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Use billions wasted on bed-blocking to bolster residential care, urges think tank

‘Fast track discharge fund’ would free up NHS beds and expand care home provision

Caroline White

Wednesday, 02 March 2016

The £3.3 billion the NHS is going to waste in the next five years caring for patients who are medically fit to leave hospital would be better spent on a Fast Track Discharge Fund to move vulnerable older people into care homes and bolster residential care provision, concludes a report* published by independent think tank ResPublica.

Caring for all delayed transfer patients in residential care facilities would cost £835 million over the next five years to 2020-21, compared to £3.3 billion in an acute bed, estimates the report.

The £2.4 billion left over should be invested in bed capacity, skills, training and facilities in residential care to equip the sector to step up to this more substantial role, says the report.

Since 2011-12, the health service has spent £2bn caring for patients who are medically fit to leave. Over the next five years to 2020-21, this will rise to £3.3 billion, says the report.

The equivalent of 3,575 hospital beds were ‘blocked’ 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 2015-16, it says.

By 2020-21 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, estimates the report.

“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,” commented the think tank’s director, Phillip Blond.

“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,” he added.

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, says the report.

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, suggests the report.

It found that as well as healthcare needs being met by nursing staff in care homes, such a move would reduce pressure on accident and emergency departments, where there has been a sharp decline in meeting the four hour waiting target.

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.”

The report authors highlight the human, as well as financial, cost to bed-blocking with frail older people 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.

Dr Sarah Wollaston MP, Chair of the parliamentary Health Select Committee, said: This report from ResPublica provides compelling evidence that social care cannot be seen in isolation from the NHS. There is an urgent need to improve access to social care and to address the delayed transfers of care and this can no longer be side-lined by policy makers.”

Mike Parish, Chief Executive of care provider Care UK, said: “The most critical issue facing our NHS hospitals is inpatient and A&E congestion caused by the unnecessary admission of patients, due principally to limitations in primary care, and difficulties in discharging frail and elderly patients because of the under-funded and under-developed state of social care.

“This can be addressed through more effective partnership and investment in better resourced and technologically enabled forms of primary and social care, and this report makes a strong case for such strategies.”

Justin Bowden, GMB National Officer for the care sector, said: “The future of the NHS is intertwined with the fate of social care; as government underfunding sends social care down the pan, so the NHS is dragged with it.

“Proper investment now in the residential care sector, which is willing and ready to help with the bed-blocking crisis in the NHS, is cheaper in the long run, better for those who should be discharged and frees beds for those who actually need to be in hospital.”


* Crawford E, Read C, Sim D. Care after cure: Creating a fast track pathway from hospitals to homes. ResPublica, March 2016.

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