People who don’t get care support at home are nearly a third more likely to end up in hospital
- 61% of older people who do not get help with the basics visit hospital each year
- Experts from NHS Confederation, British Red Cross, and Care and Support Alliance speak out
- Government must to address “chronic underfunding” in care system
The evidence that community care prevents people being isolated, falling into crisis and ending up in hospitals is now impossible to ignore, according to 75 organisations supporting older and vulnerable people, and family carers.
As MPs prepare to have their final debate on the Care Bill, the Care and Support Alliance, argue that getting care reform right is crucial to easing the growing pressure on our health system.
The CSA points to new analysis of the latest Health Survey for England. It says this is the “missing evidence” that backs up the succession of influential voices who have recently spoken out on the increasing numbers of older and disabled people reporting to hospitals, rather than community-based services.
Today two more voices speak out: the NHS Confederation – which represents all organisations that commission and provide NHS services – and the Red Cross, whose teams work in A&E to prevent or shorten hospital stays of people who are clinically fit but do need care and support at home.
Richard Hawkes, chair of the Care and Support Alliance, said:
“For the first time we can put a finger on the considerable impact local care support has on easing pressure on hard-pressed hospitals.
“This is the missing evidence that backs up a succession of experts speaking out on the issue.
“The winter A&E crisis is being intensified by an historic squeeze on council-funded local care.
“Chronic underfunding has left hundreds of thousands of older and disabled people, who need support to do the basics, like getting up or out of the house, cut out of the care system
“The impact is being felt throughout the health and care system.
“The Government has put forward strong proposals in its Care Bill, which will greatly improve a social care system which is on its knees. But it’s becoming clear that a huge number of older and disabled people will not see any of the benefits of the new system, because of plans to tightly restrict who gets care.
“This will place huge pressure on family carers.
“We want the Government to have the courage to see its bold plans through, and make sure that those who need support to live independently get council care.
“To do this, the Government needs to commit to properly funding the social care system.”
Rob Webster, Chief Executive of the NHS Confederation, said:
“When people’s needs are not met by the social care system, they have nowhere to turn but the NHS. This means pressures in social care lead to pressures in the NHS and poorer quality care, with community services under pressure, delays in getting people home from hospital and problems at A&E
“A sustainable long-term funding settlement for social care that allows local authorities to spend money on all those who need care is crucial if the health and social care system as a whole is to be sustainable. We agree with the Care and Support Alliance that the objectives of social care reform and the Care Bill will not be met without sufficient funding.
“The health and social care system will struggle to meet people’s needs unless we can reshape care to be better co-ordinated and more community based, to prevent people reaching crisis point and to maintain their wellbeing for as long as possible.
“The NHS Confederation’s 2015 Challenge is calling for an honest national debate about how the NHS and care system needs to change if provision of care, free at the point of need, is to be sustainable.”
The British Red Cross staff and volunteers work in major A&Es to help people who turn to hospitals when they might be better served by support in the community.
Mike Adamson, Managing Director, British Red Cross, said:
“Elderly patients in particular often arrive in A&E as a first port of call, when there isn’t a significant clinical need but they feel unwell and this is compounded by their isolation. We know that A&E units sometimes admit these patients to the wards because staff are concerned about the patient’s vulnerability and because there is no support at home.
“Yet reaching a point where admission seems the only safe course of action is avoidable if the right support networks are in place.
“Our staff and volunteers support A&E units across the country by preventing admission to the acute wards. We help patients who would otherwise be admitted because of social need to safely return home or arrange care elsewhere.
“Ultimately, however, our services are a stop-gap and the system needs to be reformed so that people do not turn to hospitals due to a lack of support at home in the first place.””
Rachael Jones, Sister at Accident and Emergency Department Observation Ward Blackpool Victoria Hospital
“Many patients are admitted to A&E when their needs are more of a social care nature and linked to general ill health or the fragility of advanced age. This doesn’t mean they don’t have medical issues, but these could often be managed better in the community and studies back this up. A lack of support at home can bring about more admissions to the A&E department when people struggle to manage.
“Sometimes patients will be discharged because no further medical intervention is required but return a few days later because they are distressed, frightened or not coping well on their own.
“When the British Red Cross provide the Enhanced Discharge Service it gives the A&E medical staff peace of mind knowing they will make sure the patient is settled at home, be able to assess the home situation and carry out follow up work if needed. This also releases much needed beds in a busy environment for incoming patients.”
3. Influential voices speak who have recently spoken out on the link between care and A&E:
The Health Secretary Jeremy Hunt MP said: “If the NHS is going to be sustainable with an ageing population we need to be much, much better at looking after people out of hospital.”
Sir Bruce Keogh medical director of NHS England echoed those sentiments in his evidence to the Commons Health Committee, “… A&E is where the problem is manifest, but actually the problems lie in social care, they lie in primary care, they lie in communities…”
Health research and think-tank The King’s Fund sees community-based care as essential to reduce hospital admission rates, and stemming growing demand for hospital beds.
Last year Care Quality Commission head David Prior said emergency departments were ‘out of control’, and ‘Many frail elderly people who ended up in hospital should not be there’.
4. Funding squeeze
Cash-strapped councils are rationing care. The number of people receiving support has plummeted for five years in a row – by a total of 347,000 since 2008. Sitting behind the squeeze is the fact that councils have had to reduce their adult social care budgets by £2.6bn in the last three years alone, according to social services directors
5. Care Bill
MPs are set to hold their final debate on the Care Bill, Monday 10th March. The CSA has called the bill ‘a real achievement’ and praised a series of positive amendments to the Care Bill, including the right to an independent advocate for some of the most vulnerable people. However, outside of parliamentary debates, restricted access and funding remain issues.
The Government is planning to restrict the number of people who can benefit from the new system.
According to the London School of Economics, setting the threshold at ‘substantial’ means approximately 362,000 older and disabled people will not receive any support from their council. They will have to pay for their own care without their costs being capped.
Of the 152 councils in England, government figures (“Social Care Legal Reform IA”; 2.5 table 8) show 86% now offer care only to those with the highest level of needs – deemed as ‘critical’ or ‘substantial’ needs.
In those areas this means older and disabled people who are unable to undertake several aspects of personal care, or of work, education or training are no longer eligible for council-funded care.
Under the current system they are described as people with ‘moderate needs’. But the CSA argues that description doesn’t capture the significant impact not having support has on a person’s life.
The Care and Support Alliance is calling on the Government to set eligibility at ‘moderate’ so as many people as possible benefit from the new system, and get the preventative support that keeps them from falling into crisis and ending up in A&E.
The final decision on where the national threshold will be set will be published for consultation in spring 2014 year and voted on in autumn 2014.
7. Analysis of Health Survey for England
The CSA analysed over 1,000 respondents to the Health Survey aged 65 and over who said they need help with activities of daily living (things like help getting washed, dressed, going to the toilet).
They examined if those same people had received any care and support at home, and cross referenced that if they have been to hospital in the past twelve months.
|Have you been to hospital in the last 12 months?|
|People whose care needs are met||
|People with one or more unmet care needs||
Source: Health Survey for England (2011), baseline=1,166