Asked by
To ask His Majesty’s Government what assessment they have made of
the number of hospital beds currently occupied by patients who
could be discharged to their own homes or to residential care if
social care support were available.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
There are around 13,000 people in hospital who do not meet the
clinical criteria to reside, including, but not limited to,
people waiting to go home and people awaiting access to
residential care. We constantly look to reduce these delayed
discharges to ease flow in the system, and we have provided a
£500 million discharge fund to support people to be discharged at
the right time, to the right place and with the right
support.
(Lab)
My Lords, I am grateful to the Minister for answering the
Question. Does he understand that many of us will think it is a
complete disgrace that, for a long time now, hospital beds have
been blocked by people who could be discharged into the community
or residential care? These people would be better off and have a
decent quality of life. Should we not be making this a high
priority, instead of saying that we are planning to do this? We
have heard that for so long.
(Con)
It absolutely is a high priority. Noble Lords have heard me say
many times that the key to the whole system is flow through the
system, to relieve times in A&E and ambulance wait times.
That flow depends on us discharging the 13% of beds that are
currently held up. That is why we put the £500 million discharge
fund in place and will put £2.8 billion of funding next year, and
£4.7 billion the year after, to solve exactly this problem.
(Con)
My Lords, I currently serve on the Joint Committee that is
scrutinising the mental health Bill. Could my noble friend the
Minister outline whether that 13,000 includes those who are
perhaps in secure mental health beds, awaiting discharge? That of
course causes backlogs, and not only into A&E: currently,
some of those people could be being held in a police cell, which
is not an ideal place if you need admission for assessment to a
mental health bed.
(Con)
I will happily write on the detail, but, yes, it includes
everyone who could be provided a space, either in a care home or
a mental health home, and those who are fit to go home but need
domiciliary care.
(LD)
My Lords, Our Plan for Patients, which was published at the end
of September, says:
“This winter, the NHS will open up the equivalent of 7,000 beds
so that every hospital has space to see and treat patients more
quickly.”
Winter is clearly here, so how many of those virtual beds are in
operation now?
(Con)
I thank the noble Baroness. She is absolutely right that the
target of 7,000 beds is a key part of this. All Ministers have
been talking about it with every ICB over the last few days to
see exactly where they are on the target for both real beds and
virtual beds. I will happily provide exact information on the
target, but I know that we are making good progress.
(Lab)
My Lords, an estimated one in four hospital beds is occupied by
people living with dementia. Many of the admissions would have
been avoidable if they had had better community support. Of
course, their stay in hospital is typically twice as long as
those of other people who are over the age of 65. Does the
Minister acknowledge that those dementia patients need to be
discharged to a place of their own, or their carer’s, choosing,
after a holistic assessment? What steps are the Government taking
to ensure that this happens, so that people with dementia do not
experience discharges that are inappropriate and unsafe?
(Con)
I thank the noble Baroness. We are all seeing different shapes
and forms of describing how we need a local care system set up by
the integrated care boards that can have an overview of all the
needs in their area. That is exactly what we are doing, and
exactly what the review is reviewing. It
will give advice on how best to do that by looking at the best
needs of mental health care patients, or any other kind of
patient, to make sure that the proper institutions and places are
set up to give them the up-front support so that, as the noble
Baroness said, they never need to go to hospital in the first
place.
(CB)
My Lords, while recognising the current problems caused by bed
blockages in NHS hospitals due to capacity and social care
issues, does the Minister agree with the report from the Health
Foundation, which, looking ahead, suggests that, because of
changing demography and disease patterns in future, we will
require between 25,000 and 40,000 more beds in the NHS if we are
going to cope with the pressures on both the NHS and social care?
What plans do the Government have to address that?
(Con)
We are absolutely aware that we need long-term plans and
forecasts. That is also one of the things that the healthcare
workforce plan will take into account: it will look at exactly
where the capacity needs to be on a regional basis going forward
so that we have the right number of hospital beds and social care
places for an elderly and growing demographic in terms of age
groups.
(Lab)
My Lords, is it not the case that patients are stuck in hospital
because social care staff are leaving in droves? They are leaving
because they are not respected, not given a career and not paid
sufficiently. Should we not be doing something about retaining
these vital social care staff?
(Con)
The number of care workers is key to all this and I delighted to
say that the latest data shows that we are back to the levels of
April 2021. Too many people have left, but we have managed to
fill the gaps with the international recruitment fund and other
measures. We all agree that we need to progress that further, but
we are now making the increases that are needed in this
space.
My Lords, we have heard how important a sustainable workforce is,
both in social care and healthcare. Can the Minister tell us what
the Government are doing to listen to the concerns of health and
social care workers about patient safety and their own working
conditions at this time?
(Con)
Clearly, if we are going to retain and recruit the key staff in
this area, it has got to be a good career, and that means that we
must listen to their concerns. I know that Minister Whately is
talking to and visiting them all, so it is a key part of the
plan. As I say, the fact that we are managing to grow the
workforce again shows, I think, that we getting on top of it—but
absolutely we need to keep close and make sure it is a good place
to work.
(Con)
Does my noble friend agree that there are main concerns in some
hospitals that dialysis patients are having to be retained in
hospital over the Christmas period because of their deep concerns
about transport arrangements, partly through the threatened
ambulance strikes but also in other ways? Is this not another
problem with regard to the bed blocking that we are looking at at
the moment?
(Con)
The best hospital trusts I have seen have got that absolutely
organised. We see a difference in different trusts between as low
as 6% bed blocking for social care and over 30%. That depends
somewhat on local demography and the amount of care homes, but
also on how quickly they can arrange transport, and that is what
the best ones are doing, so that cases such as the ones brought
up by my noble friend do not exist.
(CB)
My Lords, the report from the Adult Social Care Committee that
was published just a few days ago—which I commend most warmly to
the Minister—highlights that in the past 10 years there has been
a 29% real-terms reduction in local government spending power.
This is despite the increase in the population during that
period. Can the Minister assure the House that the Government are
taking seriously the reality of life in social care?
(Con)
I thank the noble Lord. Yes, we are, and I think that is shown by
the investment we are putting into place. As I say, that will be
up to £2.8 billion next year and up to £4.7 billion the year
after, which will be a 22% increase. That shows that we are very
serious about this.
(LD)
My Lords, we have already heard about the crisis in the social
care workforce. NHS leaders are calling on the Government to
introduce a new national minimum care worker wage of at least
£10.50 an hour to stem the flow of social care staff to other
sectors. Can the Minister say what plans they have to introduce
such a minimum wage, which could hardly be said to be stoking
inflation at that level?
(Con)
Of course, the noble Baroness is aware that it is the third
parties, whether it be the local authorities or the private
sector, that employ them. But what we have done in terms of
setting the national living wage, which I believe is around that
amount, is exactly making sure that there is a minimum amount
that these people can get. About 65% of the funding going into
the system goes through to wages, so the £2.8 billion increase
next year will flow largely into wages and salaries.
(Lab)
Every one of the interventions we hear about points to the
inadequacy of the social care system and every one of the
interventions that the Minister makes, however well
intentioned—and I do not dispute that they are well
intentioned—concerns piecemeal reforms. Will the Government ever
accept that the only thing that is going to solve this ongoing
problem, which is only going to get worse, is a wholesale reform
of the social care system?
(Con)
There are a lot of questions that we need to answer in this
space—I absolutely accept that—and lots of things that need
long-term thought. I think and hope that noble Lords are starting
to see that thinking emerge. A lot more needs to be done at the
moment, but I think that we accept that this is a long-term issue
that needs to be resolved with help from all sides of the House.
