Commercial Director, CHS Healthcare
Care Quality Commission State of Care report 2021 described this winter as ‘the most challenging of winters’. The health and social care ecosystem is running red hot and faces an array of challenges: a record number of patients waiting for elective surgery; a workforce crisis in the NHS itself; and around 100,000 unvaccinated care home staff who will soon have to leave their roles for this reason – adding even more pressure to an understaffed sector. Last week a letter from NHS England’s medical director, director for emergency and elective care, and its regional directors asked all local chief executives and chairs to take immediate action to stop all delays in ambulance handovers. Images of ambulances queuing outside hospital being amongst the most inflammatory depictions of winter pressures for the public.
Treasury funding for community care initiated at the start of the pandemic has made a significant difference to patient flow out of hospitals to this point. It’s true the backdoor may not have the striking imagery of queuing ambulances but of course the backdoor is the key to the front door.
We’re now in a period where Treasury funding now applies to 28 days of care for new or additional needs of an individual on discharge from hospital. This means health and care staff handling these D2A pathways will be required to ensure checklists, assessments and health and care reviews can all take place in a timely fashion. This will allow people to move through these beds into long term care fit for their individual needs releasing capacity for others.
To ensure these necessary assessments and reviews can happen within this funded period, processes must be followed meticulously and teams across health, care as well as providers must be working symbiotically. 28 days leaves little wriggle room and each day counts.
In State of Care the CQC noted that 45% of people with a disability and 20% of people with a long-term condition said their support needs were not being met following their discharge. And Carers UK reported in ‘Carers experience of hospital discharge’ (September 2021) that the majority (56%) of carers are not involved in discharge decisions.
As well as ensuring capacity, skills and know-how are plentiful in hospital discharge teams, it’s important to remember that patient experience of care as well as that of their friends, family and carers has never been more important. This is true both for long term recovery and quality of life but also to avoid unplanned re-admissions which place unnecessary pressure on an already overwhelmed system.
Chris Ham wrote in the BMJ recently that: ‘The NHS is falling over. Not everywhere, but in some places and in some services the signs of extreme stress are manifest. These signs are the result of the irresistible force of rising demand for care meeting the immovable object of constrained capacity.’
Much has been written about NHS funding following the budget last week. The Resolution Foundation noting that a staggering £84 billion of the £111 billion a year increase in day-to-day Whitehall-controlled departmental spending since 2009-10 will go to the Department of Health and Social Care by 2024-25. With more people living longer and new medicines and therapies available some of this is predictable but a reasoned public debate about the future of the NHS may feel some way off. Therefore we must innovate within the system as it exists today so that capacity is not constrained permanently. For example looking at innovative strategies to how we manage discharge services contracting with providers so they can complete checklists and creating recharge arrangements between LAs and CCGs releasing more flexibility in processes.
The big issues need consideration and contribution from all areas of health and care but for the foreseeable future we will be focussed on working with teams across England helping them to create and maintain patient flow. We do this through dedicated patient flow and discharge support, bolstering capacity. We have unparalleled knowledge of local care provision and identify, secure and manage community beds, timely assessments and end-to-end case management. We are proud to be known for our exemplary support of patients and their families helping them to make decisions about care in a way that supports their needs. All of this helps to make sure that the time people spend in hospital and in the D2A pathway is as short as possible and focussed on their rehabilitation and long-term care.
We also work in the community providing scalable reablement and rehabilitation community care to help patients to get home quickly and receive the care they need at home so they can continue their rehabilitation journey and avoid readmission.
The coming months look daunting. Our focus will be to support health and care colleagues with our skills, capacity, and know-how and to make sure patients and their families have the care and support in the right place at the right time.