The NHS is going to waste £3.3 billion caring for patients who don’t need medical treatment but the money would be better spent on a Fast Track Discharge Fund to move vulnerable older people into care homes, according to a report from the independent think tank ResPublica.
In Care after cure: creating a fast track pathway from hospitals to homes, ResPublica says thousands of hospital beds would be freed up for medical cases and residential care homes could look after recuperating patients who currently occupy wards because they have no safe place to go.
ResPublica found caring for all delayed transfer patients in a residential care setting would cost £835 million over five years to 2020/21, compared to £3.3 billion in an acute bed. The report argues the remaining £2.4 billion should be invested in bed capacity, skills, training and facilities in residential care to allow the sector to step up to this more substantial role.
“The bed blocking crisis in the NHS is only getting worse – clogging up wards and leaving newly arrived patients on trolleys in hospital corridors. Meanwhile, as ResPublica showed last year, a staggering 37,000 beds could be lost in residential care homes over the next five years because the sector is losing money for every publicly funded resident.
“To redress both of these awful situations care homes should be given the necessary financial resources as an appropriate alternate care setting to alleviate the problem of bed blocking.”
A Fast Track Discharge Fund would also address the crisis which is seeing care homes closing because of the low amount they currently receive for funded residents, and the impact of the National Living Wage.
Out-of-hospital services – largely in residential care homes – for patients fit to leave wards but in need of extra support would improve under the fund, which would be used by Clinical Commissioning Groups.
The report found that as well as healthcare needs being met by nursing staff in care homes, pressure would be reduced on accident and emergency departments, where there has been a sharp decline in meeting the 4 hour target to conduct an initial assessment on 95% of patients.
Report author Emily Crawford said: “The gap between social care and hospitals needs to be bridged. Residential homes can provide good quality care for people who are currently being left in hospital beds. These patients, often frail and elderly, stand a much better chance of recovering in the community than in a hospital.
“As we confront the task of caring for an ageing population with finite budgets, this would also free up the much needed beds on our NHS wards.”
Dr Sarah Wollaston MP, chair of the Health Select Committee, said: “This report from ResPublica provides compelling evidence that social care cannot be seen in isolation from the NHS. There is an urgent need to improve access to social care and to address the delayed transfers of care and this can no longer be side-lined by policy makers.”
Baroness Joan Bakewell, a champion for older people, said: “Care homes are vital to our community and most importantly to the people who live in them. I welcome ResPublica’s report that acknowledges the important role that care homes play in our society and proposes important mechanisms for ensuring their sustainable future.
“We value the work good care homes do and this report acknowledges this role and can contribute to securing it for the future. Helping vulnerable people with dementia to live in an environment appropriate for their needs, rather than in an environment not suitable for them, is crucial. Bed-blocking in hospitals causes great grievance to vulnerable elderly people, and this report is a great first step in helping this situation.”
Ian Smith, chairman of Four Seasons Healthcare, said: “Discharging medically stable patients from hospital to a recovery period of care in a nursing home is a good idea that works in practice. We know because is already happening in our homes, although so far it is on a relatively small scale. We currently have around 375 people who are recuperating in our homes while their longer term care needs are assessed and arrangements made for their ongoing care. It is freeing up hospital beds and saving NHS budgets. We recently launched a 24-7 rapid response assessment and admissions service that helps hospital discharge teams to locate care services in appropriate homes.”
Mike Parish, chief executive of care provider Care UK, said: “The most critical issue facing our NHS hospitals is inpatient and A&E congestion caused by the unnecessary admission of patients, due principally to limitations in primary care, and difficulties in discharging frail and elderly patients because of the under-funded and under-developed state of social care.
“This causes unnecessary distress and harm to these patients and is immensely costly.
“This can be addressed through more effective partnership and investment in better resourced and technologically enabled forms of primary and social care, and this report makes a strong case for such strategies.”
Justin Bowden, GMB National Officer for the care sector, said: “The crippling costs to the NHS of bed-blocking prove that there is no place for austerity in the funding of social care – to do so is morally indefensible and financially stupid.
“The future of the NHS is intertwined with the fate of social care; as government underfunding sends social care down the pan, so the NHS is dragged with it: bed-blocking rises, we spend money we don’t need to spend keeping people in hospital who shouldn’t be there and, to cap it all, make many of them sicker by doing so.
“Proper investment now in the residential care sector, which is willing and ready to help with the bed-blocking crisis in the NHS, is cheaper in the long run, better for those who should be discharged and frees beds for those who actually need to be in hospital.”
Peter Kyle, the MP for Hove who has campaigned for better care for the elderly, said: “The situation in the residential care home sector is dire at the moment. The 2% precept and the Better Care Fund are supposed to make up the gap in public spending on the social care sector, but there is little confidence that they can – or will – do this. I welcome ResPublica’s practical proposals as an important step in developing funding models for a more sustainable health and social care system.”