Home discharges should not be overlooked, sector leaders tell government

The government has this week announced immediate funding to buy short-term placements in community settings, including care homes, to enable patients in England to be discharged from hospital.

Backed by up to £200 million, the government says the scheme will allow local areas to buy thousands of extra beds to help discharge more patients who are fit to leave hospital and free up hospital beds for those who need them.

“The NHS is under enormous pressure from COVID-19 and flu, and on top of tackling the backlog caused by the pandemic, strep A and upcoming strikes, this winter poses an extreme challenge,” Health and Social Care Secretary, Steve Barclay, said.

“I am taking urgent action to reduce pressure on the health service, including investing an additional £200 million to enable the NHS to immediately buy up beds in the community to safely discharge thousands of patients from hospital and free up hospital capacity.”

However, responding to the announcement, organisations and individuals across the adult social care sector have generally welcomed the funding but questioned aspects of the approach – most notably, its focus on discharging patients into care homes, rather than their own homes.

“The best place for most people leaving hospital is their own home – with the appropriate support in the community that they need to recover,” Sarah McClinton and Sheila Norris, President and Chief Executive respectively of the Association of Directors of Adult Social Services (ADASS) said in a joint statement.

The pair said that people having a choice in where they live was the right option, both legally and morally. Noting findings from their survey of their members – current and former directors of adult care and social services – they argue investment should be focused equally on home and community-based support, the social care workforce and support for family carers, not just care homes.

“Use of the funding should be guided by the ‘home first’ principle, rather than the default being that people are discharged into care homes. Otherwise we run the risk of people being inappropriately placed and then remaining in residential provision indefinitely.”

“We must recognise that long-term, sustainable investment is needed in primary and community based care and support and for family carers. We must stop thinking that pots of crisis funding are the solution. We want to enable people to remain independent and healthy in their own homes for as long as possible and to recover there after a spell in hospital.”

This was echoed by the British Association of Social Workers (BASW) who said that the ongoing impact of the pandemic, winter pressures, lack of investment in social care and staff vacancies across the social care and health sector is continuing to put pressure on an “incredibly fragile system”.

“Additional funds must be used to support people in their own homes where at all possible, to support re-enablement safely and promote the rights and choice of citizens,” the association said in a statement.

The announcement comes after reports that hospitals in the South West of England have set up so-called “care hotels” to allow them to discharge patients who no longer need to be in hospital but cannot yet be transferred into the social care system. These establishments will generally be staffed by live-in care workers and provided by private homecare companies, with patients staying in the accommodation for around three weeks.

Criticising the use of “care hotels”, BASW said buying extra beds in care homes is “not the answer for many people who would prefer to be discharged to their own homes.”

“Social workers and social care staff play an essential role in supporting people to remain living in their own homes in local communities. Citizen choice, rights, and needs must not become secondary to hospital discharge driven processes that focuses on numbers and targets rather than people.”

Individuals in the sector have also criticised the announcement as a further step towards privatisation of the NHS.

Rob Mitchell, Social Worker and co-author of Social Work, Cats & Rocket Science, questioned whether the reaction would be different had the target of the announcement not been adults receiving care.

“Yesterday the govt announced a £250M shift from NHS provision to private provision. The privatisation of the NHS could not be more explicit,” Rob wrote on Twitter.

“I wonder if this shift was instead about services for working age adults or children & not older people the reaction would be different?”

“Imagine replacing paediatric NHS hospital beds with £200M of beds in children’s homes? It would be an outrage. It’s the same for adults! Adults must be supported to be healthy, happy and crucially wherever possible - at home!”