Today, the Telegraph printed a letter sent to them by the Chair of the NHS Confederation which states that
The NHS Confederation has expressed concern that cuts to local government could have a knock-on impact on NHS services.
Less support from council services will quickly lead to increased pressure on emergency services and hospitals. Hospital beds will be blocked for those who badly need care because the support services that the elderly require after discharge will not available.
Of course, this comes as no surprise. This happens today and has been happening for years. It was the impetus behind the Community Care (Delayed Discharge) Act 2003 which allowed hospitals to charge local authorities for patients that they are unable to provide care for when the patients are ‘ready for discharge’.
The difference now is that the services to be provided will be in shorter supply, on tighter budgets and the local authorities won’t necessarily be able to pay the charges that are imposed through this Act.
This Act is one of the sharpest indicators of a ‘robbing Peter to pay Paul’ approach to health and social care funding when money is taken out of one pot to put into another.
Has it speeded up hospital discharges? Yes.
Has it speeded up appropriate hospital discharges? Debatable.
The raising of eligibility criteria and the increase of costs for services to those who are means testing will challenge local authorities as they seek to provide services on discharge.
Indeed, of the £1 billion health service budget that seems to have been redirected to social care, the Chancellor was careful to specify ‘reenablement projects’ which are often exactly the projects that manage speedy hospital discharges, providing a free initial service before the costs kick in.
Only one problem here. The money isn’t ringfenced.
I don’t like referring to ‘bed blocking’. Each of those patients in those beds needs to be treated with dignity and respect. When I was in hospital (as a patient) myself, I saw a consultant berating the woman in the bed opposite me for still being in hospital when it cost so much and she was clearly ready to go home.
Poor woman. So much for dignity.
She explained to the person in the neighbouring bed that it would cost her £12 per hour for the support the social worker said she needed and she wasn’t sure her husband would agree.
It was a glimpse into the future for me and a chance to look beyond the role I have as I was merely another patient in another bed at that point.
This is where we will be going because there will be more people unwilling or unable to pay the means-tested amounts to see them out of hospitals. Hospitals will be under ever-increasing pressure to discharge and the local authorities will be left to pick up the pieces for ever too speedy hospital discharges or to break the news when the ‘re-enablement’ money runs out.
Because it will run out. It will run out very quickly.
But there’s two sides to this. Yes, the local authority will struggle to provide care to facilitate speedy discharges because they will have fewer resources and fewer members of staff but also, higher eligibility criteria will mean that more people come to social services via hospitals than at earlier stages of their needs when the hospital admission may have been preventable.
Spending on social care and widening eligibility does not cost, it saves. It saves pain and hardship. It saves dignity and potentially unnecessary hospital admissions. It saves money. It saves lives.
- Spending Review 2010: NHS faces bed-blocking crisis (telegraph.co.uk)
- Cuts ‘will see hospital beds fill’ (mirror.co.uk)
- Care cuts ‘may hit hospital beds’ (bbc.co.uk)
- Care cuts ‘will see hospital beds fill up’ (independent.co.uk)
- Patients lying in corridors will expose this Tory botch | Polly Toynbee (guardian.co.uk)
- You: NHS bed lack could affect neediest (guardian.co.uk)