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Care Homes: Hospital Discharges

Volume 785: debated on Monday 16 October 2017


Tabled by

To ask Her Majesty’s Government what is their estimate of the number of people currently in hospital waiting to be discharged to care homes when places become available.

My Lords, on behalf of my noble friend Lord Dubs, and with his permission, I beg leave to ask the Question standing in his name on the Order Paper.

My Lords, information is collected on the number of bed days occupied by patients waiting to be discharged from hospital. The latest available information estimates that on an average day in August this year, 1,574 beds were occupied by patients waiting to be discharged to nursing or residential care homes.

My Lords, that is a big number. I understand that over the last financial year, about 2.3 million days were essentially lost because of transfer delays. We know the number of nursing home places has been reduced by 4,000 over the last two years; we know social services are under pressure; we know the health service is not using housing services sufficiently. Why does the health service seem determined, in its STP plans for each area, to rush into yet further plans to cut acute capacity when hospitals are under so much pressure at the moment?

I am glad the noble Lord mentioned the number within a year. He will be interested to know, as other noble Lords will, that the number of delayed transfers of care went down year on year between August 2016 and August 2017. That is good news. That reduction has been caused by greater funding in that period and a greater focus on accountability, particularly for local authorities and trusts together. In terms of acute capacity, the number of beds has been relatively stable recently and NHS England has introduced a new test for any reconfigurations that adds a fifth category, looking at the number of beds available in any given area.

Does the Minister agree that the position is likely to get more difficult as more care homes are saying that they cannot function on the level of fees being offered by local authorities? They are therefore withdrawing beds that are supported by public funds from this facility. Will the Minister look into that?

I know of the issue that the noble Lord raises about withdrawing beds. As we discussed last week, there has been a small reduction in the number of nursing and residential care home beds. However, there has also been an increase in the number of domiciliary care packages. The noble Lord may also be interested to know that we are creating 6,000 new supported homes through the Care and Support Specialised Housing Fund. It is a changing market. I understand the funding pressures on local authorities, which is why we are putting in more funding.

In the broader context, would it not help my noble friend if we looked at the role and number of district nurses who, in the past, kept people out of hospital and ensured that GPs were relieved of some of their work?

The noble Lord is right to highlight the issue of community nurses, where in particular there has been a reduction in numbers even though the total pool of nurses has increased in recent years. He will hopefully have noticed an announcement at the Conservative Party conference from my right honourable friend the Secretary of State about more nurse training places—25% more—to address the kind of issues he is talking about.

My Lords, with the pressure on hospitals to discharge people and the lack of nursing and residential care beds, does the Minister agree that undue and unfair pressure is sometimes put on families and carers to accept discharge in an unsuitable situation? Last week, I spoke to an 87 year-old carer, herself frail and with severe angina, who was induced—I use the word advisedly—to accept discharge of her 91 year-old husband, still immobile after a fall, with a promise of visits from a community nurse twice daily. Of course, those visits have not yet materialised.

I am sorry to hear about that particular issue. I obviously have not seen the details; perhaps the noble Lady might write to me about it. Clearly, nobody should be induced or otherwise forced to accept the care of somebody for whom they are not capable of caring. Looking at our growing and aging population, I think we all accept that the number of operations and admissions going through the NHS is increasing. We need much more capacity in the system, whether in nursing and residential homes or, increasingly, in domiciliary care.

My Lords, since the difficulties of hospital patients awaiting discharge to care homes is but one of a number of bottlenecks in the present system, does that not suggest that we need a fully integrated national health and social care service and that, until we achieve such integration, these problems are bound to recur—as the National Audit Office report in February this year so clearly and vividly illustrated?

The point about integration is critical. The CQC’s report from last week, which we were discussing, is all about collaboration and integration. Someone in their 80s who is experiencing care does not distinguish between different bits of it as we do bureaucratically. They want to know that there is seamless care. That is what the sustainability and transformation process is attempting to do.

My Lords, I am grateful for the right reverend Prelate’s comment about the National Audit Office’s report from February, which makes it clear that 43% of the multidisciplinary team meetings in acute hospitals began immediately, which is to be encouraged, but only 20% of local authorities were invited to those early meetings. What are the Government doing to ensure that the advice from NHS Improvement about getting that earliest intervention will actually happen?

The noble Baroness raises an excellent point. She may know that the better care fund—the route by which the additional money goes into social care—reviews and holds accountable local authorities and the NHS for interacting with one another to deal with delayed transfers of care. There is something called the high-impact change model, which is designed precisely to bring people together to ensure that the number of delayed transfers in care are reduced. That is compulsory as part of the funding provided.

My Lords, the essential issue is pressure on hospital beds. Will my noble friend tell us what the effect is of the work of charitable—I am sorry, the name has gone, but which charitable institutions take people in their last days?

Thank you very much—retirement draws closer. What effect do charitable hospices have on the pressure on hospital beds? To what extent could a nationally efficient National Health Service palliative care service continue that effort?

I hope that my noble friend’s retirement is still a long way off. I do not have specific numbers on the impact of hospices, but various changes are going on in the funding of palliative care to make sure there is much more consistency across the country for what is available. I hope that will be one of the ways we can ease the pressure.