Post No26…Government pledges £200 million for care home beds, but where are they?
Introduction
The government has recently announced a plan to try and ease the pressure on the NHS by block buying beds in care homes, with the aim of increasing patient discharge from the ever encumbered hospitals.
This sounds, in principle, to be a good idea, but it is really sustainable or even possible in the current climate?
This post is going to analyse the concept in a bit more detail.
What is the ‘new’ plan?
The new plan is actually not new at all, because the NHS and local authorities have been block booking beds in care homes for many years. The idea is to increase the speed at which patients who are medically fit to leave the hospital can be discharged into a care home, which is extremely important in the winter.
Current figures provided by ITV news on 9th January 2023, suggest that 13,000 patients are medically optimised but cannot leave the hospitals, which causes bed blocking, issues with patient flow, longer wait times, and sadly, deaths. An article in the Daily Mail suggests that 500 people per week are dying from being in hospital for longer than they should be (Kate Pickles, Health Editor, 14/11/22)
These huge issues are what the new plan is trying to solve...
How does it work?
At a local level, both the ICB’s (Integrated Care Boards, formally known as CCG’s) and local authorities are offering care providers a block contract to temporarily purchase their beds. The negotiation will include agreeing a weekly fee, staffing, and how patients will be discharged to the home. Sounds easy, right?
But where are these beds?
This is quite a big problem, because data from leading global property adviser Knight Frank revealed that UK care home supply has grown by only 6% in the last decade, while the UK’s over 65 population has increased by 22% over the same period.(Knight Frank’s annual UK Healthcare Development Opportunities 2021)
Julian Evans, Head of Healthcare at Knight Frank, goes on to say ‘The UK is on the brink of a significant demographic shift that will see the over 85 population grow from 1.6 million in 2020 to 3.7 million by 2050.'
So the question is, even with £200 million available, where are the government hoping to find these beds they can block buy? As yet, the answer has not fully come forth...
And what about staffing?
The trio of Brexit, Covid and the cost of living crisis has made recruitment challenging for the care sector. The residents in care homes must be kept safe, and so where are the extra staff coming from to support these block bookings?
The recent strikes and regular news paper headlines over work conditions and pay will not help with retention nor attracting new people into the industry, meaning staffing really needs to be addressed as part of the solution to prolonged patient discharges and bed blocking.
Is it the right time to do this?
The short answer is yes because patients need to be discharged, but the longer answer is no. The reason for no is because of the operational time it takes to put these plans in place, not only do beds need to be sourced but they need to be negotiated and contract accepted by a care provider.
Suitable accommodation also needs to be considered, with some 21% of care homes in the UK being rated ‘inadequate’ or ‘requires improvement’ by the industry regulator the CQC. It is potentially unlikely that block contracts can be purchased in these homes due to operational or safety concerns, reducing the amount of stock available.
In order to do this properly, a plan for winter 2023 needs to be being formed at government level now, giving all parties time to discuss how this can work for the best result for the patients. Formulating this plan in January is simply too late to make it effective in practice.
Improving the discharge process
In some circumstances the ICB’s or local authorities will require, as part of the contract, a patient to be discharged into a care home within 2 hours of being assessed as medically fit. This is good for the hospital, but not always for the care home, or indeed the patient. Getting the right patient into the right care home is a complex process, as is staffing, and not all can be done in this time frame.
As a result, care homes maybe put off entering into these contracts because of the risks involved. In order to maximise care home agreement and therefore supply, mixed with positive patient outcomes, this part of the process needs refining to ensure all parties are happy with the contracted agreement.
Conclusion
Without getting too political, this concept has good intentions but is ill timed, and has not been planned to get the maximum benefit the hospitals so desperately need.
If it is planned properly, it could work well and provide some much needed support to patient flow, patient discharge, and positive patient outcomes.
We know that the winter in 2023 is going to bring similar challenges as many recent winters gone by, but without proper planning I fear things will only become more difficult for NHS staff, who are already on their knees.
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