public health and social care

‘Political maladministration’ blamed for unsafe hospital discharges

Urgent action is needed to better integrate social care with health care and ensure it is sustainably funded, the Public Administration and Constitutional Affairs Committee (PACAC) has said in a new report into hospital discharges.

The report said: “At a structural level, the historic split between health and social care means that interdependent services are being managed and funded separately. We consider this to be political maladministration.”

It found that health and care systems were often unable to negotiate a patient’s discharge because they had incompatible IT, records and funding systems.

In some cases, patients were left in hospital because no agreement could be reached on whether their continuing care would be funded by the council, the NHS or whether it would be self-funded.

There was also a ‘culture clash’ between health service concerns with treating a patient’s immediate illness and social service concerns with providing ongoing care.

Delayed discharges for patients, especially elderly patients with complex ongoing care needs, are thought to have reached 2.7 million days in 2015.

The PACAC said it endorsed recommendations in a Public Accounts Committee (PAC) report into delayed discharges that NHS England should increase the adoption of “good practice models” for integrated care.

The report also said that there was a “persistent problem” with patients being discharged despite being seriously frail and not receiving adequate follow-up care. This was partly due to a lack of beds, with some trusts reporting staff being pressured to discharge patients whether they were ready or not in order to free up space.

The committee endorsed an LGA recommendation that hospitals need to display “strong leadership and engagement with staff” to support them in not prematurely discharging patients.

Bernard Jenkin MP, chair of the PACAC, said: “Hospital staff seem to feel pressured to discharge patients before it is safe to do so.

“Hospital leadership must reassure their staff that organisational pressures never take priority over person-centred care. And staff need to feel a level of trust and openness that enables them to raise concerns about unsafe discharge.”

NHS could ‘collapse’ without sustainable social care funding

The report added: “We are clear that pressures on funding and overall resources in health and social care do not excuse the egregious examples of poor discharge that we have heard about. However, it is clear from the evidence we received that pressures on social care funding have made it increasingly difficult for hospitals to discharge patients in a timely and appropriate manner.”

Social care funding will suffer a £3.5bn deficit by 2020 following government cuts. A recent report from the Nuffield Trust and the King’s Fund admitted that state funding of individual care may no longer be possible in the long term.

The PACAC warned that current plans for social care will not address the gap long term. The government has promised more funding from the Better Care Fund, but the majority of this will not be delivered until 2020 despite calls from councils to bring it forward.

Furthermore, a large portion of the money is meant to be delivered via the New Homes Bonus, which is paid to councils only when they oversee the building of a certain level of housing. This means that councils that cannot deliver the necessary housebuilding activity will not receive the money.

The PACAC called this “an extraordinary way to fund essential public services”. It urged the government to clarify what will happen to areas that will not receive the funding.

It said the government should develop “a long-term, sufficient, sustainable, integrated approach to adult social care funding”, with at least a route map for the funding model available by March 2017.

Cllr Izzi Seccombe, chair of the LGA’s community wellbeing board, welcomed the report, saying: “Councils are absolutely committed to reducing the level of delayed transfers of care from the NHS and in the vast majority of areas are working with their local health partners to help reduce pressures on the NHS. But unless social care is properly funded, the NHS is in real danger of collapse.”

A Department of Health spokesperson said patients should only be discharged from hospital when itis clinically appropriate and safe for them and their families — and the best way to ensure that is to meaningfully integrate health and social care.

“We are investing billions to do so over the course of this Parliament to improve the experience of patients, many of whom will be vulnerable,” they added.

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