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Hospital Beds and Social Care

Volume 817: debated on Thursday 6 January 2022


Asked by

To ask Her Majesty’s Government what estimate they have made of the number of people occupying hospital beds because (1) there are not enough places in care homes to accommodate them, or (2) there is insufficient domiciliary social care support.

Although the number of people continually changes, there are approximately 10,000 people in hospital who do not currently meet the criteria to reside and have not yet been discharged. To drive progress and to support local system arrangements, we have established a national discharge task force to monitor and address the causes of delayed discharges. We have also provided £462.5 million via local authorities over winter to support care providers to increase recruitment and existing care support.

My Lords, I appreciate the Minister’s Answer, but is it not the case that this bed-blocking has been happening for a long time, and that health service hospitals are under enormous pressure because of it? Can he give us some idea of when anything will happen as a result of his proposals? Can he comment on another representation that I have had—that there are empty places in care homes not being used?

I begin by wishing the noble Lord and all your Lordships a happy new year. We have started the national discharge task force, with membership from local government, the NHS and national government, and we have looked at the different pathways. There are four pathways: one is direct discharge, one is interim discharge, and one is for those who need a bit more support. But then sometimes individual cases are quite different; sometimes a place is offered, but the family may not be happy, so we have to find other ways. One thing that the national discharge task force has been doing is to look for spaces, wherever they may be, across the health and social care system to see whether they would be suitable for interim—but we are looking at all sorts of solutions in partnership with local authorities.

My Lords, while I welcome the very substantial additional resources given to the health service, will my noble friend revisit the decision to delay making money available for social care purposes? That money is needed now to finance the care workers and finance those places in care homes. Without it, we will continue to see bed-blocking, so it is a policy that is self-defeating.

My noble friend makes an important point. In the White Paper, People at the Heart of Care, we have set out our vision for adult social care and outlined our priorities. Throughout the pandemic, we made available nearly £2.9 billion in specific funding for adult social care—£1.75 billion for infection prevention and control, £523 million for testing and £583 million to support workforce capacity and recruitment, as well as all the other measures that I have previously referred to as part of the task force.

What assessment have the Government made of NHS or other publicly owned land that is currently unused and could be converted into accommodation for people who are rehabilitating and no longer need to be in hospital but cannot be discharged into their own home? Does the Minister agree that rehabilitation accommodation, commonly used throughout Scandinavia and other parts of Europe, could ease the pressure on both the NHS and the social care providers?

I thank the noble Baroness for raising this issue previously with me in private, and for looking into it. One issue that is very clear to us is that effective use of the NHS estates is a top priority for the Government. We have not yet considered the benefits of using vacant hospital land or unused buildings, but we are committed to utilising the estates to their maximum capacity. Rehabilitation is a critical element of the health and care system, and there are a number of areas that we are looking into, including some of the suggestions made by the noble Baroness—but also best practice from other parts of the world.

My Lords, I think it is the turn of the Liberal Democrats. The noble Lord, Lord Jones of Cheltenham, wishes to speak virtually, so I think that this is a convenient moment to call him.

According to the Alzheimer’s Society, nearly two-thirds of all hospital admissions for people living with dementia are unnecessary and could be prevented with high-quality personalised social care. Does the Minister agree that providing such care will reduce pressure on our NHS? If so, can he outline the steps that the Government are taking to deliver high-quality personalised care to people with dementia?

The noble Lord raises an important point about dementia. We have had many debates and discussions in this Chamber about dementia and increasing awareness of the issue, right across educating the workforce in the health and social care sector, and in how we can address specific issues on dementia and healthy living. As part of the reforms under social care, there will be more training and more specific focus on issues including dementia, to ensure that all inhabitants of care homes or recipients of domiciliary care receive appropriate care.

My Lords, with today’s reports of hundreds of care homes closing their doors to new admissions because of the rapid spread of omicron, adding to the huge pressure on hospitals, can the Minister explain in more detail why urgent priority funding is not being directed to the provision of step-down facilities to address the escalating crisis? We are told that we have new diagnostic units and resurrected Nightingale hospitals, but step-down facilities in local NHS and community settings, where patients medically fit for discharge can be monitored and properly assessed, have been shown to be working very successfully. Would not that provide the right care at the right time, as promised in last month’s social care White Paper?

We have been looking at different pathways out of hospitals, and one of the discharge pathways is step-down care. One issue that the task force has looked at is how we improve and increase accessibility to appropriate step-down care when a patient is unable to go straight to their home.

I will follow on from the question from the Labour Front Bench. Who is taking responsibility for actively recruiting staff so that any step-down beds can be staffed and managed? We have a workforce problem; without actively recruiting back into the workforce people who have experience but currently have left, we will not bridge that gap in manpower and womanpower provision.

All noble Lords will appreciate the work and dedication of all our social care workers, especially in these challenging times and with the extra pressure that omicron has brought. Throughout the pandemic, we have provided different types of funding. In December 2021, we announced an extra £300 million to support local authorities working with care providers to recruit and retain staff throughout the winter. This funding is in addition to the £162.5 million announced in October 2021. We recognise the issue, and it is about working with local authorities and others to make sure that this money gets into the system and achieves what it is intended to do.

My Lords, following on from the question from the noble Lord, Lord Jones of Cheltenham, does the Minister agree that it will be important for the discharge team to also look at the reasons for admission, since many people would not have been in hospital at all—they would never have been admitted—if there had been adequate domiciliary care services? Will the task force focus on those issues as well as the issues for not discharging?

The noble Baroness makes an important point. The task force, working with all the various partners, is looking at the different pathways. Most patients can be discharged from hospital to their own home, but a number are held back because they should be discharged from hospital to their own homes but with a new additional or restarted package, which may take time. Patients might be discharged to residential care within the independent and community sector, but one issue is that a number of our care homes are owned privately and are not necessarily as joined up in the system. Patients may also have been discharged to a care home, but sometimes the family may not appreciate or approve of the first venue given and may push back and ask for another one. There are a number of issues that we are looking at; it is very complicated, which I am sure all noble Lords understand. We are trying to really push and get to the bottom of this. Another thing is to make sure that there is education across health and social care staff so that they really understand the needs of particular patients.

My Lords, the noble Baroness, Lady Masham, wishes to speak virtually, so I think this is a convenient point to call her.

My Lords, as president of the Spinal Injuries Association, I ask the Minister whether he realises that there are many people who are severely paralysed, some of whom need two or three carers each day living in their own homes. Is he aware that the skilled labour market of carers from Europe has dried up since Brexit, leaving many people in a state of fear and anxiety of being at risk? The Government can help. Will they?

The noble Baroness makes a very important point. One thing that the Government announced before Christmas was on visas and encouraging more care workers to come to this country. Where she and I might disagree is that we are going to approach the best in the world, not just Europe—we want the best staff possible.