Post No68...Hospital discharging this winter in Hampshire – a 2024 update
Well, here we are again, the start of the festive season is upon us as are tons of horrible colds and other infections, there’s not one person I know who is not coughing right now! Where does the time go…
Unlike other winters, this coming season could become rather tricky for Hampshire County Council due to financially governed changes that have been made to social care this year in Hampshire. This post is going to explain what’s changed, and how I fear it will impact hospital discharging.
Hampshire County Council’s New Framework
On May 13th 2024, Hampshire County Council launched its new social care framework. The framework has been many months in the making, and all care providers across the county were invited to learn about it and discuss it in group sessions. The framework is detailed and complex, but in short, the purpose of the framework is to save Hampshire County Council money, and to be fair I cannot really blame them for this, given the nature of things in the current climate.
The framework gives care providers a choice, they can either sign up and be on the framework, or they stay off it. The threat for those who are unsure about signing up lies in Hampshire’s refusal to send that provider any potential new residents who are state funded, which for some care homes is a serious risk. Signing up to the framework is free, but by doing so the care provider is locked in to providing care at a price determined not by them, but by the local authority.
Purpose built Vs converted care homes
For many converted care homes, signing up to the framework is a no brainer, these homes relay somewhat on the local authority to occupy the home and often have smaller rooms they can rent out for framework rates. For purpose-built homes however, the story is a bit different. Larger homes cost more to run, they have higher overheads and staffing, and often high rents. With the framework offering rates well below the cost of care (see this as the breakeven point) it’s hard to see how purpose-built care homes can financially support these types of admissions.
How does the pricing structure work?
As part of the process, Hampshire County Council complete a care needs assessment, from here they will determine the type of care a person needs (residential care, nursing care etc) and then whether the needs are low, medium, or enhanced. These categories then have fee rates that correspond to them and this is the amount the local authority offers to care homes.
This is not too different from their previous way of working but there is one very key difference; pre framework there was scope to negotiate, post framework there is not, and this is why I am concerned about hospital discharging in the upcoming winter.
How will this affect hospital discharging?
Admittedly, the framework has not been in place through a winter yet, but let us consider something that rears it ugly head every year in hospitals – bed blocking. Bed blocking occurs when a person who is medically fit to leave the hospital cannot leave, normally for older patients this is because there are difficulties finding a suitable care package or care setting for them to be safely discharged to.
The Mail Online reported in March 2024 that 250 people per week were ‘needlessly’ dying in hospitals due to long wait times, and other sources say up to 8000 people per year were dying as a result of bed blocking, both staggering and very sad statistics.
What therefore troubles me is this; if bed blocking is already a problem, then is the new framework going to make the situation in Hampshire worse? By effectively removing many purpose-built care homes from the state funded market, it does beg the question, where are these patients going to go?
Without meaning to scaremonger too much on this, it is genuinely a question that troubles me given the stark figures listed in The Mail and other sources. Converted care homes are often smaller and full up, state run domiciliary provision is finding it more and more difficult to staff and now, by potentially removing purpose-built care homes who have available beds but at higher than framework prices, Hampshire County Council may find it even more difficult to get patients out of, and therefore into, hospitals this year.
Conclusion
There is only really one way to conclude a post of this nature, which is to say that if you are elderly and if you can, try your best to stay away from hospitals this winter. In other posts I write about things you can consider to prevent a hospital admission, and I cannot stress enough how important this topic is, both for the older person, but also for the staff at the hospital.
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