Severe pressures in hospitals this winter has seen thousands of operations cancelled, causing social care leaders to urge NHS bosses to ‘start listening’ and let care homes do more to help.
Elderly people are among those who are most at risk of illnesses such as flu during the winter months. NHS England has said hospitals, GPs, ambulances and other NHS services have been extremely challenged this winter, and have reported higher levels of respiratory illness and flu.
In the final week of 2017, the NHS 111 helpline received more than 480,000 calls.
Martin Green, chief executive of Care England, which represents independent care home providers, said: “The NHS Acute Trusts could significantly reduce winter pressures by establishing long-term relationships with independent care providers. The care sector has been saying this for years and yet again the NHS has not listened and is in yet another crisis”.
Health secretary Jeremy Hunt apologised to patients following a decision to postpone tens of thousands of operations in January because the NHS is struggling to cope with a surge in patients this winter.
Non-urgent treatments had already been cancelled until mid-January, but this has now been extended to the end of the month.
Handover delays outside A&E departments stop ambulances from getting to new emergencies. The handover of patient by ambulances at A&E departments is supposed to take no more than 15 minutes.
Almost 5,000 people were left waiting in ambulances outside A&E departments for one hour in the last week of December, as 12 hospital trusts revealed they had no beds free. These health trusts were operating at 100 per cent, well above the recommended 85 per cent.
A&E staff can’t move patients out of their department and onto hospital wards, because hospitals can’t discharge patients from their wards into the community. Shropshire County Council is working with care homes to ensure patients don’t stay in hospital any longer than necessary. The council is working to cut the number of patients delayed in hospital, known as a Delayed Transfer of Care (DToC).
At the end of December, Shropshire’s A&E departments got hospital staff from other wards to help with the volume of emergency patients it received and had already commissioned extra beds in care homes, which are block purchased to ensure they are there when needed.
The Shropshire-based care home The Uplands offers nursing and specialist dementia care. It is run by Marches Care and has been drafted in to help this winter. Mandy Thorn, the managing director of Marches Care and vice-chair of the National Care Association (NCA), which is made up of small-and medium-sized care providers says: “If care homes were more involved in local winter planning, which is actually a year-round issue, we would probably see less of a problem with DToC.”
She believes this would be possible if they are “engaged early enough and sensible and respectful contract discussions take place – around block contracts at a price that reflects the additional support that short-term admissions require.”
She says when it comes to care homes being used to address winter pressures it’s “a patchy picture across the country”.
“Smaller independent providers are not always considered when local authorities and CCGs get together to discuss their response to winter pressures. When health and care professionals get together to respond to hospital bed pressures, not every local area takes into account the residential and nursing beds that may be available.”
According to figures from the Institute of Public Care, from April 2012 and April 2017, the number of care home beds available fell by 3,769. Add to this a major staff retention and recruitment problem in the care sector and the country’s ability to respond to a winter NHS crisis gets more challenging.
Responding to criticism from the care sector that some care homes’ beds are ignored in different parts of the country, Colin Noble, the leader of Suffolk council and health and social care spokesman for the County Councils Network, (made up of 27 county councils and 10 unitary councils), told carehome.co.uk: “I think it comes down to market intelligence.
“Every single day we are working with every single care home. It’s a question of how much of a silo between CCGs [Clinical Commissioning Groups] and councils exists in an area. Local authorities know all of their care homes but that’s not always the case for CCGs.
“It’s a matter of CCGs using the council’s market intelligence about care homes.”
Mandy Thorne puts it simply. “Staff in my care home report increased job satisfaction because they see people admitted to us from hospital needing significant support who then leave to go home after a couple of weeks because they are well enough to return to their own homes.
“Long-term residents have also benefited because they can interact with a wider variety of people who come into the care home, and who by seeing people get better and go home they can be more motivated to do more themselves.”
Is it not time that we saw a closer working relationship between social care and the NHS to reduce the pressures of bed blocking. In Shropshire they have set a good example of forward planning, by block booking care home beds in advance. Colin Noble highlights the importance of market intelligence to alleviate the problem and Mandy Thorne suggests that more consideration needs to be given to smaller providers. Surely, making better use of what social care can offer will be of benefit to patients and hospitals and reduce the crises experienced by the NHS each winter. Come on NHS is it not time you started listening.
Albert Cook BA, MA & Fellow Charted Quality Institute
Bettal Quality Consultancy