It was very welcome news that a Government summit had recommended implementation of a policy to provide extra “band aid” funding (£200m initially) to assist the relocation of patients from unsuitable hospital accommodation to the more homely and appropriate placement of those people in care homes which are much more suited to their chronic illnesses and care needs and pastoral requirements.
In very broad terms the number of “bed blockers” in hospital is about the same as the as the number of vacant beds in care services.
We, at Ridouts, have been advocating this basic and simple policy change which is long overdue. We applaud the decision, and, are disappointed that the immediate reaction of many of the usual commentators is to decry this constructive and welcome development.
Again, in very broad terms the cost of a hospital bed is about 3 x that of a nursing home bed and rather more, if “assessed need” is only for residential care. NHS costs will not be reduced but the release of bed space will achieve an immediate and sustainable benefit.
We are, however, disappointed that the management and distribution of the benefits of this policy are to be delegated to local and usually, NHS Commissioners. NHS purchasing managers have a long history of effecting a diversion of new funding to their own projects rather than to front line services, and, in particular, Social Care which is seen as undeserving, when, in fact, it is the hidden and simple first and best solution to NHS funding and delivery issues.
Of course, there will be need for local information and care assessment expertise, but, the simple truth is that the needs assessments will already have been completed, if patient need has identified the individual as fit for discharge. Those needs are exactly the needs that nursing and residential care services are established to provide and skilled in delivery.
Some within the social care sector immediately continue to chant their mantra that more money is required; for those pundits no amount of money will ever be sufficient. That is no reason not to thankfully accept what is offered and use the funds to demonstrate how efficient, effective and constructive the social care service can be in the nations interest; and indeed in its own medium and long term interests.
The vacant bed spaces in Social Care require little extra delivery cost, and, will lead to a very significant profit uplift. The social care sector knows this, and, should play its part by negotiation realistically to discount the bed prices when where there is little increased direct cost. The money will go further and surpluses/ profits will be enhanced.
Our answer, to this puzzle, is that the new funds should remain with the central control of NHSE who will more easily and effectively be able to effect direct commissioning with more speed and direct control of results. Social care providers should play their part by constructive and results driven price negotiation. It is unlikely that the care needs of those assessed as ready for discharge will be beyond the capacity of competent nursing and residential care providers.
Negotiations will be assisted by the presentation of a simple 4 to 5 page document rather than the monster tome which is the NHS one size fits all document. Provision of accommodation and care services is a very basic service agreement to which can be attached an individual assessment which, as argued above, must surely be in place already.
Government needs to be bold and maintain the funding so that cohorts of patients can be replaced as circumstances develop. The Care Provider sector needs to have confidence that the pipeline and admissions will be sustained even when the current crisis abates. It would be foolish to allow the same difficulties to arise again. Bed blockers should not be in unsustainable and expensive hospital placements – crisis or no crisis.
The contracts are basic and simple. The policy can be expressed as ongoing provided assessed needs continue to point to discharge from hospital and sustainable placement in social care.
Properly established the implementation of such a developing, simple and obvious policy would likely stimulate investor appetite to fund the construction of a new wave of care services which are so much in demand. Thereby the health of the social care sector could be restored to its proper place as an integral bedrock supporting the whole health service rather than an unwarranted and unsung Cinderella service.
The Governments bold approach could then be seen as the discarded glass slipper from which a new dawn can arise.
