The NHS is going to waste £3.3 billion caring for patients who don’t need medical treatment but the money would be better spent on a Fast Track Discharge Fund to move vulnerable older people into care homes, according to a report from the independent think tank ResPublica.
In Care after cure: creating a fast track pathway from hospitals to homes, ResPublica says thousands of hospital beds would be freed up for medical cases and residential care homes could look after recuperating patients who currently block wards because they have no safe place to go.
ResPublica has found caring for all delayed transfer patients in a residential care setting would cost £835 million over five years to 2020/21, compared to £3.3 billion in an acute bed. The report argues the remaining £2.4 billion should be invested in bed capacity, skills, training and facilities in residential care to allow the sector to step up to this more substantial role.
Director of ResPublica, Phillip Blond, said: “The way health and social care work together needs to improve dramatically.
“The bed blocking crisis in the NHS is only getting worse – clogging up wards and leaving newly arrived patients on trolleys in hospital corridors. Meanwhile, as ResPublica showed last year, a staggering 37,000 beds could be lost in residential care homes over the next five years because the sector is losing money for every publicly funded resident.
“To redress both of these awful situations care homes should be given the necessary financial resources as an appropriate alternate care setting to alleviate the problem of bed blocking.”
A Fast Track Discharge Fund would also address the crisis which is seeing care homes closing because of the low amount they currently receive for funded residents, and the impact of the National Living Wage.
Out-of-hospital services - largely in residential care homes - for patients fit to leave wards but in need of extra support would improve under the fund, which would be used by Clinical Commissioning Groups.
The report found that as well as healthcare needs being met by nursing staff in care homes, pressure would be reduced on accident and emergency departments, where there has been a sharp decline in meeting the 4 hour target to conduct an initial assessment on 95% of patients.
Report author Emily Crawford said: “The gap between social care and hospitals needs to be bridged. Residential homes can provide good quality care for people who are currently being left in hospital beds. These patients, often frail and elderly, stand a much better chance of recovering in the community than in a hospital.
“As we confront the task of caring for an ageing population with finite budgets, this would also free up the much needed beds on our NHS wards.”
- Over the past five years (2011/12-2015/16), the health service spent £2bn caring for patients who are medically fit to leave. Over the next five years to 2020/2021, £3.3 billion will be spent by hospitals on acute care for patients who have no medical requirement to be there.
- The equivalent of 3,575 hospital beds were continually taken up by patients who had no medical need for them in 2011/12. This will rise by 21% to 4, 282 beds by the end of this financial year (2015/16).
- By 2020/21, ResPublica estimates that the equivalent number of hospital beds continually ‘blocked’ will reach over 5,300. This means that for every two ‘bed blocking’ patients in hospitals in 2011/12, there will be three such patients in 2020/21.
The report authors highlighted a human, as well as financial, cost to bed blocking with frail older people unnecessarily in a hospital bed being much better served by expert care in the community. On a ward they are at risk of hospital acquired infection, emotional ill health and a loss of independence.
Ian Smith, Chairman of Four Seasons Healthcare, said: “Discharging medically stable patients from hospital to a recovery period of care in a nursing home is a good idea that works in practice. We know because is already happening in our homes, although so far it is on a relatively small scale. We currently have around 375 people who are recuperating in our homes while their longer term care needs are assessed and arrangements made for their on-going care. It is freeing up hospital beds and saving NHS budgets. We recently launched a 24-7 rapid response assessment and admissions service that helps hospital discharge teams to locate care services in appropriate homes.”
Date published: 15 September 2017