Timely Discharge Series: Two sides of the same coin

Professor Martin Green OBE is Chief Executive of Care England. He is also Chair of the International Longevity Centre and a Trustee of the National Aids Trust. In 2013 he was appointed Visiting Professor of Social Care to Buckinghamshire New University. In 2012, in his role as Department of Health Independent Sector Dementia Champion, he led the development of the Dementia Care and Support Compact for The Prime Minister's Challenge on Dementia.

This is the third blog in the BGS’s ‘Timely Discharge’ series. We aim to raise awareness of the detrimental effects on older people of being stuck in hospital when they are 'medically fit for discharge'. Our blog series explores the causes of delayed discharges, the knock-on effects to the wider health and social care system, and what needs to change.

Ensuring a joined-up health and social care system is no easy task, but one that is at the crux of a system fit for the 21st century. At Care England, the largest representative body for independent providers of adult social care, we want to reclaim the term integration and ensure that people using both health and social care experience a seamless journey. Part of this journey is about ensuring timely discharges to care homes when an older person has been in hospital.

Unfortunately, we have some way to go, as currently there are many logistical issues meaning that older people are often stuck in hospital. This is a loss on all counts; the patient doesn’t want to be in hospital, the NHS doesn’t want the cost or burden especially during the pandemic and the system gets clogged up.  Care homes are in the unique position of having the capacity to help the NHS, if, however, they can recruit the necessary amount of staff.  With the right resources in place, including support from care home staff and the early detection of deterioration, care home residents may be spared emergency admissions. When residents return to the care home from hospital, the right care from care home staff can be invaluable and help them recover, thus reducing the risk of readmission. Throughout the country, there are many providers of high-quality person-centred care, who have demonstrated the improved outcomes that can be achieved when people are supported closer to home and with better access to the communities they live in.

The health and social care reforms outlined by the Prime Minister in September are very much focused on the NHS. Health and social care are two sides of the same coin; you can’t fix one without fixing the other. True integration has been shown to save the public purse money by reducing emergency hospital admissions and delayed discharges. The necessity of integration has only been heightened by the COVID-19 pandemic which has exacerbated funding pressures across health and social care.

Unfortunately, the lack of parity between health and social care was again demonstrated when an additional £5.4 billion was allocated to the NHS to aid the COVID-19 response in early September. Whilst welcome, as the money will see the continuation of the hospital discharge programme, the adult social care sector requires a similar level of investment. Whilst money is being allocated to the health sector, adult social care can create some of the capacity to help reduce the burden placed upon primary and secondary care services by freeing up acute beds. Equally as significantly, the short-term funding is not conducive to meaningful long-term partnerships between the health and social care sectors which should strive to produce consistent, high-quality outcomes. Without meaningful investment, there is a real danger that the sector simply will not be in a position to bid for some of the Discharge to Assess contracts. This is a major sticking point and needs remedying.

A critical part of facilitating true integration is addressing the workforce issues within adult social care. The adult social workforce has shown its enormous importance over the course of the pandemic by performing everyday heroics; our workforce is our best resource and needs to be recognised and rewarded as such. In economic terms, Skills for Care estimates that the sector accounts for 6% of total employment in the UK and the sector’s role in the UK economy is set to grow as a consequence of an ageing population. Such growth is, however, contingent upon the requisite funding and sustainability of the adult social care sector.

Unfortunately, many providers are in the midst of a workforce crisis. The Government’s policy to impose mandatory vaccination on the residential care home workforce, in advance of even consulting our colleagues in the NHS, was not well-executed and has led to staff leaving just at the time when there has never been a greater need. Care is a skilled career and like no other, but it needs sustainable resourcing from the Government.  Care staff deserve better, We Care for England.  

The adult social care workforce needs to be seen for what it is: an exciting, challenging, professional career and we have to ensure that staff are remunerated accordingly. We need to seize this opportunity while social care is at the forefront of the nation’s mind to recognise and celebrate the amazing people who work in social care. In addition, it is important to highlight the diversity of rewarding roles, and opportunities to build a career that makes a difference and is as equally represented as those within the NHS.

As ever there is huge innovation in our sector; it is one of the best things about it. Our members are exploring the role of technology and how this can assist discharges. Whilst we can never replace the vital role that care workers do, technology can help to make the system smarter. This is beneficial for all and a key part of ensuring that people do not need to stay in hospital any longer than is necessary and have the right support once they are discharged. Care homes are home to some 400,000 people across the UK.  A failure to invest in and support the care home workforce undermines the quality of care for some of society’s most vulnerable individuals. It also threatens timely discharge from hospital for older people after an admission by reducing the availability of care home beds with the necessary staffing support. We urge the Government to develop a sustainable workforce solution as a matter of priority to ensure residents are able to receive timely ongoing care in their care home after a hospital admission.