Transfer delays from hospital to social care impacts mental health of older people
Delaying transfers from hospitals to social care is having a tragic impact on the mental health and wellbeing of older people
The financial crisis engulfing health and social care risks driving the NHS and local government further apart.
A recent report in the Local Government Chronicle has revealed that ministers have instructed 47 of the 152 councils running social care to reduce delayed transfers of care from hospitals attributable to social services by 60% or more, based on their performance in February.
The accompanying letter from the Department of Health and Department for Communities and Local Government made clear that councils that fail to hit their target risk being penalised in the allocation of the £2bn of additional social care funding announced in the budget. These threats are hardly likely to improve the relationship between the NHS and Local Government.
The Local Government Association has already withdrawn support for the Better Care Fund planning guidance for this year, which compels councils to focus on reducing pressure on the NHS irrespective of their local priorities.
This raises two crucial issues: whether this is a sensible way to tackle delays in transfers of care, and what this increasingly fractious debate says about relations between health and local government.
According to the official statistics, there were 178,400 days lost through delays in May. Around 55% were attributable to the NHS, 37% to social care and the remainder had shared responsibility. Delays started rising sharply in 2014, reaching a peak of more than 200,000 in October 2016.
The human cost is immense, paid in the physical and mental wellbeing of mostly older people deprived of the comfort, security and independence of home.
But the underlying causes of delayed transfers of care are complex, and reducing it to a simplistic blame game makes it more difficult to identify solutions.
For example, could an admission have been avoided? Was the frailty team engaged as soon as the patient arrived to ensure they were kept as active as possible, thereby reducing their eventual care needs? Was discharge planning begun soon after the patient arrived? Have delays in medical care, such as waiting for scans or test results, increased their care needs by reducing muscle strength or increasing confusion? How well are social care teams integrated with hospital operations?
Slapping an arbitrary target on councils contributes nothing to solving these issues; it simply exacerbates underlying tensions between health and local government.
Councils always resent being ordered about by ministers, and are particularly sensitive over anything to do with the NHS. Many councillors are bitter that their ability to implement severe cuts is rewarded with a requirement to do more of the same, while the NHS is rewarded for going into deficit with more cash. Now even the rare good news of the additional social care funding is being made conditional on helping the NHS.
This dispute is undermining the substantial progress made over the last two years in strengthening collaboration between health and local government. Sustainability and transformation partnerships (STPs), whatever their shortcomings, mark a determined effort by NHS England to involve local politicians and officers in key decisions around the future of local services. The Greater Manchester devolution deal, and now the ambitious agreement for integrating health and care in Surrey Heartlands, demonstrate a willingness to take bold steps towards local empowerment.
But in issuing ill-considered orders around the Better Care Fund, ministers are reverting to old habits of command and control, which are wrong in principle and fail in practice. Their behaviour is reminiscent of a manager who has been trying to be a good leader, but can’t help shouting at the staff when things get tough.
Delays in transferring people from hospital to social care is having a traumatic effect on the lives of people who wish to live more independently. Improvement in the relationship between health and local government is essential if delays in transfers are to be reduced.
The NHS undoubtedly needs local government support to modernise its care and establish something approaching financial stability. The collaborative approach exemplified by STPs is the only way to achieve this; government interference, arbitrary targets and financial penalties will not only inflict long-term harm, it may well continue to deny people who are able to leave hospital when they choose and live their lives in their community.
Albert Cook BA, MA & Fellow Charted Quality Institute
Bettal Quality Consultancy