Why the new Adult Social Care Discharge Fund is a Drop in the Ocean
In September 2022, the Department of Health and Social Care (DHSC) said there were 13,000 people in hospital who should be receiving care in the community. These “delayed discharge patients”, were taking up over 10% of the 100,000 hospital beds in England, resulting in A&E units becoming heavily congested and long delays in ambulance handovers.
The announcement of the £500m adult social care discharge fund for this autumn and winter has been welcomed by health and social services, but there are a number of major problems.
Dedicated hospital discharge funding isn’t new. In response to the Coronavirus pandemic, central Government funding was made available between March 2020 and March 2022 to assist Health and Social Services in releasing hospital beds to new patients. Commonly referred to as “Discharge to Assess” funding (D2A), the policy and operating models were mandatory.
In addition to relieving pressure on health and social care services, D2A funding provided a period of certainty in which our client’s support needs would be fully funded pending the assessment of their longer-term health and social care needs and care arrangements.
The Government withdrew D2A funding in March 2022, ignoring the arguments of NHS Confederation that D2A funding should become a permanent feature, to remove the long-standing tensions between the health and social care systems at the point when an adult is medically fit to be discharged from hospital. Data collected by NHS Confederation revealed that the D2A funding policies had freed up 130,000 hospital bed days during the pandemic and was a major contributor to the NHS and social care system managing despite other pressures such as staff shortages.
A major issue is that this is not new money – it will be sourced from existing DHSC budgets, which may mean cuts elsewhere.
Also, despite the announcement six weeks ago, none of the funding has been distributed, and it isn’t yet clear how and to whom the funding will be allocated. This inevitably leaves local health and social services unable to plan ahead or to set up systems to support people at this critical time in their lives.
There are currently 100,000 vacancies in the social care sector, and many people prefer the better hourly rate offered by supermarkets and delivery warehouses for work that is less challenging than front line social care.
The President of the Association of Directors of Adults Social Services recently acknowledged that the funding crisis results in unmet, under met and wrongly met need. The reality of people having unmet social care needs is that they will deteriorate, and may well end up with an avoidable hospital admission, then joining the waiting list for a community based social care package.
In September 2022, Age UK research revealed that 2.6 million adults aged 50+ in England are living with some unmet need for care and support. This includes 1.2 million adults who have difficulty bathing or showering without support. The Association of Directors of Adult Social Services Survey found that 73% of local authorities were reporting increased breakdown of unpaid carer arrangements, with families struggling to continue to provide high levels of care without outside support.
Consequently, the adult social care discharge fund is a short-term response to a long-term problem. What is needed is sustainable investment that fully addresses the social care funding crisis, including recruitment and retention, the hourly rate paid to social carers and quality of care.