The problems caused by delayed discharges have been making headline news for a while now. Delayed discharges are not only a key indicator of how well hospitals are performing but also how well our health and care systems overall are working. The latest English data suggests a 23% rise in the number of days patients were delayed in December 2014, compared with the figures from 2013.
In September, the Royal Voluntary Service surveyed 401 older people across England, Scotland and Wales. Around a quarter of them who had been readmitted to hospital within three months of a previous admission felt that they had been discharged before they were ready to go home. 43% said they had needed a great deal or quite a lot of help when they left hospital, yet only 6 in 10 reported getting all they support they needed.
The latest survey, carried out in January this year, builds on that earlier work with the Royal Voluntary Service exploring the issue of support on discharge by looking at nurses' experiences of discharge in English hospitals.
There is a great deal of new information in this survey:
- Almost 70% of respondents say they frequently have to delay discharging patients because there is no support in place for patients once they leave hospital
- More than 35% of nurses have discharged patients aged over 75 before they felt they were ready to leave hospital in order to "free up a bed"
- The vast majority of survey respondents believe that the three key factors causing delayed discharge are a lack of social care support and availability of home care; the need to wait for a final assessment before discharge and having to wait for non-acute care to become available elsewhere in the NHS
About 75% of nurses questioned think pressures on the NHS could be eased by working alongside charities and volunteers to ease the transfer of older people back home. We know that people who are helped by volunteer services value them immensely and there are indications that this kind of 'Home from Hospital' programme may also help reduce readmission rates, although there is more work to be done in this area.
Together with official information collected by NHS England and September's survey of patients' experiences this new survey of nurses in discharge settings provides evidence of a service under increasing strain.
Thanks to the work of the Royal Voluntary Service, we now have a richer picture than we have ever had before of older people's experiences of being in hospital and being discharged and how the work of volunteers can help both patients and hospital staff.
Senior Fellow, Public Health and Inequalities at The King's Fund
Across the UK delayed discharges are a key indicator of the performance of not only hospitals, but how our overall health and care systems are working.
In recent months, this has become a key concern for health and care systems across the country. The latest English data suggests a 23% rise in the number of patients being delayed comparing December 2014 with a year earlier.
Delayed discharges in England are measured and recorded on a monthly basis by NHS England. The latest data is for December 2014. In December 2013 there were overall 112,629 days delayed in terms of discharges, in December 2014 139,156, a rise of 23%.
The most common reasons for delay in December 2014 were:
- Awaiting residential or nursing home placement or availability - 24%,
- Awaiting further non-acute NHS care - 20%
- Awaiting completion of assessment - 19%
From December 2013 to December 2014, there has been a major rise in “awaiting care package in own home” as a source for delay, from 11% to 15% of all delayed discharges.
Analysis based on NHS England data available from england.nhs.uk
On the day of a historic first parliamentary seat for UKIP in Clacton, I look back at this week’s health and social care announcements from the Liberal Democrats and compare them to the messages from Labour and Conservative over the past few weeks.
There were some big announcements from Norman Lamb on mental health aimed at narrowing the gap in how physical and mental health is treated. There were also new pledges that will benefit carers by offering a £250 ‘Carers Bonus’ paid annually by 2020 and increasing the carers allowance earnings disregard from £100-£150, allowing carers to keep more of what they earn.
Lamb also made commitments to shift the system from repair towards prevention, further integration and more personalisation and control to individuals, continuing the emphasis that the Lib Dems have placed on these themes in the coalition. Lamb also made special reference to the important role that volunteers in the community can play in reducing loneliness and hospital admissions.
On funding the Lib Dems committed to put an additional £1billion into the NHS above the ring fenced amount in 16/17 and 17/18 and free social care for people at the end of life. In addition the Lib Dems pledged to reform pensions so that the current ‘triple lock’ indexation is made permanent through law.
During the conference a motion on Age Ready Britain was debated. The motion highlighted that there is no single action or policy that will prepare the UK for an ageing society - it requires a co-ordinated approach across many areas of public policy to create an age-friendly nation. In particular the conference called for a Cabinet Committee on wellbeing and ageing to be established, the appointment of a Minister for Ageing and a statutory independent Older People's Commissioner. It was also recommended that Health and Wellbeing Boards should be strengthened and other important recommendations were made around housing and the planning system.
The dust has now settled and it’s clear that health and social care will be a key battleground in next May’s general election.
All the main parties made new pledges to increase NHS funding to some extent, from ring fencing by the Conservatives to Labour’s new £2.5 billion “Time to Care Fund”. However, it seems that the Lib Dems have made the clearest commitment on funding and have accepted the immediate urgency by pledging to re-open next year’s funding settlement. There is a good deal of agreement on the need for more integration but a lot more is hidden behind party politics on competition and other structural issues.
But will a billion here and there make the difference? Experts indicate that by 2020 the NHS funding gap will be in the region of £30 billion. Therefore, the sums being pledged significantly underplay the massive scale of the challenges that the health and social care services face in the next few years, especially with an increasing demand from an ageing population with a growing number of complex conditions.
The Lord Filkin led House of Lords Committee on Public Service and Demographic Change in 2013 said that Governments had been woefully underprepared for ageing and that there had been a collective failure to address the implications. Without urgent action ageing could turn into a series of miserable crises. He called for all political parties to consider the ageing society in their manifestos for the 2015 election. It appears from the events of the past 3 weeks that the main parties are still not prepared to tackle this head on.
We call on all parties, whoever comes to power next May, to engage with the voluntary sector to help them get their policies right and to build a stronger agreement about the changes needed to create better health and care.
Posted by Steve Smith at 15:17
Friday, 10 October 2014.
On Thursday 26 April, I will be giving evidence to the Welsh Assembly’s Health & Social Care Committee
as part of its inquiry into the residential care of older people in Wales. I am doing so in my role as Chair of the Welsh Reablement Alliance
, an umbrella group of bodies who provide support to people when they come out of lengthy hospital stays and help them to adapt back to life at home.
Reablement is a hugely important step-change for social care – it changes the presumption of what sort of help people need, seeking to help them re-learn daily skills so they can stay in their own homes and remain independent rather than needing to look at formalised home care or residential care. This not only affords more dignity to older people, it also make significant savings for the public purse by preventing hospital readmissions and costly long-term care packages.
Typical examples of reablement might be short-term physiotherapy interventions, or physical adaptations to the home, or it might mean short-term social support to help a person (such as a lift to the shops, or a volunteer helping to walk the dog whilst they regain physical strength) – in practice though, it is a whole range of these services. Long-term hospital stays can knock a person’s self-confidence, diminish them physically, and put all sorts of practical barriers in place which make it hard to adapt to life back at home. Reablement is simply about overcoming those barriers through short-term interventions.
Currently, there are some excellent examples of reablement in Wales – but they are all too often quite patchy and inconsistent, with huge variations between regions and huge discrepancies in the levels of funding they attract. That is partly an accident of how the service has evolved over time, but now that the Welsh Government is making bold plans to extend reablement as part of its Social Services Bill
, the time has come for a more consistent level playing field for reablement, and for the Welsh Government to set out what it expects local authorities to provide.
The evidence session will be broadcast on senedd.tv
at 1pm on Thursday – be sure to tune in!
Posted by Ed Bridges, Public Affairs Manager (Wales) at 00:00
Thursday, 26 April 2012.
Welsh Reablement Alliance,
Social Services Bill,