In September 2022, the Department of Health and Social Care announced the launch of the Adult Social Care Discharge Fund. Worth £500 million, the funding package aimed to ensure that patients were discharged from hospitals in England and into social care support, where appropriate. 60% of the money was to be awarded to Integrated Care Boards (ICBs) to ‘improve bed capacity’, with the remaining 40% going to local authorities to ‘bolster the social care workforce, increasing capacity to take on more patients from hospitals’.
Further funding of up to £200 million was unveiled in January 2023 in an attempt to discharge ‘thousands of extra medically fit patients’ by buying ‘short-term care placements’.
By acting in this way, the Government has finally recognised the impact that inadequate social care capacity has on the NHS.
The Association of Directors of Adult Social Services (ADASS) has reported that there are around 542,000 people awaiting assessment, review or the start of a care service/direct payment.
Research evidence indicates that reductions in public long-term care spending lead to substantial increases in the number of emergency department (A&E) visits made by patients aged 65 and above, explaining between a quarter and a half of the growth in A&E use, and to an increase in the share of patients revisiting A&E within seven days.
Once in hospital, problems arise if people cannot be discharged in an efficient manner. If beds are occupied by people who no longer need to be there, new patients needing help cannot be admitted. This means that ambulances cannot transfer patients requiring admission to A&E and are also not available to respond to new emergencies. It also means that people requiring elective treatment cannot be admitted and waiting lists are currently over 7 million.
While the government expenditure is welcome, is it merely a sticking plaster over the key issues? Indeed, almost a quarter (24%) of delayed discharges from hospital are due to people waiting for homecare. This is the result of there being an alarming shortage of homecare workers, with the sector’s vacancy rate reaching a record high of 14.1% in October 2022, though by April 2023, it had fallen to 13.0%.
In a new survey of 343 homecare providers, representing 52,600 careworkers supporting more than 79,800 people in their own homes, conducted by the Homecare Association, over half of providers (54%) reported that they are delivering less care than this time last year. This is despite almost three-quarters (74%) of providers stating that the demand for homecare had increased since the beginning of 2022.
Homecare providers have also seen a significant increase in demand for hospital discharge services – nearly two-thirds (64%) suggested there has been a rise in the quantity of care packages for people who were being discharged from hospital. Furthermore, 71% felt that there is an added time pressure to ensure a care package is arranged.
People leaving hospital need more complex care than before the pandemic, with more than half (56%) of homecare providers agreeing that more complex tasks were now being commissioned by the NHS.
The impact of the pressures on the health and care system is being felt by those who need healthcare, with 85% of providers saying that the people they support were finding it more difficult to access healthcare than this time last year.
Despite the thousands of people stuck in hospital awaiting discharge, 46% of private-pay providers had expressed an interest in providing homecare for discharge services but were not commissioned.
As a result, we make the following recommendations:
- Adequate funding needs to be provided by government to local authorities to enable them to pay a fair price for care, so that careworkers can receive wages equivalent to Band 3 healthcare assistants in the NHS with 2+ years’ experience. According to the Homecare Association’s Minimum Price for Homecare 2023-24, this would require an hourly fee rate of at least £28.44.
- The practice of local authorities and the NHS purchasing homecare ‘by-the-minute’ must be ended, alternatively focusing on achieving the outcomes people want, enhanced by technology solutions.
- The Government should work with the sector to develop a credible 10-year workforce strategy for social care, aligned with the NHS People Plan.
Read the full report:Care Provision and Workforce Survey 2023 - final.pdf