last week, over 5,000 patients were medically fit to be discharged but still occupying hospital beds. This is before the winter pressures really start to pile on.

Cuts to social care services may have provided financial savings to the social care budget, but they are having a knock on effect on the NHS budget despite the Chancellor “front loading” the extra money promised by the Tories before the election.

It is far more expensive to keep medically fit patients in hospital beds, than it is to discharge them and to provide social care support for them in the community.

Given this, it is vitally important that the social care budget is viewed alongside the NHS budget and that healthcare professionals are able to provide a seamless service so that social care packages are able to be put into place as soon as they are needed.  

These challenges have knock-on effects elsewhere within the NHS, For example, patients in A&E departments are waiting on hospital trolleys beyond the four-hour target wait time to be admitted to a ward – only 88 per cent of individuals are seen within this benchmark target according to the latest figures.

It’s not difficult to see that if patients are occupying beds when they are medically fit to be discharged, then those beds are not available for other patients who need them – hence the number of non-urgent operations being cancelled.

The Local Government Association predicts that if extra money is not found for the social care system, then the shortfall will be £4bn by 2020 – it does not expect the increase in council tax to cover this.

Unfortunately, while social care budgets are being cut, the need for care is increasing due to our ageing population. Councils have been warning for years that a lack of funding is causing significant challenges and it’s clear the Government need to listen. We need to develop a long-term strategy to deal with an ageing population that will have greater social care needs in the future.

Greater integration is needed in the health and social care sectors, so England could follow the example of Scotland and merge the NHS and care budgets.

Already the Government is promising greater autonomy in some areas within England, for example in Greater Manchester as part of the devolution deal. Everyone interested in seeing a sustainable health service going forward will watch with interest to see how this develops. If it delivers greater connectivity between health and social care, and a better experience for patients, it could prove a model worth following across the country.

David Wood is Principal Lecturer in Adult Nursing and Public Health at Sheffield Hallam University.