Blaming localities for poor delayed discharge an ‘unacceptable cop-out’ – PAC chair
Delayed discharges of elderly patients from hospital are being made worse because of local authorities’ problems with integrating services and funding social care, according to a new report from the Public Accounts Committee (PAC).
The PAC report criticised the Department of Health and NHS England for a “poverty of ambition” in tackling the growing problem of delayed discharges.
In its evidence to the committee, the Department of Health said that only 40% of local authorities had achieved their planned reduction in delayed transfers of care, with the best improvement frequently seen in areas which had greater integration of services.
However, the department said some local areas did not fully benefit from the Better Care Fund because of a lack of alignment of incentives between different organisations.
It is now requiring organisations to put in place risk-share mechanisms so there is a joint and agreed responsibility for delayed discharges.
Charity Independent Age also told the committee that it has seen lack of co-ordination between the NHS and local authorities leading to delayed discharges because of funding conflicts, patients being readmitted to hospital because they had received the wrong care, and problems providing equipment and re-ablement services.
The PAC report also said that problems with the market for providing social care services were increasingly causing problems with delayed discharges.
Meg Hillier MP, chair of the PAC, said: “Delayed discharge is damaging the health of patients and that of the public purse.
“While there have been improvements, the Department of Health and NHS bodies are still failing to properly address the root causes of this problem.
“Blaming local circumstances for poor performance short-changes patients and is an unacceptable cop-out when the government has clear indicators of what works and the power to drive change.
“Best practice can be as simple as planning a patient’s discharge early in their hospital stay, or conducting shared patient assessments between health and social care providers. NHS Improvement should move faster to ensure such approaches are widely adopted.
Local authority spending on social care has fallen by 10% in real terms in 2009-15, meaning commissioners of adult social care are under pressure to keep the fees they pay to providers as low as possible.
This, combined with factors such as the introduction of the national living wage, is increasing the financial pressure on care providers, making it harder for them to recruit and retain staff.
The Department of Health said that it had recently written to every local authority reminding them of their duty under the Care Act to promote a sustainable market, including diversity and choice.
Cllr Izzi Seccombe, the LGA’s portfolio holder for community wellbeing, said: “What is clear is that this is no longer just a winter pressure but is now a whole year challenge to ensure that the entire health and social care system is able to cope with the increased demand on the NHS.
“Getting people out of hospital more quickly and back living at home will only work properly if councils get enough resource throughout the whole year to properly fund adequate provision of care services.”
She repeated calls for the government to bring forward the £700m in funding through the Better Care Fund earmarked for the end of the decade to this year.
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