Asked by
To ask Her Majesty’s Government what estimate they have made of
the number of people occupying hospital beds because (1) there
are not enough places in care homes to accommodate them, or (2)
there is insufficient domiciliary social care support.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care
Although the number of people continually changes, there are
approximately 10,000 people in hospital who do not currently meet
the criteria to reside and have not yet been discharged. To drive
progress and to support local system arrangements, we have
established a national discharge task force to monitor and
address the causes of delayed discharges. We have also provided
£462.5 million via local authorities over winter to support care
providers to increase recruitment and existing care support.
My Lords, I appreciate the Minister’s Answer, but is it not the
case that this bed-blocking has been happening for a long time,
and that health service hospitals are under enormous pressure
because of it? Can he give us some idea of when anything will
happen as a result of his proposals? Can he comment on another
representation that I have had—that there are empty places in
care homes not being used?
I begin by wishing the noble Lord and all your Lordships a happy
new year. We have started the national discharge task force, with
membership from local government, the NHS and national
government, and we have looked at the different pathways. There
are four pathways: one is direct discharge, one is interim
discharge, and one is for those who need a bit more support. But
then sometimes individual cases are quite different; sometimes a
place is offered, but the family may not be happy, so we have to
find other ways. One thing that the national discharge task force
has been doing is to look for spaces, wherever they may be,
across the health and social care system to see whether they
would be suitable for interim—but we are looking at all sorts of
solutions in partnership with local authorities.
My Lords, while I welcome the very substantial additional
resources given to the health service, will my noble friend
revisit the decision to delay making money available for social
care purposes? That money is needed now to finance the care
workers and finance those places in care homes. Without it, we
will continue to see bed-blocking, so it is a policy that is
self-defeating.
My noble friend makes an important point. In the White Paper,
People at the Heart of Care, we have set out our vision for adult
social care and outlined our priorities. Throughout the pandemic,
we made available nearly £2.9 billion in specific funding for
adult social care—£1.75 billion for infection prevention and
control, £523 million for testing and £583 million to support
workforce capacity and recruitment, as well as all the other
measures that I have previously referred to as part of the task
force.
What assessment have the Government made of NHS or other publicly
owned land that is currently unused and could be converted into
accommodation for people who are rehabilitating and no longer
need to be in hospital but cannot be discharged into their own
home? Does the Minister agree that rehabilitation accommodation,
commonly used throughout Scandinavia and other parts of Europe,
could ease the pressure on both the NHS and the social care
providers?
I thank the noble Baroness for raising this issue previously with
me in private, and for looking into it. One issue that is very
clear to us is that effective use of the NHS estates is a top
priority for the Government. We have not yet considered the
benefits of using vacant hospital land or unused buildings, but
we are committed to utilising the estates to their maximum
capacity. Rehabilitation is a critical element of the health and
care system, and there are a number of areas that we are looking
into, including some of the suggestions made by the noble
Baroness—but also best practice from other parts of the
world.
My Lords, I think it is the turn of the Liberal Democrats. The
noble Lord, of Cheltenham, wishes to speak
virtually, so I think that this is a convenient moment to call
him.
of Cheltenham
According to the Alzheimer’s Society, nearly two-thirds of all
hospital admissions for people living with dementia are
unnecessary and could be prevented with high-quality personalised
social care. Does the Minister agree that providing such care
will reduce pressure on our NHS? If so, can he outline the steps
that the Government are taking to deliver high-quality
personalised care to people with dementia?
The noble Lord raises an important point about dementia. We have
had many debates and discussions in this Chamber about dementia
and increasing awareness of the issue, right across educating the
workforce in the health and social care sector, and in how we can
address specific issues on dementia and healthy living. As part
of the reforms under social care, there will be more training and
more specific focus on issues including dementia, to ensure that
all inhabitants of care homes or recipients of domiciliary care
receive appropriate care.
My Lords, with today’s reports of hundreds of care homes closing
their doors to new admissions because of the rapid spread of
omicron, adding to the huge pressure on hospitals, can the
Minister explain in more detail why urgent priority funding is
not being directed to the provision of step-down facilities to
address the escalating crisis? We are told that we have new
diagnostic units and resurrected Nightingale hospitals, but
step-down facilities in local NHS and community settings, where
patients medically fit for discharge can be monitored and
properly assessed, have been shown to be working very
successfully. Would not that provide the right care at the right
time, as promised in last month’s social care White Paper?
We have been looking at different pathways out of hospitals, and
one of the discharge pathways is step-down care. One issue that
the task force has looked at is how we improve and increase
accessibility to appropriate step-down care when a patient is
unable to go straight to their home.
I will follow on from the question from the Labour Front Bench.
Who is taking responsibility for actively recruiting staff so
that any step-down beds can be staffed and managed? We have a
workforce problem; without actively recruiting back into the
workforce people who have experience but currently have left, we
will not bridge that gap in manpower and womanpower
provision.
All noble Lords will appreciate the work and dedication of all
our social care workers, especially in these challenging times
and with the extra pressure that omicron has brought. Throughout
the pandemic, we have provided different types of funding. In
December 2021, we announced an extra £300 million to support
local authorities working with care providers to recruit and
retain staff throughout the winter. This funding is in addition
to the £162.5 million announced in October 2021. We recognise the
issue, and it is about working with local authorities and others
to make sure that this money gets into the system and achieves
what it is intended to do.
My Lords, following on from the question from the noble Lord,
of Cheltenham, does the Minister
agree that it will be important for the discharge team to also
look at the reasons for admission, since many people would not
have been in hospital at all—they would never have been
admitted—if there had been adequate domiciliary care services?
Will the task force focus on those issues as well as the issues
for not discharging?
The noble Baroness makes an important point. The task force,
working with all the various partners, is looking at the
different pathways. Most patients can be discharged from hospital
to their own home, but a number are held back because they should
be discharged from hospital to their own homes but with a new
additional or restarted package, which may take time. Patients
might be discharged to residential care within the independent
and community sector, but one issue is that a number of our care
homes are owned privately and are not necessarily as joined up in
the system. Patients may also have been discharged to a care
home, but sometimes the family may not appreciate or approve of
the first venue given and may push back and ask for another one.
There are a number of issues that we are looking at; it is very
complicated, which I am sure all noble Lords understand. We are
trying to really push and get to the bottom of this. Another
thing is to make sure that there is education across health and
social care staff so that they really understand the needs of
particular patients.
My Lords, the noble Baroness, Lady Masham, wishes to speak
virtually, so I think this is a convenient point to call her.
My Lords, as president of the Spinal Injuries Association, I ask
the Minister whether he realises that there are many people who
are severely paralysed, some of whom need two or three carers
each day living in their own homes. Is he aware that the skilled
labour market of carers from Europe has dried up since Brexit,
leaving many people in a state of fear and anxiety of being at
risk? The Government can help. Will they?
The noble Baroness makes a very important point. One thing that
the Government announced before Christmas was on visas and
encouraging more care workers to come to this country. Where she
and I might disagree is that we are going to approach the best in
the world, not just Europe—we want the best staff possible.
