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Hospital Beds: Social Care

Volume 826: debated on Monday 19 December 2022


Asked by

To ask His Majesty’s Government what assessment they have made of the number of hospital beds currently occupied by patients who could be discharged to their own homes or to residential care if social care support were available.

There are around 13,000 people in hospital who do not meet the clinical criteria to reside, including, but not limited to, people waiting to go home and people awaiting access to residential care. We constantly look to reduce these delayed discharges to ease flow in the system, and we have provided a £500 million discharge fund to support people to be discharged at the right time, to the right place and with the right support.

My Lords, I am grateful to the Minister for answering the Question. Does he understand that many of us will think it is a complete disgrace that, for a long time now, hospital beds have been blocked by people who could be discharged into the community or residential care? These people would be better off and have a decent quality of life. Should we not be making this a high priority, instead of saying that we are planning to do this? We have heard that for so long.

It absolutely is a high priority. Noble Lords have heard me say many times that the key to the whole system is flow through the system, to relieve times in A&E and ambulance wait times. That flow depends on us discharging the 13% of beds that are currently held up. That is why we put the £500 million discharge fund in place and will put £2.8 billion of funding next year, and £4.7 billion the year after, to solve exactly this problem.

My Lords, I currently serve on the Joint Committee that is scrutinising the mental health Bill. Could my noble friend the Minister outline whether that 13,000 includes those who are perhaps in secure mental health beds, awaiting discharge? That of course causes backlogs, and not only into A&E: currently, some of those people could be being held in a police cell, which is not an ideal place if you need admission for assessment to a mental health bed.

I will happily write on the detail, but, yes, it includes everyone who could be provided a space, either in a care home or a mental health home, and those who are fit to go home but need domiciliary care.

My Lords, Our Plan for Patients, which was published at the end of September, says:

“This winter, the NHS will open up the equivalent of 7,000 beds so that every hospital has space to see and treat patients more quickly.”

Winter is clearly here, so how many of those virtual beds are in operation now?

I thank the noble Baroness. She is absolutely right that the target of 7,000 beds is a key part of this. All Ministers have been talking about it with every ICB over the last few days to see exactly where they are on the target for both real beds and virtual beds. I will happily provide exact information on the target, but I know that we are making good progress.

My Lords, an estimated one in four hospital beds is occupied by people living with dementia. Many of the admissions would have been avoidable if they had had better community support. Of course, their stay in hospital is typically twice as long as those of other people who are over the age of 65. Does the Minister acknowledge that those dementia patients need to be discharged to a place of their own, or their carer’s, choosing, after a holistic assessment? What steps are the Government taking to ensure that this happens, so that people with dementia do not experience discharges that are inappropriate and unsafe?

I thank the noble Baroness. We are all seeing different shapes and forms of describing how we need a local care system set up by the integrated care boards that can have an overview of all the needs in their area. That is exactly what we are doing, and exactly what the Patricia Hewitt review is reviewing. It will give advice on how best to do that by looking at the best needs of mental health care patients, or any other kind of patient, to make sure that the proper institutions and places are set up to give them the up-front support so that, as the noble Baroness said, they never need to go to hospital in the first place.

My Lords, while recognising the current problems caused by bed blockages in NHS hospitals due to capacity and social care issues, does the Minister agree with the report from the Health Foundation, which, looking ahead, suggests that, because of changing demography and disease patterns in future, we will require between 25,000 and 40,000 more beds in the NHS if we are going to cope with the pressures on both the NHS and social care? What plans do the Government have to address that?

We are absolutely aware that we need long-term plans and forecasts. That is also one of the things that the healthcare workforce plan will take into account: it will look at exactly where the capacity needs to be on a regional basis going forward so that we have the right number of hospital beds and social care places for an elderly and growing demographic in terms of age groups.

My Lords, is it not the case that patients are stuck in hospital because social care staff are leaving in droves? They are leaving because they are not respected, not given a career and not paid sufficiently. Should we not be doing something about retaining these vital social care staff?

The number of care workers is key to all this and I delighted to say that the latest data shows that we are back to the levels of April 2021. Too many people have left, but we have managed to fill the gaps with the international recruitment fund and other measures. We all agree that we need to progress that further, but we are now making the increases that are needed in this space.

My Lords, we have heard how important a sustainable workforce is, both in social care and healthcare. Can the Minister tell us what the Government are doing to listen to the concerns of health and social care workers about patient safety and their own working conditions at this time?

Clearly, if we are going to retain and recruit the key staff in this area, it has got to be a good career, and that means that we must listen to their concerns. I know that Minister Whately is talking to and visiting them all, so it is a key part of the plan. As I say, the fact that we are managing to grow the workforce again shows, I think, that we getting on top of it—but absolutely we need to keep close and make sure it is a good place to work.

Does my noble friend agree that there are main concerns in some hospitals that dialysis patients are having to be retained in hospital over the Christmas period because of their deep concerns about transport arrangements, partly through the threatened ambulance strikes but also in other ways? Is this not another problem with regard to the bed blocking that we are looking at at the moment?

The best hospital trusts I have seen have got that absolutely organised. We see a difference in different trusts between as low as 6% bed blocking for social care and over 30%. That depends somewhat on local demography and the amount of care homes, but also on how quickly they can arrange transport, and that is what the best ones are doing, so that cases such as the ones brought up by my noble friend do not exist.

My Lords, the report from the Adult Social Care Committee that was published just a few days ago—which I commend most warmly to the Minister—highlights that in the past 10 years there has been a 29% real-terms reduction in local government spending power. This is despite the increase in the population during that period. Can the Minister assure the House that the Government are taking seriously the reality of life in social care?

I thank the noble Lord. Yes, we are, and I think that is shown by the investment we are putting into place. As I say, that will be up to £2.8 billion next year and up to £4.7 billion the year after, which will be a 22% increase. That shows that we are very serious about this.

My Lords, we have already heard about the crisis in the social care workforce. NHS leaders are calling on the Government to introduce a new national minimum care worker wage of at least £10.50 an hour to stem the flow of social care staff to other sectors. Can the Minister say what plans they have to introduce such a minimum wage, which could hardly be said to be stoking inflation at that level?

Of course, the noble Baroness is aware that it is the third parties, whether it be the local authorities or the private sector, that employ them. But what we have done in terms of setting the national living wage, which I believe is around that amount, is exactly making sure that there is a minimum amount that these people can get. About 65% of the funding going into the system goes through to wages, so the £2.8 billion increase next year will flow largely into wages and salaries.

Every one of the interventions we hear about points to the inadequacy of the social care system and every one of the interventions that the Minister makes, however well intentioned—and I do not dispute that they are well intentioned—concerns piecemeal reforms. Will the Government ever accept that the only thing that is going to solve this ongoing problem, which is only going to get worse, is a wholesale reform of the social care system?

There are a lot of questions that we need to answer in this space—I absolutely accept that—and lots of things that need long-term thought. I think and hope that noble Lords are starting to see that thinking emerge. A lot more needs to be done at the moment, but I think that we accept that this is a long-term issue that needs to be resolved with help from all sides of the House.