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NHS crisis can only be solved when social care is adequately funded

The crisis facing the NHS as hospitals struggle to cope with the massive rise in demand will not be solved until social care services are adequately funded, the Local Government Association has warned.

Health and social care services support the elderly and vulnerable in the community and help them stay out of hospital longer, but they have been chronically underfunded, according to Cllr Izzi Seccombe, chair of the LGA's Community Wellbeing Board. She said that investing in social care is a crucial part of alleviating the pressures on the NHS.

“Investing extra money in the NHS whilst forcing councils to cut their social care budgets is simply a false economy and will not solve this ever-growing problem,” Cllr Sercombe explained.

"The current care system is in crisis and unless adult social care is urgently put on a sustainable footing the situation is set to get even worse over next two years, and undoubtedly continue to have a knock on effect on vital NHS services. We simply cannot wait any longer for this to be fixed.”

Cllr Sercombe added that the cuts to local government budgets throughout this parliament have meant that councils have had to make “tough decisions about the care services they can provide”.

"It's not enough to keep plastering over the cracks. Government needs to invest money in protecting a system which will be there to look after people in the future and not just in the immediate term. This will only be achieved through a determined effort from councils, the health service and government working together.”

She added: “If social care continues to be inadequately funded, this will tip some services into failure and leave the most vulnerable members of communities at risk of losing essential care."

On Tuesday figures released by NHS England show that A&E waiting times in England over the Christmas period have hit their worst levels since records began. The week before Christmas in tier 1 A&Es, those emergency departments based in hospitals, only 83.1% of patients were treated or admitted within four hours of arrival. The target hospitals are expected to hit is 95%.

At least 16 hospitals have declared major incidents, where they step-down focus on non-urgent activities to focus on emergency admissions. This leads to clinics and scheduled operations being cancelled as staff are redeployed to help in A&E and assessment units and deal with emergency admissions.

David Cameron admitted the NHS was under pressure but dismissed claims that the health service was “on the brink of disaster”.

Instead the PM said there was a “short-term pressure issue which we need to meet with resources and management”.

His remarks also appeared to agree with Cllr Sercombe, that elderly and frail patients were taking up space in A&E when it was not the best place for them.

He said: “We’ve got a longer-term issue which is making sure that there are named GPs in your local area which are responsible for every single frail, elderly person. A lot of the pressure on A&E is coming from frail, elderly people, often with many different health conditions and the best place for them, frankly, is not A&E.”

One of the cumulative effects of the lack of social care and a large amount of elderly and frail patients attending A&E is a surge in ‘bed blocking’, a term used to describe patients who are forced to remain in hospital when not medically necessary because there is no one to care for them when they are sent home. Others reject the use of that term, saying it is the system at fault – not patients.

In November our sister site NHE reported that a lack of social care funding was forcing 1,000 patients a day to remain needlessly in hospital, which Sir Bruce Keogh, the medical director of NHS England, described as a “major issue”.

This major issue is now making the current crisis worse as hospitals are unable to discharge patients who are fit to go home and therefore cannot find beds for new admissions.

Research by NHS Providers found that half of hospitals reported that at least 10% of beds are taken up by “bed blockers”, in a survey of 50 NHS trust heads across England. Twenty of the respondents said as many as one in five beds could not be used for new admittances.

The Guardian has reported that at Addenbrooke’s in Cambridge 87 of 1,000 beds are filled with such patients. One has been there for 72 days after she was declared fit to leave and another for 59 days.

Chris Hopson, chief executive of NHS Providers, which represents NHS trusts, told us: “Our members tell us delayed discharges are a very significant problem and a major contributor to current performance difficulties in accident and emergency services. You get what you pay for, and you cannot reduce social care funding without significantly increasing risk for the NHS, however hard local authorities work. The government has to properly fund both the NHS and social care to deal with rapidly rising levels of demand as the population lives longer and with increasing numbers of older patients with complex multiple conditions.”

The charity Age UK also criticised cuts to social care.

"We know that social care spending has fallen dramatically and that without social care older people are more likely to end up in A&E because of a health crisis," said Caroline Abrahams, Age UK's director.

"It is also clear that without the proper social care to support them on discharge, whether that be at home or in a care home, stays in hospital are often longer than they need to be for medical reasons.

"Waiting in hospital for care to be organised not only undermines an older person's chances of recovery, it is also profoundly upsetting for them and their families. It is madness to waste expensive NHS resources in this way, when it would be much more cost effective and better for older people to ensure good social care is available for them instead," she added.

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