By Cllr David Hare
Central Government is putting £750million into the NHS to help hospital discharge, but is this the answer to an ongoing problem?
Adult Social Care (ASC) is where some people are accommodated, either in care homes or with domiciliary care, and they are often blamed for delays, but what is the real situation?
Former NHS England chief executive Sir David Nicolson recently called the measurement of delayed discharge “useless” and explicitly designed to show social care in a poor light.
Over many years, and especially through austerity, Local Authorities got less and less money from Central Government.
This meant that all the services got less, as ASC is about 40% of the budget for Wokingham this affected the service in many ways. Coupled with this, the fact that the number of hospital beds has halved in the last 30 years, gets us into a different league.
Indeed, many people being discharged do not need residential care, but need the support necessary to re-establish them in the community. But often, if people are discharged into a care home for recuperation, they will get stuck in the care system and sometimes will never return home.
Care workers wages have not gone up anything like enough, they are paid less that supermarket staff. So domiciliary is very short of care workers, these are the people who check someone is managing when they are sent home. As only about 5%, according to the Government, of people leaving hospital need to go into a care home, the people supporting residents in their own home is a vital part of this equation. Whether extra money will now be available for this is a question, but also where do domiciliary staff come from?
If the pay of these staff is increased, quite rightly, to encourage recruitment, what happens when this project finishes, do Local Authorities then have to pick up the increased cost?
Regarding care homes there is a similar problem. Wokingham cannot afford the cost of some of the more expensive homes, the budget is not available. The NHS is not used to placing people in homes, there needs to be an assessment of need, negotiation about cost relative to that need, and agreement about the expected length of stay. If these things are not done the wrong people will have the wrong care plan, and the problem will be moved from Hospital to care home. But are there beds available.
There are some beds available in care homes, but these come at a cost. One problem is staffing, again, care staff deserve to have their wages increased, but if this happens what about the cost to the Wokingham in the long term? If more staff can be recruited to serve the increased number of beds, and this will only happen if wages are increased, the result will again be increased payments for Wokingham, with no increase in money available. Having aired my concerns about the NHS I would say that in Wokingham we work well with the NHS. Indeed with the emergence of the new Integrated Care System I believe we can see a future where we work even better together, not without disagreements but with a common goal to serve the people of Wokingham.
I believe Central Government needs to stop reacting to this difficulty with sticking plaster answers and look at the real problems. The system of care is broken because of long term lack of funding, resulting in a lack of care staff and care homes not having the incentive to run to full capacity.
What is needed is a long-term view, with Adult Care funding increasing, the Local Government Authority say by about £13billion, to pay care staff and to pay care homes, and so their staff, better. If this is not done the problem will keep being booted down the road, with short term answers that will often make the problem worse in the long term.
There is also the fact that hospital discharge must not be the epitome of funding. Keeping people out of hospital, with support in the community, good domiciliary care and appropriate day services, is vital but often overlooked.
These services are important, we can look at initiatives like the Wokingham KIT that helps people remain in the community. This supports people who have been identified as vulnerable, making sure they are cared for in the community and so helping to keep them out of hospital. There is also the fact that discharge from hospital must be at the right time.
Speaking from experience being sent home when you don’t feel ready, then being readmitted some few days later is traumatic, a waste of time and blocks beds. Everyone must be fit to leave hospital (but are there enough beds for this) when they are discharged, re-admittance often means you are in hospital longer than if discharged at the right time.
There is another lesson that, I hope, must be learnt by the Government about last-minute, short-term, emergency funding of social care instead of a worked out, thought through, sustainable plan to deal with a recurring problem. If the investment needed to stabilise social care is too much, at least get some permanent funding into the system to increase care staff wages.
Yes, social care needs more investment to get it to where it needs to be. But in addition to this long-term investment much more would have happened to deal with the problem of people stuck in hospital if last spring commissioners and providers had been asked for their answers to the problem. If they knew they had £750m to deal with the problem, I am sure there would have been innovative ideas to boost capacity in home and social care.
I know many people in Wokingham who want to solve the pain of bed blocking, but don’t get a chance.
Instead, hospitals have been given control of a system they are not experienced in and providers have been left scrabbling around for some of this money. I expect there will be some positives from this input, but it will not be a long-term, sustainable answer to a problem that comes forward year after year and is not only, by a long way, the fault of social care.
Cllr David Hare is the Executive Member for Adult Care and Wellbeing
