HEALTHCARE DELIVERY
its importance to patient safety, there are also examples of poor performance worsened by inadequate systems which have been allowed to continue for too long. Long waits for ambulance staff to transfer patients to A&E departments are unacceptable and must be addressed, the Health Commitee argued.
Struggle to manage demand
As identified by NHS England’s chief executive, emergency departments will struggle to manage demand unless additional infrastructure funding is made available to those struggling in inadequate premises. The Health Committee says that it is essential that the Government ensures that sufficient capital funding is available for Trusts to develop the infrastructure that will enable them to meet performance levels demanded by Ministers. The first step will be an assessment of the infrastructure investment required to ensure that type 1 emergency departments are fit for purpose, which should be completed through the Sustainability and Transformation Plan process.
Call for sufficient funding
The report calls on the Government to make sure that sufficient funding is available to support the infrastructure investment required to ensure that type 1 emergency departments are fit for purpose, and to review the real terms cuts to NHS capital budgets. The Committee calls for NHS Improvement to consider the steps that it can take this winter
to ensure that all A&E departments are properly staffed and for Health Education England to look again at the long-term sustainability of staffing, including for paramedics, within major emergency departments and the ambulance service. Three leading health charities have also issued a call for the Government to address the gap in social care funding.3
In a recent
briefing, the Health Foundation, The King’s Fund and the Nuffield Trust analysed the state of health and social care finances, concluding that cuts and rising demand will leave adult social care facing a £1.9 billion funding gap in 2017.
The three organisations concluded that, Incoming president of the BGS calls for
respect for ‘victims of underfunding’ Dr Eileen Burns, the new president of the British Geriatrics Society, has called for public recognition that older people facing delays in discharge from hospital are the victims of underfunding of social care and not ‘the problem’. Dr Burns is urging members of the public, and media, to reject pejorative terms like ‘bed blockers’ and urge the Government to give social care the priority it deserves. Accessible social care is a key factor in reducing hospital admissions and delayed discharges for older people. According to research published by Age UK, the number of older people in England who don’t get the social care they need has soared to a new high of 1.2 million – up by 48% since 2010. There is a direct correlation between these statistics and the latest data from NHS England which found that delayed discharges are at their highest level since records began in 2010, with the number of delayed days in September reaching 196,246. It is this lack of support for older people in their homes and communities, rather than patient or physician choice, which has led to such
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high numbers of hospital admissions and delayed discharges, which has in turn put tremendous pressure on an already overburdened acute sector, Dr Burns pointed out. She commented: “The vast majority of older patients would prefer to be in the comfort of their own home when they feel well enough, and some are actively distressed at having to stay in hospital. The term ‘bed blocker’ in no way conveys the true situation and lack of choice these patients are facing. As physicians our hands are also tied as we are unable and unwilling to send patients home without the knowledge they will be safe and receive the care they need. “Patients who experience delayed discharge are not the problem; they are the victims of underfunded social services and deserve our understanding and respect. Without adequate funding we will continue to have high numbers of delayed discharges and I would urge both the Government, and the general public, to understand this vital connection between health and social care.”
despite mounting pressures on the NHS, finding money to plug this gap is the most urgent priority. They urge the Government to bring forward planned increases in social care funding through the Better Care Fund, warning that, without this, thousands more older and disabled people will be denied access to the care they need, with severe consequences for the NHS. This follows a 9% real terms cut in social care spending by local authorities between 2009/10 and 2014/15, which has led to 400,000 fewer people accessing social care.
The three organisations also warned that the planned increase in the Department of Health’s budget between 2015/16 and 2020/21 will not be enough to meet rising demand for services, maintain standards of NHS care and deliver the changes to services set out in the NHS Five Year Forward View. The briefing warned that the pressures on the NHS will peak in 2018/19 and 2019/20, when there is almost no planned growth in real terms funding, and argues that the Government will also need to consider additional NHS funding in future financial statements or be clear about the consequences for patient care.
The analysis shows that health spending in England will increase by £4.2 billion over this parliament, an average rise of 1.1% per year in real terms. This is almost identical to the increase in the last parliament and much lower than average annual increases of nearly 4% since the NHS was established, despite rising demand for services. It is also much lower than the funding increases for the NHS cited by the Government as it covers all health spending, not just the budget for NHS England. Richard Humphries, assistant director for policy at The King’s Fund, said: “Cuts to social care funding are leaving older and disabled people reliant on an increasingly threadbare local authority safety net. For many, the care they get is based not on what they need but on what they can afford and where they live. More people are left stranded in hospital. This Government has committed to creating a country which
MARCH 2017
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