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HEALTHCARE DELIVERY
Social carefundinggap puts pressure onA&E
Adult social care is reported to be facing a £1.9 billion funding gap in 2017. A number of organisations have highlighted an urgent need for increased funding in order to relieve the pressure on health services.
A number of healthcare organisations, politicians and health charities are warning that there is a need to tackle the gap in funding for adult social care in order to relieve increasing pressure on the NHS. The Care Quality Commission’s report on the ‘State of healthcare and adult social care’ (2015/16)1
found that there is some
evidence of a deterioration in care quality, with some providers struggling to improve their rating beyond ‘requires improvement’. The CQC found a great deal of good and outstanding care – particularly in children’s and young people’s services and critical care. However, too much acute care was found to be ‘inadequate’ – particularly in the areas of urgent and emergency services and medical services. It warned that it will be increasingly difficult for NHS Trusts to make improvements to these services unless they are able to work more closely with adequately funded adult social care and primary care providers. The CQC commented that: “The fragility of the adult social care market and the pressure on primary care services are now beginning to impact both on the people who rely on these services and on the performance of secondary care.” It stated that the combination of a growing and ageing population, more people with long-term conditions, and a challenging economic climate meant greater demand on services and more problems for people in accessing care. According to the CQC, this is translating into increased A&E attendances, emergency admissions and delays to people leaving hospital, which in turn is affecting the ability of a growing number of Trusts to meet their performance and financial targets.
Health Committee: pressure on A&E
The Health Committee has also warned that unless the shortfall in social care provision is addressed, people will continue to face avoidable admission and delayed discharge from hospital, and has called on the Government to provide urgent funding.2 Dr Sarah Wollaston MP, chair of the Health Committee, commented: “Accident and emergency departments in England are managing unprecedented levels of demand. The pressures are now continuing year round without the traditional respite over the summer months as departments try to cope with increasing numbers of patients with complex needs.” For major emergency departments in 2015, only 88% of patients were admitted,
For many, the care they get is based not on what they need but on what they can afford and where they live.
MARCH 2017
transferred or discharged within four hours, well short of the 95% standard set by the Government. This figure masks great variation in the performance of Trusts, which cannot be explained by financial challenge, demographics and demand alone.
Patient flow
The Health Committee report points out that some Trusts are supporting patient flow out of hospitals by creating their own services that provide social care in order to address the problem of delayed discharge. These initiatives, however, have a limited scope when Trusts are themselves under such financial pressure. The Health Committee said that investing in social and intermediate care should be a priority. The current level of variation in meeting
the four-hour waiting time standard is also due to differences in the way that Trusts manage flows within hospitals. While there are examples of excellent practice and systems alongside a culture of all staff supporting the A&E department because of
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