Joint letter from the LGA, ADASS and Solace urging the Government to fully engage with local government and its partners in future discussions about tackling pressures in hospitals.
Rt Hon Steve Barclay MP
Secretary of State for Health and Social Care
Department of Health and Social Care
39 Victoria Street
cc: Helen Whately MP, Minister for Social Care
Dear Secretary of State,
Re: Winter pressures and discharge
As in previous years, local government is a willing and committed partner in helping to alleviate demand pressures facing the NHS. This winter, with the scale of pressures so severe, councils’ adult social care teams are working around the clock to mitigate the strain our health service is under. We fully recognise the extent of the pressure, the urgent need to address it, and the level of priority afforded to the issue by the Government.
However, 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.
You will of course be aware of the interdependence of health and social care and that pressure in the NHS is also impacting on social care, particularly in relation to primary, community and mental health services, increased levels of need, and people waiting for NHS treatment. Whilst we have been prioritising the needs of people in relation to abuse and neglect and hospital discharge, more people are waiting for care at home, some will inevitably deteriorate and need hospital treatment, and this will inevitably be accelerating a vicious circle.
The narrative 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. Indeed, there has been a significant increase in care at home delivered by social care, albeit that need has increased even more rapidly.
We agree with the Department’s March 2022 hospital discharge and community support guidance that simple discharges are likely to be a minimum of half of all people discharged. We also understand that adult social care currently accounts for less than 50 per cent of delayed discharges. Whilst there is rightly attention on the risks to, and experience of, people waiting to get treatment in hospitals, it is also important that these risks and experience are in focus for those being discharged: there is a risk of this being lost in all the talk of “beds” and “flow”.
Social care cannot be both part of the problem and not part of the solution.
It is therefore critical that local government, the wider sector, and people who draw on care and support, are represented at relevant national discussions on how best to tackle the issue of pressures on hospitals.
We have always valued the opportunity to engage directly with Ministers and senior officials, attending every forum to which we have been invited. We therefore urge the Government to fully engage with local government and its partners in future discussions about tackling pressures in hospitals.
Solutions for a way forward
We recognise the steps the Government is taking to tackle the issue of delayed discharge, including the initiative of the NHS buying extra places in residential care and other settings.
While we do not oppose this, our experience suggests certain conditions need to be in place in order to avoid the approach leading to people spending longer than necessary in care homes and costing the taxpayer more as a result. It will help if this is presented as the rapid establishment of recovery services in care home settings, so as to distinguish from the purchase of a standard care home place.
The following conditions are essential to success:
- There needs to be a clustering of such places into a purposeful therapeutic environment.
- Wrap-around reablement support from multi-disciplinary teams must underpin the approach.
- People must have time to recover and, if necessary, their longer-term needs and options (including what it will cost them) must be assessed and reviewed, otherwise they are effectively forced into a permanent move of home.
- Reviews for the people benefiting from the initiative must be prioritised, but whilst ensuring that people already in the system are not disadvantaged.
- Clarity must be provided on how the funding will work, including who will fund the person’s care once the four-week package of support ends.
- There needs to be a coordinated approach to commissioning the care home places so as not to destabilise the provider market.
- ‘Quality’ must be a fundamental consideration – commissioning providers rated ‘Inadequate’ or ‘Requires improvement’ may not secure the desired outcomes for people and may put further pressure on these providers.
- There must be joint multi-agency discussions with people and families about the appropriateness of placements in care.
In addition to the steps the Government is taking, we put forward the following short-term actions that could be taken now to help address immediate pressures in hospitals, as well as medium-term actions that will help preparations for next winter.
- Focus on ‘simple discharges’: people without complex needs who could be discharged rapidly.
- Invest in voluntary sector support, which can mobilise quickly and provide access to an additional workforce. Services such as ‘sitting services’ (which provides reassurance for people who may not need care but are concerned at being alone after discharge), unpaid carer support, handyperson services, and home from hospital services can all play a key role in meeting low-level needs after discharge, as well contributing to preventing possible readmission.
- Invest in support for unpaid carers. They are the backbone of care and support but too many of them are breaking down. Equally, the labour market is losing too many people, especially those in their 50s, who are having to give up work to care.
- Invest in therapeutic-led reablement – intensive short-term interventions with follow-up support – which support recovery after time spent in hospital.
- Increase care worker pay – including one-off increases and/or retention bonuses – to help tackle the serious recruitment and retention issues facing the sector.
- Develop robust commissioning arrangements to ensure that the commissioning system does not create two tier systems and lead to disagreements between councils, the NHS and the care sector.
- Focus on delivering effective transfers of care by ensuring hospital discharge teams provide accurate discharge information including therapy plans and sufficient supplies of medication at the point of discharge.
- Focusing on prevention and recovery services, including steps to support the voluntary sector to provide fast, low-level support, is essential.
- Build on the good work being done in some areas to identify and target the people most at risk of admission.
- Invest properly in primary and community services and intermediate care that is multidisciplinary and can resolve crises in health and care, thus avoiding hospital admission and help people back on their feet or enable them to make informed choices.
- Tackle the long-standing issue of care worker pay.
While the conflation of several different factors has created the enhanced level of pressure facing the NHS this winter, this is an annual and predictable challenge. By acting on the issues we have set out above, we firmly believe we will give our care and health services the very best chance of overcoming the difficulties they face here and now and, with ongoing funding, we could ensure that community and bed based services to support recovery are available on an ongoing basis all year round and avoid an annual last minute search for solutions. In so doing, we will all be better placed to provide the very best support to the people we are equally committed to serving.
Cllr David Fothergill
Chair, LGA Community Wellbeing Board
Spokesperson for Health and Social Care, Solace
Chief Executive, Sefton Metropolitan Borough Council