HEALTHCAR E DE LIVE RY
The battleground for the future of the NHS
As this 20th anniversary edition of CSJ reflects on the past two decades in healthcare, we know that the NHS has been experiencing significant winter pressures for some time. However, Matt Currall argues that we need to look beyond blaming social care to unlock patient flow and delayed discharge.
At the time of writing, the NHS is facing the prospect of an immensely challenging winter period ahead. Winter is traditionally the health service’s busiest period with an increase in coughs and colds, along with more falls and accidents caused by icy conditions, leading to a greater number of people seeking to access healthcare. Winter 2022 is likely to be a unique one.
We approach this tricky time after a summer where the health service has seen pressures at a similar level to previous winters. We also have the challenge of COVID-19 still in circulation, but with no public restrictions in place. In August, national hospital capacity sat at over 94%, with bulging waiting lists across emergency and elective care, and harrowing delays in A&E with people facing long waits in ambulances across the country.1
A focus on patient flow is therefore absolutely necessary. NHS’ data, from time
of writing, indicates that 1 in 7 (15.6%) patients in hospitals are well enough for discharge, meaning thousands of people currently residing in hospital beds could be elsewhere – either at home or being looked after somewhere else.2,3
This is a reflection
of the importance of flow and the need to get it right to unlock the system. If we can succeed and get hospitals operating efficiently, then we will see waiting lists greatly reduced with significant benefits for patients and hardworking staff. To help accelerate flow, the Health and Social Care Secretary, Thérèse Coffey, announced a package of measures designed to help hospitals and hardworking healthcare professionals cope with the increased demand that was coming down the tracks. This package consisted of £500m of funding to bolster social care, and ultimately address flow. However, we believe that funding directed toward social care will not entirely
alleviate the pressures that we’re seeing, as this is not the sole, root cause of the problem; there are many more contributing factors that must be addressed, as we will outline in this article. From a survey conducted by CHS Healthcare earlier this year, of frontline NHS and social care staff, our data showed that social care challenges are complex and not simply a case of not enough space, with a clear disconnect between the perspectives of hospital and social care staff. The majority of care workers reported
that paperwork, admin and bureaucracy (54%), no clear discharge planning pathway (48%), and delays in agreeing funding (47%) were the biggest causes of delayed discharge.
Although, over three quarters of hospital workers responding to our survey (76%) told us that lack of social care capacity was a cause of delayed discharge for patients that require additional support or a new placement, this was not the case for care workers, with over three quarters (78%) not reporting care capacity as a cause for delays for patients who come directly from hospital. This tells us that there is a clear breakdown in communication between the hardworking professionals in both hospitals and in social care, with this breakdown meaning more delays for patients. In addition, analysis of the data from the NHS and the Office for Health Improvement and Disparities4
suggests that regions with
the greatest availability of social care beds still face significant issues with delayed discharge, and the regions with the lowest percentages of medically optimised patients remaining in hospital do not have the uppermost social care capacity. Therefore, while social care is of course a crucial factor, our evidence indicates that the root cause of delayed hospital discharge is not solely due to social care capacity – as
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