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Tory Ministers Need To Wake Up To The Deepening Crisis In Care

16/08/2017 09:10 BST | Updated 16/08/2017 09:10 BST
Jeff J Mitchell via Getty Images

Recent figures released by the NHS show that the year since Theresa May became Prime Minister was the worst year on record for delayed transfers of care in the NHS.

Delayed transfers of care, when patients are medically fit to be discharged from hospital but are delayed from doing so, are the consequence of failures in our health and care systems. And these delays are rising. 2.2million NHS bed days were lost in the last year due to delayed transfers of care and a third of them were attributable either partly or wholly to a lack of social care provision. The biggest cause of delay is now patients awaiting care packages in their own homes.

Behind these numbers are thousands of older and vulnerable people keen to get home to their families rather than being stuck in a hospital bed. Keeping people in hospital longer than necessary poses a risk to their recovery, affects their mental wellbeing and increases the likelihood of contracting hospital-acquired infections. And it means patients who do need to be in hospital are unable to access the care they require because there are no beds available.

Given this human cost, we should focus on reducing delayed transfers of care. But, the Tory response to this complex problem, and to social care more widely, has been overly simplistic, their approach ill-judged and their actions likely to make the problem worse.

First, Tory Ministers have failed to understand the depth of the problem. Delayed transfers of care measure only part of the problem of people being trapped in the wrong part of the health and care system for their needs. According to the Nuffield Trust, delayed transfers substantially underestimate the number of patients who are medically fit to go home, with up to two-thirds of patients who are stuck unnecessarily in hospital beds unaccounted for within the official data. In one rural hospital, while 14% of patients were counted in the statistics, a further 42% of patients could have been discharged had the right support been made available. By focusing only on those patients who fit the Government's narrow definition Ministers risk ignoring a much bigger problem - that there are far too many patients stuck in hospital who could be better cared for elsewhere.

But ensuring patients can be cared for in the right settings requires investment - not only in social care, but also in intermediate care, re-ablement services and sheltered and supported housing. This is investment this Government has not been prepared to make.

Second, Ministers must see that the rising numbers of people stuck in hospital and unable to get home are symptomatic of the mounting crisis in social care more generally. Ministers have been repeatedly warned of this crisis - the Care Quality Commission confirmed only recently that the sector remains at "tipping point".

Yet, since 2010 Ministers have presided over £6.3billion being taken out of social care, resulting in over 400,000 fewer people getting publicly funded social care, care contracts being handed back to councils and care quality falling, with one in four services now failing on safety grounds. The problem of delayed discharges will only be solved if the Government tackles the bigger problem of the mounting funding crisis in social care.

The announcement of £2billion up to 2020 for social care in the Budget gave the care sector only a few months breathing space. But councils were rightly angered when they learnt that this extra funding would be directly linked to performance against arbitrary targets on delayed discharges, preventing local authorities from spending the funding on the social care priorities as they see fit.

This decision by Tory Ministers is a mistake. Aside from making life difficult for councils which had already made commitments on how to spend this year's allocation, it punishes those local authorities that face the biggest challenges and with the greatest needs in their communities.

And it is a mistake because Tory Ministers have pitted councils and the NHS against each other, just when we need them to be working together. His actions resulted in the serious decision by the Local Government Association to withdraw its support for the Government's Better Care Fund guidance.

The Tories' approach to dealing with delayed transfers of care reveals a deeper, more worrying truth - that this Tory Government simply does not understand social care. This Government sees social care purely through the prism of the ageing population and the impact of social care issues on the NHS. And the Tories do not recognise the preventative role of social care, which is why they are focused only on how to get older people out of hospital. What they fail to understand is that while the NHS treats people when they have had a fall, it is social care that stops them falling and ending up in A&E in the first place.

Jeremy Hunt's actions on delayed discharges have sent a clear message: that this Government is only interested in social care insofar as it helps relieve pressure on the NHS.

It is time that Jeremy Hunt finally woke up to the deepening crisis in care created on his watch and argued for the extra funding needed to stabilise the care sector and fund a decent living wage for care staff.