A&E units are struggling to cope because social care services that help elderly people have been cut so much that they are reaching a “tipping point”, England’s care regulator is to warn.
English care home closures are leaving vulnerable people at risk, says watchdog
Hospitals are ending up dangerously full and have seen “bedblocking” hit record levels because of a widespread failure to give elderly people enough support to keep them healthy at home, says the Care Quality Commission.
A worsening lack of at-home care services and beds in care homes are forcing hospitals to admit more patients as emergencies, which deepens their already serious financial problems. “What’s happening, we think, is that where people aren’t getting access to [social] care, and we are not preventing people’s needs developing through adult social care, is that they are presenting at A&E,” said David Behan, the CQC’s chief executive.
Figures contained in the commission’s annual report show that the number of hospital bed days lost through patients being unable to leave because social care was not available to allow them to be discharged safely soared from 108,482 in April 2012 to 184,199 in July this year – a 70% rise.
The fact that growing numbers of mainly frail, elderly people are being left without the help they need with basic chores such as washing, dressing and cooking “creates problems in other parts of the health and care system, such as overstretched A&E departments or delays in people leaving hospital,” he added. GP surgeries are also having to treat patients who became unwell or suffered an injury because they did not receive help they needed.
Behan urged ministers to give social care a higher priority and urgently find extra money for it to prevent its ongoing deterioration causing even worse problems. “We are becoming concerned about the fragility of the adult social care market, with evidence suggesting that it might be approaching a tipping point,” he said.
The CQC’s assessment of health and social care, called State of Care, adds that: “The difficulties in adult social care are already affecting hospitals. Bed occupancy rates exceeded 91% in January to March 2016, the highest quarterly rate for at least six years, and in 2015-16 we saw an increase in the number of people having to wait to be discharged from hospital, in part due to a lack of suitable care options,” the CQC’s annual report says.
The number of people in England receiving local council-funded social care services fell by 26% from 1.1m in 2009 to about 850,000 in 2013-14, at a time of Whitehall-driven cuts to town hall budgets. The number of people with unmet needs has risen from 800,000 in 2010 to more than 1 million last year, according to Age UK.
Growing unavailability of social care was a key driver of the 3% rise in emergency admissions to hospital last year and 11% rise in bed days lost to bedblocking. That was mainly due to patients having to wait for a package of care to be put in place to let them return home or for a place in a nursing home to become available. “The effect of these delays on the NHS is significant, costing hospitals £820m a year,” the National Audit Office says.
NHS bodies, health thinktanks and charities urged government to use next month’s autumn statement to inject extra funding into social care.
Simon Stevens, the chief executive of NHS England, has already called for any extra funding for the health service to instead be used to prop up social care. Jeremy Hunt, the health secretary, is understood to privately agree. On Monday Stephen Dorrell, the ex-Conservative health secretary, said that the government’s policy of giving social care less and less money was “insane economics and bad social policy” and undermined its claim to be backing the NHS.
Cuts to social care and also mental health and public health mean “the NHS is being stretched to the limit,” said Stephen Dalton, chief executive of the NHS Confederation, which represents hospitals. “Relying on political rhetoric that promises to protect the NHS but fails to acknowledge that a cut in social care results in a cost to the NHS, is an economic deception.”
The CQC also disclosed that about 800,000 patients are registered with a GP practice that its inspectors have judged to be inadequate on safety grounds. It is concerned that some surgeries deliver “unacceptable standards of care”. Safety failings include poor management of medicines, inappropriately trained staff and premises that are unsuitable.
The Department of Health welcomed the CQC’s findings that “the majority of the NHS, 72% of adult social care services and 87% of GP practices inspected are good or better – and that improvement is taking place all over the country”.
A spokeswoman said: “The NHS is performing well at a time of increasing demand. The government is investing £10bn to fund its own plan for the future, and crucially is ensuring that the amount of money available to local authorities for social care is rising in future years of the parliament, reaching up to £3.5bn extra by 2020.”