Some patients are unable to be discharged from hospital because councils do not have the funds or wherewithal to facilitate their care afterwards. The media reports that hospital corridors in emergency departments are filled with people nursed on trolleys or being cared for in ambulances, a result of not being able to transfer patients onwards. These scenarios, acted out across the country, are the result of a number of factors, not least the result of decades-old systemic problems that have never been addressed, putting people's lives in jeopardy.
The dire state of our NHS is reflected in the correspondingly dire state of our adult social care. A central issue that prevails is an increasingly ageing society and how little, if anything, has been done to prepare for it. There are massive holes in care provision, leading to patients who should be discharged from hospital left stranded there and patients who should be in hospital left stranded in ambulances or at home.
The Royal College of Emergency Medicine (2023) suggested that as many as 13 000 NHS patients are deemed medically ready to leave hospital; however, there is nowhere for them to go. This is a human tragedy. Being unable to formulate care packages for people in the advanced stages of terminal illness who wish to go home to die, for example, may not happen as the home care they need is just not available.
The Care Quality Commission (2022) reported that, in the first 3 months of last year, there were more than 2 million annual hours of home care that could not be delivered due to a lack of workforce. By the end of April 2022, there were around 300 000 people in England waiting for an assessment of care needs (Association of Directors of Adult Social Services, 2022).
In 2022, the Department of Health and Social Care (DHSC), announced a £500 million Adult Social Care Discharge Fund with the intention of helping to get people out of hospitals and into social care (DHSC, 2022). This was the first step in a plan to rebalance funding across health and care, establishing a strong and viable social care sector along with greater accountability for the use of taxpayers' money.
The fund will be used by local health and care systems, as they target those areas that are facing the biggest challenges, as well as bolstering the sector's capacity to recruit and retain staff. Local NHS and local authorities will be held to account for implementation. It is anticipated that this will improve pathways for those fit to leave hospital, along with the right care and support in place when discharged.
There is a need to increase the number of care workers - there are around 165 000 vacancies (Fenton et al, 2022). A national recruitment campaign has been launched, encouraging more people to join social care. The knowledge and skills framework is being developed and career pathways and ongoing investment in learning and development to support progression for care workers and registered managers. An investment of £15 million will help enhance international recruitment of care staff (DHSC, 2022).
The Adult Social Care Discharge Fund is there to support discharge from hospital into the community and strengthen the social care workforce, to ‘free up beds for patients who need them’ (DHSC, 2022). This is a disparaging phrase - the aim seems to be to deal with the plight of thousands of humans as if they were counters in a board game who can be moved from place to place. Those people in hospital, waiting to be transferred into the community, who want to go home, are human beings and deserve to be respected. To make a crass statement such as ‘to free up beds for patients who need them’ is unfortunate to say the least. It is as if those who have found themselves in a hospital bed are malingering and squatting, when it is the system and years of underfunding that is at fault.