Healthcare delivery published People at the Heart of Care 9 , which
encapsulates the plans for reform of social care in England. It sets out a 10-year vision for social care, as well as plans for investment into the sector. The proposed reforms also introduced a cap on individuals’ lifetime care costs, set at eighty-six thousand pounds, and an extension of the upper means test to £100,000. Proposals also include plans to end the
cross subsidy often paid by people who fund their own care, by encouraging councils to pay higher fees to providers. The postponement of the implementation of the reform, which has been the subject of many plans and white papers, is said to be in recognition of the significant financial pressures currently faced by local authorities. Last autumn, the Chancellor announced that further funding would be available for social care discharge, but sceptics have identified that this merely allows for inflationary pressures, rather than any investment to improve or increase the level of care.
Conclusion The key component of any reforms is: do they address the central problem? The cap on lifetime costs is a start but is an ungenerous offer. Equally, the reforms do not address the issues that are central to comprehensive provision, which are the workforce issues, and also wider unmet needs of those being discharged into the community. It seems that, while recent administrations have identified the need to make reforms, those that are designed will not solve the problems. Patients will go on occupying beds in hospital when they ought to be offered supportive care in a place where their needs can be met. One aspect of winter pressures, so dreaded by healthcare organisations, which could have been reduced, is that of delayed discharges. These will continue to be a problem for many years to come.
References 1 How local partnerships to improve urgent and emergency care have impacted delayed transfers of care from hospitals in England: an analysis based on a synthetic control estimation method, BMJ Open
2 NHS Key Statistics England 2020 Dehttps://
allcatsrgrey.org.uk/wp/wpfb-file/cbp- 7281_2-pdf
3 Delayed transfer of care from NHS secondary care to primary care in England: its determinants, effect on hospital bed days, prevalence of acute medical conditions and deaths during delay, in older adults aged 65 years and over, SpringerLink
4 Social care causes of delayed transfer of care (DTOC) from hospital for older people: Unpicking the nuances of ‘provider capacity’ and ‘patient choice’ (
wiley.com)
5 Challis, D., Hughes, J., Xie, C., & Jolley, D. (2014). An examination of factors influencing delayed discharge of older people from hospital. International Journal of Geriatric Psychiatry, 29(2), 160–168.
6 Jasinarachchi, K. H., Ibrahim, I. R., Keegan, B. C., Mathialagan, R., J. C., Phillips, J. R., & Myint, P. K. (2009). Delayed transfer of care from NHS secondary care to primary care in England: Its determinants, effect on hospital bed days, prevalence of acute medical conditions and deaths during delay, in older adults aged 65 years and over. BMC Geriatrics, 9(1), 4.
7 Tucker, S., Hargreaves, C., Wilberforce, M., Brand, C., & Challis, D .(2017). What becomes of people admitted to acute old age psychiatry wards? An exploration of factors affecting length of stay, delayed discharge and discharge destination. International Journal of Geriatric Psychiatry, 32(9), 1027–1036.
8 Hospital discharge and community support guidance,
GOV.UK (
www.gov.uk)
9 People at the Heart of Care: adult social care reform white paper,
GOV.UK (
www.gov.uk)
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