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Trust admits staff shortages causing inappropriate discharges

Published on: 17 Mar 2022

A report to East Kent Hospitals University Foundation Trust’s board last week revealed that 160 extra beds had been commissioned to maintain flow across the local health economy “due to insufficient domiciliary/care package capacity.”

It went on: “The clinical commissioning group have tried via Kent County Council to commission additional domiciliary care without success. It is acknowledged by the local health economy that it is important to withdraw from these additional beds as quickly as possible as they are not a cost-effective resource and more importantly, in many cases, they are not the ideal discharge destination for those patients who could have been discharged home with a care package.

“Patients are being transferred into community hospital beds or residential home beds due to a lack of domiciliary care packages. Although this is a national issue, it will not be resolved locally until appropriate pathway capacity is commissioned.”

Professor Adam Gordon, president elect of the British Geriatrics Society, said: “If people have been sent to a care home when they don’t want or need to be there that can affect their motivation and result in a form of deconditioning. One of the principles of effective rehabilitation in older people is that if you don’t use it, you lose it.”

He said there were shortages of both care home beds and home care workers around the country, varying by area. Short-term solutions were being tried by NHS trusts such as more discharge-to-assess capacity and intensive rehabilitation, but this was often “moving the deckchairs on the Titanic,” he said, with any sustainable solution needing to address pay and conditions for care staff.

Last week, EKHUFT had 107 patients in hospital beds who no longer meet the criteria to reside – although it would not confirm how many patients who are judged to need domiciliary care are being discharged into care home or community hospital beds.

In December NHS England and Improvement set trusts a target to reduce their numbers of medically fit for discharge patients remaining in beds by 30 per cent – which EKHUFT has now met, despite a rising number of patients requiring more complex discharges with additional support.

Initial home care packages and placements are funded by the NHS for up to four weeks. Both residential care and home care packages are usually means tested beyond that point, with the local authority being responsible for costs not met by the individual, except when individuals are eligible for continuing healthcare which is NHS funded.

Kent County Council said the care sector had been under “unprecedented pressure” nationally but it had robust plans to manage this. It added it had occupational therapists and enablement support officers to help people regain independence.

Kent and Medway CCG, on behalf of the local health economy, said that it was a priority to help people discharged to a care home to then “step down” to less supported environments, including returning home. “Residential care is about active living to help people return, where possible, to where they normally live, sometimes living independently,” it added.

Homecare Association’s chief executive Dr Jane Townson said: “Demand for homecare is exceeding supply. Homecare providers have done a stellar job of increasing their capacity by around 15 per cent over the last year. But this has only been possible by using existing staff. Recruitment and retention is the most difficult it has been in living memory. Pay, terms and conditions are key reasons for this, as well as competition with other business sectors and of course covid restrictions and the issues surrounding vaccinations and testing.  

“We welcome the government’s vision for social care, which places home-based support and care at the centre. To turn this vision into reality, homecare needs much greater investment. Investing adequately in homecare helps to enhance quality of life, improve outcomes, take pressure off the NHS and save money for the health and care system.”